| Objective:This article aims to explore the use of biological amniotic membrane combined with bone substitute materials for extraction site preservation,and to discuss the effect of amniotic membrane on the maintenance of alveolar cells,as well as the effect of tritium and its application value in extraction site preservation,through clinical detection,imaging measurement,model measurement.Methods:From December 2017 to July 2019,56 patients with 62 teeth accepting extraction of the mandibular first and second molars were recorded in our hospital,and they were randomly divided into three groups,among these patients,38 of them with 42 teeth underwent site preservation besides extraction.Amniotic membrane & Hai'ao bone meal(group A,19 patients with 21 teeth)and Hai'ao collagen membrane & Hai'ao bone meal(group B,19 patients with 21 teeth)were randomly used,while the remaining 18 patients with 20 teeth were blank control group(group C),without any filling and covering.The indicators observed before and after operation are: clinical examination of the affected teeth;postoperative pain response;CBCT was taken immediately after the operation and the buccal-lingual bone height and alveolar ridge width of alveolar ridge at the site were measured.A plaster model was made and the bone width and bone height of alveolar ridge at the site were measured by the model method.(1)Group A:minimally invasive tooth extraction.After the blood overflows the tooth extraction socket,the Hai'ao bone meal particles are implanted and mixed with it,then added to the place flush with the highest point of bone crest.Trimming Ruiji amniotic membrane,covering the surface of bone graft material,with the edge exceeding the outer edge of the tooth extraction socket by at least 2 to 3 mm.Reducing gum tension and suturing,with the margin distance less than 5mm,compressing and hemostasis with sterile gauze cotton roll,and removing stitches in 10 days.(2)Group B: The method was the same as Group A,covering Hai'ao collagen membrane.(3)Group C: Minimally invasive tooth extraction,compressing and hemostasis with sterile gauze cotton roll.The degree of pain was recorded in 7 days after operation;the color,swelling,and bleeding of the soft tissue were observed and recorded in 14 days after the operation;CBCT and plaster models were taken at the follow-up visit 3 and 6 months after the operation.CBCT method was used to measure the changes of buccal-lingual bone height and the changes of alveolar crest root width of 1mm,3mm and 5mm at the site.The model method was used to measure the bone width variation of 2mm from the root of the buccal lingual gingival margin at the site and the height variation from the middle point of the line connecting the buccal-lingual mark points to the measuring guide plate.Results:1.All 56 patients were returned to the clinic and examined on time.During the observation period,60 sites of the operation area healed normally without complications such as wound infection,dehiscence and graft material loss.2 patients suffered from membrane loss and bone meal loss at two sites,including one case of amniotic membrane and another of collagen membrane,which is excluded by subsequent clinical observation and measurement.2.Clinical observation: There was no difference between amniotic membrane Group A and collagen membrane Group B(P > 0.05),but there was a statistical difference between Group AB and group C(P < 0.05),compared with the 7-days pain degree,and14-days soft tissue healing grade(color,swelling and bleeding)after operation.3.Imaging results:(1)At 3 months after operation,the changes of buccal-lingual bone height and alveolar bone width of 1mm,3mm and 5mm above the root of alveolar ridge were statistically different between the AC groups and BC groups(P < 0.05),but there was no statistical difference between the AB groups(P> 0.05).(2)At 6 months after operation,the changes of buccal-lingual bone height and alveolar bone width of 1mm,3mm and 5mm above the root of alveolar ridge were statistically different between the AC groups and BC groups(P < 0.05),but there was no statistical difference between the AB groups(P > 0.05).(3)At 6 months after operation,the changes in bone height and bone width were compared statistically before and after 3 months(P <0.05).4.Model measurement results:(1)At 3 months after operation,the changes in width of 2mm from the midpoint of the bucco-lingual gingival margin,and the height variation from the middle point of the line connecting the buccal-lingual mark points to the measuring guide plate were preserved between the AC and BC groups(P <0.05),but there was no statistical difference between the AB groups(P> 0.05).(2)At 6 months after operation,the changes in width of 2 mm from the midpoint of the bucco-lingual gingival margin,and the height variation from the middle point of the line connecting the buccal-lingual mark points to the measuring guide plate were preserved between the AC and BC groups(P <0.05),but there was no statistical difference between the AB groups(P> 0.05).(3)At 6 months after operation,the changes in width and height were compared statistically before and after 3 months(P <0.05).Conclusion:1.Compare with normal healing of tooth extraction wounds,site preservation can significantly reduce the absorption of alveolar ridge,and it has a positive effect on maintaining the height and width of alveolar ridge.2.Ruiji biological amniotic membrane and Hai'ao collagen membrane have similar clinical effects on site preservation.3.CBCT measurement method has more advantages than plaster model measurement method in measuring the height and width of alveolar bone. |
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