| background Physiological absorption after tooth loss can cause different degrees of horizontal and/or vertical bone defects in the posterior tooth area of the jaw.One of the prerequisites for implant treatment is that the implant site has sufficient bone mass.Guided bone regeneration(GBR)has been widely used to solve the problem of insufficient bone mass at the implant site since it was introduced into the field of oral implants in the 1980 s.Although a large number of clinical studies have shown that the amount of marginal bone resorption in the short and medium term after GBR or delayed implantation is similar to that without GBR implantation,there are relatively few long-term studies.As a systemic disease,diabetes is totally different from bone metabolism in non diabetes patients.However,it is not known whether the same conclusion can be reached after GBR in patients with non diabetes.Alveolar ridge preservation(ARP)is usually used to prevent alveolar ridge absorption after tooth extraction,which can reduce additional bone grafting during implant implantation.However,the prognosis of marginal bone resorption and implant repair in type 2 diabetes patients with ARP is rarely reported.Therefore,this study evaluated the long-term effect of GBR bone increment on implant repair through bone absorption and retention rate at the edge of implant.At the same time,to explore the marginal bone absorption of type 2 diabetes patients after GBR,and to provide clinical basis for type 2 diabetes patients to develop effective intervention measures for tooth extraction socket.This study is divided into two parts:PART 1: Comparison of long-term prognosis between implant patients with or without GBRObjective: To analyze and compare the marginal bone resorption,implant retention rate,mechanical complications of implant denture and the soft tissue condition around the implant in GBR patients with simultaneous implantation,delayed implantation and non-implantation.The long-term effect of GBR bone augmentation and the influencing factors of bone loss at the edge of implant after GBR bone augmentation were analyzed.Materials and methods: The patients who were treated by the Department of Dental Implantation,School of Stomatology,Fourth Military Medical University from October2008 to June 2012 for dental implantation and restoration of the posterior teeth of the jaw were selected as the study subjects.Planting by row the timing of operation and GBR operation was divided into control group(no bone graft),GBR simultaneous implantation group and GBR delayed implantation group.Compare and measure the apical film taken immediately after the completion of the control repair and the follow-up of the patient,and calculate the implant the height of marginal bone in the proximal and distal part of the body,and the change of the two heights is recorded as the amount of marginal bone absorption.To evaluate the modified plaque index,modified gingival sulcus bleeding index,depth of probing,width of keratinized gingiva and gingiva around the implant at the 10-year follow-up after restoration.The gingival nipple height was compared between groups.Then,the follow-up time,gender,age,jaw position,implant brand,implant length and diameter,repair type,modified plaque index,modified gingival sulcus bleeding index,Probing depth,height of gingival papilla and height of keratinized gingiva are the independent variables,and the bone resorption at the implant edge of GBR+simultaneous implantation,GBR+delayed implantation and non-bone grafting control groups are the dependent variable Include multiple linear regression model analysis.Results: 27,50 and 22 patients(65,105 and 41 implants)were followed up in the non-bone graft group,GBR simultaneous implantation group and delayed implantation group,respectively.The 10-year survival rate of implants was 100%;Marginal bone loss(1.02±0.23),(0.92±0.22)and(1.05±0.27)mm,respectively.There was a significant difference in marginal bone absorption between the GBR simultaneous implantation group and the two groups,but there was no difference between the non-graft group and the GBR delayed implantation group difference in school planning.There was no significant difference in the modified plaque index,modified gingival sulcus bleeding index,depth of probing,width of keratinized mucosa and height of gingival papilla among the three groups(P>0.05).Multiple linear regression analysis showed that the implant was straight diameter and repair type are the influencing factors of marginal bone resorption in GBR simultaneous implant group,and the width of keratinized gingiva is the common influencing factor of marginal bone loss in the three groups.Conclusion: The long-term marginal bone resorption and retention rate of GBR implants with simultaneous and delayed implantation in the posterior region of the jaw are consistent with those without bone grafting.It can be considered that the long-term prognosis of GBR implants in the posterior region of the jaw remains good.Implants diameter and repair type have significant influence on long-term prognosis of GBR simultaneous implantation;The maintenance of the width of keratinized gingiva is significant for the long-term good prognosis of GBR implant prosthesis.PART 2: Investigate the effect of alveolar ridge preservation applied in patients with type 2 diabetes mellitus on marginal bone lossObjective: To evaluate the long-term prognosis of GBR bone augmentation and site preservation for implant osseointegration and implant repair of complex bone defects in type 2 diabetes patients,and to discuss the suitable bone for type 2 diabetes implant patients after tooth extraction Incremental interventions.Materials and Methods: Totally 53 patients with type 2 diabetes,26 of whom were male,were included in the dental implant department of the Fourth Military Medical University Dental Hospital from January 2010 to January 2018,There were 27 female patients with 61 implants in total.Type 2 diabetes patients without or with a small amount of bone graft during implantation were taken as the control group,and type 2 diabetes patients with GBR after tooth extraction or before implantation were taken as the experimental group,Compare whether there are differences among the three groups in the bone resorption at the edge of the implant,the success rate of the implant and the prevalence of peri-implantitis.Results: The control group,site preservation group and delayed implantation group were followed up to 19,14 and 20 patients,24,15 and 22 implants,and the 5-year success rate of implants was 95.8%,93.3% and 90.9% respectively;At the time of the visit,the prevalence of peri-implantitis was 4.16%,6.67% and 9.09%,taking implants as the unit;The marginal bone resorption of the three groups in the first year was(1.08±0.83),(1.07±0.90),and(1.02±0.11)mm,respectively,There was no statistical difference.The marginal bone resorption of the three groups were(1.32±0.36),(1.48±0.29)and(1.52±0.60)mm respectively at the 5-year follow-up,and there was no statistical difference.Conclusion: The long-term prognosis of posterior dental implant repair in type 2 diabetes patients is good,and marginal bone resorption is basically stable.Post extraction site preservation technology for type 2 diabetes patients with posterior tooth area can ensure the success rate of implant repair and biologicalIn terms of the incidence of complications,there was no difference between the GBR delayed implantation group and the control group with type 2 diabetes,suggesting that clinically,after the extraction of teeth in patients with type 2 diabetes,site preservation should be used to prevent alveolar ridge absorption. |
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