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ID naloge: 119 Letnik: 2002 Predmet: stomatologija
Celjenje kostnine celjustnic po puljenju zob
Avtor: Maja Gluvic
Mentor: doc. dr. Nataša Ihan Hren
IZHODIŠCE. Pri izpuljenju zoba nastane kostna in sluznicna rana, ki se celi z zaporedjem dogajanj, ki vodijo v kostno in sluznicno zacelitev. Ceprav se to konca približno 60 dni po puljenju, je to stanje šele izhodišce za atrofijo celjustnic, ki je ireverzibilna izguba kostnine in predstavlja problem za proteticno rehabilitacijo pacientov.
NAMEN. Namen raziskave je bil oceniti zakostenevanje zobne alveole dva meseca po puljenju zob klinicno in objektivno z oceno rentgenogramov. Ocena zakostenevanja je v tem casu pomembna za nadaljnjo proteticno rehabilitacijo nastalega brezzobega predela. Dobro zakostenevanje alveole predstavlja cimbolj ohranjena višina alveolarne kostnine ter podobna gostota novonastale kostnine kot je gostota okolišnje kostnine.
HIPOTEZA. Hipoteza naše raziskave je bila, da je zakostenevanje alveole odvisno od starosti ter prisotnosti sosednjih zob ob kostnem defektu v casu zakostenevanja in neodvisno od spola. Na zakostenevanje vplivajo tudi vzroki za puljenje zob.
METODE. Za analizo višine zakostenevanja alveole smo uporabili preprosto geometrijsko analizo za primerjavo dveh rentgenogramov. Prvi rentgenogram zoba pred puljenjem nam je omogocal merjenje in izracun dvodimenzionalne velikosti kostnega defekta, ki nastane po enostavnem puljenju zoba brez zapletov. Na rentgenogramu alveolarnega grebena dva meseca po puljenju zoba smo izmerili dejansko višino novonastale alveolarne kostnine ter jo primerjali z velikostjo pri puljenju nastalega kostnega defekta in tako zakostenevanje izrazili v odstotkih. Rentgenogram dva meseca po puljenju smo skenirali in s pomocjo racunalniškega programa Image tools izmerili gostoto kostnine lamel na rentgenogramu, ki jo predstavlja sivina v vrednostih od 0 do 256. Vrednosti sivine v sredini alveole na skeniranem rentgenogramu smo primerjali z vrednosti okolišnje neprizadete kostnine. Delež sivine novonastale kostnine smo izrazili v primerjavi s sivino okolišnje neprizadete kostnine v odstotkih. Rezultate smo statisticno obdelali z dvosmernim Studentovim testom t za razlicne variance in testom regresije.
REZULTATI. Povprecno zakostenevanje pri naših preiskovancih v starosti od 13 do 81 let je 87,1% glede na višino kostnega defekta, ki nastane pri puljenju zoba. Zakostenevanje je najvišje v starosti od 10 do 20 let (97,5%) ter s starostjo upada. Najslabše zakostenevanje smo dobili pri preiskovancih starih od 61 do 70 let (81,3%). Opazovane zobe smo razdelili v tri skupine glede na prisotnost sosednjih zob ter rezultati kažejo najboljše zakostenevanje alveole ob prisotnosti obeh sosednjih zob (97,4%) ter najslabše, ko alveola nima nobenega sosednjega zoba (82,2%) Med skupinami smo Studentovim t testom dokazali statisticno znacilnost razlik. Glede na vrsto zob smo ugotovili najslabše zakostenevanje v interkaninem sektorju zgornje celjustnice. Med vzroki za puljenje zob, se je pri paradontalni bolezni pokazalo najslabše zakostenevanje med indikacijami za puljenje zob. Merjenje gostote zakostenevanja v zaceljeni zobni alveoli v primerjavi z okolišnjo kostnino je pokazalo, da je ta v povprecju 82%. Tudi ta parameter je statisticno znacilno odvisen od starosti pacientov v casu puljenja zob. Glede na regresijsko premico dobljenih parametrov, lahko napovemo kostno gostoto glede na starost pacientov.
ZAKLJUCKI. Rezultati raziskave kažejo osnovne znacilnosti zakostenevanja zobne alveole dva meseca po puljenju glede višine in gostote zakostenevanja in so potrdili naše hipoteze. Na zakostenevanje primarno vpliva starost pacientov ter stanje obzobnih tkiv. Prisotnost sosednjih zob pogojuje boljše zakostenevanje zobne alveole.
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[Abstract / English version]
Celjenje kostnine celjustnic po puljenju zob
Author: Maja Gluvic
Mentor: doc. dr. Nataša Ihan Hren
BACKGROUND. After the extraction of a tooth, there remains a wound in a jaw and mucousa. A certain sequence of healing process in the alveolar socket leads to the final bone and mucous regeneration. The wound healing process ends approximately 60 days after the extraction. This condition presents the origin of further alveolar bone atrophy, which means the irreversible loss of alveolar bone, and it presents an important clinical consideration in definitive prosthetic treatment.
AIM. The aim of this research was to evaluate clinically and objectively (with evaluation of roentgenograms) bone healing two months after the tooth extraction. This evaluation of extraction wound is important for subsequent prosthetic treatment decision. The persistent alveolar-bone height and the density of the reformed bone are the factors which show the success of the healing process.
HYPOTHESIS. Hypothesis of our research was that the alveolar socket healing process depends of the patient's age and the presence of neighboring teeth around alveolar socket and independent of sex. The cause of a tooth extraction has an influence on healing process, too.
METHODS. For analysis the height of alveolar bone we used simple geometric analysis with the comparison of two roentgenograms. We used the first roentgenogram (before tooth extraction) for measurement and calculation of two-dimensional bone defect after simple tooth extraction following no complications. On the second roentgenogram, which shows the alveolar ridge two months after the tooth extraction, we measured actual height of reformed alveolar bone and compared it with the height of bone failure immediately after extraction of a tooth. The rate of healing process was expressed in percentage. We scanned the roentgenogram which was made two months after extraction of a tooth, then we measured the density of bone lamellas with the aid of computer program Image tools. The bone density was present with grayness in value from 0 to 256. Then we compared the grayness intensity in the middle alveolar socket to the grayness intensity of surrounding unconcerned bone on scanned roentgenogram. The grayness value in reformed bone compared to the grayness value in surrounding bone we expressed in percentage. Results were processed with the Student t test for unequal variance and with the regression test.
RESULTS. This study shows that the average height of bone healing is 87,1% in patients between 13 and 81 years, regarding to the level of alveolar-bone height immediately after the tooth extraction. The best healing process (97,5%) is in patients of age between 10 and 20. The alveolar sockets with the worst ability to heal (81,3%) we found in patients in age from 61 to 70 years. We classified the extracted teeth into three groups regarding to the presence or not of surrounding teeth. The results show the best alveolar socket healing tendency in the case of presence of both, mesial and distal teeth (97,4%). The worst alveolar socket healing tendency is present in the case where the alveolar socket of extracted tooth din' t have any surrounding tooth (82,2%). The difference between the groups are statistical significant, what we proved with Student t test. We established that anterior maxillary teeth have the worst bone healing tendency. Periodontitis as the cause of tooth extraction manifested the lowest rate of healing process between all indications for tooth extraction. Measurement of reformed bone density in healed alveolar socket compared to surrounding bone showed average of 82%. This parameter is statistically significantly dependent of age. Regarding to regression straight line we can predict bone density regarding to patient's age.
CONCLUSIONS The results of this study show the basic characteristics of extraction wound healing process in first two months after tooth extraction regarding to bone height and density. Our results confirmed our hypothesis. The patient's age and tissue condition are a decisive factors in healing process. The presence of surrounding teeth also plays an important role in better extraction wound healing process.
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