| Objective:Implant surgery is often faced with the problem of insufficient bone,and the method of implant placement combined with simultaneous bone grafting has received widespread attention.As the"gold standard"of bone substitute materials,autogenous bone has the ability of bone induction and osteogenesis,it is widely used,but additional surgical areas are needed.Allogeneic materials are widely used and have a certain potential for bone induction,and its effect has been confirmed by a large number of literature.In many cases,it can be used as a substitute for autogenous bone.Hydroxyapatite is a widely used bone graft material with low replacement rate,which can maintain osteogenic space for a long time.In this study,allogeneic demineralized freeze-dried bone combined with hydroxyapatite was used to treat the bone defect on the labial and buccal site of dental implant,we wanted to find out whether this method was superior to CHA used alone.Methods:This study was a prospective randomized double-blind trial.Patients who underwent implant surgery in the Department of periodontitis of the affiliated Stomatological Hospital of China Medical University from June 2021 to June 2022 were selected according to the inclusion and exclusion criteria.The patients were randomly divided into experimental group and control group.In the experimental group,allogeneic demineralized freeze-dried bone combined with hydroxyapatite was used to treat the labial and buccal bone defect after implantation,while patients in the control group were treated with hydroxyapatite alone.When stitches were removed two weeks after operation,CBCT was taken,the healing condition was recorded,and the index of wound inflammation was evaluated.Six months after operation,two-stage implant operation was performed,and CBCT was taken again after operation.The indexes need to be observed included:the changes of the width of the bone graft at the implant platform level,1,3 and 5mm below the implant platform in the 2 CBCTs;The changes of bone density in the 2 CBCTs;The volume change of bone graft material during 6 months of bone remodeling;The inflammation index of wound area two weeks after operation;The pink aesthetic score of the final restoration in anterior tooth;Patients’satisfaction with the pink aesthetic and functional use;Postoperative status and implant success rate.All the indexes were analyzed by SPSS software,the difference was statistically significant when P<0.05.Results:In this study,13 patients,11 males and 2 females,with 17 implants,was included.There were 12 Zimmer implants and 5 Bicon implants,8 implants in the experimental group,9 in the control group,11 in the upper anterior teeth,2 in the lower anterior teeth and 4 in the lower posterior teeth.There was no significant difference in age,sex and other common status between the two groups.The results are as follows:1.At implant shoulder level,there were 8 implants in the experimental group,6 had high density images on the labial side of the implants at first measurement,and the width changed by 51.58%when measured again,there were still high density images on the labial sides of the 6 implants.Of the 9 implants in the control group,6 had high density images on the labial side at implant shoulder level at first measurement,and 5 at second measurement,the width changed by 64.53%when measured again.Bone tissue images exist on the labial and buccal side of all the implant at 1mm,3mm and 5mm away from the implant shoulder.The proportion of changes at 1mm,3mm and 5mm away from the shoulder platform in the experimental group was 44.53%,28.81%and 18.18%,while that in the control group was34.04%,22.43%and 15.46%.There was no significant difference between the two groups(P>0.05).2.The gray value of CBCT in the bone graft area of the control group was1462.11HU and that of the experimental group was 767.50 HU at two weeks.Six months after operation,the gray value of the experimental group was 987.13 HU,which was significantly higher than that of two weeks,and the difference was statistically significant(P<0.05),while that of the control group was 1622.33 HU,the difference was not statistically significant(P>0.05).3.The volume of bone graft materials in the experimental group and the control group was similar in the first measurement,and there was no statistical difference.In the measurement 6 months after bone grafting,the volume of the experimental group converted to the picture was 3.23 cm~2,and the control group was 3.98 cm~2.After 6 months,the volume of the bone graft area of the experimental group decreased by 53.75%,while that of the control group decreased by 47.10%(P>0.05).4.When the stitches were removed two weeks later,the average wound inflammation index was 2.00±1.76 in the experimental group and 1.80±0.83 in the control group.There was no significant difference(P>0.05).5.The total pink aesthetic score of the anterior tooth sites in the experimental group was 12.33±1.72,while that in the control group was11.86±0.79.There was no significant difference between the two groups(P>0.05).6.There was no significant difference in the final satisfaction scores of pink aesthetics and functional use between the experimental group and the control group(P>0.05).7.The wounds of the two groups healed well after operation,and the implants combined well with bone tissue 6 months after implantation,and there was no abnormal phenomenon happened after loading。Conclusion:In CBCT,obvious bone plate were observed on the labial and buccal side of the implant 6 months after bone grafting in both groups,and the patients were satisfied with the aesthetics and function.The use of allogeneic bone may stabilize the volume of the bone graft to some extent,but the absorption rate is higher,which will have a certain impact on the maintenance of osteogenic space.In this study,it is not clear that the use of allogeneic bone combined with hydroxyapatite has more advantages than the use of hydroxyapatite alone. |
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