【摘要】：隨著口腔醫(yī)學的發(fā)展,種植已經成為牙齒缺失、牙列缺損的重要修復方式;近年,由于臨床醫(yī)生與患者對早期恢復口腔功能的重視,種植體早期修復與負載成為研究的熱點。種植體的早期穩(wěn)定是判斷骨結合、選擇修復與負載時間的重要依據(jù),是影響成功率的主要因素,因此受到諸多學者及醫(yī)生的關注。影響早期穩(wěn)定性的因素包括頜骨骨質與骨量、種植體形貌、手術方式等諸多方面,正確客觀地分析這些因素在植入早期對穩(wěn)定性的影響,有利于醫(yī)生在術前對植入效果進行預判,防止骨結合不良,保證種植修復的成功。本臨床研究以第四軍醫(yī)大學口腔醫(yī)院修復科牙齒缺失患者為樣本來源,首先,采用前瞻性隊列研究方法,對不同因素與種植體早期穩(wěn)定性的關系進行分析,初步判斷影響種植體早期穩(wěn)定性的相關因素;然后利用不同因素與種植體早期穩(wěn)定性的相關關系,在術前對穩(wěn)定性進行預測,并初步探討其準確性與可靠度,以期為臨床工作提供必要的參考與依據(jù)。第一部分種植體早期穩(wěn)定性影響因素的臨床研究[目的]初步探討影響種植體早期穩(wěn)定性的相關因素。[方法]于2014年9月至2015年9月,從第四軍醫(yī)大學口腔醫(yī)院修復科選擇單顆牙缺失并行種植修復的患者共106例,采用CBCT分別測量其種植區(qū)的頜骨密度(HU值)后,各植入Nobel ReplaceTM Tapered種植體一枚,共植入106枚。采用Ostell ISQ種植體穩(wěn)定性測量儀分別于術后即刻、第12周測量ISQ值;采用CBCT測量各種植體周圍骨壁厚度;采用X線影像測量各種植體邊緣骨吸收水平;對所有臨床資料進行統(tǒng)計分析。[結果]所有種植體均取得良好的初始ISQ值(68.07±10.31),術后第12周ISQ值均顯著增高(P0.05)。統(tǒng)計學分析結果顯示,種植區(qū)位置、HU值以及直徑對ISQ值存在顯著影響(P0.05),種植體周圍骨壁厚度、種植體邊緣骨吸收水平以及種植體長度對種植體的ISQ值影響不顯著(P0.05)。[結論]本研究條件下種植體早期穩(wěn)定性可能受種植區(qū)部位、HU值以及種植體直徑的影響,而其他因素的影響尚缺乏臨床依據(jù)。第二部分采用CBCT預測種植體早期穩(wěn)定性的臨床研究[目的]探討采用CBCT測量HU值預測種植體早期穩(wěn)定性的可行性。[方法]于2015年6月至2015年12月,選擇修復科就診的后牙區(qū)單顆牙齒缺失患者,其中上頜與下頜各10例。采用CBCT分別測量各種植區(qū)頜骨密度(HU值),利用第一部分所得線性回歸方程分別計算ISQ預測值。在種植區(qū)各植入Nobel ReplaceTM Tapered種植體一枚,分別于術后即刻、第12周測量種植體ISQ值。采用Spearman秩相關比較分析ISQ預測值與測量值。[結果]種植體植入后即刻及第12周,ISQ測量值與預測值之間相關系數(shù)均呈顯著相關性(P(27)0.05)。[結論]本研究條件下,初步認為術前采用CBCT測量HU值對種植體早期ISQ值進行預測是可行的。
[Abstract]:With the development of stomatology, implant has become an important way to repair tooth loss and dentition defect. In recent years, due to the attention of clinicians and patients to early recovery of oral function, implant early repair and loading become a hot topic. The early stability of implants is an important basis for judging bone union, choosing the time of repair and loading, and is the main factor affecting the success rate. Therefore, many scholars and doctors pay close attention to it. The factors that affect the early stability include the bone mass of the mandible, the shape of the implant, the operation method and so on. The influence of these factors on the stability in the early stage of implantation is analyzed correctly and objectively. It is helpful for doctors to predict the effect of implant before operation, to prevent poor bone bonding and to ensure the success of implant repair. In this clinical study, dental defects in the Department of Restoration, Department of Stomatology, fourth military Medical University were used as a sample source. First, a prospective cohort study was used to analyze the relationship between different factors and the early stability of implants. The correlation factors affecting the early stability of implants were preliminarily judged, and then the stability was predicted before operation by using the correlation between different factors and the early stability of implants, and the accuracy and reliability of these factors were preliminarily discussed. In order to provide the necessary reference and basis for clinical work. Part one: clinical study on the influencing factors of early implant stability [objective] to explore the related factors affecting the early stability of implants. [methods] from September 2014 to September 2015, 106 patients were selected from Department of Stomatology, Department of Stomatology, fourth military Medical University, and their maxillary density (Hu) was measured by CBCT. One Nobel ReplaceTM Tapered implant was implanted and 106 implants were implanted. Ostell ISQ implant stability measurement instrument was used to measure the ISQ value immediately and 12 weeks after operation, CBCT was used to measure the bone wall thickness around the implants, X-ray images were used to measure the bone resorption level at the edge of the implants. All clinical data were statistically analyzed. [results] all implants obtained good initial ISQ value (68.07 鹵10.31), and the ISQ value increased significantly at the 12th week after operation (P0.05). The results of statistical analysis showed that the ISQ value was significantly affected by Hu value and diameter in planting area (P0.05), while the thickness of bone wall around implant, bone resorption level at implant edge and implant length had no significant effect on ISQ value of implant (P0.05). [conclusion] in this study, the early stability of implants may be affected by Hu value and implant diameter, but the effect of other factors is still lack of clinical basis. In the second part, we use CBCT to predict the early stability of implants [objective] to explore the feasibility of using CBCT to predict the early stability of implants. [methods] from June 2015 to December 2015, 10 cases of maxilla and 10 cases of mandible were selected from patients with single tooth loss in posterior teeth. The mandibular density (Hu) was measured by CBCT and the predicted value of ISQ was calculated by linear regression equation in the first part. One Nobel ReplaceTM Tapered implant was implanted in the planting area and the ISQ value was measured immediately after operation and 12 weeks after operation. The ISQ predicted value and the measured value were analyzed by Spearman rank correlation comparison. [results] the correlation coefficient between ISQs and predicted values was significantly correlated with the predicted values immediately after implant implantation and 12 weeks after implantation (P (27). [conclusion] under the condition of this study, it is feasible to use CBCT to predict the early ISQ value of implants.
【學位授予單位】：第四軍醫(yī)大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R783.6
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本文編號：2165032