不同屏障材料在牙槽嵴保存术中的应用对比

Comparison of different barrier materials for alveolar ridge preservation

摘要:

目的 探讨富血小板纤维蛋白（PRF）膜、自体浓缩生长因子（CGF）膜、血浆基质膜、骨胶原膜在牙槽嵴保存术中的应用效果。方法 选取2022年7月—2025年12月在佛山市中医院接受种植牙修复的患者112例，患牙112颗。采用随机数字表法分为PRF组、CGF组、基质膜组、胶原膜组，各28例。PRF组、CGF组、基质膜组、胶原膜组患者在牙槽嵴保存术中分别采用PRF膜、CGF膜、血浆基质膜、骨胶原膜与Bio-Oss骨粉混合填充牙槽窝，填充后上层分别覆盖PRF膜、CGF膜、血浆基质膜、骨胶原膜。比较各组牙槽嵴保存术后骨增量、疼痛程度、成骨细胞因子、破骨细胞因子、骨吸收、牙周指标的差异及并发症发生情况。结果 术后6个月，4组垂直骨增量、水平骨增量、骨体积增量及种植体周围牙龈指数、探诊深度及菌斑指数比较，差异均无统计学意义（P >0.05）。4组患者术后24 h、术后48 h、术后1周的视觉模拟评分法（VAS）评分比较，结果 ①不同时间点VAS评分比较，各组术后疼痛评分随时间推移呈逐渐下降趋势（P <0.05）；②4组VAS评分比较，差异无统计学意义（P >0.05）；③4组VAS评分变化趋势比较，差异无统计学意义（P >0.05）。4组患者术后2周、术后4周、术后3个月的血清Ⅰ型前胶原N端肽（P1NP）、Ⅰ型胶原交联C端肽（CTX）水平比较，结果 ①不同时间点P1NP、CTX水平比较，各组P1NP水平随术后恢复时间延长持续升高，CTX水平随术后恢复时间延长持续降低（P <0.05）；②4组P1NP、CTX水平比较，差异均有统计学意义（P <0.05）；③4组P1NP、CTX变化趋势比较，差异均无统计学意义（P >0.05）。术后6个月PRF组、CGF组垂直骨吸收量、水平骨吸收量均低于基质膜组、胶原膜组（P <0.05）。4组患者均未发生严重术后并发症，安全性良好。结论 PRF膜、CGF膜、血浆基质膜、骨胶原膜有助于促进牙槽嵴骨增量，但PRF膜和CGF膜在抑制术后骨吸收方面的疗效更为显著。

Abstract:

Objective To compare the effects of platelet-rich fibrin (PRF) membrane, autologous concentrated growth factor (CGF) membrane, plasma matrix membrane, and bone collagen membrane in alveolar ridge preservation.Methods A total of 112 patients (112 teeth) who underwent dental implant restoration at Foshan Hospital of Traditional Chinese Medicine between July 2022 and December 2025 were randomly divided into PRF, CGF, matrix membrane, and collagen membrane groups, with 28 patients in each group. During alveolar ridge preservation, the extraction sockets were filled with Bio-Oss bone graft mixed with PRF membrane, CGF membrane, plasma matrix membrane, or bone collagen membrane, respectively, and then covered with the corresponding membrane. Bone gain, pain, osteoblast-related factors, osteoclast-related factors, bone resorption, periodontal indices, and complications were compared among the groups. Results At 6 months postoperatively, vertical bone gain, horizontal bone gain, bone volume gain, peri-implant gingival index, probing depth, and plaque index did not differ significantly among the four groups (P > 0.05). Analysis of pain VAS scores at 24 h, 48 h, and 1 week postoperatively showed a significant effect of time (P < 0.05), with pain decreasing over time, but no significant group effect or time-by-group interaction (P > 0.05). Analysis of serum procollagen type I N-terminal propeptide (P1NP) and C-terminal telopeptide of type I collagen (CTX) levels at 2 weeks, 4 weeks, and 3 months postoperatively showed significant effects of time and group (P < 0.05) but no significant time-by-group interaction (P > 0.05); P1NP increased and CTX decreased over time in all groups. At 6 months postoperatively, vertical and horizontal bone resorption were lower in the PRF and CGF groups than in the matrix membrane and collagen membrane groups (P < 0.05). No severe postoperative complications occurred in any group.Conclusion PRF, CGF, plasma matrix, and bone collagen membranes promote bone gain after alveolar ridge preservation, but PRF and CGF membranes are more effective in limiting postoperative bone resorption.