| Background and Objectives:Jaw cyst is a common and frequently-occurring disease in oral and maxillofacial surgery,and its incidence is higher.Jaw cysts are mostly asymptomatic in the early stages,but as the lesions develop,they can cause jaw swelling and bone resorption in the lesion area,which often require surgery.Common operative procedures include cystectomy and decompression.The effect of decompression is closely related to the patient's compliance.It has better efficacy for patients with good compliance,and should be more cautious for patients with poor compliance and weak self-management ability after the surgery.The osteogenesis rate of the bone cavity left after the curettage is slower,which increases the chance of postoperative infection,and the height or strength of the alveolar ridge is not restored.It increases the difficulty of denture repair,resulting in reduced mastication efficiency or loosening of adjacent teeth,and even pathological fracture occurred.In addition,it will affect the shape and quality of the jaw bone,and it is difficult for patients with tooth loss to obtain good implant repair time.Therefore,the recovery and quality of life of postoperative patients depend on how bone defects are managed.In order to promote the repair of bone defects,bone tissue or bone replacement materials have been gradually applied in clinical practice to fill bone defect areas.At present,there are few reports of the efficacy by using oral biological membranes and bone replacement materials in the treatment of jaw cysts.In this study,oral biological membranes and synthetic bone repair materials?-tricalcium phosphate(?-TCP)and xenogeneic bone repair materials Bio-OSS were used to repair bone defects after jaw cysts excision.Osteogenic effect of bone defects was evaluated by cone beam computed tomography(CBCT),in order to find a more effective clinical treatment method to promote bone defect repair.Materials and Methods:1.Clinical Data:The clinical data of 108 patients who underwent oral and maxillofacial surgery in the First Affiliated Hospital of Zhengzhou University from June 2016 to June 2018 and were pathologically confirmed to be odontogenic jaw cysts were retrospectively analyzed.According to the different treatment methods of bone defects,they are divided into four groups according to random numbers(27 cases in each group):group A is the control group without any biological material;group B is referred to as the cover biological membrane group,which is to cover the surface of bone defect area with the biological membrane;group C is referred to as?-tricalcium phosphate(?-TCP)group,that is,bone defect area is filled with ?-TCP and covered with biological membrane;group D is referred to as Bio-OSS bone powder group,which is filled with Bio-OSS bone powder and covered with the biological membrane.Inclusion criteria:2)complete root canal treatment before surgery;4)rule out systemic diseases(such as diabetes,Bone metabolism abnormalities,etc.);5)Jaw cyst curettage was performed during operation;6)Case data were complete.2.Method:All patients underwent CBCT before surgery,and CBCT was reviewed at 3,6,and 12 months afer surgery.Bone mineral density of the bone defect area was measured and recorded,which was expressed by HU value.SPSS 21.0(IBM Corp,Armonk,NY,USA)statistical software was used to analyze and compare the osteogenesis effect of the four groups of patients.Univariate analysis of variance(F test)was used at preoperation,3m and 6m postoperatively.And the nonparametric multiple-group independent sample Kruskal-Wallis test was used to analyze between the four groups at 12m after operation p<0.05 was considered statistically significant.Results:Of the 108 patients included in the study,66 were males and 42 were females;aged 11-60 years,with an average age of 36.2 years;27 cases in the anterior teeth area of the maxilla,15 cases in the anterior teeth.area of the mandible,and 28 cases in the mandibular body.There were 38 cases of mandibular angle and ascending branch,and 2 cases were closely related to maxillary sinus.No recurrence occurred in 81 patients.1.Comparison of CT values of the four groups before surgeryThe average CT value of preoperation was 48.9 ± 13.2 in group A,48.4 ± 13.8 in group B,47.6 ± 14.2 in group C,and 43.1 ± 11.0 in group D.By statistical Univariate analysis of variance,there was no statistical difference between the groups(p>0.05)2.Comparison of CT values at 3,6,and 12 months after operation among the four groups of patientsThe average CT values of the four groups at 3 months after operation were:97.3± 10.1 in group A,125.8± 9.5 in group B,397.8 ± 14.8 in group C,and 622.8 ± 216.2 in group D.There were statistically significant differences between each group(Univariate analysis of variance,p<0.001).The results showed that the oral biological membrane,?-TCP bone repair material and Bio-Oss bone powder all had osteogenic effect at 3 months after operation.The combined application of ?-TCP bone repair material and Bio-Oss bone powder.with oral biological membrane was better.And Bio-Oss bone powder has better osteogenesis effect than ?-TCP bone repair material.The average CT values of the four groups at 6 months after operation were:122.0±1.8 in group A,195.3 ± 15.1 in group B,602.6 ± 13.5 in group C,and 625.0 ±14.0 in group D.There were statistically significant differences between the groups.(Univariate analysis of variance,p<0.001).The comparison of the osteogenic effect of each group was the same as the above-mentioned three-month study.The average CT values of the four groups at 12 months after operation were:group A 157.8 ± 18.3,group B 281.2 ± 23.8,group C 579.6 ± 99.9,and group D 632.9 ± 13.8.There is a significant difference in statistics between each group(Kruskal-Wallis test analysis of non-parameter multiple independent samples,p<0.001).The results still show that 12 months after operation,no matter the oral biological membrane alone or the combined application of oral biological membrane with bone replacement materials have osteogenic effect;the combined application of osteogenesis is better than the simple application,of which combined application of oral biological membrane+Bio-Oss bone powder has better osteogenesis effect than?-TCP.Conclusion:Compared with the traditional jaw cyst curettage method,the bone defect area after the jaw cyst curettage has an osteogenic effect regardless of the application of oral biological membrane alone or combined application of oral biological membrane with bone substitute materials.The osteogenesis effect of the combined application is better than that of the mere application.The combination of oral biological membrane and Bio-Oss bone powder has better osteogenesis effect. |
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