即刻种植与拔牙窝内填塞Bio-oss联合钛膜引导对牙槽嵴吸收影响的实验研究
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摘要
目的:探讨拔牙后即刻种植和拔牙窝内填塞Bio-oss人工骨联合应用钛膜引导成骨对预防牙槽嵴吸收的可行性,为临床提供实验依据。
材料与方法:全麻下拔除四只杂种犬双侧下颌第二、第三前磨牙,每侧四个拔牙窝随机选取三个,其内分别植入种植体(A组)、填塞Bio-oss人工骨粉(B组)、拔牙窝常规愈合作为对照(C组)。在每组牙槽窝颊侧边缘下方约10mm处钉入小钛钉作为定点标志,测量A、B、C三组牙槽嵴的高度和宽度并记录。在A、B两组牙槽嵴顶覆盖钛膜,四角用小钛钉固定,严密缝合牙龈。术后五个月处死动物,行临床大体检查,牙槽嵴的高度和宽度的测量,影像学检查,组织学检查(脱钙及不脱钙),扫描电镜钙磷能谱分析。
结果:1、大体观察:四例粘膜裂开、钛膜暴露,仅一例发生炎症,钛膜脱落,其他三例粘膜虽未愈合但未见明显炎症,有良好的成骨效果。2、大体测量:牙槽嵴高度减少:A组0.27±0.07㎜,B组0.49±0.07㎜,C组1.40±0.15㎜,A、C两组,B、C两组相比差异有显著性意义(P﹤0.05),A、B两组相比差异无显著性意义(P﹥0.05)。牙槽嵴宽度减少:A组0.24±0.13㎜,B组0.21±0.10㎜,C组1.19±0.51㎜,A、C两组,B、C两组相比差异有显著性意义(P﹤0.05),A、B两组相比差异无显著性意义(P﹥0.05)。3、影像学结果:A组种植体与骨组织接触紧密,未见间隙存在。B、C两组灰度值分别为73.04±7.05、45.10±4.71,两组骨密度差异有显著性意义( P﹤0.05)。4、组织学检查:A组种植体周围为板层骨包绕,两者紧密结合,未见纤维组织长入;B组的Bio-oss部分降解,周围有大量板层骨及编织骨生成,两者融合,在新生骨表面可见成排的成骨细胞。C组骨小梁稀疏、纤细,骨髓腔面积大,成骨量明显少于B组。5、扫描电镜钙磷能谱分析:测定犬正常牙槽窝处牙槽骨的钙磷比值为2.63,实验组钙磷比值A组2.01±0.12,B组1.98±0.14,对照组C组1.53±0.22,A、B、C三组与正常值相比差异均有显著性(P﹤0.05);A、C两组相比差异有显著性意义(P﹤0.05),B、C两组相比差异有显著性意义(P﹤0.05),A、B两组差异无显著性意义(P﹥0.05)。
结论:
1、即刻种植联合钛膜引导组织再生能预防牙槽嵴吸收,钛膜引导能促进种植体周围成骨;
2、拔牙窝内填塞Bio-oss并联合应用钛膜对拔牙创的牙槽骨有较好的引导作用,能减少剩余牙槽骨的吸收;
3、即刻种植与拔牙窝内填塞Bio-oss对牙槽嵴吸收的预防作用,在短期内未见差别;
4、应用钛膜术后常出现伤口裂开,即刻种植创口张力大也容易导致粘膜裂开,即刻种植应用钛膜应慎重。
Objects: Study on the feasibility of using immediate implantation and Bio-oss as space filler combined with pure titanium membranes to prevent the absorption of alveolar bone and supply experiment foundation for clinical treatment.
Materials and Methods:After the general anesthesia, extract the second and third premolars on bilateral mandible, randomly select three in four tooth sockets, one for immediate implantation(A group),one for filling Bio-oss(B group),one as control(C group).Knock small titanium screw in each group’s at buccal alveolar plate of tooth socket as sentinel sign, measure each height and width of alveolar and record. Cover the alveolar of A and B group with titanium membranes, fix four point with small titanium screw and suture contralateral gums tightly. Dogs are sacrificed after 5 months, by means of gross inspection、measure each height and width of alveolar、imaging examination、histological examination、scan energy spectrum analysis to analysis.
Result:1、Gross inspection and membranes: there are 4 samples mucosa dehiscence, but only one’s titanium membranes loosing, the other three osteogenesis effects are ideal. 2、Ridge height resorption: A group 0.27±0.07㎜ ,B group0.49±0.07㎜ , C group1.40±0.15㎜ , there are significant differences between A and C(P﹤0.05) , there are significant differences between B and C(P﹤0.05), there are no significant differences between A and B (P﹥0.05). Ridge width resorption: A group 0.24±0.13 ㎜ ,B group0.21±0.10㎜ , C group1.19±0.51㎜ , there are significant differences between A and C (P﹤0.05), there are significant differences between B and C(P﹤0.05), there are no significant differences between A and B (P﹥0.05). 3、Imaging examination: implants contact with bone closely, there is no gap between them. The grey scale value of B and C group is 73.04±7.05、45.10±4.71 respectively, there are significant differences between B、C group(P﹤0.05). 4、Histological examination: A group there is lamellar bone around implant, implants contact with bone closely, there is no fibrous tissue;B group : there are partial degradation of Bio-oss particles, a great deal of woven bone on the periphery of Bio-oss, we can observe a row of osteoblast on the surface of neonatal bone. C group’s bone trabeculars are arrange sparsely, and tenuously, the square of medullary cavity is larger than B group’s. 5、Scan energy spectrum analysis: calcium-phosphorus ratio of dog’s normal mandible is 2.63, calcium-phosphorus ratio of A is 2.01±0.12,B is 1.98±0.14, C is 1.53±0.22, there are significant differences between the three groups and normal mandible(P﹤0.05), there are no significant differences between A and B group(P﹥0.05).
Conclusion:
1.Immediate implantation combined with pure titanium membranes can prevent ridge resorption, pure titanium membranes can promote osteogenesis around cervical part of implant.
2. Bio-oss as space filler following tooth extraction combined with pure titanium membranes can prevent ridge resorption and guided bone tissue regeneration.
3.There are no significant differences between this two methods in short term.
4.The use of pure titanium membranes easily cause mucosa dehiscence, immediate implantation either, so designing of immediate implantation combined with pure titanium membranes should be cautious.
材料与方法:全麻下拔除四只杂种犬双侧下颌第二、第三前磨牙,每侧四个拔牙窝随机选取三个,其内分别植入种植体(A组)、填塞Bio-oss人工骨粉(B组)、拔牙窝常规愈合作为对照(C组)。在每组牙槽窝颊侧边缘下方约10mm处钉入小钛钉作为定点标志,测量A、B、C三组牙槽嵴的高度和宽度并记录。在A、B两组牙槽嵴顶覆盖钛膜,四角用小钛钉固定,严密缝合牙龈。术后五个月处死动物,行临床大体检查,牙槽嵴的高度和宽度的测量,影像学检查,组织学检查(脱钙及不脱钙),扫描电镜钙磷能谱分析。
结果:1、大体观察:四例粘膜裂开、钛膜暴露,仅一例发生炎症,钛膜脱落,其他三例粘膜虽未愈合但未见明显炎症,有良好的成骨效果。2、大体测量:牙槽嵴高度减少:A组0.27±0.07㎜,B组0.49±0.07㎜,C组1.40±0.15㎜,A、C两组,B、C两组相比差异有显著性意义(P﹤0.05),A、B两组相比差异无显著性意义(P﹥0.05)。牙槽嵴宽度减少:A组0.24±0.13㎜,B组0.21±0.10㎜,C组1.19±0.51㎜,A、C两组,B、C两组相比差异有显著性意义(P﹤0.05),A、B两组相比差异无显著性意义(P﹥0.05)。3、影像学结果:A组种植体与骨组织接触紧密,未见间隙存在。B、C两组灰度值分别为73.04±7.05、45.10±4.71,两组骨密度差异有显著性意义( P﹤0.05)。4、组织学检查:A组种植体周围为板层骨包绕,两者紧密结合,未见纤维组织长入;B组的Bio-oss部分降解,周围有大量板层骨及编织骨生成,两者融合,在新生骨表面可见成排的成骨细胞。C组骨小梁稀疏、纤细,骨髓腔面积大,成骨量明显少于B组。5、扫描电镜钙磷能谱分析:测定犬正常牙槽窝处牙槽骨的钙磷比值为2.63,实验组钙磷比值A组2.01±0.12,B组1.98±0.14,对照组C组1.53±0.22,A、B、C三组与正常值相比差异均有显著性(P﹤0.05);A、C两组相比差异有显著性意义(P﹤0.05),B、C两组相比差异有显著性意义(P﹤0.05),A、B两组差异无显著性意义(P﹥0.05)。
结论:
1、即刻种植联合钛膜引导组织再生能预防牙槽嵴吸收,钛膜引导能促进种植体周围成骨;
2、拔牙窝内填塞Bio-oss并联合应用钛膜对拔牙创的牙槽骨有较好的引导作用,能减少剩余牙槽骨的吸收;
3、即刻种植与拔牙窝内填塞Bio-oss对牙槽嵴吸收的预防作用,在短期内未见差别;
4、应用钛膜术后常出现伤口裂开,即刻种植创口张力大也容易导致粘膜裂开,即刻种植应用钛膜应慎重。
Objects: Study on the feasibility of using immediate implantation and Bio-oss as space filler combined with pure titanium membranes to prevent the absorption of alveolar bone and supply experiment foundation for clinical treatment.
Materials and Methods:After the general anesthesia, extract the second and third premolars on bilateral mandible, randomly select three in four tooth sockets, one for immediate implantation(A group),one for filling Bio-oss(B group),one as control(C group).Knock small titanium screw in each group’s at buccal alveolar plate of tooth socket as sentinel sign, measure each height and width of alveolar and record. Cover the alveolar of A and B group with titanium membranes, fix four point with small titanium screw and suture contralateral gums tightly. Dogs are sacrificed after 5 months, by means of gross inspection、measure each height and width of alveolar、imaging examination、histological examination、scan energy spectrum analysis to analysis.
Result:1、Gross inspection and membranes: there are 4 samples mucosa dehiscence, but only one’s titanium membranes loosing, the other three osteogenesis effects are ideal. 2、Ridge height resorption: A group 0.27±0.07㎜ ,B group0.49±0.07㎜ , C group1.40±0.15㎜ , there are significant differences between A and C(P﹤0.05) , there are significant differences between B and C(P﹤0.05), there are no significant differences between A and B (P﹥0.05). Ridge width resorption: A group 0.24±0.13 ㎜ ,B group0.21±0.10㎜ , C group1.19±0.51㎜ , there are significant differences between A and C (P﹤0.05), there are significant differences between B and C(P﹤0.05), there are no significant differences between A and B (P﹥0.05). 3、Imaging examination: implants contact with bone closely, there is no gap between them. The grey scale value of B and C group is 73.04±7.05、45.10±4.71 respectively, there are significant differences between B、C group(P﹤0.05). 4、Histological examination: A group there is lamellar bone around implant, implants contact with bone closely, there is no fibrous tissue;B group : there are partial degradation of Bio-oss particles, a great deal of woven bone on the periphery of Bio-oss, we can observe a row of osteoblast on the surface of neonatal bone. C group’s bone trabeculars are arrange sparsely, and tenuously, the square of medullary cavity is larger than B group’s. 5、Scan energy spectrum analysis: calcium-phosphorus ratio of dog’s normal mandible is 2.63, calcium-phosphorus ratio of A is 2.01±0.12,B is 1.98±0.14, C is 1.53±0.22, there are significant differences between the three groups and normal mandible(P﹤0.05), there are no significant differences between A and B group(P﹥0.05).
Conclusion:
1.Immediate implantation combined with pure titanium membranes can prevent ridge resorption, pure titanium membranes can promote osteogenesis around cervical part of implant.
2. Bio-oss as space filler following tooth extraction combined with pure titanium membranes can prevent ridge resorption and guided bone tissue regeneration.
3.There are no significant differences between this two methods in short term.
4.The use of pure titanium membranes easily cause mucosa dehiscence, immediate implantation either, so designing of immediate implantation combined with pure titanium membranes should be cautious.
引文
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5. Hutmacher D , Hurzeler MB , Schliephake H. A review of material properties of biodegradable and bioresorbable polymers and devices for GTR and GBR application [J ] . Int J oral Maxillofac Implants ,1996 ,11(5) :667– 6781
6. Grump TB ,BS , Francisco RH , et al. Influence of threemembrane types on healing of bone defects [J ] . Oral Surg Oral Med Oral Pathol ,1996 ,82 :3651
7.张浩.引导组织再生膜材料的研究进展[J ] .国外医学:生物医学工程分册,1997 ,20 :21 - 24.
8. Cirelli JA , Marcantonio EJ . Evalution of anionic collagen membranes in the treatment of classⅡ. Frication Lesions : a histometric analysis in dogs[J ] . J Biomaterials ,1997 ,18 : 1227– 12341
9. Hureler MB , Kohal RT , Naynshandi J , et al. evaluation of a hew bioresorbable barrier to facilitate guided bone regeneration around exposed implant threads [J ] . Int J Oral Maxillofac Surg ,1998 ,27 :315– 3201
10. Albert ES . New ideas and advancing technologies in periodontology: surgical options with advancing technologies [J ] . Int Dent J ,1993 ,43 :5671
11. Barboza EP. Clinical and histologic evalution of the demineralized freeze - dried bon membrane used for ridge augmentation [J ] . J Periodontic Restorative Dem , 1999 ,19(6) :601– 6071
12.刘希云,周丛豪.冷冻异体骨膜引导即刻种植体周围缺损修复的临床研究[J ] .中国口腔种植学杂志,2002 ,6(7) :73 - 75.
13.包崇云,陈治清,欧国敏.聚羟基丁酸酯引导组织再生膜材料的初探[J ] .华西口腔医学杂志,2002 ,4 (20) :107 - 109.
14. Amino Y, Ota M , Sekoguchi K, et al. Evaluation of a poly - l - lactic acid membrane and membrane fixing pin for guided tissue regeneration on bone defects in dogs [J ] .Oral Surg Oral Med Oral Pathol Oral Radiol Endod ,2004 ,97 : 155– 1631
15. Maoc . Guided tissue regeneration around dental implants in fresh extraction socket : comparison of resorbable and nonresorbable membranes [J ] . Int J Oral and Macilliofac Surg Supplement No. 1 ,1997 ,26 :27.
16. Chen ST , Darby IB , Adams GG, et al. A prospective clinical study of bone augmentation techniques at immediate implants[J ] . Clin Oral Implants Res , 2005 , 16 (2) : 176 - 184.
17. Wheeler SL , Vogel RE , Casellini R. Tissue preservation and maintenance of optimum esthetics : A clinical report [J ] . Int J Oral Maxillofacial Implants , 2000 ,21 (1) 11 -121
18. Found K, Arndt H. Soft tissue management in oral implantology : A review of surgical techniques for shaping an esthetic and functional peri - implant soft tissue structure [J ] . Quintessence Int , 2000 ,31 :483– 4991
19. Barboza W , Becker BE , Pliezzi G, et al. Autogenous bone grafting of bone defects adjacent to implants placed into immediate extraction sockets in patients : A prospective study [J ] . Int J Oral Maxillofac Implants , 1994 ,9 :3891
20. Stentz WC . et al. Effects of guided bone regeneration around commercially pure titanium and hydroxyapatite -coated dental implants : radiographic analysis [J ] . J Periodontol ,1997 ,68 :199.
21.徐欣,兰晶,罗圣磊. Bio-oss混合自体骨移植联合膜引导骨再生术在口腔中的临床应用[J ] .中国口腔种植学杂志,2003 ,6 (2) :69 - 76.
22. Meffert RM. How to treat ailing and failing implants[J ] . Implant Meffert RM Dent , 1992 ,1 (1) :251
23. Fugazzotto PA. Bone regeneration over a poorly - positioned implant to correct an esthetic deformity : a case report [J ] . J Periodontol ,1993 ,64 :1088.
24.耿威,宿玉成. Bio-oss结合Bio-Gide修复牙种植体周围缺损的组织学研究[J ]1口腔医学研究, 2005 ,21(1) :4–6