| Objective In severe periodontitis,the teeth bone walls often have irregular absorption and destruction.After extraction,the alveolar ridge will often become narrow and flat,and the soft tissue will atrophy and collapse accordingly,causing great difficulties for subsequent repair,especially implantation repair.Site Preservation refers to the use of various methods and bone substitute materials to take intervention measures to reduce bone loss in the extraction socket,promote bone regeneration,and maximize the retention of the original soft and hard tissue contour around the extraction socket.Recently,the research on site preservation mainly focuses on the application of single bone graft material to fill the extracted socket,and the cases included are mostly the aesthetic area of the anterior teeth with periodontal health.In this study,the combination of deproteinized bovine bone matrix and concentrated growth factor was innovative applied,by evaluating the three-dimensional changes of alveolar bone profile and postoperative pain at the extraction site,this study provides a reference for the combined application of bone graft materials in site preservation of posterior teeth with severe periodontitis.Methods From September 2020 to March 2022,30 patients in Hefei Stomatological Hospital with posterior teeth suffering from severe periodontitis requiring extraction and with the intention of implant restoration were selected.A random number table was used to divide the patients into experimental group and control group,with 15 patients in each group and a total of 30 affected teeth.The experimental group included6 males and 9 females,with an average age of(42.47±13.12)years.In the control group,there were 4 males and 11 females,with an average age of(46.53 ± 12.40)years.Site preservation after minimally invasive tooth extraction and complete debridement:The experimental group was treated with DBBM and CGF mixture +Haiao repair membrane + free gingival graft;The control group was treated with DBBM+ Haio repair membrane + free gingival tissue.CBCT scan was performed at initial diagnosis,immediately after surgery,and 6 months after surgery.CBCT images were imported into mimics 20.0 software package for fitting.CBCT fitting at initial diagnosis and 6 months after surgery was used to measure the change of alveolar bone vertical height and the change of alveolar bone horizontal width at 1mm,3mm and5 mm below the crest of alveolar ridge before and after surgery.Immediate postoperative and 6 months postoperative CBCT were used to compare the vertical absorption rate of bone graft material and the horizontal absorption rate of three levels below the alveolar crest at 6 months after surgery;Pain intensity scores were recorded with visual analogue scales at 24 h,3 days and 7 days after surgery.SPSS 26.0 software package was used for statistical analysis,P<0.05 was considered statistically significant,and the test level was ɑ=0.05.Results Comparison of CBCT 6 months after surgery with initial diagnosis:The vertical height of alveolar bone in the experimental group and the control group was significantly increased(P<0.05),but there was no significant difference in the vertical height difference between the two groups 6 months after surgery and the initial diagnosis(P>0.05);There were statistical differences in alveolar bone width between the two groups at 1mm below the alveolar ridge(P < 0.05),and the horizontal width absorption of the experimental group was less than that of the control group,but there was no statistical significance in the horizontal width changes at 3mm and 5mm below the alveolar ridge(P > 0.05).Comparison of CBCT at 6 months and immediately after surgery:The horizontal absorption rate of bone graft material at 1mm below the crest of alveolar ridge in the experimental group was lower than that in the control group,and the difference was statistically significant(P<0.05).However,there was no statistically significant difference in the vertical absorption rate and the horizontal absorption rate at 3mm and 5mm below the crest of alveolar ridge in the two groups(P>0.05).VAS score showed that there was no significant difference in pain intensity between the two groups 24 h after surgery(P>0.05),but there was significant difference in pain intensity between the two groups 3 days and 7 days after surgery,and the experimental group was less than the control group(P<0.05).Conclusion After thorough debridement,it is safe to proceed site preservation in the tooth with severe periodontitis,and can achieve similar effect to other tooth extraction socket.Compared with the application of DBBM alone,the combination of DBBM and CGF in the extraction socket of posterior teeth with severe periodontitis can achieve better maintenance of the contour of extraction socket and reduce the postoperative pain in the short term after surgery. |
