个体化钛修复体修复下颌角缺损的实验研究
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摘要
目的:应用计算机辅助设计和快速成型技术预制个体化钛修复体修复下颌角缺损,为该方法在临床的广泛应用提供实验基础和初步的临床经验。
方法:在动物实验研究部分,我们将16只小型猪均分为两组,制作了小型猪下颌角缺损的动物模型(A组8只小型猪行左侧下颌角截骨术,B组8只小型猪行双侧下颌角截骨术)。根据术前、术后的CT扫描数据,应用三维重建及快速成型技术制作获得三维头颅模型,并在此基础上设计和制作个体化纯钛修复体。应用该个体化修复体修复16只小型猪左侧下颌角缺损。左侧均为实验侧,右侧(A组正常下颌角侧和B组单纯下颌角截骨侧)为对照侧。将实验侧和对照侧进行大体、光镜、电镜等方面的对照研究。
在临床应用研究部分,我们采用该方法制备个体化下颌角修复体修复下颌角缺损3例。
结果:在动物实验研究部分,应用快速成型技术制作的个体化钛修复体与缺损形态非常吻合,远期通过组织学和电镜观察可见钛修复体与骨之间逐渐形成完全的钛-骨整合。A组有1例小型猪于术后6个月出现感染,其余未见并发症。A组术后早期可以达到完全对称,但随着小型猪成长,实验侧(左侧)呈现出稍微小于正常侧(右侧)的趋势。B组单纯截骨侧(右侧)有小部分自愈,但仍明显小于实验侧(左侧)。
在临床应用研究部分,患者的下颌角缺损得到了很好的修复,双侧基本对称。所有患者未见并发症,效果满意。
结论:快速成型技术预制的个体化钛修复体可将缺损下颌角恢复到正常形态,钛修复体与骨质发生理想的骨整合,该个体化修复体具有广阔的临床应用前景。
目的:研究钛植入体在植入动物或人体后的钛离子扩散规律和产生的影响,以及钛植入体的表面形貌和元素构成变化,为钛植入体在临床的安全应用提供实验数据。
方法:在动物实验研究部分:实验组16只小型猪,各植入1枚个体化纯钛修复体修复左侧下颌角缺损;对照组4只小型猪,未植入任何钛植入体。(1)采用电感耦合等离子体质谱分析法(ICP-MS)对钛修复体植入前和植入后第1、3、6、12、18个月血清、尿、毛发中的钛离子水平、以及对照组和实验组植入后第3、6、12、18个月远处器官(包括肝、脾、肺、肾、颌下淋巴结、脊髓)中的钛离子水平进行定量检测。(2)应用X射线能谱分析(EDAX)检测钛修复体植入前和植入后表面元素构成变化和骨组织中钛离子含量变化规律,扫描电镜(SEM)观察钛修复体形貌变化。(3)光镜下观察植入钛修复体后邻近组织和远处器官的组织学改变。
在临床研究部分:(1)我们应用ICP-MS检测了植入钛合金修复体患者术前和术后第1周、2周、1、3、5个月的血清、尿液的钛离子浓度变化,并分析变化规律。(2)应用俄歇电子能谱(AES)对临床常用的钛接骨板进行分析,比较未植入和植入后6个月接骨板在不同深度、不同接触面的元素变化。
结果:在动物实验研究部分:(1)钛修复体在血清、尿液、毛发、肝、脾、肺、肾、颌下淋巴结、脊髓的术后钛离子浓度均较术前和对照组升高。尿的钛离子峰值出现在术后第1个月,毛发的钛离子峰值出现在术后第6个月,其余均出现在术后第3个月。除肾脏的钛离子浓度下降不明显外,其余均在半年后呈现不同程度的下降趋势。(2)应用EDAX检测我们发现,随植入时间延长,钛修复体表面的钛含量会相应降低,SEM观察钛修复体表面变得粗糙。钛在骨中最远探测极限距钛-骨界面250-300μm左右。(3)术后3个月包膜有黑染现象,光镜观察存在黑色颗粒,但6个月以后黑染及黑色颗粒均消失。在长达18个月的术后观察中未见与钛植入体相关的不良反应,组织学观察这种微量钛离子的沉积对周围组织并未造成明显的变性、坏死和引起局部病理性的增生。
在临床研究部分:(1)患者血清钛离子浓度在术后第3个月到达峰值,随后下降;尿钛离子在术后第2周达到峰值,随后下降。(2)应用AES检测发现,术后6个月的钛接骨板在表面和10nm深度的Ti含量均低于未植入接骨板(P＜0.01),接触骨组织面的Ca含量在表面和10nm深度均高于未植入接骨板和接触软组织面(P＜0.01)。Ti含量随深度增加而增加(P＜0.01),Ca含量随深度增加而减少(P＜0.01)。
结论:钛金属虽在体内有钛离子释放、沉积和元素交换现象,但均属微量,不足以导致组织器官结构、功能的改变和金属沉着症。钛具有良好的生物相容性和化学稳定性,但更为长期的植入安全性仍有待观察和研究。
目的:观察下颌角缺损个体化纯钛修复体修复术后咬肌体积的变化规律。
方法:小型猪16只均分为两组,在A组左侧及B组双侧制作下颌角缺损模型。A组8只小型猪行左侧下颌角缺损个体化纯钛修复体修复术,B组8只小型猪行左侧下颌角缺损个体化纯钛修复体修复术和右侧咬肌剥离术。对术后第3、6、12、18个月CT扫描所得到的断层数据进行图像处理,分离咬肌数据,并通过分体重建技术对咬肌进行三维重建和体积测量,并对A组小型猪的修复侧(左侧)和正常侧(右侧)、B组小型猪的修复侧(左侧)和单纯截骨侧(右侧)咬肌的体积变化进行对照研究。
结果:A组小型猪的个体化纯钛修复体修复侧(左侧)的咬肌体积均小于正常侧(右侧),但双侧体积差距有逐渐缩小趋势;双侧咬肌体积在术后第3、6、12个月有统计学差异(术后第3、6月P＜0.01,术后第12月P＜0.05),在术后第18个月无统计学差异(P＞0.05)。B组小型猪的纯钛修复体修复侧(左侧)的咬肌体积均大于单纯截骨侧(右侧),但双侧体积差距有逐渐增大的趋势;双侧咬肌体积在术后第3、6、12个月有统计学差异(P＜0.01),在术后第18个月无统计学差异(P＞0.05)。
结论:下颌角截骨术后咬肌体积会出现一定程度的萎缩,个体化钛修复体修复下颌角缺损利于咬肌体积的恢复,但仍小于正常体积。
PartⅠ:The experimental study and clinical application of reconstruction of mandibular angle defect with individulized precast titanium prosthesis using rapid prototyping technology
Objective To explore the method of reconstruction of mandibular angle defect with individulized precast titanium prosthesis using computer aided design(CAD)and rapid prototyping(RP)technology,and provide experimental foundation and preliminary clinical experience for clinical wide application of this method.
Methods In the part of animal experiment,We divided 16 minipigs into two groups equally,and established mandibular angle defect models of minipigs(8 minipigs of group A received mandibular angle osseotomy on the left sides,and the other 8 minipigs of group B received mandibular angle osseotomy on the bilateral sides).Basing on the data resource from CT,we manufactured the three dimensional cranial models and designed the individulized precast pure titanium prostheses using three dimensional reconstruction and rapid prototyping technology.We repaired the mandibular angle defects on the left sides of 16 minipigs using the individulized titanium prostheses.The left sides were all experimental sides and the right sides(the normal sides of group A and the simple mandibular angle osseotomy sides of group B)were all control sides.We carried out a control study with experimental sides and control sides by in general,light microscope and electron microscope.
In the part of clinical research,we adopted this method to produce individulized precast titanium prostheses and repair mandibular angle defects in three cases. Results In the part of animal experiment,the precast titanium prostheses tallied with the shape of mandibular angle defects perfectly.The formation of titanium-osseointegration could be seen gradually after long-term histological and electron microscope observation. Only one minipig in group A appeared infection 6 months postoperatively,and there were no complications in other minipigs.In group A,it was symmetry in early postoperative stage,but with the minipigs growing,the experimental sides(the left sides)appeared a little smaller than the normal sides(the right sides).In group B,the simple mandibular angle osseotomy sides(the right sides)had partial recovery,but were still smaller than the experimental sides(the left sides)markedly.
In the part of clinical research,the defects of the patients had been repaired and the symmetry was fine.There were no complications and the results were satisfactory.
Conclusions Individualized precast titanium prosthesis using rapid prototyping technology can reshape favorable and normal contour of mandibular angle,form ideal titanium-osseointegration and has an extensive prospect of clinical application.
PartⅡ:The Experimental Study of titanium ions release and surface elements change after titanium implants implantation
Objective To study regularity of titanium ion release,effect,surface topography and elements composition change after titanium implants implantation,and provide an experimental data for clinical application of titanium implants.
Methods In the part of animal experiment:16 minipigs in experimental group received reconstruction of mandibular angle defects on their left sides using individulized precast pure titanium prostheses;4 minipigs in control group had not any titanium implantations. (l)We completed the quantitative detection of titanium ion level in blood serum,urine, hair before implantation and at the 1st,3rd,6th,12th,18th month after implantation,and completed the quantitative detection of titanium ion level in distant organs(including liver,spleen,lung,kidney,submandibular lymph nodes,spinal cord)of control group and experimental group at the 3rd,6th,12th,18th month after implantation using Inductively coupled plasma mass spectrometry(ICP-MS).(2)We detected the elements composition change of titanium prostheses and the regularity of titanium ion content change in bone using Energy-dispersive X-ray analysis(EDAX)before implantation and at the 3rd,6th,12th,18th month after implantation,and observed the surface topography using Scanning electron microcopy(SEM).(3)We studied the histological change of adjacent tissues and distant organs using light microscope after implantation.
In the part of clinical research:(l)We detected the titanium ion in blood serum and urine of one patient who had implanted a titanium alloy prosthesis before implantation and at the 1st,2nd week and the 1st,3rd,5th month after implantation,and analyzed the changing regularity.(2)We detected the elements change with different depth and contact surfaces of the unused plates and the plates implanted 6 months using Auger electron spectroscopy(AES).
Results In the part of animal experiment:(1)The titanium ion concentrations of postoperation in blood serum,urine,hair,in liver,spleen,lung,kidney,submandibular lymph nodes,spinal cord were all higher than those of preoperation and control group. The peak value of titanium ion in urine appeared at the 1st month postoperatively,the peak value of titanium ion in hair appeared at the 6th month postoperatively,and others appeared at the 3rd month postoperatively.The titanium ion presented descended tendency of different degree in all the tissues and organs 6 months postoperatively except kidney.(2)We found that the Ti content of the prostheses surface decreased with the implanted period going on using EDAX,and found the surface became rough using SEM. The limit of detection of Ti was 250-300μm from the titanium-osseointegration interface in bone.(3)We found dark stain in capsule at the 3rd month after implantation,and found black particles by light microscope,but all of them disappeared 6 months after implantation.There were no adverse effects,denaturation,necrosis and pathological hyperplasia related to the implants during the postoperative observation of 18 months.
In the part of clinical research:(l)The peak value of titanium ion in blood serum appeared at the 3rd month postoperatively and decreased later;and the peak value of titanium ion in urine appeared at the 2nd week postoperatively and decreased later. (2)Using AES we found that the Ti content of the plates implanted 6 months was lower than the unused plates on the surface and at the 10nm depth(P＜0.01).The Ca content of the side contacted bones was higher than the unused plates and the side contacted soft tissues on the surface and at the 10nm depth(P＜0.01).The content of Ti increased with the depth(P＜0.01),while Ca decreased.(P＜0.01).
Conclusions There is phenomenon of titanium ions release,deposition and elements exchange in vivo which is just trace and not enough to cause structure,function change and metallosis of tissues and organs.Titanium has good biocompatibility and chemical stability,but the safety of much longer term after implantation still needs observation and study.
PartⅢ:The Experimental Study of masseter volume change after reconstruction of mandibular angle defect using individulized precast pure titanium prosthesis
Objective To study the masseter volume changing regularity after reconstruction of mandibular angle defect using individulized precast pure titanium prosthesis.
Methods We divided 16 minipigs into two groups equally,then established mandibular angle defect models on the left sides of group A and bilateral sides of group B.Then 8 minipigs of group A received reconstruction of mandibular angle defects on the left sides using individulized precast pure titanium prostheses,the other 8 minipigs in group B received reconstruction of mandibular angle defects on the left sides using individulized precast pure titanium prostheses and dissection of masseter on the right sides.According to the CT scanning data of the 3rd,6th,12th,18th month postoperation,we completed image processing to segment masseter from CT scans,and three-dimensional(3D) reconstruction and volume measurement using picture segmenting and partial reconstruction techniques.Furthermore,we carried out a control study on masseter volume change between the reconstructive sides(the left sides)and the normal sides(the right sides)of group A,as well as between the reconstructive sides(the left sides)and the simple mandibular angle osseotomy sides(the right sides)of gourp B.
Results The masseter volume of the reconstructive sides(the left sides)using individulized precast titanium prosthesis were all smaller than the normal sides(the right sides)in group A,and the volume difference tended to diminish;bilateral masseter volume had statistical difference at the 3rd,6th and 12th month(the 3rd and 6th month P＜0.01,the 12th month P＜0.05),and had no statistical difference at the 18th month postoperatively(P＞0.05).The masseter volume of the reconstructive sides(the left sides) using individulized precast titanium prosthesis were all larger than the simple mandibular angle osseotomy sides(the right sides)in group B,and the volume difference tended to largen;bilateral masseter volume had statistical difference at the 3rd,6th and 12th month (P＜0.01),and had no statistical difference at the 18th month postoperatively(P＞0.05)
Conclusions Certain extent of atrophy happens to masseter after madibular angle osseotomy.Madibular angle reconstruction using individulized precast pure titanium prosthesis is beneficial to masseter volume recovery;but the volume is still smaller than normal.
方法:在动物实验研究部分,我们将16只小型猪均分为两组,制作了小型猪下颌角缺损的动物模型(A组8只小型猪行左侧下颌角截骨术,B组8只小型猪行双侧下颌角截骨术)。根据术前、术后的CT扫描数据,应用三维重建及快速成型技术制作获得三维头颅模型,并在此基础上设计和制作个体化纯钛修复体。应用该个体化修复体修复16只小型猪左侧下颌角缺损。左侧均为实验侧,右侧(A组正常下颌角侧和B组单纯下颌角截骨侧)为对照侧。将实验侧和对照侧进行大体、光镜、电镜等方面的对照研究。
在临床应用研究部分,我们采用该方法制备个体化下颌角修复体修复下颌角缺损3例。
结果:在动物实验研究部分,应用快速成型技术制作的个体化钛修复体与缺损形态非常吻合,远期通过组织学和电镜观察可见钛修复体与骨之间逐渐形成完全的钛-骨整合。A组有1例小型猪于术后6个月出现感染,其余未见并发症。A组术后早期可以达到完全对称,但随着小型猪成长,实验侧(左侧)呈现出稍微小于正常侧(右侧)的趋势。B组单纯截骨侧(右侧)有小部分自愈,但仍明显小于实验侧(左侧)。
在临床应用研究部分,患者的下颌角缺损得到了很好的修复,双侧基本对称。所有患者未见并发症,效果满意。
结论:快速成型技术预制的个体化钛修复体可将缺损下颌角恢复到正常形态,钛修复体与骨质发生理想的骨整合,该个体化修复体具有广阔的临床应用前景。
目的:研究钛植入体在植入动物或人体后的钛离子扩散规律和产生的影响,以及钛植入体的表面形貌和元素构成变化,为钛植入体在临床的安全应用提供实验数据。
方法:在动物实验研究部分:实验组16只小型猪,各植入1枚个体化纯钛修复体修复左侧下颌角缺损;对照组4只小型猪,未植入任何钛植入体。(1)采用电感耦合等离子体质谱分析法(ICP-MS)对钛修复体植入前和植入后第1、3、6、12、18个月血清、尿、毛发中的钛离子水平、以及对照组和实验组植入后第3、6、12、18个月远处器官(包括肝、脾、肺、肾、颌下淋巴结、脊髓)中的钛离子水平进行定量检测。(2)应用X射线能谱分析(EDAX)检测钛修复体植入前和植入后表面元素构成变化和骨组织中钛离子含量变化规律,扫描电镜(SEM)观察钛修复体形貌变化。(3)光镜下观察植入钛修复体后邻近组织和远处器官的组织学改变。
在临床研究部分:(1)我们应用ICP-MS检测了植入钛合金修复体患者术前和术后第1周、2周、1、3、5个月的血清、尿液的钛离子浓度变化,并分析变化规律。(2)应用俄歇电子能谱(AES)对临床常用的钛接骨板进行分析,比较未植入和植入后6个月接骨板在不同深度、不同接触面的元素变化。
结果:在动物实验研究部分:(1)钛修复体在血清、尿液、毛发、肝、脾、肺、肾、颌下淋巴结、脊髓的术后钛离子浓度均较术前和对照组升高。尿的钛离子峰值出现在术后第1个月,毛发的钛离子峰值出现在术后第6个月,其余均出现在术后第3个月。除肾脏的钛离子浓度下降不明显外,其余均在半年后呈现不同程度的下降趋势。(2)应用EDAX检测我们发现,随植入时间延长,钛修复体表面的钛含量会相应降低,SEM观察钛修复体表面变得粗糙。钛在骨中最远探测极限距钛-骨界面250-300μm左右。(3)术后3个月包膜有黑染现象,光镜观察存在黑色颗粒,但6个月以后黑染及黑色颗粒均消失。在长达18个月的术后观察中未见与钛植入体相关的不良反应,组织学观察这种微量钛离子的沉积对周围组织并未造成明显的变性、坏死和引起局部病理性的增生。
在临床研究部分:(1)患者血清钛离子浓度在术后第3个月到达峰值,随后下降;尿钛离子在术后第2周达到峰值,随后下降。(2)应用AES检测发现,术后6个月的钛接骨板在表面和10nm深度的Ti含量均低于未植入接骨板(P＜0.01),接触骨组织面的Ca含量在表面和10nm深度均高于未植入接骨板和接触软组织面(P＜0.01)。Ti含量随深度增加而增加(P＜0.01),Ca含量随深度增加而减少(P＜0.01)。
结论:钛金属虽在体内有钛离子释放、沉积和元素交换现象,但均属微量,不足以导致组织器官结构、功能的改变和金属沉着症。钛具有良好的生物相容性和化学稳定性,但更为长期的植入安全性仍有待观察和研究。
目的:观察下颌角缺损个体化纯钛修复体修复术后咬肌体积的变化规律。
方法:小型猪16只均分为两组,在A组左侧及B组双侧制作下颌角缺损模型。A组8只小型猪行左侧下颌角缺损个体化纯钛修复体修复术,B组8只小型猪行左侧下颌角缺损个体化纯钛修复体修复术和右侧咬肌剥离术。对术后第3、6、12、18个月CT扫描所得到的断层数据进行图像处理,分离咬肌数据,并通过分体重建技术对咬肌进行三维重建和体积测量,并对A组小型猪的修复侧(左侧)和正常侧(右侧)、B组小型猪的修复侧(左侧)和单纯截骨侧(右侧)咬肌的体积变化进行对照研究。
结果:A组小型猪的个体化纯钛修复体修复侧(左侧)的咬肌体积均小于正常侧(右侧),但双侧体积差距有逐渐缩小趋势;双侧咬肌体积在术后第3、6、12个月有统计学差异(术后第3、6月P＜0.01,术后第12月P＜0.05),在术后第18个月无统计学差异(P＞0.05)。B组小型猪的纯钛修复体修复侧(左侧)的咬肌体积均大于单纯截骨侧(右侧),但双侧体积差距有逐渐增大的趋势;双侧咬肌体积在术后第3、6、12个月有统计学差异(P＜0.01),在术后第18个月无统计学差异(P＞0.05)。
结论:下颌角截骨术后咬肌体积会出现一定程度的萎缩,个体化钛修复体修复下颌角缺损利于咬肌体积的恢复,但仍小于正常体积。
PartⅠ:The experimental study and clinical application of reconstruction of mandibular angle defect with individulized precast titanium prosthesis using rapid prototyping technology
Objective To explore the method of reconstruction of mandibular angle defect with individulized precast titanium prosthesis using computer aided design(CAD)and rapid prototyping(RP)technology,and provide experimental foundation and preliminary clinical experience for clinical wide application of this method.
Methods In the part of animal experiment,We divided 16 minipigs into two groups equally,and established mandibular angle defect models of minipigs(8 minipigs of group A received mandibular angle osseotomy on the left sides,and the other 8 minipigs of group B received mandibular angle osseotomy on the bilateral sides).Basing on the data resource from CT,we manufactured the three dimensional cranial models and designed the individulized precast pure titanium prostheses using three dimensional reconstruction and rapid prototyping technology.We repaired the mandibular angle defects on the left sides of 16 minipigs using the individulized titanium prostheses.The left sides were all experimental sides and the right sides(the normal sides of group A and the simple mandibular angle osseotomy sides of group B)were all control sides.We carried out a control study with experimental sides and control sides by in general,light microscope and electron microscope.
In the part of clinical research,we adopted this method to produce individulized precast titanium prostheses and repair mandibular angle defects in three cases. Results In the part of animal experiment,the precast titanium prostheses tallied with the shape of mandibular angle defects perfectly.The formation of titanium-osseointegration could be seen gradually after long-term histological and electron microscope observation. Only one minipig in group A appeared infection 6 months postoperatively,and there were no complications in other minipigs.In group A,it was symmetry in early postoperative stage,but with the minipigs growing,the experimental sides(the left sides)appeared a little smaller than the normal sides(the right sides).In group B,the simple mandibular angle osseotomy sides(the right sides)had partial recovery,but were still smaller than the experimental sides(the left sides)markedly.
In the part of clinical research,the defects of the patients had been repaired and the symmetry was fine.There were no complications and the results were satisfactory.
Conclusions Individualized precast titanium prosthesis using rapid prototyping technology can reshape favorable and normal contour of mandibular angle,form ideal titanium-osseointegration and has an extensive prospect of clinical application.
PartⅡ:The Experimental Study of titanium ions release and surface elements change after titanium implants implantation
Objective To study regularity of titanium ion release,effect,surface topography and elements composition change after titanium implants implantation,and provide an experimental data for clinical application of titanium implants.
Methods In the part of animal experiment:16 minipigs in experimental group received reconstruction of mandibular angle defects on their left sides using individulized precast pure titanium prostheses;4 minipigs in control group had not any titanium implantations. (l)We completed the quantitative detection of titanium ion level in blood serum,urine, hair before implantation and at the 1st,3rd,6th,12th,18th month after implantation,and completed the quantitative detection of titanium ion level in distant organs(including liver,spleen,lung,kidney,submandibular lymph nodes,spinal cord)of control group and experimental group at the 3rd,6th,12th,18th month after implantation using Inductively coupled plasma mass spectrometry(ICP-MS).(2)We detected the elements composition change of titanium prostheses and the regularity of titanium ion content change in bone using Energy-dispersive X-ray analysis(EDAX)before implantation and at the 3rd,6th,12th,18th month after implantation,and observed the surface topography using Scanning electron microcopy(SEM).(3)We studied the histological change of adjacent tissues and distant organs using light microscope after implantation.
In the part of clinical research:(l)We detected the titanium ion in blood serum and urine of one patient who had implanted a titanium alloy prosthesis before implantation and at the 1st,2nd week and the 1st,3rd,5th month after implantation,and analyzed the changing regularity.(2)We detected the elements change with different depth and contact surfaces of the unused plates and the plates implanted 6 months using Auger electron spectroscopy(AES).
Results In the part of animal experiment:(1)The titanium ion concentrations of postoperation in blood serum,urine,hair,in liver,spleen,lung,kidney,submandibular lymph nodes,spinal cord were all higher than those of preoperation and control group. The peak value of titanium ion in urine appeared at the 1st month postoperatively,the peak value of titanium ion in hair appeared at the 6th month postoperatively,and others appeared at the 3rd month postoperatively.The titanium ion presented descended tendency of different degree in all the tissues and organs 6 months postoperatively except kidney.(2)We found that the Ti content of the prostheses surface decreased with the implanted period going on using EDAX,and found the surface became rough using SEM. The limit of detection of Ti was 250-300μm from the titanium-osseointegration interface in bone.(3)We found dark stain in capsule at the 3rd month after implantation,and found black particles by light microscope,but all of them disappeared 6 months after implantation.There were no adverse effects,denaturation,necrosis and pathological hyperplasia related to the implants during the postoperative observation of 18 months.
In the part of clinical research:(l)The peak value of titanium ion in blood serum appeared at the 3rd month postoperatively and decreased later;and the peak value of titanium ion in urine appeared at the 2nd week postoperatively and decreased later. (2)Using AES we found that the Ti content of the plates implanted 6 months was lower than the unused plates on the surface and at the 10nm depth(P＜0.01).The Ca content of the side contacted bones was higher than the unused plates and the side contacted soft tissues on the surface and at the 10nm depth(P＜0.01).The content of Ti increased with the depth(P＜0.01),while Ca decreased.(P＜0.01).
Conclusions There is phenomenon of titanium ions release,deposition and elements exchange in vivo which is just trace and not enough to cause structure,function change and metallosis of tissues and organs.Titanium has good biocompatibility and chemical stability,but the safety of much longer term after implantation still needs observation and study.
PartⅢ:The Experimental Study of masseter volume change after reconstruction of mandibular angle defect using individulized precast pure titanium prosthesis
Objective To study the masseter volume changing regularity after reconstruction of mandibular angle defect using individulized precast pure titanium prosthesis.
Methods We divided 16 minipigs into two groups equally,then established mandibular angle defect models on the left sides of group A and bilateral sides of group B.Then 8 minipigs of group A received reconstruction of mandibular angle defects on the left sides using individulized precast pure titanium prostheses,the other 8 minipigs in group B received reconstruction of mandibular angle defects on the left sides using individulized precast pure titanium prostheses and dissection of masseter on the right sides.According to the CT scanning data of the 3rd,6th,12th,18th month postoperation,we completed image processing to segment masseter from CT scans,and three-dimensional(3D) reconstruction and volume measurement using picture segmenting and partial reconstruction techniques.Furthermore,we carried out a control study on masseter volume change between the reconstructive sides(the left sides)and the normal sides(the right sides)of group A,as well as between the reconstructive sides(the left sides)and the simple mandibular angle osseotomy sides(the right sides)of gourp B.
Results The masseter volume of the reconstructive sides(the left sides)using individulized precast titanium prosthesis were all smaller than the normal sides(the right sides)in group A,and the volume difference tended to diminish;bilateral masseter volume had statistical difference at the 3rd,6th and 12th month(the 3rd and 6th month P＜0.01,the 12th month P＜0.05),and had no statistical difference at the 18th month postoperatively(P＞0.05).The masseter volume of the reconstructive sides(the left sides) using individulized precast titanium prosthesis were all larger than the simple mandibular angle osseotomy sides(the right sides)in group B,and the volume difference tended to largen;bilateral masseter volume had statistical difference at the 3rd,6th and 12th month (P＜0.01),and had no statistical difference at the 18th month postoperatively(P＞0.05)
Conclusions Certain extent of atrophy happens to masseter after madibular angle osseotomy.Madibular angle reconstruction using individulized precast pure titanium prosthesis is beneficial to masseter volume recovery;but the volume is still smaller than normal.
引文
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