J Clin Periodontol:不同富含血小板的纤维蛋白基质对多颗牙齿拔除术中牙槽嵴位点保存的作用

2021-10-19 MedSci原创 MedSci原创

拔牙后硬组织和软组织轮廓的改变已经被广泛的研究。最近的一项系统综述和荟萃分析中,发现与自然愈合相比,牙槽嵴保存(ARP)程序能有效地限制生理性牙槽嵴减少。然而,即使使用ARP,也发现有一定程度的骨吸收

拔牙后硬组织和软组织轮廓的改变已经被广泛的研究。最近的一项系统综述和荟萃分析中,发现与自然愈合相比,牙槽嵴保存(ARP)程序能有效地限制生理性牙槽嵴减少。然而,即使使用ARP,也发现有一定程度的骨吸收。二代血小板浓缩物,即白细胞和富含血小板的纤维蛋白(L-PRF)是一种含有血小板和白细胞的100%自体纤维蛋白基质,可以加速新血管生成,刺激周围细胞分化和增殖的局部环境,并在7-14天内持续释放生长因子。最近,新的PRF方案[高级富含血小板的纤维蛋白(A-PRF),和高级富含血小板的纤维蛋白+(A-PRF+)]可增加生长因子的释放以及白细胞和血小板的浓度。

近日,发表于J Clin Periodontol的一项随机试验评估了拔牙后使用L-PRF或A-PRF+时,与无辅助的牙槽骨愈合(对照)相比,牙槽嵴的尺寸变化。主要结果变量被定义为牙槽嵴1毫米水平宽度的变化。次要结果变量被确定为牙槽骨-3毫米和-5毫米处水平宽度的变化,以及颊侧和腭侧的垂直吸收。拔牙窝骨填充为三级结果变量。最后,骨量/组织量的百分比(BV/TV)和骨的微结构为第四级结果。

研究纳入20名需要在美学区至少拔三颗牙的患者。随机分配到L-PRF、A-PRF+或对照组,在不同条件下留有一个空牙槽/无牙部位。拔牙后立即进行CBCT扫描,并在愈合3个月后进行扫描。计算了牙槽嵴和牙槽骨填充物的水平和垂直尺寸变化。骨组织活检的组织学和显微CT分析被用来评估手术后骨骼结构的愈合。

 

结果显示,三个部位在牙槽嵴下1mm处(颊侧和腭侧)的平均水平和垂直变化相似(P>0.05)。对于牙槽骨的填充,L-PRF(85.2%)和A-PRF+(83.8%)优于对照组(67.9%)。组织学和放射学分析表明,PRF组有更多的新形成的骨,两者之间没有任何明显的差异。

综上所述,该研究结果表明,PRF基质未能减少上颌前牙区多颗牙齿拔除后的尺寸变化。在3个月的愈合后,两种PRF基质在放射学上显示出对牙槽窝填充的明显优势。从组织学上看,它们似乎都能加速新骨的形成。

 

原始出处:

 

Ana B Castro, et al., Effect of different platelet-rich fibrin matrices for ridge preservation in multiple tooth extractions: A split-mouth randomized controlled clinical trial. J Clin Periodontol. 2021 Jul;48(7):984-995. doi: 10.1111/jcpe.13463.  

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    2022-05-24 kksonne
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    2021-12-31 feather89
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    2021-11-04 ms9000000892709945

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