CGF对种植修复中骨组织再生和牙龈修复的临床研究
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摘要
目的:探讨浓缩生长因子(concentrated growth factor,CGF)应用于种植修复对患者骨缺损修复再生和牙龈修复的临床效果。方法:选取2012年1月～2013年12月入我院诊治的56例上颌后牙区骨量不足和牙龈缺损的种植修复患者作为研究对象,随机分为实验组(n=28)和对照组(n=28)。所有患者均采用上颌窦底提升术同期种植,共植入73颗种植体。实验组上提上颌窦底黏膜后衬垫CGF膜,对照组衬垫形态大小一致的胶原膜。对患者手术前、手术完成及术后进行定期复查,随后每隔半年复查1次。检查两组患者软组织瓣愈合、牙龈修复及感染情况,X线平片检查种植区骨组织再生和修复情况,口腔锥形束CT(cone-beam CT,CBCT)评价骨质密度。对种植体周围牙龈情况进行评估,了解修复体松动度及患者对美观、咀嚼功能的满意度。结果:两组患者术后SBP、DBP、术后24h VAS评分及术后3月种植体留存率等指标无显著差异(P> 0. 05),实验组患者术后1周黏膜愈合情况显著优于对照组(P <0. 05)。修复后种植体周围软组织恢复效果良好,两组患者修复后各评价指标得分均高于术前(P <0. 05)。实验组手术完成6月后的各评分均高于对照组,实验组软组织修复效果更好(P <0. 05)。实验组术后6月、术后1年、术后2年的骨组织修复率与对照组比较均有显著差异(P <0. 05)。实验组术后修复为优的患者较对照组多,修复较差的患者较少(P <0. 05)。实验组术后3月及术后6月骨质密度明显高于对照组(P <0. 01)。与对照组比较,实验组无术后出血、感染、黏膜撕裂或穿孔、种植体移位等其他不良并发症出现(P <0. 05)。术后实验组患者的满意率为96. 43%,高于对照组满意率82. 14%;实验组患者不满意率为3. 57%,明显低于对照组的17. 86%(P <0. 05)。结论:CGF应用于上颌后牙区骨量不足种植修复,对骨缺损患者的牙龈修复和成骨具有显著效果,值得临床推广使用。
Objective: To investigate the clinical effect of concentrated growth factor( CGF) applied to implant repair on bone defect repair and gingival repair. Methods: A total of 56 implanted patients with insufficient bone mass in the maxillary posterior region who were admitted to our hospital from January 2012 to December 2013 were randomly divided into experimental group( n = 28) and control group( n = 28). A double-blind trial was performed. All patients were implanted simultaneously with maxillary sinus floor elevation and a total of 73 implants were implanted. In the experimental group,the CGF membrane was placed on the maxillary sinus mucosa,the control group was padded with a collagen membrane of the same size. The patient was regularly reviewed before surgery,surgery,and postoperatively,and then reviewed every six months. The soft tissue flap healing,gingival repair and infection were examined in both groups. X-ray plain film was used to examine the regeneration and repair of bone tissue in the implanted area,and oral cone-beam CT( CBCT) was used to evaluate bone density. The condition of the gum around the implant was evaluatedto understand the looseness of the restoration and the patient's satisfaction with the aesthetic and chewing function were analyzed. Results: There were no significant differences in postoperative SBP,DBP,postoperative 24 h VAS scores,and postoperative 3-month implant retention rates between the two groups( P> 0. 05). The experimental group had significantly better mucosal healing than the control group at 1 week postoperatively( P< 0. 05). The recovery of soft tissue around the implant was good after repair. The scores of each evaluation index after repair were higher than those before operation( P < 0. 05). The scores of the experimental group after completion of surgery were higher than those of the control group after 6 months. The soft tissue repair effect of the experimental group was better( P <0. 05). The bone repair rate of the experimental group at 6 months,1 year after surgery and 2 years after surgery was significantly different from that of the control group( P < 0. 05). In the experimental group,there were more patients with better postoperative repair than those in the control group,and fewer patients with poor repair( P < 0. 05). The bone density of the experimental group was significantly higher than that of the control group( P < 0. 05),especially after 3 months and 6 months after operation. Compared with the control group,there were no other adverse complications such as postoperative bleeding,infection,mucosaltearor perforation,and implant displacement( P < 0. 05). The satisfaction rate of the experimental group was96. 43%,which was higher than the control group's satisfaction rate of 82. 14%. The unsatisfactory rate of the experimental group was 3. 57%,which was significantly lower than the control group of 17. 86%( P < 0. 05). Conclusion: CGF is applied to the restoration of bone mass and soft tissue defects in the maxillary posterior region. It has a good effect on bone tissue and gingival repair and osteogenesis that worthy of clinical application.
Objective: To investigate the clinical effect of concentrated growth factor( CGF) applied to implant repair on bone defect repair and gingival repair. Methods: A total of 56 implanted patients with insufficient bone mass in the maxillary posterior region who were admitted to our hospital from January 2012 to December 2013 were randomly divided into experimental group( n = 28) and control group( n = 28). A double-blind trial was performed. All patients were implanted simultaneously with maxillary sinus floor elevation and a total of 73 implants were implanted. In the experimental group,the CGF membrane was placed on the maxillary sinus mucosa,the control group was padded with a collagen membrane of the same size. The patient was regularly reviewed before surgery,surgery,and postoperatively,and then reviewed every six months. The soft tissue flap healing,gingival repair and infection were examined in both groups. X-ray plain film was used to examine the regeneration and repair of bone tissue in the implanted area,and oral cone-beam CT( CBCT) was used to evaluate bone density. The condition of the gum around the implant was evaluatedto understand the looseness of the restoration and the patient's satisfaction with the aesthetic and chewing function were analyzed. Results: There were no significant differences in postoperative SBP,DBP,postoperative 24 h VAS scores,and postoperative 3-month implant retention rates between the two groups( P> 0. 05). The experimental group had significantly better mucosal healing than the control group at 1 week postoperatively( P< 0. 05). The recovery of soft tissue around the implant was good after repair. The scores of each evaluation index after repair were higher than those before operation( P < 0. 05). The scores of the experimental group after completion of surgery were higher than those of the control group after 6 months. The soft tissue repair effect of the experimental group was better( P <0. 05). The bone repair rate of the experimental group at 6 months,1 year after surgery and 2 years after surgery was significantly different from that of the control group( P < 0. 05). In the experimental group,there were more patients with better postoperative repair than those in the control group,and fewer patients with poor repair( P < 0. 05). The bone density of the experimental group was significantly higher than that of the control group( P < 0. 05),especially after 3 months and 6 months after operation. Compared with the control group,there were no other adverse complications such as postoperative bleeding,infection,mucosaltearor perforation,and implant displacement( P < 0. 05). The satisfaction rate of the experimental group was96. 43%,which was higher than the control group's satisfaction rate of 82. 14%. The unsatisfactory rate of the experimental group was 3. 57%,which was significantly lower than the control group of 17. 86%( P < 0. 05). Conclusion: CGF is applied to the restoration of bone mass and soft tissue defects in the maxillary posterior region. It has a good effect on bone tissue and gingival repair and osteogenesis that worthy of clinical application.
引文
[1]Slot W,Raghoebar GM,Vissink A,et al.A comparison between 4 and 6implants in the maxillary posterior region to support an overdenture;1-year results from a randomized controlled trial[J].Clin Oral Implants Res,2013,25(5):560-566.
[2]Whitman DH,Berry RL,Green DM.Platelet gel:an autologous alternative to fibrin glue with applications in oral and maxillofacial surgery[J].J Oral Maxillofac Surg,1997,55(11):1294-1299.
[3]Ohya M,Yamada Y,Wada K,et al.Bone regeneration method using mesenchymal stem cells and PRP complexes in maxillary sinus lift[J].JP J Oral Maxillofac Surg,2011,50(10):559-566.
[4]Slot W,Raghoebar GM,Vissink A,et al.A comparison between 4 and 6implants in the maxillary posterior region to support an overdenture;1-year results from a randomized controlled trial[J].Clin Oral Implants Res,2013,25(5):560-566.
[5]Pirpir C,Yilmaz O,Candirli C,et al.Evaluation of effectiveness of concentrated growth factor on osseointegration[J].Int J Implant Dent,2017,3(1):7.
[6]Borsani E,Bonazza V,Buffoli B.Biological characterization and in vitro effects of human concentrated growth factor preparation:An innovative approach to tissue regeneration[J].Bio Med,2015,7(5):157-161.
[7]Sbordone L,Levin L,Guidetti F,et al.Apical and marginal bone alterations around implants in maxillary sinus augmentation grafted with autogenous bone or bovine bone material and simultaneous or delayed dental implant positioning[J].Clin Oral Implan Res,2011,22(5):485-491.
[8]Honda H,Tamai N,Naka N,et al.Bone tissue engineering with bone marrow-derived stromal cells integrated with concentrated growth factor in Rattusnorvegicuscalvaria defect model[J].J Artif Organs,2013,16(3):305-315.
[9]Kim JM,Lee JH,Park I S.New bone formation using fibrin rich block with concentrated growth factors in maxillary sinus augmentation[J].JKorean Assoc Oral Maxillofac Surg,2011,37(4):278.
[10]Kim JM,Sohn DS,Bae MS,et al.Flapless transcrestal sinus augmentation using hydrodynamic piezoelectric internal sinus elevation with autologous concentrated growth factors alone.[J].Implant Dentistry,2014,23(2):168-74.
[11]Park IS,Sohn DS.Maxillary sinus elevation using concentrated growth factor(CGF)[J].Int J Oral Maxillofac Surg,2011,40(10):1133-1133.
[12]Kim TH,Kim SH,Sándor GK,et al.Comparison of platelet-rich plasma(PRP),platelet-rich fibrin(PRF),and concentrated growth factor(CGF)in rabbit-skull defect healing[J].Arch Oral Biol,2014,59(5):550-558.
[2]Whitman DH,Berry RL,Green DM.Platelet gel:an autologous alternative to fibrin glue with applications in oral and maxillofacial surgery[J].J Oral Maxillofac Surg,1997,55(11):1294-1299.
[3]Ohya M,Yamada Y,Wada K,et al.Bone regeneration method using mesenchymal stem cells and PRP complexes in maxillary sinus lift[J].JP J Oral Maxillofac Surg,2011,50(10):559-566.
[4]Slot W,Raghoebar GM,Vissink A,et al.A comparison between 4 and 6implants in the maxillary posterior region to support an overdenture;1-year results from a randomized controlled trial[J].Clin Oral Implants Res,2013,25(5):560-566.
[5]Pirpir C,Yilmaz O,Candirli C,et al.Evaluation of effectiveness of concentrated growth factor on osseointegration[J].Int J Implant Dent,2017,3(1):7.
[6]Borsani E,Bonazza V,Buffoli B.Biological characterization and in vitro effects of human concentrated growth factor preparation:An innovative approach to tissue regeneration[J].Bio Med,2015,7(5):157-161.
[7]Sbordone L,Levin L,Guidetti F,et al.Apical and marginal bone alterations around implants in maxillary sinus augmentation grafted with autogenous bone or bovine bone material and simultaneous or delayed dental implant positioning[J].Clin Oral Implan Res,2011,22(5):485-491.
[8]Honda H,Tamai N,Naka N,et al.Bone tissue engineering with bone marrow-derived stromal cells integrated with concentrated growth factor in Rattusnorvegicuscalvaria defect model[J].J Artif Organs,2013,16(3):305-315.
[9]Kim JM,Lee JH,Park I S.New bone formation using fibrin rich block with concentrated growth factors in maxillary sinus augmentation[J].JKorean Assoc Oral Maxillofac Surg,2011,37(4):278.
[10]Kim JM,Sohn DS,Bae MS,et al.Flapless transcrestal sinus augmentation using hydrodynamic piezoelectric internal sinus elevation with autologous concentrated growth factors alone.[J].Implant Dentistry,2014,23(2):168-74.
[11]Park IS,Sohn DS.Maxillary sinus elevation using concentrated growth factor(CGF)[J].Int J Oral Maxillofac Surg,2011,40(10):1133-1133.
[12]Kim TH,Kim SH,Sándor GK,et al.Comparison of platelet-rich plasma(PRP),platelet-rich fibrin(PRF),and concentrated growth factor(CGF)in rabbit-skull defect healing[J].Arch Oral Biol,2014,59(5):550-558.