上海交通大学学报（医学版）

上海交通大学学报(医学版) ›› 2020, Vol. 40 ›› Issue (10): 1414-1419.doi: 10.3969/j.issn.1674-8115.2020.10.020

• 论著·临床研究 • 上一篇    下一篇

上颌前牙区牙槽骨缺损形态学特征与引导骨再生手术效果的相关性研究

李 元，史俊宇，张 枭，赖红昌   

  1. 上海交通大学医学院附属第九人民医院·口腔医学院口腔种植科，国家口腔疾病临床医学研究中心，上海市口腔医学重点实验室，上海市口腔医学研究所，上海 200011
  • 出版日期:2020-10-28 发布日期:2020-11-27
  • 通讯作者: 赖红昌，电子信箱：lhc9@hotmail.com。
  • 作者简介:李 元（1995—），男，住院医师，硕士；电子信箱：ly9919@hotmail.com。
  • 基金资助:
    上海申康医院发展中心临床创新三年行动计划项目（16CR3033A）；上海市口腔疾病临床医学研究中心项目（19411950100）；上海交通大学医学院多中心临床研究项目（DLY201822）。

Correlation between the morphology of alveolar bone defect in the maxillary anterior region and the outcome of guided bone regeneration

LI Yuan, SHI Jun-yu, ZHANG Xiao, LAI Hong-chang   

  1. Department of Oral and Maxillo-facial Implantology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Institute of Stomatology, Shanghai 200011, China
  • Online:2020-10-28 Published:2020-11-27
  • Supported by:
    Clinical Research Plan of Shanghai Shenkang Hospital Development Center (16CR3033A); Shanghai Clinical Research Center Program for Oral Diseases (19411950100); Multicenter Clinical Research Program of Shanghai Jiao Tong University School of Medicine (DLY201822).

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摘要： 目的·分析上颌前牙区牙槽骨缺损形态对引导骨再生（guided bone regeneration，GBR）术后效果的影响。方法·采用回顾性队列研究，纳入2018年5月—2019年9月于上海交通大学医学院附属第九人民医院口腔种植科行上颌前牙区种植体植入同期GBR的患者，利用锥形束CT（cone beam CT，CBCT）测量术后即刻到术后6个月的植骨吸收率。根据术前CBCT数据重建初始骨缺损三维结构，定义其近远中向、颊舌向和冠根向的形态学变量。通过Spearman相关性分析、多因素Logistic回归分析及受试者工作特征曲线（receiver operating characteristic curve，ROC曲线）分析评估初始骨缺损形态学变量与植骨吸收率的相关性，尝试建立植骨吸收率的预测模型并通过留一法进行内部验证。结果·共纳入30名患者，术后6个月植骨吸收率的中位数为52.1%。相关性分析结果显示术后植骨吸收率与多个初始骨缺损形态变量均具有相关性；多因素Logistic回归分析结果显示初始骨缺损颊舌向距离最大值（maximum buccal-lingual distance，mBL）、冠根向距离最大值（maximum coronal-apical distance，mCA）与近远中向距离最大值（maximum mesial-distal distance，mMD）的比值（rmCA/mMD）是术后植骨吸收率的主要影响因素。ROC曲线分析结果显示基于mBL和rmCA/mMD的预测模型预判GBR术后6个月植骨吸收率的曲线下面积为0.946，留一交叉验证结果显示总的预测准确率为76.7%，灵敏度、特异度分别为0.714和0.813。结论·初始骨缺损形态对GBR术后6个月的植骨效果有显著影响；骨缺损形态学变量对术后植骨吸收率有较好的预测作用。

关键词: 牙槽骨缺损, 引导骨再生, 锥形束CT, 形态学插值法

Abstract:

Objective · To analyze the influence of the initial ridge defect morphology on the outcome of guided bone regeneration (GBR) in the maxillary anterior region. Methods · This retrospective study included patients being placed with simultaneous GBR in the implant in the maxillary anterior region from May 2018 to September 2019 in the Department of Oral and Maxillo-facial Implantology, Shanghai Ninth People's Hospital. Cone beam CT (CBCT) examinations of patients were used to measure the resorption rate of grafted bone from the moment to 6 months after surgery. The 3D surface rendering of initial defect was reconstructed based on preoperative CBCT, and morphological variables were defined in mesial-distal, buccal-lingual, and coronal-apical directions. The Spearman correlation, Logistic regression model and receiver operating characteristic (ROC) curve analysis were used to assess the possible association between initial defect morphological variables and the resorption rate of grafted bone. A prediction model was established and verified by the leave-one-out cross-validation method. Results · A total of 30 patients were included and the median value of resorption rate of grafted bone was 52.1%. The correlation analysis results showed that the resorption rate of grafted bone was significantly correlated with multiple morphological variables of initial bone defect. The results of multivariate Logistic regression analysis showed that the maximum buccal-lingual distance (mBL) of the initial bone defect and the ratio of the of maximum coronal-apical / mesial-distal distance (rmCA/mMD) were the main factors affecting the resorption rate of grafted bone. The ROC curve analysis results showed that the area under the curve of mBL- and rmCA/mMD-based prediction model to predict the postoperative resorption rate of grafted bone was 0.946. The results of the leave-one-out cross-validation method showed that the prediction accuracy of the model was 76.7%, and the sensitivity and specificity were 0.714 and 0.813, respectively. Conclusion · The initial bone defect morphology has a significant effect on the outcome of the GBR 6 months after surgery, and bone defect morphological variables have a good predictive effect on the resorption rate of grafted bone.

Key words: alveolar bone defect, guided bone regeneration (GBR), cone beam CT (CBCT), morphological contour interpolation

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