钛芯与骨形成蛋白复合材料修复即刻种植牙槽骨缺陷的评价
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摘要
背景:致力于种植牙槽骨缺损修复的实验和临床研究是现代科技发展方向,寻找适合的骨替代材料成为人们研究的热门课题。目的:研究钛芯羟基磷灰石与骨形成蛋白复合材料修复即刻种植后牙槽骨缺陷的效果。方法:将24只新西兰兔随机分为3组,正常组不进行任何处理,实验组、对照组制作股骨大转子区骨缺损模型,实验组于骨缺损处植入种植体及钛芯羟基磷灰石与骨形成蛋白复合材料;对照组植入种植体及钛芯羟基磷灰石材料。植入后4周,检测血CD4~+、CD8~+淋巴细胞比例及NK细胞活性、白细胞介素2水平;植入后16周,采用X射线检测骨密度,组织学观察种植体周围成骨情况。结果与结论:(1)实验组骨密度高于对照组(P<0.05);(2)实验组复合材料周围有不同程度的裂解,新生骨组织细胞和基质细胞较为丰富,并且在种植体周围有良好的骨结合接触,内部出现有红染成熟骨组织进入;对照组骨细胞数量、纤维细胞增生少于实验组;(3)实验组CD4~+与CD8~+淋巴细胞比例、NK细胞活性、白细胞介素2水平低于对照组(P<0.05);(4)结果表明,钛芯羟基磷灰石与骨形成蛋白复合材料能够有效修复即刻种植后牙槽骨缺陷区域,引导骨细胞生长。
BACKGROUND: Now experimental and clinical research on suitable bone substitutes for alveolar bone defects after dental implantation is an issue of concern. OBJECTIVE: To study the therapeutic effect of titanium core/bone morphogenetic protein(BMP) composite material on alveolar bone defects after immediate implant placement. METHODS: Twenty-four New Zealand rabbits were randomly assigned into normal group(no intervention), experimental group or control group. Animal models of bone femoral greater trochanter defect were made in the experimental and control groups. Dental implant and titanium core/BMP composite material were implanted in the experimental group, while dental implant and titanium core were implanted in the control group. Percentage of CD4~+, CD8~+ T lymphocytes, natural killer cell activity and interleukin 2 level were detected at postoperative 4 weeks; bone mineral density and osteogenesis around the implant were detected at postoperative 16 weeks through X-ray and histological examinations. RESULTS AND CONCLUSION: X-ray results showed that the bone mineral density in the experimental group was significantly higher than that in the control group(P < 0.05). Histological results showed that in the experimental group, different degrees of cell lysis around the composite, more bone cells and bone matrices were found, implant-bone osseointegration formed well, and red-dyed mature bone tissues were detective inside the implant. Compared with the experimental group, lower number of bone cells and fibrocytes were found in the control group. Additionally, the percentage of CD4~+ and CD8~+ T lymphocytes, natural killer cell activity and interleukin 2 level in the experimental group were significantly lower than those in the control group(P < 0.05). To conclude, the titanium core/BMP composite material can effectively repair alveolar bone defects after immediate implant placement to guide the growth of bone cells.
BACKGROUND: Now experimental and clinical research on suitable bone substitutes for alveolar bone defects after dental implantation is an issue of concern. OBJECTIVE: To study the therapeutic effect of titanium core/bone morphogenetic protein(BMP) composite material on alveolar bone defects after immediate implant placement. METHODS: Twenty-four New Zealand rabbits were randomly assigned into normal group(no intervention), experimental group or control group. Animal models of bone femoral greater trochanter defect were made in the experimental and control groups. Dental implant and titanium core/BMP composite material were implanted in the experimental group, while dental implant and titanium core were implanted in the control group. Percentage of CD4~+, CD8~+ T lymphocytes, natural killer cell activity and interleukin 2 level were detected at postoperative 4 weeks; bone mineral density and osteogenesis around the implant were detected at postoperative 16 weeks through X-ray and histological examinations. RESULTS AND CONCLUSION: X-ray results showed that the bone mineral density in the experimental group was significantly higher than that in the control group(P < 0.05). Histological results showed that in the experimental group, different degrees of cell lysis around the composite, more bone cells and bone matrices were found, implant-bone osseointegration formed well, and red-dyed mature bone tissues were detective inside the implant. Compared with the experimental group, lower number of bone cells and fibrocytes were found in the control group. Additionally, the percentage of CD4~+ and CD8~+ T lymphocytes, natural killer cell activity and interleukin 2 level in the experimental group were significantly lower than those in the control group(P < 0.05). To conclude, the titanium core/BMP composite material can effectively repair alveolar bone defects after immediate implant placement to guide the growth of bone cells.
引文
[1]戴印和,戴超.即刻种植牙的研究进展[J].中国口腔种植学杂志,2015,20(2):97-99.
[2]杨晓晖,魏彦君,冯月转.即刻种植牙手术患者的围手术期护理[J].护理实践与研究,2015,12(6):77-78.
[3]董新新.种植牙拔牙后即刻种植和延期种植稳定性的比较[J].全科口腔医学电子杂志,2015,2(10):34.
[4]黄永平.Bio-Oss骨粉在种植牙骨缺损中的临床应用分析[J].亚太传统医药,2008,4(2):85-87.
[5]陈冬,白轶,李蓉,等.新型骨修复材料修复种植牙骨缺损的前瞻性临床研究[J].口腔医学研究,2015,31(11):1129-1132.
[6]尹燕,夏天东,赵文军,等.钛合金/HA涂层新型医用复合材料的制备及研究现状[J].兰州理工大学学报,2004,30(4):26-30.
[7]Shu DY,Wojciechowski MC,Lovicu FJ.Bone Morphogenetic Protein-7 Suppresses TGFβ2-Induced Epithelial-Mesenchymal Transition in the Lens:Implications for Cataract Prevention.Invest Ophthalmol Vis Sci.2017;58(2):781-796.
[8]Sun M,Chang Q,Xin M,et al.Endogenous bone morphogenetic protein 2 plays a role in vascular smooth muscle cell calcification induced by interleukin 6 in vitro.Int JImmunopathol Pharmacol.2017:394632016689571.doi:10.1177/0394632016689571.[Epub ahead of print]
[9]田卫东,王大章,闵维宪,等.骨形成蛋白-多孔羟基磷灰石复合人工骨的实验研究[J].华西口腔医学杂志,1992,10(1):18-21.
[10]马三成,袁祥民,林兆全,等.骨形成蛋白复合钛心多孔羟基磷灰石涂层种植体的临床疗效研究[J].新疆医学院学报,1996,19(3):216-220.
[11]袁志,胡蕴玉,马平,等.新型植骨材料-复合rh BMP-2的异种骨的实验研究[J].现代康复,2000,4(10):1510-1511.
[12]李凤,班宇.即刻种植的临床研究新进展[J].临床口腔医学杂志,2012,28(2):126-128.
[13]Ettinger RL,Spivey JD,Han DH,et al.Measurement of the interface between bone and immediate endosseous implants:a pilot study in dogs.Int J Oral Maxillofac Implants.1993;8(4):420-427.
[14]Cawood JI,Howell RA.A classification of the edentulous jaws.Int J Oral Maxillofac Surg.1988;17(4):232-236.
[15]邱立新,林野,王兴,等.骨劈开技术在上颌前牙种植外科中的应用[J].中国口腔种植学杂志,2000,5(2):67-69.
[16]李恺.种植体数目与分布对下颌种植覆盖义齿牙槽骨改建的影响[D].第四军医大学,2014.
[17]贾小玥.椎束CT测量颌骨密度及评估种植体初期稳定性的可行性研究[D].浙江大学,2013.
[18]王峰.牙种植体骨界面多尺度下的模拟构建及力学耦合[D].第四军医大学,2013.
[19]薛丽丽,杜莉,王虎,等.愈合期埋植型和非埋植型种植体周围牙槽骨吸收情况观察[J].中国口腔种植学杂志,2009,14(3):60-62,67.
[20]Dhaliwal JS,Albuquerque RF Jr,Fakhry A,et al.Customized Smart Peg for measurement of resonance frequency of mini dental implants.Int J Implant Dent.2017;3(1):4.doi:10.1186/s40729-017-0066-6.
[21]胡金龙,王静成,颜连启.组织工程学技术治疗骨缺损的最新研究进展[J].中国矫形外科杂志,2013,21(2):150-152.
[22]Rodella LF,Favero G,Boninsegna R,et al.Growth factors,CD34 positive cells,and fibrin network analysis in concentrated growth factors fraction.Microsc Res Tech.2011;74(8):772-777.
[23]Findik Y,Baykul T,Aydin MA,et al.Rehabilitation of the Work Accident-Related Traumatic Mandible With Iliac Free Flap,Distraction Osteogenesis,and Dental Implants.J Craniofac Surg.2017.doi:10.1097/SCS.0000000000003466.[Epub ahead of print]
[24]解涓.氧化锆全瓷修复体在后牙种植区应用的临床回顾性研究[D].第四军医大学,2014.
[25]王青,李再仁,郑宗范,等.四种牙体修复材料体外充填微渗漏的实验研究[J].口腔材料器械杂志,1995,4(4):156-158,197.
[26]王青,郑宗范,凌涤生,等.牙体修复材料体外充填密合度的扫描电镜研究[J].山东医科大学学报,1995,40(3):248-251.
[27]付志厚.组织工程化骨修复人工关节周围骨缺损的实验研究[D].第三军医大学,2008.
[28]Wang X,Yu T,Chen G,et al.Preparation and characterization of a chitosan/gelatin/extracellular matrix scaffold and its application in tissue engineering.Tissue Eng Part C Methods.2017.doi:10.1089/ten.TEC.2016.0511.[Epub ahead of print]
[29]胡堃,刘斌.骨移植材料发展趋势[J].生物骨科材料与临床研究,2010,7(3):32-38.
[30]吴汉江,朱兆夫,李运良,等.羟基磷灰石涂层牙种植体骨内种植的临床研究[J].中国口腔种植学杂志,1997,2(1):15-18.
[31]孙伟.羟基磷灰石涂层种植体临床应用现状的系统评价[D].中国医科大学,2004.
[32]王茸影,易静.骨形成蛋白调控成骨分化的信号机制[J].生命科学,2005,17(1):34-39.
[33]Cubo J,Hui M,Clarac F,et al.Static osteogenesis does not precede dynamic osteogenesis in periosteal ossification of Pleurodeles(Caudata,Amphibia)and Pogona(Squamata,Lepidosauria).J Morphol.2017.doi:10.1002/jmor.20659.[Epub ahead of print]
[34]段智霞,郑启新,郭晓东,等.骨形成蛋白2活性多肽体外定向诱导骨髓间充质干细胞向成骨方向分化的剂量依赖性研究[J].中国修复重建外科杂志,2007,21(10):1118-1122.
[35]孙健,谢富强,李平,等.复方骨形成蛋白生物复合物预防剩余牙槽嵴吸收实验[J].实用口腔医学杂志,2008,24(6):801-805.
[36]Masaomi Y,Yoshifumi S,Itaru N,et al.Humoral im-mune responses during acute rejection in rat lung trans-plantation.Transplant Immunol.2003;11:31-37.
[37]詹斌,樊友竹,袁洪,等.种植牙患者的临床和免疫学分析[J].现代口腔医学杂志,1996,12(4):235-236.
[38]刘红红,张志宏.种植义齿与邻近天然牙龈沟液中白介素-2水平的比较[J].安徽医科大学学报,2009,44(4):450-452.
[39]李善昌,苗波,魏良富.磷酸钙骨水泥与骨形成蛋白复合修复即刻种植牙骨缺损的实验研究[J].口腔医学研究,2003,19(4):255-257.
[2]杨晓晖,魏彦君,冯月转.即刻种植牙手术患者的围手术期护理[J].护理实践与研究,2015,12(6):77-78.
[3]董新新.种植牙拔牙后即刻种植和延期种植稳定性的比较[J].全科口腔医学电子杂志,2015,2(10):34.
[4]黄永平.Bio-Oss骨粉在种植牙骨缺损中的临床应用分析[J].亚太传统医药,2008,4(2):85-87.
[5]陈冬,白轶,李蓉,等.新型骨修复材料修复种植牙骨缺损的前瞻性临床研究[J].口腔医学研究,2015,31(11):1129-1132.
[6]尹燕,夏天东,赵文军,等.钛合金/HA涂层新型医用复合材料的制备及研究现状[J].兰州理工大学学报,2004,30(4):26-30.
[7]Shu DY,Wojciechowski MC,Lovicu FJ.Bone Morphogenetic Protein-7 Suppresses TGFβ2-Induced Epithelial-Mesenchymal Transition in the Lens:Implications for Cataract Prevention.Invest Ophthalmol Vis Sci.2017;58(2):781-796.
[8]Sun M,Chang Q,Xin M,et al.Endogenous bone morphogenetic protein 2 plays a role in vascular smooth muscle cell calcification induced by interleukin 6 in vitro.Int JImmunopathol Pharmacol.2017:394632016689571.doi:10.1177/0394632016689571.[Epub ahead of print]
[9]田卫东,王大章,闵维宪,等.骨形成蛋白-多孔羟基磷灰石复合人工骨的实验研究[J].华西口腔医学杂志,1992,10(1):18-21.
[10]马三成,袁祥民,林兆全,等.骨形成蛋白复合钛心多孔羟基磷灰石涂层种植体的临床疗效研究[J].新疆医学院学报,1996,19(3):216-220.
[11]袁志,胡蕴玉,马平,等.新型植骨材料-复合rh BMP-2的异种骨的实验研究[J].现代康复,2000,4(10):1510-1511.
[12]李凤,班宇.即刻种植的临床研究新进展[J].临床口腔医学杂志,2012,28(2):126-128.
[13]Ettinger RL,Spivey JD,Han DH,et al.Measurement of the interface between bone and immediate endosseous implants:a pilot study in dogs.Int J Oral Maxillofac Implants.1993;8(4):420-427.
[14]Cawood JI,Howell RA.A classification of the edentulous jaws.Int J Oral Maxillofac Surg.1988;17(4):232-236.
[15]邱立新,林野,王兴,等.骨劈开技术在上颌前牙种植外科中的应用[J].中国口腔种植学杂志,2000,5(2):67-69.
[16]李恺.种植体数目与分布对下颌种植覆盖义齿牙槽骨改建的影响[D].第四军医大学,2014.
[17]贾小玥.椎束CT测量颌骨密度及评估种植体初期稳定性的可行性研究[D].浙江大学,2013.
[18]王峰.牙种植体骨界面多尺度下的模拟构建及力学耦合[D].第四军医大学,2013.
[19]薛丽丽,杜莉,王虎,等.愈合期埋植型和非埋植型种植体周围牙槽骨吸收情况观察[J].中国口腔种植学杂志,2009,14(3):60-62,67.
[20]Dhaliwal JS,Albuquerque RF Jr,Fakhry A,et al.Customized Smart Peg for measurement of resonance frequency of mini dental implants.Int J Implant Dent.2017;3(1):4.doi:10.1186/s40729-017-0066-6.
[21]胡金龙,王静成,颜连启.组织工程学技术治疗骨缺损的最新研究进展[J].中国矫形外科杂志,2013,21(2):150-152.
[22]Rodella LF,Favero G,Boninsegna R,et al.Growth factors,CD34 positive cells,and fibrin network analysis in concentrated growth factors fraction.Microsc Res Tech.2011;74(8):772-777.
[23]Findik Y,Baykul T,Aydin MA,et al.Rehabilitation of the Work Accident-Related Traumatic Mandible With Iliac Free Flap,Distraction Osteogenesis,and Dental Implants.J Craniofac Surg.2017.doi:10.1097/SCS.0000000000003466.[Epub ahead of print]
[24]解涓.氧化锆全瓷修复体在后牙种植区应用的临床回顾性研究[D].第四军医大学,2014.
[25]王青,李再仁,郑宗范,等.四种牙体修复材料体外充填微渗漏的实验研究[J].口腔材料器械杂志,1995,4(4):156-158,197.
[26]王青,郑宗范,凌涤生,等.牙体修复材料体外充填密合度的扫描电镜研究[J].山东医科大学学报,1995,40(3):248-251.
[27]付志厚.组织工程化骨修复人工关节周围骨缺损的实验研究[D].第三军医大学,2008.
[28]Wang X,Yu T,Chen G,et al.Preparation and characterization of a chitosan/gelatin/extracellular matrix scaffold and its application in tissue engineering.Tissue Eng Part C Methods.2017.doi:10.1089/ten.TEC.2016.0511.[Epub ahead of print]
[29]胡堃,刘斌.骨移植材料发展趋势[J].生物骨科材料与临床研究,2010,7(3):32-38.
[30]吴汉江,朱兆夫,李运良,等.羟基磷灰石涂层牙种植体骨内种植的临床研究[J].中国口腔种植学杂志,1997,2(1):15-18.
[31]孙伟.羟基磷灰石涂层种植体临床应用现状的系统评价[D].中国医科大学,2004.
[32]王茸影,易静.骨形成蛋白调控成骨分化的信号机制[J].生命科学,2005,17(1):34-39.
[33]Cubo J,Hui M,Clarac F,et al.Static osteogenesis does not precede dynamic osteogenesis in periosteal ossification of Pleurodeles(Caudata,Amphibia)and Pogona(Squamata,Lepidosauria).J Morphol.2017.doi:10.1002/jmor.20659.[Epub ahead of print]
[34]段智霞,郑启新,郭晓东,等.骨形成蛋白2活性多肽体外定向诱导骨髓间充质干细胞向成骨方向分化的剂量依赖性研究[J].中国修复重建外科杂志,2007,21(10):1118-1122.
[35]孙健,谢富强,李平,等.复方骨形成蛋白生物复合物预防剩余牙槽嵴吸收实验[J].实用口腔医学杂志,2008,24(6):801-805.
[36]Masaomi Y,Yoshifumi S,Itaru N,et al.Humoral im-mune responses during acute rejection in rat lung trans-plantation.Transplant Immunol.2003;11:31-37.
[37]詹斌,樊友竹,袁洪,等.种植牙患者的临床和免疫学分析[J].现代口腔医学杂志,1996,12(4):235-236.
[38]刘红红,张志宏.种植义齿与邻近天然牙龈沟液中白介素-2水平的比较[J].安徽医科大学学报,2009,44(4):450-452.
[39]李善昌,苗波,魏良富.磷酸钙骨水泥与骨形成蛋白复合修复即刻种植牙骨缺损的实验研究[J].口腔医学研究,2003,19(4):255-257.