牙槽嵴保存术手术方式的最新研究进展
The Latest Research Progress on Surgical Protocols of Alveolar Ridge Preservation
摘要: 牙槽嵴保存术(ARP)旨在减少拔牙后的牙槽骨吸收和软组织塌陷，本综述探讨了其手术方案的最新进展，重点关注生物材料选择、牙槽窝分类、拔牙窝封闭方式和愈合时间，同时评估其临床效果和局限性。最新的拔牙窝分类系统根据周围骨壁的形态和周围软组织缺陷进行分类，而在拔牙窝封闭方面，部分研究显示二期愈合较一期愈合可减少术后疼痛并增加角化组织的宽度。未来牙槽嵴保存术应继续致力于优化微创手术技术并完善软组织轮廓，以提高种植体成功率，确保稳定的生物学与美学效果。本综述可为临床医生选择有效且可靠的治疗方案提供指导。
Abstract: This review discusses recent advances in surgical protocols for alveolar ridge preservation (ARP), aiming to mitigate alveolar bone resorption and soft tissue collapse following tooth extraction. It focuses on biomaterial selection, socket classification, socket sealing approaches and healing time, while assessing their clinical effectiveness and limitations. The most recent classification system for extraction sockets categorizes them based on the morphology of the surrounding bone walls and the surrounding soft tissue defects. Some studies suggested secondary wound closure reduced postoperative pain and increased keratinized tissue width compared to primary closure. Also, there is a positive correlation between the healing duration and the amount of vital bone. Future advancements in alveolar ridge preservation should focus on optimizing minimally invasive surgical techniques and enhancing soft tissue contouring to improve implant success rates and ensure stable biological and aesthetic outcomes. This review offers guidance to clinicians in choosing effective and reliable treatment options.
文章引用：张信予, 周鹂鹂. 牙槽嵴保存术手术方式的最新研究进展[J]. 临床医学进展, 2025, 15(10): 729-737. https://doi.org/10.12677/acm.2025.15102812

参考文献

[1] Tan, W.L., Wong, T.L.T., Wong, M.C.M. and Lang, N.P. (2012) A Systematic Review of Post‐Extractional Alveolar Hard and Soft Tissue Dimensional Changes in Humans. Clinical Oral Implants Research, 23, 1-21. [Google Scholar] [CrossRef] [PubMed]
[2] Horváth, A., Mardas, N., Mezzomo, L.A., Needleman, I.G. and Donos, N. (2012) Alveolar Ridge Preservation. A Systematic Review. Clinical Oral Investigations, 17, 341-363. [Google Scholar] [CrossRef] [PubMed]
[3] Bassir, S., Alhareky, M., Wangsrimongkol, B., Jia, Y. and Karimbux, N. (2018) Systematic Review and Meta-Analysis of Hard Tissue Outcomes of Alveolar Ridge Preservation. The International Journal of Oral & Maxillofacial Implants, 33, 979-994. [Google Scholar] [CrossRef] [PubMed]
[4] Avila‐Ortiz, G., Chambrone, L. and Vignoletti, F. (2019) Effect of Alveolar Ridge Preservation Interventions Following Tooth Extraction: A Systematic Review and Meta‐Analysis. Journal of Clinical Periodontology, 46, 195-223. [Google Scholar] [CrossRef] [PubMed]
[5] Natto, Z.S., Parashis, A., Steffensen, B., Ganguly, R., Finkelman, M.D. and Jeong, Y.N. (2017) Efficacy of Collagen Matrix Seal and Collagen Sponge on Ridge Preservation in Combination with Bone Allograft: A Randomized Controlled Clinical Trial. Journal of Clinical Periodontology, 44, 649-659. [Google Scholar] [CrossRef] [PubMed]
[6] Haugen, H.J., Lyngstadaas, S.P., Rossi, F. and Perale, G. (2019) Bone Grafts: Which Is the Ideal Biomaterial? Journal of Clinical Periodontology, 46, 92-102. [Google Scholar] [CrossRef] [PubMed]
[7] Baldini, N., De Sanctis, M. and Ferrari, M. (2011) Deproteinized Bovine Bone in Periodontal and Implant Surgery. Dental Materials, 27, 61-70. [Google Scholar] [CrossRef] [PubMed]
[8] Fan, Q., Zeng, H., Fan, W., Wu, T., Sun, J., Yan, Q., et al. (2021) Ridge Preservation of a Novel Extraction Socket Applying Bio-Oss® Collagen: An Experimental Study in Dogs. Journal of Dental Sciences, 16, 831-839. [Google Scholar] [CrossRef] [PubMed]
[9] Nart, J., Barallat, L., Jimenez, D., Mestres, J., Gómez, A., Carrasco, M.A., et al. (2016) Radiographic and Histological Evaluation of Deproteinized Bovine Bone Mineral Vs. Deproteinized Bovine Bone Mineral with 10% Collagen in Ridge Preservation. A Randomized Controlled Clinical Trial. Clinical Oral Implants Research, 28, 840-848. [Google Scholar] [CrossRef] [PubMed]
[10] Iorio-Siciliano, V., Blasi, A., Nicolò, M., Iorio-Siciliano, A., Riccitiello, F. and Ramaglia, L. (2017) Clinical Outcomes of Socket Preservation Using Bovine-Derived Xenograft Collagen and Collagen Membrane Post-Tooth Extraction: A 6-Month Randomized Controlled Clinical Trial. The International Journal of Periodontics & Restorative Dentistry, 37, e290-e296. [Google Scholar] [CrossRef] [PubMed]
[11] Wood, R.A. and Mealey, B.L. (2012) Histologic Comparison of Healing after Tooth Extraction with Ridge Preservation Using Mineralized versus Demineralized Freeze‐Dried Bone Allograft. Journal of Periodontology, 83, 329-336. [Google Scholar] [CrossRef] [PubMed]
[12] Borg, T.D. and Mealey, B.L. (2015) Histologic Healing Following Tooth Extraction with Ridge Preservation Using Mineralized versus Combined Mineralized‐Demineralized Freeze‐Dried Bone Allograft: A Randomized Controlled Clinical Trial. Journal of Periodontology, 86, 348-355. [Google Scholar] [CrossRef] [PubMed]
[13] Zimmermann, G. and Moghaddam, A. (2011) Allograft Bone Matrix versus Synthetic Bone Graft Substitutes. Injury, 42, S16-S21. [Google Scholar] [CrossRef] [PubMed]
[14] Miron, R.J., Zhang, Q., Sculean, A., Buser, D., Pippenger, B.E., Dard, M., et al. (2016) Osteoinductive Potential of 4 Commonly Employed Bone Grafts. Clinical Oral Investigations, 20, 2259-2265. [Google Scholar] [CrossRef] [PubMed]
[15] 廖军, 徐普. 富血小板血纤蛋白在牙槽嵴位点保存中的应用[J]. 国际口腔医学杂志, 2016, 43(2): 216-219.
[16] Steigmann, L., Di Gianfilippo, R., Steigmann, M. and Wang, H. (2022) Classification Based on Extraction Socket Buccal Bone Morphology and Related Treatment Decision Tree. Materials, 15, Article 733. [Google Scholar] [CrossRef] [PubMed]
[17] Kim, J., Ben Amara, H., Chung, I. and Koo, K. (2021) Compromised Extraction Sockets: A New Classification and Prevalence Involving Both Soft and Hard Tissue Loss. Journal of Periodontal & Implant Science, 51, Article 100. [Google Scholar] [CrossRef] [PubMed]
[18] Vignoletti, F., Matesanz, P., Rodrigo, D., Figuero, E., Martin, C. and Sanz, M. (2011) Surgical Protocols for Ridge Preservation after Tooth Extraction. a Systematic Review. Clinical Oral Implants Research, 23, 22-38. [Google Scholar] [CrossRef] [PubMed]
[19] Aladmawy, M.A., Natto, Z.S., Kreitzer, M., Ogata, Y. and Hur, Y. (2022) Histological and Histomorphometric Evaluation of Alveolar Ridge Preservation Using an Allograft and Nonresorbable Membrane with and without Primary Closure: A Pilot Randomized Controlled Clinical Trial. Medicine, 101, e29769. [Google Scholar] [CrossRef] [PubMed]
[20] Barone, A., Toti, P., Piattelli, A., Iezzi, G., Derchi, G. and Covani, U. (2014) Extraction Socket Healing in Humans after Ridge Preservation Techniques: Comparison between Flapless and Flapped Procedures in a Randomized Clinical Trial. Journal of Periodontology, 85, 14-23. [Google Scholar] [CrossRef] [PubMed]
[21] Aladmawy, M.A., Natto, Z.S., Steffensen, B., Levi, P., Cheung, W., Finkelman, M., et al. (2019) A Comparison between Primary and Secondary Flap Coverage in Ridge Preservation Procedures: A Pilot Randomized Controlled Clinical Trial. BioMed Research International, 2019, Article ID: 7679319. [Google Scholar] [CrossRef] [PubMed]
[22] Atieh, M.A., Alfardan, L. and Alsabeeha, N.H.M. (2022) Flapped versus Flapless Alveolar Ridge Preservation: A Systematic Review and Meta-Analysis. International Journal of Oral and Maxillofacial Surgery, 51, 133-142. [Google Scholar] [CrossRef] [PubMed]
[23] Sun, D., Lim, H. and Lee, D. (2019) Alveolar Ridge Preservation Using an Open Membrane Approach for Sockets with Bone Deficiency: A Randomized Controlled Clinical Trial. Clinical Implant Dentistry and Related Research, 21, 175-182. [Google Scholar] [CrossRef] [PubMed]
[24] Pang, C., Ding, Y., Zhou, H., Qin, R., Hou, R., Zhang, G., et al. (2014) Alveolar Ridge Preservation with Deproteinized Bovine Bone Graft and Collagen Membrane and Delayed Implants. Journal of Craniofacial Surgery, 25, 1698-1702. [Google Scholar] [CrossRef] [PubMed]
[25] 詹雅琳, 胡文杰, 甄敏, 等. 去蛋白牛骨基质与可吸收胶原膜的磨牙拔牙位点保存效果影像学评价[J]. 北京大学学报(医学版), 2015, 47(1): 19-26.
[26] Botilde, G., Colin, P., González‐Martín, O., Lecloux, G., Rompen, E. and Lambert, F. (2020) Hard and Soft Tissue Analysis of Alveolar Ridge Preservation in Esthetic Zone Using Deproteinized Bovine Bone Mineral and a Saddle Connective Tissue Graft: A Long‐Term Prospective Case Series. Clinical Implant Dentistry and Related Research, 22, 387-396. [Google Scholar] [CrossRef] [PubMed]
[27] Seyssens, L., Eghbali, A., Christiaens, V., De Bruyckere, T., Doornewaard, R. and Cosyn, J. (2019) A One‐Year Prospective Study on Alveolar Ridge Preservation Using Collagen‐Enriched Deproteinized Bovine Bone Mineral and Saddle Connective Tissue Graft: A Cone Beam Computed Tomography Analysis. Clinical Implant Dentistry and Related Research, 21, 853-861. [Google Scholar] [CrossRef] [PubMed]
[28] Ghanaati, S., Schlee, M., Webber, M.J., Willershausen, I., Barbeck, M., Balic, E., et al. (2011) Evaluation of the Tissue Reaction to a New Bilayered Collagen Matrix in Vivo and Its Translation to the Clinic. Biomedical Materials, 6, Article 015010. [Google Scholar] [CrossRef] [PubMed]
[29] Maiorana, C., Poli, P.P., Deflorian, M., Testori, T., Mandelli, F., Nagursky, H., et al. (2017) Alveolar Socket Preservation with Demineralised Bovine Bone Mineral and a Collagen Matrix. Journal of Periodontal & Implant Science, 47, Article 194. [Google Scholar] [CrossRef] [PubMed]
[30] Kotsakis, G., Chrepa, V., Marcou, N., Prasad, H. and Hinrichs, J. (2014) Flapless Alveolar Ridge Preservation Utilizing the “Socket-Plug” Technique: Clinical Technique and Review of the Literature. Journal of Oral Implantology, 40, 690-698. [Google Scholar] [CrossRef] [PubMed]
[31] 姜健, 黄盛兴. 口腔屏障膜在位点保存术中的研究进展[J]. 分子影像学杂志, 2019, 42(4): 498-505.
[32] Arbab, H., Greenwell, H., Hill, M., Morton, D., Vidal, R., Shumway, B., et al. (2016) Ridge Preservation Comparing a Nonresorbable PTFE Membrane to a Resorbable Collagen Membrane: A Clinical and Histologic Study in Humans. Implant Dentistry, 25, 128-134. [Google Scholar] [CrossRef] [PubMed]
[33] Troiano, G., Zhurakivska, K., Lo Muzio, L., Laino, L., Cicciù, M. and Lo Russo, L. (2018) Combination of Bone Graft and Resorbable Membrane for Alveolar Ridge Preservation: A Systematic Review, Meta‐Analysis, and Trial Sequential Analysis. Journal of Periodontology, 89, 46-57. [Google Scholar] [CrossRef] [PubMed]
[34] Nelson, A.C. and Mealey, B.L. (2020) A Randomized Controlled Trial on the Impact of Healing Time on Wound Healing Following Ridge Preservation Using a 70%/30% Combination of Mineralized and Demineralized Freeze‐Dried Bone Allograft. Journal of Periodontology, 91, 1256-1263. [Google Scholar] [CrossRef] [PubMed]
[35] Zellner, J.W., Allen, H.T., Kotsakis, G.A. and Mealey, B.L. (2023) Wound Healing after Ridge Preservation: A Randomized Controlled Trial on Short‐Term (4 Months) versus Long‐Term (12 Months) Histologic Outcomes. Journal of Periodontology, 94, 622-629. [Google Scholar] [CrossRef] [PubMed]
[36] Moghaddas, O., Naddafpour, N., Farhadi, S., Nikookar, P. and Khandan, S. (2022) Comparison of Healing Time and the Histopathology of Bone Formation Following Tooth Extraction Using Freeze-Dried Bone Allograft: A Randomized Controlled Clinical Trial. Journal of Advanced Periodontology & Implant Dentistry, 14, 69-75. [Google Scholar] [CrossRef] [PubMed]
[37] Jung, R.E., Ioannidis, A., Hämmerle, C.H.F. and Thoma, D.S. (2018) Alveolar Ridge Preservation in the Esthetic Zone. Periodontology 2000, 77, 165-175. [Google Scholar] [CrossRef] [PubMed]

为你推荐