一种改良型牵张式种植体的实验研究
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摘要
种植义齿修复因具有传统义齿修复无法比拟的良好功能和美学效果，已得到越来越多医生和患者的青睐。然而，各种原因导致的牙槽嵴高度不足却严重限制了其应用。目前可用于解决牙槽嵴高度不足的方法主要有骨移植、引导骨组织再生（GBR）、牙槽嵴牵张成骨（ADO）等。其中ADO是激发机体自身的再生能力而自然成骨，具有无需植骨、没有供骨区的二次创伤、骨吸收率低、获得骨量大、软组织可获得同步延伸等优点，近年来得到广泛的关注。
现有的牙槽嵴牵张设备依据其植入的位置和功能可分为骨内型牵张器，骨外型牵张器和牵张种植体（DI）。与前两者相比，DI兼具了牵张器与种植体双重功能，仅需一次手术就可以完成颌骨牵张和种植体的植入，既简化了手术过程，减少了对牙周组织的创伤，同时也大大缩短了整体治疗时间。
虽然DI具有其独特的优势，然而，在临床及研究应用中发现，现有牵张设备也存在着很多不足。一是设备体积较大，适用范围窄；二是设备结构复杂，发生并发症的可能性大；三是现有牵张设备在牵张完成后变成两端大中间小的哑铃型结构，一旦发生失败，设备难以完整取出，进而增加了手术的风险。因此，如何通过有效的手段对现有牵张设备进行改进，解决上述的一项或几项问题，是推广DI应用的关键。
本课题针对牙槽嵴高度不足时的种植修复问题，设计应用一种改良型DI。通过有限元优化设计，离体生物力学测试，以及离体、在体动物牵张实验评价该DI的性能。以期通过对DI相关参数的优化改良，使之从功能上实现“早期可靠牵张，远期最佳载力”。
第一部分：有限元优化设计
实验一：有限元模型的建立
方法：以一种旋入型DI的结构为参照。在Pro/E软件中分别建立DI-基台复合体（DAC）及自适应变化的下颌骨的三维实体模型，并将二者组装在一起，成为最终模型。分别施加轴向100N及颊舌向45度30N的力。采用皮质骨、松质骨及DI的最大米塞斯应力（Max EQV stress）和DAC的位移对模型进行可靠性检验。
结果：成功建立了包含下颌骨骨块及DAC的三维有限元模型，可靠性检验结果证实模型可靠。
实验二：中心牵张螺丝（DS）直径（D）的优化分析
方法：设定DS的D为输入变量(1.0~3.0mm)，应用Ansys DesignXplorer三维有限元优化分析模块，对这一个参数进行优化分析。
结果：随着D的增加，在轴向力的作用下，皮质骨、松质骨和DS的EQV峰值分别下降了21.83%、69.60%、62.67%，DS位移峰值下降22.22%；在颊舌向力的作用下，皮质骨、松质骨和DS的EQV峰值分别下降13.30%、31.69%、44.92%，DS位移峰值下降12.75%。当D≥2mm时，应力及位移可以达到最小。
实验三：DI骨内上下两段长度比例（R）的优化分析
方法：设定R为输入变量（5:5~9:1），应用Ansys DesignXplorer三维有限元优化分析模块，对其进行优化分析。
结果：随着R的增加，在轴向力的作用下，皮质骨、松质骨及DAC的EQV峰值分别下降了9.19%、19.25%、32.97%，DAC位移峰值下降6.18%；在颊舌向力的作用下，皮质骨、松质骨和DAC的EQV峰值分别下降10.94%、67.32%、12.63%，DS位移峰值下降9.36%。当R=8:2时，应力及位移可以达到最小。
第一部分结论：
1.成功建立了包含下颌骨骨块及DAC的三维有限元模型。
2. D≥2mm，R=8:2为最优设计参数。
第二部分：离体实验
实验四：DI设计加工制作及离体生物力学测试
方法：根据上述优化结果，设计并加工制作出一种改良型DI。将牵张高度为6mm的DI与普通种植体进行相关生物力学性能的比较分析，分别进行了轴向拔出实验及周期荷载疲劳实验的检测。
结果：轴向拔出实验的结果显示，DI的最大拔出力为1106±75.22N，普通种植体的最大拔出力为1094±114.3N，二者差别无统计学意义；周期荷载疲劳实验结果显示，经历240万次（模拟10年咀嚼状态）的加载，所有牵张种植体试件与普通种植体的试件均未发生断裂疲劳。
实验五：离体牵张测试
方法：在新鲜的犬离体下颌骨上模拟DI植入及牵张的全过程：水平截骨-打种植孔-平行植入两枚DI-垂直截骨-更换牵张螺丝-试牵张。
结果：手术操作过程顺利，成功将游离骨块牵起。
第二部分结论：
1.牵张6mm的改良型DI具有良好的生物力学性能。
2.该改良型DI具备可靠的牵张性能。
第三部分：动物实验
实验六：双侧下颌牙槽嵴萎缩动物模型的建立及DI植入术
方法：选择3只杂种犬作为实验动物。通过拔除其双侧下颌全部前磨牙并进行牙槽嵴修整，建立双侧下颌牙槽嵴萎缩的犬模型。在确定模型建好后，采用一种自创的全新的手术方式，在双侧分别植入两枚DI。
结果：拔牙三个月后大体及X线片结果显示成功建立了双侧下颌牙槽嵴萎缩的犬模型；新式DI植入手术操作方便、出血量少，成功将DI植入。
实验七：牵张早期成骨效果的评价
方法：DI植入后5天将连接螺丝更换为牵张螺丝并开始第一次牵张，每两天牵张1次，每次牵张1mm，牵张6次达到6mm的牵张高度。观察30天后将动物处死，分别通过大体、X线、CT、Micro-CT、组织病理学分析评价其牵张早期成骨的情况。
结果：牵张30天后，大体观察可见8枚DI均稳定，未出现松动、脱落。牵张区域新生组织色泽偏暗红，质地较硬，颊侧新生组织表面粗糙不平，舌侧较为光滑平整，肉眼已分辨不出截骨线位置；X线、CT、Micro-CT、硬组织病理结果显示牵张区域成骨活跃，已有部分新生骨生成；牙龈组织病理示牙龈组织已基本恢复正常状态，仅个别标本的部分区域可见牙龈上皮层增厚，细胞层数增多。
第三部分结论：
1.新式DI植入术能有效减小术区软硬组织的创伤，有利于游离骨块的稳定性及成活。
2.动物实验早期结果证实参数优化后的DI具有较为可靠的牵张成骨性能。
Dental implants have been extensively used as replacements of lost ordamaged natural teeth, which have better functional and aesthetic resultscompared with other kinds of restorations. However, insufficient alveolar heightresulting from atrophy, trauma, congenital malformation, and resection oftumors limits implant placement. As a result, various augmentation techniques,such as bone grafting, guided bone regeneration (GBR) and alveolar distractionosteogenesis (ADO) have been used to correct this deformity. Among thevarious augmentation techniques, ADO is a technique of gradual bonelengthening allowing the body's natural healing mechanisms to generate newbone. It offers significant advantages including predictability, elimination of adonor site for autogenous grafts, and simultaneous bone and soft-tissueregeneration. Currently, ADO has been demonstrated to be a promisingtechnique and has gained increasing acceptance.
Currently available alveolar distraction designs include extraosseous distractors placed on the lateral side of the bone, endosseous distracters insertedinto the bone segments, and distraction implant (DI). Among them, DI canfunction as both a distractor and an implant eventually. Its predominantadvantage is the single-step surgical technique, which not only simplifies theoperation and minimizes the trauma, but also dramatically reduces the treatmenttime, thus satisfying both patients and dentists.
However, DI has its own drawbacks like narrow indication, high risk ofcomplications and unfavorable biomechanical properties due to the complexstructure. In addition, the device will prove difficult to remove if it fails with anincrease in morbidity of the procedure for removal. Therefore, furtherimprovement of the DI devices is in a great need.
In this study, a modified DI device was developed. Finite element analyseswere performed to optimize some parameters of DI, which could providevaluable reference for DI’s improvement. Then in vitro and in vivo studies wereperformed to evaluate the modified DI’s properties. The aim of this study was todevelop a useful DI device which can have better distraction and implantationperformance.
Part one: Finite element analyses
Experiment one:3D model design
Method：a DI system was developed by the Zhongbang Company (Xi’an,China). This system had dual functions for the distractor and prosthetic implant.A posterior mandible segment with a DI and a superstructure were modeled on apersonal computer using a3D program (Pro/E Wildfire). Forces of100N and30N were applied axially and45°buccolingually on the buccal cusp, respectively.The maximum equivalent Von Mises stress in the jaw bones and DI-abutmentcomplex, and the Max displacement of the DAC were used to evaluate the reliability of the model.
Results: a posterior mandible segment with a DI and a superstructure weremodeled successfully and the model’s reliability was conformed.
Experiment two: biomechanical optimization of the diameter (D) of thedistraction screw (DS) by three-dimensional finite element analysis
Method：in Ansys DesignXplorer, the D of DS (ranging from1mm~3mm)was set as input variable. The maximum (Max) equivalent Von Mises (EQV)stress in cortical bone, cancellous bone, and distraction screw, and the Maxdisplacement of distraction screw were set as output variables to evaluate theeffect of different distraction screw diameters on the jaw bones and DI.
Results: the results showed that under axial load, the maximum equivalentstresses in the cortical bone, cancellous bone, and distraction screw decreased by21.83%,69.60%, and62.67%respectively with increasing diameter, while underbuccolingual load, these values decreased by13.30%,31.69%, and44.92%respectively. The maximum displacements in the distraction screw decreased by22.22%and12.75%under axial and buccolingual loads respectively. When thediameter exceeded2.0mm, the stress in the jaw bones and the displacement inthe distraction screw reached the minimum.
Experiment three: biomechanical optimization of the length ratio of thetwo endosseous portions in distraction implants by three-dimensional finiteelement analysis
Method：in Ansys DesignXplorer, the length ratio (R) of the two endosseousportions of distraction implant (ranging from5:5~9:1) was set as an inputvariable. The Max EQV stress in the jaw bones and DAC, and the Maxdisplacement of the DAC were set as output variables to evaluate the effect ofdifferent ratios between the lengths of TP and SP in the jaw bones and the DI.
Results: the results showed that under axial load, the maximum equivalentstress in the cortical bone, cancellous bone, and distraction implant-abutmentcomplex decreased by9.19%,19.25%, and32.97%respectively with increasinglength ratio, while under buccolingual load, these values decreased by10.94%,67.32%, and12.63%respectively. The maximum displacements in thedistraction implant-abutment complex decreased by6.18%and9.36%underaxial and buccolingual loads respectively. When the length ratio was at8:2, thestress in the jaw bones and the displacement in the distraction implant-abutmentcomplex reached the minimum.
Conclusions of part one
1. A posterior mandible segment with a DI and a superstructure weremodeled successfully.
2. D≥2mm and R=8:2were the optimal choices.
Part two：In vitro study of DI
Experiment four: DI’s design, manufacture, and biomechanical analysis
Method: according to the optimization results above, we designed andmanufactured a modified DI. Axial pull-out test and fatigue test were conductedto compare the biomechanical properties between the DI with6mm distractionheight and a normal implant.
Results: axial pull-out test results showed that the max axial pull-outstrengths were1106±75.22N and1094±114.3N for the DI and the implantrespectively (P>0.05). The fatigue test results showed that none of the samples(DIs and implants) failed after2.4million’s loading cycles (about10years’chewing simulation).
Experiment five: In vitro distraction test
Method：DI’s insertion and distraction procesures were simulated in a fresh mandible of a dog: horizontal osteotomy-preparation of planting hole-DI’sinsertion-vertical osteotomy-distraction screw’s replacement-distraction
Results: the surgical procedures were smoothly, the transport bone wassuccessfully lifted.
Conclusions of part two
1. The modified DI with6mm distraction height’s biomechnical property isas good as the normal implant.
2. The modified DI has reliable distraction osteogenesis performance.
Part three: animal experiment
Experiment six: animal models’ setting up and DI’s insertion operation
Method: three adult mongrel dogs were used in this experiment. Allmandibular premolors were extracted and an alveoloplasty was performed.Three months later, the animal models were set up. Then, a new surgicalapproach was applied to insert DIs.
Results：three months later, the animal models with atrophic alveolar ridgewere successfully set up by both the general observarion and X ray evaluation.The new surgical approach is easy to handle with less bleeding. The DIs weresuccessfully inserted with this approach.
Experiment seven: in vivo evaluation of bone regeneration around DI inthe early stage of healing
Method：five days after DIs’ insertion, the initial connection apparatus wasreplaced by the distraction screw. Distraction was then carried out at a rate of1mm per two days for12consecutive days to achieve6mm distraction height.Thirty days later, the dogs were sacrificed and the mandible segments includeddistracted bone and DIs were harvested. X ray, CT, Micro-CT and histologicalanalysis were used to evaluate the bone regeneration.
Results: all of the DIs were in position and none of them was lost or looseduring the healing. The new generated tissue over the distraction site showeddark red color. The buccal surface of the new generated tissue was rough, whilethe lingual surface was smooth. The osteotomy line could not be seen with thenaked eye. The results of X ray, CT, Micro-CT and histological analysis showedactive osteogenesis in the distraction area where new generated bone had beenformed. Histological analysis for gingival tissue showed that most of thegingival tissue had healed well while only limited gingival tissue showedincreased epithelial thickness and more layers of epithelial cells.
Conclusions of part three
1. The new surgical approach can minimize the trauma, which is beneficialto the stability and survival of the transport bone.
2. The in vivo experiment results showed that the modified DI had reliabledistraction osteogenesis performance.
现有的牙槽嵴牵张设备依据其植入的位置和功能可分为骨内型牵张器，骨外型牵张器和牵张种植体（DI）。与前两者相比，DI兼具了牵张器与种植体双重功能，仅需一次手术就可以完成颌骨牵张和种植体的植入，既简化了手术过程，减少了对牙周组织的创伤，同时也大大缩短了整体治疗时间。
虽然DI具有其独特的优势，然而，在临床及研究应用中发现，现有牵张设备也存在着很多不足。一是设备体积较大，适用范围窄；二是设备结构复杂，发生并发症的可能性大；三是现有牵张设备在牵张完成后变成两端大中间小的哑铃型结构，一旦发生失败，设备难以完整取出，进而增加了手术的风险。因此，如何通过有效的手段对现有牵张设备进行改进，解决上述的一项或几项问题，是推广DI应用的关键。
本课题针对牙槽嵴高度不足时的种植修复问题，设计应用一种改良型DI。通过有限元优化设计，离体生物力学测试，以及离体、在体动物牵张实验评价该DI的性能。以期通过对DI相关参数的优化改良，使之从功能上实现“早期可靠牵张，远期最佳载力”。
第一部分：有限元优化设计
实验一：有限元模型的建立
方法：以一种旋入型DI的结构为参照。在Pro/E软件中分别建立DI-基台复合体（DAC）及自适应变化的下颌骨的三维实体模型，并将二者组装在一起，成为最终模型。分别施加轴向100N及颊舌向45度30N的力。采用皮质骨、松质骨及DI的最大米塞斯应力（Max EQV stress）和DAC的位移对模型进行可靠性检验。
结果：成功建立了包含下颌骨骨块及DAC的三维有限元模型，可靠性检验结果证实模型可靠。
实验二：中心牵张螺丝（DS）直径（D）的优化分析
方法：设定DS的D为输入变量(1.0~3.0mm)，应用Ansys DesignXplorer三维有限元优化分析模块，对这一个参数进行优化分析。
结果：随着D的增加，在轴向力的作用下，皮质骨、松质骨和DS的EQV峰值分别下降了21.83%、69.60%、62.67%，DS位移峰值下降22.22%；在颊舌向力的作用下，皮质骨、松质骨和DS的EQV峰值分别下降13.30%、31.69%、44.92%，DS位移峰值下降12.75%。当D≥2mm时，应力及位移可以达到最小。
实验三：DI骨内上下两段长度比例（R）的优化分析
方法：设定R为输入变量（5:5~9:1），应用Ansys DesignXplorer三维有限元优化分析模块，对其进行优化分析。
结果：随着R的增加，在轴向力的作用下，皮质骨、松质骨及DAC的EQV峰值分别下降了9.19%、19.25%、32.97%，DAC位移峰值下降6.18%；在颊舌向力的作用下，皮质骨、松质骨和DAC的EQV峰值分别下降10.94%、67.32%、12.63%，DS位移峰值下降9.36%。当R=8:2时，应力及位移可以达到最小。
第一部分结论：
1.成功建立了包含下颌骨骨块及DAC的三维有限元模型。
2. D≥2mm，R=8:2为最优设计参数。
第二部分：离体实验
实验四：DI设计加工制作及离体生物力学测试
方法：根据上述优化结果，设计并加工制作出一种改良型DI。将牵张高度为6mm的DI与普通种植体进行相关生物力学性能的比较分析，分别进行了轴向拔出实验及周期荷载疲劳实验的检测。
结果：轴向拔出实验的结果显示，DI的最大拔出力为1106±75.22N，普通种植体的最大拔出力为1094±114.3N，二者差别无统计学意义；周期荷载疲劳实验结果显示，经历240万次（模拟10年咀嚼状态）的加载，所有牵张种植体试件与普通种植体的试件均未发生断裂疲劳。
实验五：离体牵张测试
方法：在新鲜的犬离体下颌骨上模拟DI植入及牵张的全过程：水平截骨-打种植孔-平行植入两枚DI-垂直截骨-更换牵张螺丝-试牵张。
结果：手术操作过程顺利，成功将游离骨块牵起。
第二部分结论：
1.牵张6mm的改良型DI具有良好的生物力学性能。
2.该改良型DI具备可靠的牵张性能。
第三部分：动物实验
实验六：双侧下颌牙槽嵴萎缩动物模型的建立及DI植入术
方法：选择3只杂种犬作为实验动物。通过拔除其双侧下颌全部前磨牙并进行牙槽嵴修整，建立双侧下颌牙槽嵴萎缩的犬模型。在确定模型建好后，采用一种自创的全新的手术方式，在双侧分别植入两枚DI。
结果：拔牙三个月后大体及X线片结果显示成功建立了双侧下颌牙槽嵴萎缩的犬模型；新式DI植入手术操作方便、出血量少，成功将DI植入。
实验七：牵张早期成骨效果的评价
方法：DI植入后5天将连接螺丝更换为牵张螺丝并开始第一次牵张，每两天牵张1次，每次牵张1mm，牵张6次达到6mm的牵张高度。观察30天后将动物处死，分别通过大体、X线、CT、Micro-CT、组织病理学分析评价其牵张早期成骨的情况。
结果：牵张30天后，大体观察可见8枚DI均稳定，未出现松动、脱落。牵张区域新生组织色泽偏暗红，质地较硬，颊侧新生组织表面粗糙不平，舌侧较为光滑平整，肉眼已分辨不出截骨线位置；X线、CT、Micro-CT、硬组织病理结果显示牵张区域成骨活跃，已有部分新生骨生成；牙龈组织病理示牙龈组织已基本恢复正常状态，仅个别标本的部分区域可见牙龈上皮层增厚，细胞层数增多。
第三部分结论：
1.新式DI植入术能有效减小术区软硬组织的创伤，有利于游离骨块的稳定性及成活。
2.动物实验早期结果证实参数优化后的DI具有较为可靠的牵张成骨性能。
Dental implants have been extensively used as replacements of lost ordamaged natural teeth, which have better functional and aesthetic resultscompared with other kinds of restorations. However, insufficient alveolar heightresulting from atrophy, trauma, congenital malformation, and resection oftumors limits implant placement. As a result, various augmentation techniques,such as bone grafting, guided bone regeneration (GBR) and alveolar distractionosteogenesis (ADO) have been used to correct this deformity. Among thevarious augmentation techniques, ADO is a technique of gradual bonelengthening allowing the body's natural healing mechanisms to generate newbone. It offers significant advantages including predictability, elimination of adonor site for autogenous grafts, and simultaneous bone and soft-tissueregeneration. Currently, ADO has been demonstrated to be a promisingtechnique and has gained increasing acceptance.
Currently available alveolar distraction designs include extraosseous distractors placed on the lateral side of the bone, endosseous distracters insertedinto the bone segments, and distraction implant (DI). Among them, DI canfunction as both a distractor and an implant eventually. Its predominantadvantage is the single-step surgical technique, which not only simplifies theoperation and minimizes the trauma, but also dramatically reduces the treatmenttime, thus satisfying both patients and dentists.
However, DI has its own drawbacks like narrow indication, high risk ofcomplications and unfavorable biomechanical properties due to the complexstructure. In addition, the device will prove difficult to remove if it fails with anincrease in morbidity of the procedure for removal. Therefore, furtherimprovement of the DI devices is in a great need.
In this study, a modified DI device was developed. Finite element analyseswere performed to optimize some parameters of DI, which could providevaluable reference for DI’s improvement. Then in vitro and in vivo studies wereperformed to evaluate the modified DI’s properties. The aim of this study was todevelop a useful DI device which can have better distraction and implantationperformance.
Part one: Finite element analyses
Experiment one:3D model design
Method：a DI system was developed by the Zhongbang Company (Xi’an,China). This system had dual functions for the distractor and prosthetic implant.A posterior mandible segment with a DI and a superstructure were modeled on apersonal computer using a3D program (Pro/E Wildfire). Forces of100N and30N were applied axially and45°buccolingually on the buccal cusp, respectively.The maximum equivalent Von Mises stress in the jaw bones and DI-abutmentcomplex, and the Max displacement of the DAC were used to evaluate the reliability of the model.
Results: a posterior mandible segment with a DI and a superstructure weremodeled successfully and the model’s reliability was conformed.
Experiment two: biomechanical optimization of the diameter (D) of thedistraction screw (DS) by three-dimensional finite element analysis
Method：in Ansys DesignXplorer, the D of DS (ranging from1mm~3mm)was set as input variable. The maximum (Max) equivalent Von Mises (EQV)stress in cortical bone, cancellous bone, and distraction screw, and the Maxdisplacement of distraction screw were set as output variables to evaluate theeffect of different distraction screw diameters on the jaw bones and DI.
Results: the results showed that under axial load, the maximum equivalentstresses in the cortical bone, cancellous bone, and distraction screw decreased by21.83%,69.60%, and62.67%respectively with increasing diameter, while underbuccolingual load, these values decreased by13.30%,31.69%, and44.92%respectively. The maximum displacements in the distraction screw decreased by22.22%and12.75%under axial and buccolingual loads respectively. When thediameter exceeded2.0mm, the stress in the jaw bones and the displacement inthe distraction screw reached the minimum.
Experiment three: biomechanical optimization of the length ratio of thetwo endosseous portions in distraction implants by three-dimensional finiteelement analysis
Method：in Ansys DesignXplorer, the length ratio (R) of the two endosseousportions of distraction implant (ranging from5:5~9:1) was set as an inputvariable. The Max EQV stress in the jaw bones and DAC, and the Maxdisplacement of the DAC were set as output variables to evaluate the effect ofdifferent ratios between the lengths of TP and SP in the jaw bones and the DI.
Results: the results showed that under axial load, the maximum equivalentstress in the cortical bone, cancellous bone, and distraction implant-abutmentcomplex decreased by9.19%,19.25%, and32.97%respectively with increasinglength ratio, while under buccolingual load, these values decreased by10.94%,67.32%, and12.63%respectively. The maximum displacements in thedistraction implant-abutment complex decreased by6.18%and9.36%underaxial and buccolingual loads respectively. When the length ratio was at8:2, thestress in the jaw bones and the displacement in the distraction implant-abutmentcomplex reached the minimum.
Conclusions of part one
1. A posterior mandible segment with a DI and a superstructure weremodeled successfully.
2. D≥2mm and R=8:2were the optimal choices.
Part two：In vitro study of DI
Experiment four: DI’s design, manufacture, and biomechanical analysis
Method: according to the optimization results above, we designed andmanufactured a modified DI. Axial pull-out test and fatigue test were conductedto compare the biomechanical properties between the DI with6mm distractionheight and a normal implant.
Results: axial pull-out test results showed that the max axial pull-outstrengths were1106±75.22N and1094±114.3N for the DI and the implantrespectively (P>0.05). The fatigue test results showed that none of the samples(DIs and implants) failed after2.4million’s loading cycles (about10years’chewing simulation).
Experiment five: In vitro distraction test
Method：DI’s insertion and distraction procesures were simulated in a fresh mandible of a dog: horizontal osteotomy-preparation of planting hole-DI’sinsertion-vertical osteotomy-distraction screw’s replacement-distraction
Results: the surgical procedures were smoothly, the transport bone wassuccessfully lifted.
Conclusions of part two
1. The modified DI with6mm distraction height’s biomechnical property isas good as the normal implant.
2. The modified DI has reliable distraction osteogenesis performance.
Part three: animal experiment
Experiment six: animal models’ setting up and DI’s insertion operation
Method: three adult mongrel dogs were used in this experiment. Allmandibular premolors were extracted and an alveoloplasty was performed.Three months later, the animal models were set up. Then, a new surgicalapproach was applied to insert DIs.
Results：three months later, the animal models with atrophic alveolar ridgewere successfully set up by both the general observarion and X ray evaluation.The new surgical approach is easy to handle with less bleeding. The DIs weresuccessfully inserted with this approach.
Experiment seven: in vivo evaluation of bone regeneration around DI inthe early stage of healing
Method：five days after DIs’ insertion, the initial connection apparatus wasreplaced by the distraction screw. Distraction was then carried out at a rate of1mm per two days for12consecutive days to achieve6mm distraction height.Thirty days later, the dogs were sacrificed and the mandible segments includeddistracted bone and DIs were harvested. X ray, CT, Micro-CT and histologicalanalysis were used to evaluate the bone regeneration.
Results: all of the DIs were in position and none of them was lost or looseduring the healing. The new generated tissue over the distraction site showeddark red color. The buccal surface of the new generated tissue was rough, whilethe lingual surface was smooth. The osteotomy line could not be seen with thenaked eye. The results of X ray, CT, Micro-CT and histological analysis showedactive osteogenesis in the distraction area where new generated bone had beenformed. Histological analysis for gingival tissue showed that most of thegingival tissue had healed well while only limited gingival tissue showedincreased epithelial thickness and more layers of epithelial cells.
Conclusions of part three
1. The new surgical approach can minimize the trauma, which is beneficialto the stability and survival of the transport bone.
2. The in vivo experiment results showed that the modified DI had reliabledistraction osteogenesis performance.
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