种植体表面处理的研究进展

骨内种植体植入成功的标志是:种植体和周围骨组织直接接触,光镜下种植体的周围无放射投射区,也就是无软组织介入,且能使种植体的负荷持续传导,并分散在骨组织中,也就是种植体与周围骨形成骨整合[1].     

多孔钽金属髋臼假体在初次全髋关节置换中的应用

目的 观察多孔钽金属髋臼假体进行初次全髋关节置换的临床效果.方法 自2006年9月-2010年3月我科对53例（59髋）采用多孔钽金属髋臼假体进行初次全髋关节置换术,应用临床功能及患者满意度评价、影像学评估来评价疗效.结果 42例获得随访,平均随访（33.0±7.4）个月,与术前比较,术后髋关节活动范围及临床功能评价均显著提高（P＜0.05）.影像学检查无明显假体移位、假体周围骨溶解情况的发生,其中34例（80.1%）在假体骨界面发现有明显的骨长入.结论 多孔钽金属髋臼假体是初次全髋关节置换的理想假体,能有效改善功能,假体骨长入明显,对年轻患者或老年骨质疏松患者尤其适合.     

病灶清除后打压植骨联合多孔钽金属棒植入治疗早期股骨头缺血性坏死的临床疗效

目的探讨早期股骨头发生缺血性坏死患者病灶清除后使用打压植骨联合多孔钽金属棒植入进行治疗的临床效果。方法将我院近两年骨科收治的股骨头发生缺血性坏死的38例患者作为研究对象,在清除病灶后打压植骨联合多孔钽金属棒植入进行治疗,观察患者治疗效果。结果术后所有患者的切口Ⅰ期愈合,无1例患者发生明显的感染以及不良并发症;对3例患者行人工全髋关节置换术,35例患者的关节疼痛感得到有效的缓解,股骨头的生存率为92.11%,相对于治疗前来说,随访末期患者Hrris评分明显增高,X线片评分没有明显的变化。结论早期股骨头缺血性坏死患者在清除病灶后使用打压植骨联合多孔钽金属棒植入治疗可有效改善髋关节的功能,缓解患者疼痛,可供临床推广与应用。     

非埋植式种植体修复牙列缺损52例临床体会

骨结合种植体依据其结构及植入方式可分为非埋植式和埋植式种植体两类。非埋植式种植体植入颌骨内后 ,基桩暴露在口腔 ,易受咀嚼力和口腔环境的干扰 ,而埋植式种植体可避免这些因素的影响。因此 ,多数学者主张临床采用埋植式种植体 ,但近年来研究认为非埋植式种植体同样能够达到种植体 -骨组织界面的骨性结合 ,获得良好的临床成功率 ,且种植体周围骨吸收总量及速率与埋植式无差异性[1] 。本文总结1998年 6月～ 2 0 0 2年 7月间应用非埋植式种植体修复牙列缺损 5 2例临床体会 ,现报告如下。1　材料及方法1 1　病例资料　选择种植体修复半年以…     

牙种植骨量不足患者应用骨诱导术的临床观察

目的探讨牙种植骨量不足患者应用骨诱导术的临床效果。方法回顾2008年1月2010年1月为牙种植骨量不足患者36例患采用种植体植入48枚,同时采用Bio-Oss及少量自体骨植入,并用Bio-Gide胶原膜覆盖的骨诱导术临床资料进行总结。结果依据观察内容术后10d对本组36例病例48枚种植体检查,手术切口均Ⅰ期愈合,无一例出现胶原膜外露,术后种植体无动度。结论应用Bio-Gide可吸收胶原膜和Bio-Oss粉,行骨诱导术诱导骨组织再生,在牙种植骨量不足患者取得良好效果,二者均有协同作用促进新骨形成,同时与种植体形成了紧密的骨性结合,使得种植体稳固。     

引导骨组织再生技术在种植周骨缺损的临床应用

目的评价引导骨组织再生技术在种植周骨缺损的临床效果。方法11例种植周骨缺损的患者一期植入种植体，共18颗。将Bio-oss充填于暴露的种植体周围，表面覆盖Bio-gide胶原膜，4～6个月后行二期手术，并观察骨缺损区新骨形成情况。一期术后1、3、6个月X线检查种植体周围及植骨区状况。结果种植体表面被新骨完全覆盖。11例18颗种植体无松动、脱落，均完成义齿修复。X线检查显示局部骨密度增高。结论Bio-oss联合Bio-gide胶原膜的引导骨组织再生技术应用于种植体周围骨缺损，可以引导骨组织再生，修复缺损区骨组织。     

二甲双胍对糖尿病大鼠种植体周围骨组织中OPG和RANKL表达的影响

目的研究二甲双胍对糖尿病大鼠种植体模型骨组织中OPG和RANKL表达的影响,探讨血糖变化对种植体周围骨整合的意义。方法将30只8周龄雄性SD大鼠随机分为正常种植组(T0)、糖尿病种植组(T1)、糖尿病种植二甲双胍干预组(T2)。糖尿病模型的建立采用高脂高糖饮食喂养以及腹腔注射小剂量链脲佐菌素,种植组植入纯钛种植体,降糖药物干预组每日二甲双胍灌胃。每周观察各组血糖水平,于12周处死大鼠,取胫骨,通过影像学方法观察种植体周围骨结合情况,并采用免疫组织化学方法检测各组种植体周围骨组织OPG和RANKL表达水平。结果大鼠T1表达水平比T0和T2组都高,T0和T2组RANKL表达水平相当;在RANKL/OPG比值的两两比较中,3组差异都有统计学意义,其值由高到低分别为T1组、T2组和T0组。结论糖尿病对种植体周围骨组织整合过程的影响可能是从升高RANKL表达水平和降低OPG表达水平两方面来起作用的,而二甲双胍可能通过改变OPG和RANKL的表达,促进种植体周围骨结合和骨形成。     

珊瑚羟基磷灰石与β-磷酸三钙用于修复种植体周骨缺损的研究

目的:评价珊瑚羟基磷灰石(CHA)与β-磷酸三钙(β-TCP)对种植体周围骨缺损的修复效果.方法:拔除6只Beagle犬双侧下颌前磨牙和第一磨牙.3个月愈合期后,在每侧下颌骨选择4个拔牙位点常规制备种植窝,然后于其冠方制备宽1～1.25 mm、深5 mm的环形骨缺损,每侧各植入4颗种植体,冠方骨缺损区分别按血凝块充填、植入CHA和β-TCP材料3种方式处理,非埋入式愈合.分别于术后4、12和16周处死动物,收获含种植体的骨组织标本制成硬组织切片,测算新骨与种植体接触的最冠方水平至缺损底部的距离(B-D),缺损区种植体骨结合率(BIC％),缺损区内新生骨面积百分比(NFB％)及未降解骨替代材料的面积百分比(RBS％).结果:术后种植体均未发生松动脱落,种植体周围软组织无炎症.植入4、12周时,3组种植体B-D、BIC％值差异均无统计学意义(P＞0.05);16周时,β-TCP组种植体B-D、BIC％值高于CHA组(P＜0.01).在12、16周时,CHA组的RBS％值高于β-TCP组(P＜0.01);16周时,β-TCP组的NFB％值高于CHA组(P＜0.01).结论:β-TCP较CHA能促进种植体周围骨缺损区的骨再生,β-TCP应用于种植体周围骨缺损的修复更具优势.     

紫檀芪对骨质疏松大鼠牙种植体骨整合的机制研究

目的 探究紫檀芪对骨质疏松大鼠牙种植体骨整合的影响以及可能的作用机制。方法 采用去势法建立骨质疏松大鼠模型，造模成功后进行牙种植体植入。将牙种植体植入成功大鼠随机分为模型组、紫檀芪低(20 mg·kg^-1)、中(40 mg·kg^-1)、高(80 mg·kg^-1)剂量组，每组12只；另取12只不去势大鼠作为假手术组。紫檀芪各剂量组灌胃给药，模型组与假手术组给予等体积生理盐水，1次/d，连续给药12周。采用micro-CT扫描仪进行种植区骨组织分析，亚甲基蓝-酸性品红染色观察种植区骨组织形态变化以及骨愈合情况，采用扭矩测试仪测定种植区骨组织脱位扭矩，免疫组化法检测种植区骨组织中肿瘤坏死因子α(TNF-α)、白细胞介素1β(IL-1β)表达，Western blot法检测种植区骨组织中骨形态发生蛋白2(BMP-2)、Runt相关转录因子2(Runx2)蛋白表达。结果 与假手术组比较，模型组大鼠种植体与股骨结合不够紧密，结合处骨板较薄，骨小梁间隙大，且数量较少；种植区股骨骨体积分数(BV/TV)、骨小梁数量(Tb.N)和骨结合指...     

骨形态发生蛋白-2在糖尿病大鼠种植体周围的表达

目的:应用大鼠糖尿病模型,观察实验性2型糖尿病(T 2DM)大鼠种植体周围骨形态发生蛋白-2(BM P-2)的表达水平,探讨影响糖尿病种植体骨整合的分子生物学机制,试图为发现新的治疗糖尿病骨整合方法打下理论基础。方法:将48只大鼠均分为正常组和糖尿病组。糖尿病组按40 m g/kg腹腔内一次性注射枸橼酸钠链脲佐菌素溶液建立T 2DM模型。在胫骨近骺端种植纯钛种植体。种植后2,4,8周分批分次处死动物。采用不带种植体脱钙标本硬组织切片、脱钙标本切片常规苏木精-伊红染色(HE染色)和免疫组织化学法检测种植体周围骨组织中骨形态BM P-2的表达并做图像分析。结果:HE染色镜下观察糖尿病组骨形成滞后。正常组和糖尿病组的种植体周围骨组织BM P-2免疫组织化学灰度值两组间差异有显著性(P<0.05)。结论:糖尿病者的骨质疏松化倾向可能与糖尿病种植修复较正常者失败率高有关,糖尿病者BM P-2的减少可能是影响种植体骨整合的原因之一。     

Effect of corundum-vancomycin composite on soft tissue reaction

The ceramics on the basis of corundum is used for implantation in the form of porous and solid materials. The solid form was used to produce tissue endoprosthesis while porous form is mainly used to fill in the bone defects. The corundum ceramics are also known to be used as coatings for implants in orthopedics and dentistry. On the other hand there is still a need to find out the new way of treatment of the chronic bone infection, during which the traditional way of antibiotics therapy is no more effective. One of the possibly solution is to use the different biomaterials as drug carriers and in the bone surgery one of the best are porous corundum implants, being themselves of high biocompatibility, and additionally containing Vancomycin. The main target of the investigation presented in this paper was the comparative assessment of the corundum ceramics and its composite containing Vancomycin after implantation into back muscle of the total of 15 rats. During the post mortem macroscopic assessment in the tissues which surrounded the implants there were no any inflammatory neither pathological changes observed. In the microscopic findings, in early periods, the observed inflammatory tissue reaction for implants with vancomycin was significantly greater what could be explained by the high concentration of the antibiotic in the given material. On the basis of the results of macroscopic and microscopic findings we can state that the composite material of corundum ceramic containing vancomycin is of high compatibility and could be regarded as the good drug carrier.     

Bone response to laser-induced micro- and nano-size titanium surface features

This study explored whether laser-induced, site-specific implant surface modifications with micro- and nano-scale topography were able to promote bone formation. The aim was to evaluate the biomechanical and histological response to partly laser-modified titanium implants in comparison with machined implants. After an early 8-week healing period in rabbit tibia and femur, a 250% increase in removal torque was demonstrated for the partly laser-modified surface. Further, different fracture mechanisms were demonstrated for the two surfaces. Histologically, significantly more bone was found in direct contact with the laser-modified surface for the implants in the tibia sites, and a similar amount of bone tissue was observed in contact with the implant in the femoral sites. In conclusion, an improved bone-implant interface anchorage was promoted by an increase in micro- and nano-scale implant surface topography and surface oxide induced by topological laser treatment. FROM THE CLINICAL EDITOR: Nanosized grooves in titanium implants markedly improve bone-implant anchorage by increasing the amount of bone formed in direct contact with the metal prosthesis.     

不同材料制备内植物在骨科领域的应用研究综述

目的内植物的进步是近代骨科学发展的重要组成部分之一,因此被广泛研究和讨论。方法本文就生物可吸收内植物、金属合金内植物、陶瓷类内植物、骨水泥和载抗生素内植物等几种常见材料制备的内植物的研究和发展进行综述。结果几种材料都具有生物相容性、抗侵蚀和抗化学降解性,具有足够的机械强度等特性。结论仍需努力寻找性能更佳的生物材料,探索可用于特殊用途的材料。     

Organic–Inorganic Surface Modifications for Titanium Implant Surfaces

This paper reviews current physicochemical and biochemical coating techniques that are investigated to enhance bone regeneration at the interface of titanium implant materials. By applying coatings onto titanium surfaces that mimic the organic and inorganic components of living bone tissue, a physiological transition between the non-physiological titanium surface and surrounding bone tissue can be established. In this way, the coated titanium implants stimulate bone formation from the implant surface, thereby enhancing early and strong fixation of bone-substituting implants. As such, a continuous transition from bone tissue to implant surface is induced. This review presents an overview of various techniques that can be used to this end, and that are inspired by either inorganic (calcium phosphate) or organic (extracellular matrix components, growth factors, enzymes, etc.) components of natural bone tissue. The combination, however, of both organic and inorganic constituents is expected to result into truly bone-resembling coatings, and as such to a new generation of surface-modified titanium implants with improved functionality and biological efficacy.     

Biomaterial strategies for engineering implants for enhanced osseointegration and bone repair

Bone tissue has a remarkable ability to regenerate and heal itself. However, large bone defects and complex fractures still present a significant challenge to the medical community. Current treatments center on metal implants for structural and mechanical support and auto- or allo-grafts to substitute long bone defects. Metal implants are associated with several complications such as implant loosening and infections. Bone grafts suffer from donor site morbidity, reduced bioactivity, and risk of pathogen transmission. Surgical implants can be modified to provide vital biological cues, growth factors and cells in order to improve osseointegration and repair of bone defects. Here we review strategies and technologies to engineer metal surfaces to promote osseointegration with the host tissue. We also discuss strategies for modifying implants for cell adhesion and bone growth via integrin signaling and growth factor and cytokine delivery for bone defect repair.     

Evaluation of Osseointegration around Tibial Implants in Rats by Ibandronate-Treated Nanotubular Ti-32Nb-5Zr Alloy

Materials with differing surfaces have been developed for clinical implant therapy in dentistry and orthopedics. This study was designed to evaluate bone response to titanium alloy containing Ti-32Nb-5Zr with nanostructure, anodic oxidation, heat treatment, and ibandronate coating. Rats were randomly assigned to two groups for implantation of titanium alloy (untreated) as the control group and titanium alloy group coated with ibandronate as the experimental group. Then, the implants were inserted in both tibiae of the rats for four weeks. After implantation, bone implant interface, trabecular microstructure, mechanical fixation was evaluated by histology, micro-computed tomography (μCT) and the push-out test, respectively. We found that the anodized, heat-treated and ibandronate-coated titanium alloy triggered pronounced bone implant integration and early bone formation. Ibandronate-coated implants showed elevated values for removal torque and a higher level of BV/TV, trabecular thickness and separation upon analysis with μCT and mechanical testing. Similarly, higher bone contact and a larger percentage bone area were observed via histology compared to untreated alloy. Furthermore, well coating of ibandronate with alloy was observed by vitro releasing experiment. Our study provided evidences that the coating of bisphosphonate onto the anodized and heat-treated nanostructure of titanium alloy had a positive effect on implant fixation.     

Application of Lyophilized Gene-Delivery Formulations to Dental Implant Surfaces: Non-Cariogenic Lyoprotectant Preserves Transfection Activity of Polyplexes Long-Term

Titanium is the metal of choice for dental implants because of its biocompatibility and ability to merge with human bone tissue. Despite the great success rate of dental implants, early and late complications occur. Coating titanium dental implant surfaces with polyethyleneimine (PEI)-plasmid DNA (pDNA) polyplexes improve osseointegration by generating therapeutic protein expression at the implantation site. Lyophilization is an approach for stabilizing polyplexes and extending their shelf life; however, most lyoprotectants are sugars that can aid bacterial growth in the peri-implant environment. In our research, we coated titanium surfaces with polyplex solutions containing varying amounts of lyoprotectants. We used two common lyoprotectants (sucrose and polyvinylpyrrolidone K30) and showed for the first time that sucralose (a sucrose derivative used as an artificial sweetener) might act as a lyoprotectant for polyplex solutions. Human embryonic kidney (HEK) 293T cells were used to quantify the transfection efficiency and cytotoxicity of the polyplex/lyoprotectant formulations coating titanium surfaces. Polyplexes that were lyophilized in the presence of a lyoprotectant displayed both preserved particle size and high transfection efficiencies. Polyplexes lyophilized in 2% sucralose have maintained transfection efficacy for three years. These findings suggest that modifying dental implants with lyophilized polyplexes might improve their success rate in the clinic.     

Growth factor releasing porous poly (ɛ-caprolactone)-chitosan matrices for enhanced bone regenerative rherapy

Drug releasing porous poly(epsilon-caprolactone) (PCL)-chitosan matrices were fabricated for bone regenerative therapy. Porous matrices made of biodegradable polymers have been playing a crucial role as bone substitutes and as tissue-engineered scaffolds in bone regenerative therapy. The matrices provided mechanical support for the developing tissue and enhanced tissue formation by releasing active agent in controlled manner. Chitosan was employed to enhance hydrophilicity and biocompatibility of the PCL matrices. PDGF-BB was incorporated into PCL-chitosan matrices to induce enhanced bone regeneration efficacy. PCL-chitosan matrices retained a porous structure with a 100-200 microm pore diameter that was suitable for cellular migration and osteoid ingrowth. NaHCO3 as a porogen was incorporated 5% ratio to polymer weight to form highly porous scaffolds. PDGF-BB was released from PCL-chitosan matrices maintaining therapeutic concentration for 4 week. High osteoblasts attachment level and proliferation was observed from PCL-chitosan matrices. Scanning electron microscopic examination indicated that cultured osteoblasts showed round form and spread pseudopods after 1 day and showed broad cytoplasmic extension after 14 days. PCL-chitosan matrices promoted bone regeneration and PDGF-BB loaded matrices obtained enhanced bone formation in rat calvarial defect. These results suggested that the PDGF-BB releasing PCL-chitosan porous matrices may be potentially used as tissue engineering scaffolds or bone substitutes with high bone regenerative efficacy.     

生物胶原膜与钛膜在引导骨组织再生技术中的应用比较

目的 比较生物胶原膜与钛膜在引导骨组织再生技术中的应用.方法 75例牙槽骨骨缺损的种植患者共植入82枚Xive螺纹根状种植体,同期采用植Bio-Oss小牛骨粉,盖BME-10X胶原膜或钛膜,进行引导骨再生,修复骨缺损.其中39例采用钛膜,43例采用BME-10X胶原膜;二期手术时观察膜下骨再生情况,评价成功率.结果 钛...