上颌前牙区牙槽骨缺损形态与种植修复术后植骨吸收率的相关性及影响移植骨吸收的因素分析

Correlation between the morphology of the alveolar bone defect in the maxillary anterior area and the bone graft resorption rate after implant surgery and analysis of factors affecting bone graft resorption

摘要:

目的 探究上颌前牙区牙槽骨缺损形态与种植修复术后植骨吸收率的相关性，分析影响移植骨吸收的因素。方法 选取2019年12月—2021年1月天津市第四中心医院接诊的51例牙列缺损患者作为研究对象，收集并整理患者的临床资料，所有受试者分别于植骨前、植骨后即刻和植骨6个月后行全口腔锥形束电子计算机断层扫描（CBCT），根据术前扫描结果将患者分为垂直型骨缺损组和水平型骨缺损组，并根据术后CBCT结果测定植骨吸收率。记录患者骨吸收率并根据骨吸收率水平将其分为高骨吸收率组和低骨吸收率组，采用Spearman法分析上颌前牙区牙槽骨缺损形态分类与移植骨吸收率的相关性，多因素Logistic逐步回归模型分析影响上颌前牙区牙槽骨缺损患者移植骨吸收的因素。结果 Spearman相关性分析结果显示，水平型骨缺损间距与种植修复术后植骨吸收率无相关性（r_s =0.241，P =0.826）；垂直型骨缺损间距与种植修复术后植骨吸收率呈负相关（r_s =-0.503，P =0.001）。多因素Logistic逐步回归结果显示，年龄> 60岁［O^R=3.766（95% CI：1.192，11.897）］、异体骨移植［O^R=3.725（95% CI：1.179，11.767）］、牙槽嵴倒凹深度> 1.0～2.0 mm［O^R=5.830（95% CI：1.845，18.417）］、垂直型缺损间距偏大［O^R=5.023（95% CI：1.717，14.695）］是影响上颌前牙区牙槽骨缺损患者移植骨吸收的独立危险因素（P <0.05）。结论 垂直型骨缺损间距与种植修复术后植骨吸收率呈负相关，年龄> 60岁、异体骨移植、牙槽嵴倒凹深度> 1.0～2.0 mm、垂直型缺损间距偏大是影响上颌前牙区牙槽骨缺损患者移植骨吸收的独立危险因素。

Abstract:

Objective To explore the correlation between the morphology of the alveolar bone defect in the maxillary anterior area and the bone graft resorption rate after implant surgery, and to analyze the factors affecting bone graft resorption.Methods The 51 patients with dentition defects admitted to Tianjin Fourth Central Hospital from December 2019 to January 2021 were selected, and the clinical records of the patients were collected and sorted. All patients received the cone-beam computed tomography (CBCT) scans before, immediately after, and 6 months after the implant surgery. According to the preoperative CBCT findings, the patients were divided into vertical bone defect group and horizontal bone defect group, and the bone graft resorption rates were determined based on the postoperative CBCT scans. The bone graft resorption rates of all patients were recorded, and the patients were therefore divided into high bone graft resorption rate group and low bone graft resorption rate group. The Spearman method was applied to analyze the correlation between morphology of the alveolar bone defect in the maxillary anterior area and the bone graft resorption rate. Multivariable Logistic regression analysis was performed to determine the factors affecting the bone graft resorption in patients with alveolar bone defect in the maxillary anterior area.Results The Spearman correlation analysis showed that there was no correlation between the horizontal bone defect size and the bone graft resorption rate after implant surgery (r_s = 0.241, P = 0.826）, and that the vertical bone defect size was negatively correlated with the bone graft resorption rate after implant surgery (r_s = -0.503, P = 0.001). The multivariable Logistic regression analysis revealed that age > 60 years old [O^R = 3.766 (95% CI: 1.192, 11.897) ], bone allografts [O^R = 3.725 (95% CI: 1.179, 11.767) ], the undercut location from the alveolar ridge > 1.0 to 2.0 mm [O^R = 5.830 (95% CI: 1.845, 18.417) ], and the larger vertical bone defect size [O^R = 5.023 (95% CI: 1.717, 14.695) ] were independent risk factors for bone graft resorption in patients with alveolar bone defect in the maxillary anterior area (P < 0.05).Conclusions The vertical bone defect size is negatively correlated with the bone graft absorption rate after implant surgery. The age older than 60 years, bone allografts, the undercut location from the alveolar ridge > 1.0 to 2.0 mm and large vertical bone defect size are independent risk factors affecting bone graft absorption in patients with alveolar bone defect in the maxillary anterior area.