犬牙槽骨牵张成骨的生物力学和组织学分析
|
摘要
背景:牙槽骨牵张成骨是解决严重牙槽骨萎缩的重要方法,其成骨过程和生物力学对于以后的种植和修复极为重要,目前一直缺少相关的实验研究。目的:分析犬牙槽骨牵张成骨的生物力学和组织学特点。方法:先拔除12只杂种犬双侧下颌前磨牙,牙槽骨修整后,制作萎缩牙槽骨模型。3个月后,植入骨内型牙槽骨牵张器。经过7 d的间歇期,以1 mm/d,1次/d的频率进行牙槽骨垂直向增高。在固定期的1,2和3个月,对牵张后的牙槽骨进行临床、生物力学、放射学和组织学检测。结果与结论:所有牵张器与周围组织愈合良好。牵张结束时,临床和放射学检查显示:萎缩牙槽骨分别增高(4.80±0.50)mm和(5.12±0.67)mm。组织学检测发现牵张区骨小梁在固定期的1-3个月成熟,其剪切力逐步提高,固定期3个月时和自体骨的剪切力相当。结果显示牙槽骨牵张成骨的组织学和生物力学性能在固定期3个月时与自体骨相当。
BACKGROUND: Alveolar distraction osteogenesis is an important method for treating alveolar bone atrophy, the osteogenesis process and biomechanics play a crucial role in the following implantation and repair. At present, no related experimental studies are found. OBJECTIVE: To analyze the biomechanical and histological characteristics of alveolar distraction osteogenesis in a canine model. METHODS: Twelve adult mongrel canines received premolars extraction and alveoloplasty in mandible to establish an atrophy alveolar model. After 3 months, a segmental alveolar osteotomy was performed in the randomly selected unilateral atrophy alveolar and two intra-osseous distractors were placed. After a 7-days latency period, the alveolar ridge was augmented at a rate of 1.0 mm/d for 5 days. After a consolidation of 1, 2,and 3 months, the canines were sacrificed and the specimens of the distracted alveolar bone were harvested for clinical, radiographic, histological and biomechanical analysis. RESULTS AND CONCLUSION: The alveolar distractors obtained good healing with surrounding tissue. The atrophy alveolar bones were augmented for(4.80±0.50) mm and(5.12±0.47) mm by clinical and radiographic findings immediately after distraction, respectively. The bone trabeculae in the distracted chamber matured from 1 to 3 months of consolidation by histological analysis. The shearing force of alveolar distraction chamber increased from 1 to 3 months. After 3 months' consolidation, the shearing force of distracted chamber was comparable to host bone. The histological and biomechanical property of distracted alveolar chamber is comparable to host bone after 3 months' consolidation.
BACKGROUND: Alveolar distraction osteogenesis is an important method for treating alveolar bone atrophy, the osteogenesis process and biomechanics play a crucial role in the following implantation and repair. At present, no related experimental studies are found. OBJECTIVE: To analyze the biomechanical and histological characteristics of alveolar distraction osteogenesis in a canine model. METHODS: Twelve adult mongrel canines received premolars extraction and alveoloplasty in mandible to establish an atrophy alveolar model. After 3 months, a segmental alveolar osteotomy was performed in the randomly selected unilateral atrophy alveolar and two intra-osseous distractors were placed. After a 7-days latency period, the alveolar ridge was augmented at a rate of 1.0 mm/d for 5 days. After a consolidation of 1, 2,and 3 months, the canines were sacrificed and the specimens of the distracted alveolar bone were harvested for clinical, radiographic, histological and biomechanical analysis. RESULTS AND CONCLUSION: The alveolar distractors obtained good healing with surrounding tissue. The atrophy alveolar bones were augmented for(4.80±0.50) mm and(5.12±0.47) mm by clinical and radiographic findings immediately after distraction, respectively. The bone trabeculae in the distracted chamber matured from 1 to 3 months of consolidation by histological analysis. The shearing force of alveolar distraction chamber increased from 1 to 3 months. After 3 months' consolidation, the shearing force of distracted chamber was comparable to host bone. The histological and biomechanical property of distracted alveolar chamber is comparable to host bone after 3 months' consolidation.
引文
[1]Langenbeck BV.About the pathologic length growth of long bones and its employment in surgical praxis.Berl Klin Wochenschr.1869;26:265.
[2]Ilizarov GA.The tension-stress effect on the genesis and growth of tissues.Part I.The influence of stability of fixation and soft-tissue preservation.Clin Orthop Relat Res.1989;(238):249-281.
[3]Ilizarov GA.The tension-stress effect on the genesis and growth of tissues:Part II.The influence of the rate and frequency of distraction.Clin Orthop Relat Res.1989;(239):263-285.
[4]Block MS,Daire J,Stover J,et al.Changes in the inferior alveolar nerve following mandibular lengthening in the dog using distraction osteogenesis.J Oral Maxillofac Surg.1993;51(6):652-660.
[5]Block MS,Chang A,Crawford C.Mandibular alveolar ridge augmentation in the dog using distraction osteogenesis.J Oral Maxillofac Surg.1996;54(3):309-314.
[6]Block MS,Almerico B,Crawford C,et al.Bone response to functioning implants in dog mandibular alveolar ridges augmented with distraction osteogenesis.Int J Oral Maxillofac Implants.1998;13(3):342-351.
[7]Makarov MR,Harper RP,Cope JB,et al.Evaluation of inferior alveolar nerve function during distraction osteogenesis in the dog.J Oral Maxillofac Surg.1998;56(12):1417-1423.
[8]Engel PS,Rauch DM,Ladov MJ,et al.Alveolar distraction osteogenesis:a new alternative to bone grafts.Report of three cases.J N J Dent Assoc.1999;70(1):15,20-21,56-57.
[9]Mitsukawa N,Saiga A,Morishita T,et al.Special distraction osteogenesis before bone grafting for alveolar cleft defects to correct maxillary deformities in patients with bilateral cleft lips and palates:Distraction osteogenesis performed separately for each bone segment.J Craniomaxillofac Surg.2013.[Epub ahead of print]
[10]Kumar N,Prashantha G,Raikar S,et al.Dento-Alveolar Distraction Osteogenesis for rapid Orthodontic Canine Retraction.J Int Oral Health.2013;5(6):31-41.
[11]Block MS,Gardiner D,Almerico B,et al.Loaded hydroxylapatite-coated implants and uncoated titanium-threaded implants in distracted dog alveolar ridges.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2000;89(6):676-685.
[12]Yamauchi K,Takahashi T,Nogami S,et al.Horizontal alveolar distraction osteogenesis for dental implant:long-term results.Clin Oral Implants Res.2013;24(5):563-568.
[13]Ugurlu F,Sener BC,Dergin G,et al.Potential complications and precautions in vertical alveolar distraction osteogenesis:a retrospective study of 40 patients.J Craniomaxillofac Surg.2013;41(7):569-573.
[14]Rachmiel A,Emodi O,Gutmacher Z,et al.Oral and dental restoration of wide alveolar cleft using distraction osteogenesis and temporary anchorage devices.J Craniomaxillofac Surg.2013;41(8):728-734.
[15]Ohba S,Tobita T,Tajima N,et al.Correction of an asymmetric maxillary dental arch by alveolar bone distraction osteogenesis.Am J Orthod Dentofacial Orthop.2013;143(2):266-273.
[16]Kim JW,Cho MH,Kim SJ,et al.Alveolar distraction osteogenesis versus autogenous onlay bone graft for vertical augmentation of severely atrophied alveolar ridges after 12years of long-term follow-up.Oral Surg Oral Med Oral Pathol Oral Radiol.2013;116(5):540-549.
[17]Kawashima W,Takayama K,Fujii R,et al.Vector-controlled alveolar distraction osteogenesis using an implant-fixed provisional prosthesis:a case report.Implant Dent.2013;22(1):26-30.
[18]Joss CU,Triaca A,Antonini M,et al.Neurosensory and functional evaluation in distraction osteogenesis of the anterior mandibular alveolar process.Int J Oral Maxillofac Surg.2013;42(1):55-61.
[19]Isomura ET,Shogen Y,Hamaguchi M,et al.Electrophysiologic evaluation of inferior alveolar nerve regenerated by bifocal distraction osteogenesis in dogs.Plast Reconstr Surg.2013;132(4):877-882..
[20]Isomura ET,Shogen Y,Hamaguchi M,et al.Inferior alveolar nerve regeneration after bifocal distraction osteogenesis in dogs.J Oral Maxillofac Surg.2013;71(10):1810.e1-11.
[21]Felice P,Lizio G,Checchi L.Alveolar distraction osteogenesis in posterior atrophic mandible:a case report on a new technical approach.Implant Dent.2013;22(4):332-338.
[22]Faysal U,Cem SB,Atilla S.Effects of different consolidation periods on bone formation and implant success in alveolar distraction osteogenesis:a clinical study.J Craniomaxillofac Surg.2013;41(3):194-197.
[23]Cheung LK,Chua HD,Hariri F,et al.Alveolar distraction osteogenesis for dental implant rehabilitation following fibular reconstruction:a case series.J Oral Maxillofac Surg.2013;71(2):255-271.
[24]Chiapasco M,Casentini P,Zaniboni M.Bone augmentation procedures in implant dentistry.Int J Oral Maxillofac Implants.2009;24 Suppl:237-259.
[25]McAllister BS,Haghighat K.Bone augmentation techniques.J Periodontol.2007;78(3):377-396.
[26]Uckan S,Veziroglu F,Dayangac E.Alveolar distraction osteogenesis versus autogenous onlay bone grafting for alveolar ridge augmentation:Technique,complications,and implant survival rates.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2008;106(4):511-515.
[27]Vega LG,Bilbao A.Alveolar distraction osteogenesis for dental implant preparation:an update.Oral Maxillofac Surg Clin North Am.2010;22(3):369-385.
[28]Cheung LK,Hariri F,Chua HD.Alveolar distraction osteogenesis for oral rehabilitation in reconstructed jaws.Curr Opin Otolaryngol Head Neck Surg.2011;19(4):312-316.
[29]Saulacic N,Gándara-Vila P,Somoza-Martín M,et al.Distraction osteogenesis of the alveolar ridge:a review of the literature.Med Oral.2004;9(4):321-327.
[30]Emtiaz S,Noroozi S,Caramês J,et al.Alveolar vertical distraction osteogenesis:historical and biologic review and case presentation.Int J Periodontics Restorative Dent.2006;26(6):529-541.
[31]Boyne PJ,Herford AS.Distraction osteogenesis of the nasal and antral osseous floor to enhance alveolar height.J Oral Maxillofac Surg.2004;62(9 Suppl 2):123-130.
[32]Whitesides LM,Meyer RA.Effect of distraction osteogenesis on the severely hypoplastic mandible and inferior alveolar nerve function.J Oral Maxillofac Surg.2004;62(3):292-297.
[33]Oda T,Sawaki Y,Ueda M.Alveolar ridge augmentation by distraction osteogenesis using titanium implants:an experimental study.Int J Oral Maxillofac Surg.1999;28(2):151-156.
[34]Chiapasco M,Zaniboni M,Rimondini L.Autogenous onlay bone grafts vs.alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges:a 2-4-year prospective study on humans.Clin Oral Implants Res.2007;18(4):432-440.
[35]Zhao Y,Liu Y,Liu B,et al.Bone healing process around distraction implants following alveolar distraction osteogenesis:a preliminary experimental study in dogs.Int J Periodontics Restorative Dent.2009;29(5):523-533.
[36]Chiapasco M,Consolo U,Bianchi A,et al.Alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges:a multicenter prospective study on humans.Int J Oral Maxillofac Implants.2004;19(3):399-407.
[37]Sezer B,Koyuncu BO,Günbay T,et al.Alveolar distraction osteogenesis in the human mandible:a clinical and histomorphometric study.Implant Dent.2012;21(4):317-322.
[38]Alkan A,BasB,Inal S.Alveolar distraction osteogenesis of bone graft reconstructed mandible.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2005;100(3):e39-42.
[39]Braidy H,Appelbaum M.Alveolar distraction osteogenesis of the severely atrophic anterior maxilla:surgical and prosthetic challenges.J Prosthodont.2011;20(2):139-143.
[40]Mazzonetto R,Serra E Silva FM,Ribeiro Torezan JF.Clinical assessment of 40 patients subjected to alveolar distraction osteogenesis.Implant Dent.2005;14(2):149-153.
[41]Henkel KO,Ma L,Lenz JH,et al.Closure of vertical alveolar bone defects with guided horizontal distraction osteogenesis:an experimental study in pigs and first clinical results.J Craniomaxillofac Surg.2001;29(5):249-253.
[42]Saulacic N,Zix J,Iizuka T.Complication rates and associated factors in alveolar distraction osteogenesis:a comprehensive review.Int J Oral Maxillofac Surg.2009;38(3):210-217.
[43]Perdijk FB,Meijer GJ,Strijen PJ,et al.Complications in alveolar distraction osteogenesis of the atrophic mandible.Int J Oral Maxillofac Surg.2007;36(10):916-921.
[44]Garcia Garcia A,Somoza Martin M,Gandara Vila P,et al.Alveolar ridge osteogenesis using 2 intraosseous distractors:uniform and nonuniform distraction.J Oral Maxillofac Surg.2002;60(12):1510-1512.
[45]Veziroglu F,Yilmaz D.Biomechanical evaluation of the consolidation period of alveolar distraction osteogenesis with three-dimensional finite element analysis.Int J Oral Maxillofac Surg.2008;37(5):448-452.
[46]Enislidis G,Fock N,Millesi-Schobel G,et al.Analysis of complications following alveolar distraction osteogenesis and implant placement in the partially edentulous mandible.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2005;100(1):25-30.
[47]Wolf JH.Julis Wolff and his"law of bone remodeling".Orthopade.1995;24(5):378-386.
[48]Costantino PD,Friedman CD.Distraction osteogenesis.Applications for mandibular regrowth.Otolaryngol Clin North Am.1991;24(6):1433-1443.
[49]Costantino PD,Shybut G,Friedman CD,et al.Segmental mandibular regeneration by distraction osteogenesis.An experimental study.Arch Otolaryngol Head Neck Surg.1990;116(5):535-545.
[2]Ilizarov GA.The tension-stress effect on the genesis and growth of tissues.Part I.The influence of stability of fixation and soft-tissue preservation.Clin Orthop Relat Res.1989;(238):249-281.
[3]Ilizarov GA.The tension-stress effect on the genesis and growth of tissues:Part II.The influence of the rate and frequency of distraction.Clin Orthop Relat Res.1989;(239):263-285.
[4]Block MS,Daire J,Stover J,et al.Changes in the inferior alveolar nerve following mandibular lengthening in the dog using distraction osteogenesis.J Oral Maxillofac Surg.1993;51(6):652-660.
[5]Block MS,Chang A,Crawford C.Mandibular alveolar ridge augmentation in the dog using distraction osteogenesis.J Oral Maxillofac Surg.1996;54(3):309-314.
[6]Block MS,Almerico B,Crawford C,et al.Bone response to functioning implants in dog mandibular alveolar ridges augmented with distraction osteogenesis.Int J Oral Maxillofac Implants.1998;13(3):342-351.
[7]Makarov MR,Harper RP,Cope JB,et al.Evaluation of inferior alveolar nerve function during distraction osteogenesis in the dog.J Oral Maxillofac Surg.1998;56(12):1417-1423.
[8]Engel PS,Rauch DM,Ladov MJ,et al.Alveolar distraction osteogenesis:a new alternative to bone grafts.Report of three cases.J N J Dent Assoc.1999;70(1):15,20-21,56-57.
[9]Mitsukawa N,Saiga A,Morishita T,et al.Special distraction osteogenesis before bone grafting for alveolar cleft defects to correct maxillary deformities in patients with bilateral cleft lips and palates:Distraction osteogenesis performed separately for each bone segment.J Craniomaxillofac Surg.2013.[Epub ahead of print]
[10]Kumar N,Prashantha G,Raikar S,et al.Dento-Alveolar Distraction Osteogenesis for rapid Orthodontic Canine Retraction.J Int Oral Health.2013;5(6):31-41.
[11]Block MS,Gardiner D,Almerico B,et al.Loaded hydroxylapatite-coated implants and uncoated titanium-threaded implants in distracted dog alveolar ridges.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2000;89(6):676-685.
[12]Yamauchi K,Takahashi T,Nogami S,et al.Horizontal alveolar distraction osteogenesis for dental implant:long-term results.Clin Oral Implants Res.2013;24(5):563-568.
[13]Ugurlu F,Sener BC,Dergin G,et al.Potential complications and precautions in vertical alveolar distraction osteogenesis:a retrospective study of 40 patients.J Craniomaxillofac Surg.2013;41(7):569-573.
[14]Rachmiel A,Emodi O,Gutmacher Z,et al.Oral and dental restoration of wide alveolar cleft using distraction osteogenesis and temporary anchorage devices.J Craniomaxillofac Surg.2013;41(8):728-734.
[15]Ohba S,Tobita T,Tajima N,et al.Correction of an asymmetric maxillary dental arch by alveolar bone distraction osteogenesis.Am J Orthod Dentofacial Orthop.2013;143(2):266-273.
[16]Kim JW,Cho MH,Kim SJ,et al.Alveolar distraction osteogenesis versus autogenous onlay bone graft for vertical augmentation of severely atrophied alveolar ridges after 12years of long-term follow-up.Oral Surg Oral Med Oral Pathol Oral Radiol.2013;116(5):540-549.
[17]Kawashima W,Takayama K,Fujii R,et al.Vector-controlled alveolar distraction osteogenesis using an implant-fixed provisional prosthesis:a case report.Implant Dent.2013;22(1):26-30.
[18]Joss CU,Triaca A,Antonini M,et al.Neurosensory and functional evaluation in distraction osteogenesis of the anterior mandibular alveolar process.Int J Oral Maxillofac Surg.2013;42(1):55-61.
[19]Isomura ET,Shogen Y,Hamaguchi M,et al.Electrophysiologic evaluation of inferior alveolar nerve regenerated by bifocal distraction osteogenesis in dogs.Plast Reconstr Surg.2013;132(4):877-882..
[20]Isomura ET,Shogen Y,Hamaguchi M,et al.Inferior alveolar nerve regeneration after bifocal distraction osteogenesis in dogs.J Oral Maxillofac Surg.2013;71(10):1810.e1-11.
[21]Felice P,Lizio G,Checchi L.Alveolar distraction osteogenesis in posterior atrophic mandible:a case report on a new technical approach.Implant Dent.2013;22(4):332-338.
[22]Faysal U,Cem SB,Atilla S.Effects of different consolidation periods on bone formation and implant success in alveolar distraction osteogenesis:a clinical study.J Craniomaxillofac Surg.2013;41(3):194-197.
[23]Cheung LK,Chua HD,Hariri F,et al.Alveolar distraction osteogenesis for dental implant rehabilitation following fibular reconstruction:a case series.J Oral Maxillofac Surg.2013;71(2):255-271.
[24]Chiapasco M,Casentini P,Zaniboni M.Bone augmentation procedures in implant dentistry.Int J Oral Maxillofac Implants.2009;24 Suppl:237-259.
[25]McAllister BS,Haghighat K.Bone augmentation techniques.J Periodontol.2007;78(3):377-396.
[26]Uckan S,Veziroglu F,Dayangac E.Alveolar distraction osteogenesis versus autogenous onlay bone grafting for alveolar ridge augmentation:Technique,complications,and implant survival rates.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2008;106(4):511-515.
[27]Vega LG,Bilbao A.Alveolar distraction osteogenesis for dental implant preparation:an update.Oral Maxillofac Surg Clin North Am.2010;22(3):369-385.
[28]Cheung LK,Hariri F,Chua HD.Alveolar distraction osteogenesis for oral rehabilitation in reconstructed jaws.Curr Opin Otolaryngol Head Neck Surg.2011;19(4):312-316.
[29]Saulacic N,Gándara-Vila P,Somoza-Martín M,et al.Distraction osteogenesis of the alveolar ridge:a review of the literature.Med Oral.2004;9(4):321-327.
[30]Emtiaz S,Noroozi S,Caramês J,et al.Alveolar vertical distraction osteogenesis:historical and biologic review and case presentation.Int J Periodontics Restorative Dent.2006;26(6):529-541.
[31]Boyne PJ,Herford AS.Distraction osteogenesis of the nasal and antral osseous floor to enhance alveolar height.J Oral Maxillofac Surg.2004;62(9 Suppl 2):123-130.
[32]Whitesides LM,Meyer RA.Effect of distraction osteogenesis on the severely hypoplastic mandible and inferior alveolar nerve function.J Oral Maxillofac Surg.2004;62(3):292-297.
[33]Oda T,Sawaki Y,Ueda M.Alveolar ridge augmentation by distraction osteogenesis using titanium implants:an experimental study.Int J Oral Maxillofac Surg.1999;28(2):151-156.
[34]Chiapasco M,Zaniboni M,Rimondini L.Autogenous onlay bone grafts vs.alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges:a 2-4-year prospective study on humans.Clin Oral Implants Res.2007;18(4):432-440.
[35]Zhao Y,Liu Y,Liu B,et al.Bone healing process around distraction implants following alveolar distraction osteogenesis:a preliminary experimental study in dogs.Int J Periodontics Restorative Dent.2009;29(5):523-533.
[36]Chiapasco M,Consolo U,Bianchi A,et al.Alveolar distraction osteogenesis for the correction of vertically deficient edentulous ridges:a multicenter prospective study on humans.Int J Oral Maxillofac Implants.2004;19(3):399-407.
[37]Sezer B,Koyuncu BO,Günbay T,et al.Alveolar distraction osteogenesis in the human mandible:a clinical and histomorphometric study.Implant Dent.2012;21(4):317-322.
[38]Alkan A,BasB,Inal S.Alveolar distraction osteogenesis of bone graft reconstructed mandible.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2005;100(3):e39-42.
[39]Braidy H,Appelbaum M.Alveolar distraction osteogenesis of the severely atrophic anterior maxilla:surgical and prosthetic challenges.J Prosthodont.2011;20(2):139-143.
[40]Mazzonetto R,Serra E Silva FM,Ribeiro Torezan JF.Clinical assessment of 40 patients subjected to alveolar distraction osteogenesis.Implant Dent.2005;14(2):149-153.
[41]Henkel KO,Ma L,Lenz JH,et al.Closure of vertical alveolar bone defects with guided horizontal distraction osteogenesis:an experimental study in pigs and first clinical results.J Craniomaxillofac Surg.2001;29(5):249-253.
[42]Saulacic N,Zix J,Iizuka T.Complication rates and associated factors in alveolar distraction osteogenesis:a comprehensive review.Int J Oral Maxillofac Surg.2009;38(3):210-217.
[43]Perdijk FB,Meijer GJ,Strijen PJ,et al.Complications in alveolar distraction osteogenesis of the atrophic mandible.Int J Oral Maxillofac Surg.2007;36(10):916-921.
[44]Garcia Garcia A,Somoza Martin M,Gandara Vila P,et al.Alveolar ridge osteogenesis using 2 intraosseous distractors:uniform and nonuniform distraction.J Oral Maxillofac Surg.2002;60(12):1510-1512.
[45]Veziroglu F,Yilmaz D.Biomechanical evaluation of the consolidation period of alveolar distraction osteogenesis with three-dimensional finite element analysis.Int J Oral Maxillofac Surg.2008;37(5):448-452.
[46]Enislidis G,Fock N,Millesi-Schobel G,et al.Analysis of complications following alveolar distraction osteogenesis and implant placement in the partially edentulous mandible.Oral Surg Oral Med Oral Pathol Oral Radiol Endod.2005;100(1):25-30.
[47]Wolf JH.Julis Wolff and his"law of bone remodeling".Orthopade.1995;24(5):378-386.
[48]Costantino PD,Friedman CD.Distraction osteogenesis.Applications for mandibular regrowth.Otolaryngol Clin North Am.1991;24(6):1433-1443.
[49]Costantino PD,Shybut G,Friedman CD,et al.Segmental mandibular regeneration by distraction osteogenesis.An experimental study.Arch Otolaryngol Head Neck Surg.1990;116(5):535-545.