Clinical outcomes of using operating microscope for alveolar ridge preservation: A randomized controlled trial.

IF 4.2 2区 医学 Q1 DENTISTRY, ORAL SURGERY & MEDICINE
Benyapha Sirinirund,Janet Zalucha,Amanda B Rodriguez Betancourt,Oliver D Kripfgans,Chin-Wei Wang,Diego Velasquez,Hsun-Liang Chan
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引用次数: 0

Abstract

BACKGROUND The use of the operating microscope (OM) for extraction and alveolar ridge augmentation (ARP) is increasing due to enhanced magnification and illumination. The primary objective was to compare the wound healing and crestal bone quality after the use of OM and dental loupes (DL) for ARP. METHODS Forty non-molar teeth with periapical lesions in need of extraction and ARP from 33 patients were randomly assigned to 2 groups: DL (control) or OM (test). All procedures were performed by 1 surgeon and assessments done by masked examiners. ARP was performed with an allograft and a resorbable collagen membrane. The presence of granulomatous tissue remnants after debridement was recorded. Cone-beam computed tomography (CBCT) and ultrasound (US) scans were taken during the healing phase up to 16-week visits. Bone cores were retrieved from implant osteotomies for histologic analysis. Patient-reported outcome measurements (PROMs) were assessed. RESULTS All patients completed all study visits except 1 who dropped out before the last visit. After socket debridement, the test group exhibited significantly fewer sites with tissue remnants (p = 0.01) and a better healing score at 2-week (p = 0.04) and 4-week (p = 0.01) time points. There were no significant differences in 12-week crestal bone healing by histology (p = 0.1), US (p = 0.85), and CBCT healing (p = 0.64) at 12 weeks, as well as PROMs (p > 0.1). CONCLUSION Within the limitation of the study, the use of OM for ARP resulted in significantly fewer tissue remnants and favorable early visual wound healing. CBCT and US-derived-crestal bone quality did not show a difference between the 2 groups. PLAIN LANGUAGE SUMMARY Alveolar ridge preservation (ARP) by placing bone particulates in the extraction socket, covered by a wound dressing material, is commonly applied immediately after tooth extraction to reduce jawbone shrinkage in preparation for implant placement later. The jawbone healing varies, depending largely on the ability to remove the etiology, socket features, extent of surgical trauma, and wound stability. Healed jawbone with good quality is favorable for easiness of implant placement and could be related to maintenance of long-term implant health. The surgical microscope with high magnification (up to ∼25×) and co-axial illumination is ideal for assistance in the removal of granulomatous tissue that is believed to interfere with healing, performance of minimally invasive extraction, and stabilization of the wound with meticulous tissue management and fine sutures. This study compared the use of the surgical microscope to dental loupes for ARP in a randomized controlled design. The microscope-assisted ARP is associated with a significantly higher chance of removing granulomatous tissue, favorable early healing, and similar crestal bone quality. Removal of granulomatous tissue is significant for immediate implant placement. This study serves as a model for testing the benefits of the surgical microscope for encouraging early healing in more challenging intraoral surgical procedures.
使用手术显微镜保留牙槽嵴的临床效果:随机对照试验
背景由于放大率和照明度的提高,使用手术显微镜(OM)进行拔牙和牙槽嵴增高术(ARP)的情况越来越多。研究的主要目的是比较使用手术显微镜和牙科放大镜(DL)进行 ARP 后的伤口愈合情况和牙槽嵴骨质量:DL组(对照组)或OM组(试验组)。所有手术均由一名外科医生完成,并由蒙面检查人员进行评估。ARP 采用异体移植和可吸收胶原膜进行。记录清创后肉芽肿组织残留物的存在情况。在愈合期至16周的检查期间,进行锥形束计算机断层扫描(CBCT)和超声波扫描。从种植体截骨处提取骨芯进行组织学分析。结果除一名患者在最后一次就诊前退出外,其余患者均完成了所有就诊。牙槽窝清创后,试验组有组织残留的部位明显较少(p = 0.01),2 周(p = 0.04)和 4 周(p = 0.01)时点的愈合评分较高。在 12 周组织学(p = 0.1)、US(p = 0.85)和 CBCT 愈合(p = 0.64)以及 PROMs(p > 0.1)方面,12 周骨干愈合无明显差异。牙槽嵴保留(ARP)通过在拔牙窝内放置骨颗粒,并用伤口敷料覆盖,通常在拔牙后立即使用,以减少颌骨萎缩,为以后植入种植体做准备。颌骨的愈合情况各不相同,主要取决于去除病因的能力、牙槽的特征、手术创伤的程度以及伤口的稳定性。愈合后的颌骨质量良好,有利于种植体的植入,并能长期保持种植体的健康。手术显微镜具有高倍率(高达∼25×)和同轴照明功能,可帮助清除影响愈合的肉芽肿组织,进行微创拔牙,并通过细致的组织管理和精细缝合来稳定伤口。这项研究在随机对照设计中比较了使用手术显微镜和牙科放大镜进行 ARP 的情况。在显微镜辅助下进行 ARP,肉芽肿组织的清除率明显更高,早期愈合良好,骨嵴骨质相似。肉芽肿组织的清除对即刻种植体植入具有重要意义。这项研究为测试手术显微镜在更具挑战性的口腔内外科手术中促进早期愈合的优势提供了一个模型。
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来源期刊
Journal of periodontology
Journal of periodontology 医学-牙科与口腔外科
CiteScore
9.10
自引率
7.00%
发文量
290
审稿时长
3-8 weeks
期刊介绍: The Journal of Periodontology publishes articles relevant to the science and practice of periodontics and related areas.
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