骨形成蛋白诱导活性材料联合引导组织再生术治疗牙周骨下袋的临床研究

目的评估骨形成蛋白诱导活性材料(osteoinduction active meterial,OAM)复合部分自体骨,联合引导组织再生术(guided tissue regeneration,GTR)在牙周骨下袋治疗中的临床疗效。方法 46例患者的50颗骨下袋缺损患牙随机应用OAM/自体骨/GTR(试验组)、自体骨/GTR(对照组)治疗,分别记录术前,术后12周、24周患牙牙周探诊深度(periodontal probing depth,PPD)、临床附着丧失(clinical attachment loss,CAL)、龈沟出血指数(sulcus bleeding index,SBI)及牙槽骨高度(alveolar bone height,AH)。结果两组患牙术后各项指标均比基线时明显改善,试验组与对照组比较PPD和CAL显著减少(术后12周时P<0.05,术后24周时P<0.01)、而SBI降低无显著性(P>0.05)。CBCT显示,试验组、对照组骨缺损区均有新骨形成,试验组较对照组AH显著增加(P<0.05)。结论 OAM/自体骨/GTR是治疗牙周骨下袋较为理想的方法。     

骨形成蛋白复合物联合胶原膜治疗牙周缺损的临床研究

目的　评价骨形成蛋白复合物联合胶原膜治疗牙周组织缺损的临床效果。方法　将骨形成蛋白复合物即重组合异种骨应用于引导组织再生(GTR)技术中,与传统的GTR技术和牙周翻瓣术对照研究。选择经过牙周基础治疗的35例4 5处牙周组织缺损,分为3组,BMP组:牙周缺损处植入骨形成蛋白复合物和胶原膜;GTR组:牙周缺损处植入胶原膜;OFD组:做牙周翻瓣术,为对照组。术后12、2 4周分别观察各组的牙周探诊深度(PPD)、临床牙周附着丧失(CAL)和龈沟出血指数(SBI)等临床指标变化。结果　3组术后PPD、CAL和SBI均有明显减少和降低。BMP组、GTR组与OFD组相比较,PPD和CAL减少、SBI降低,差异均有显著性(术后12周时P <0 .0 5 ,术后2 4周时P <0 .0 1) ;BMP组与GTR组相比,PPD和CAL减少,差异有显著性(P<0 .0 1) ,而SBI降低,差异无显著性(P >0 .0 5 )。结论　骨形成蛋白复合物联合胶原膜是治疗牙周组织缺损较为理想的方法     

骨形态蛋白复合物联合引导组织再生技术治疗根分叉病变的研究

目的 评价骨形态蛋白复合物联合引导组织再生技术治疗根分叉病变的临床效果。方法 选择30颗Ⅱ～Ⅲ度根分叉病变患牙，其中骨形态蛋白复合物联合引导组织再生技术治疗10颗（BMP组），引导组织再生技术治疗10颗（GTR组），常规牙周翻瓣术治疗10颗（OFD组），作为对照组。术后12周、24周分别观察各组的牙周探诊深度（PPD）、根分叉水平探入深度（HPD）、临床牙周附着丧失（CAL）和龈沟出血指数（SBI）等临床指标变化。用SPSS10．0软件包对相关数据统计学分析。结果 三组术后PPD、HPD、CAL和SBI均有明显减少，BMP组、GTR组与OFD组相比较，减少更为明显，有显著性差异（P〈0．05），BMP组与GTR组相比，PPD和CAL减少更为明显，有显著性差异（P〈0．01），而SBI无显著性差异（P〉0．05）。术前与术后X线比较，BMP组可见阴影变小，牙槽骨密度增加更为明显。结论 骨形态蛋白复合物联合GTR技术与传统的GTR术和牙周翻瓣术相比，更能有效减轻牙周炎症、减少牙周袋深度、增加临床牙周附着水平和促进牙周骨组织再生修复的能力。骨形态蛋白复合物联合GTR技术治疗Ⅱ～Ⅲ度根分叉病变可以获得满意的临床效果。     

纳米骨水泥修复根分叉病变的实验研究

目的:研究纳米骨水泥修复犬慢性牙周组织缺损.方法:将3只成年Beagle犬形成慢性Ⅱ度根分叉病变模型,按拉丁方设计方法分成3组,每组6颗牙,分别采用引导组织再生治疗术(Guided tissue regeneration,GTR)+纳米骨水泥(nano-calcium phosphate bone cement,CPC)、GTR+珊瑚羟基磷灰石人造骨(coralline hydroxyapatite por-ous,CHAP)、GTR进行移植修复治疗.12周观察牙周组织再生情况.结果:组织学观察GTR+CPC组牙槽骨、牙骨质和牙周组织的修复再生效果明显优于GTR组(P<0.05).X线片显示:GTR+CPC组骨缺损处骨质生长情况优于其他两组.结论:应用GTR技术结合纳米骨水泥移植可显著促进狗牙根分叉处牙周组织缺损的再生.     

组织工程用于修复慢性牙周组织缺损的动物实验研究

目的:应用细胞型和/或非细胞型组织工程化牙周组织移植修复慢性牙周缺损的动物实验,探讨其用于牙周再生治疗的可行性。方法:人工构建5只成年杂种狗慢性牙周缺损病变模型,分别随机采用:引导组织再生治疗术+富血小板血浆+B ioOss(GTR+PRP+B ioOss)、引导组织再生治疗术+富血小板血浆+B ioOss+自体牙周膜细胞(GTR+PRP+B ioOss+PDLCs)、引导组织再生治疗术+自体牙周膜细胞(GTR+PDLCs)和GTR治疗,其中GTR组6颗牙,其余3组各为8颗牙。12周后作病理切片,HE染色观察牙周组织再生情况。结果:动物实验发现GTR组的新生牙槽骨、牙骨质和牙周组织高度分别为(0.52±0.21)mm、(0.8±0.13)mm、(1.9±0.10)mm。而另外3组的新生牙槽骨、牙骨质和牙周组织高度分别为GTR+PRP+B ioOss组:(1.36±0.17)mm、(1.92±0.18)mm、(2.62±0.16)mm;GTR+PRP+B ioOss+PDLCs组:(1.42±0.22)mm、(2.07±0.19)mm、(2.68±0.20)mm;GTR+PDLCs组:(1.39±0.19)mm、(1.82±0.16)mm、(2.55±0.12)mm,这3组牙槽骨、牙骨质和牙周组织的修复再生效果均明显优于GTR组(P<0.05),而它们之间的差别无显著性。结论:应用GTR技术结合组织工程可显著促进狗牙周组织缺损的再生。     

多孔β-0TCP/BMP复合人工骨引导牙周组织再生的实验研究

目的　将骨形成蛋白 (bonemorphogeneticprotein ,BMP)和多孔 β磷酸三钙 (β tricalciumphosphate ,β TCP)复合人工骨联合应用于引导组织再生 (guidedtissueregeneration ,GTR)技术中 ,评价其对Ⅱ度根分叉病变牙周组织再生修复的影响和意义。方法　用健康成年杂种狗 4只 ,制备下颌后牙区人工骨缺损。实验牙位随机分为 3组 :①骨形成蛋白 /引导组织再生 (BMP/GTR)组 :缺损处植入引导膜材料和复合人工骨 ;②GTR组 :单纯放置引导膜材料 ;③以常规翻瓣术为对照组。术后 12周取材做组织学观察和评价。结果　两实验组均有明显新附着形成 ,其中BMP/GTR组有大量新生牙槽骨、牙骨质、牙周韧带生长。对照组新生组织量很少。结论　β TCP/BMP是一种具有较强骨诱导能力 ,生物相容性较好的复合人工骨 ,在引导牙周组织再生术中有良好的应用前景     

多孔β-TCP/BMP复合人工骨引导牙周组织再生的实验研究

目的 将骨形成蛋白(bone morphogenetic protein,BMP)和多孔β磷酸三钙(β-tricalcium phosphate,β-TCP)复合人工骨联合应用于引导组织再生(guided tissue regeneration,GTR)技术中,评价其对Ⅱ度根分叉病变牙周组织再生修复的影响和意义.方法 用健康成年杂种狗4只,制备下颌后牙区人工骨缺损.实验牙位随机分为3组:①骨形成蛋白/引导组织再生(BMP/GTR)组:缺损处植入引导膜材料和复合人工骨;②GTR组:单纯放置引导膜材料;③以常规翻瓣术为对照组.术后12周取材做组织学观察和评价.结果 两实验组均有明显新附着形成,其中BMP/GTR组有大量新生牙槽骨、牙骨质、牙周韧带生长.对照组新生组织量很少.结论 β-TCP/BMP是一种具有较强骨诱导能力,生物相容性较好的复合人工骨,在引导牙周组织再生术中有良好的应用前景.     

富血小板血浆在种植体周围骨缺损修复中的实验研究

目的:探讨富血小板血浆(platelet-richplasma,PRP)、PRP复合骨诱导活性材料(osteoinduction active material,OAM)对种植体周围骨缺损修复的作用。方法:Beagle犬4只,拔除每只犬一侧下颌第一、二前磨牙及其双侧下颌第四前磨牙作为实验牙位。3个月后拔牙处植入种植体,每只犬共植入3颗种植体,第一、二前磨牙牙位植入1颗种植体为对照组,对侧第四前磨牙牙位植入1颗种植体为实验A组,同侧第四前磨牙牙位植入1颗种植体为实验B组。种植术中同期制备种植体周围骨缺损并植入相应骨移植材料:A组植入PRP/OAM;B组植入PRP/磷酸三钙;对照组植入磷酸三钙。种植术后8、16周处死动物,进行组织学观察,测量种植体周围骨密度,采用SPSS13.0软件对数据进行单因素方差分析。结果:8周时,实验A组新骨与种植体形成区段性骨结合;实验B组种植体边缘可见新骨形成,但量较少;对照组种植体边缘为纤维性界面。8周时骨密度测量,各组间骨密度差异无统计学意义。16周时,实验A组可见哈佛系统,实验A、B组新骨与种植体形成骨整合;对照组仅为纤维性结合。16周时骨密度测量,两实验组骨密度均显著高于对照组。结论:PRP及PRP/OAM可促进种植体周围骨缺损修复。     

自体块状骨移植重建牙槽骨骨量不足后种植修复的临床观察

目的探讨自体块状骨移植重建牙槽骨骨量不足后种植修复的临床效果。方法 2010年1月至2016年12月完成的自体块状骨移植结合引导骨再生技术(guided bone regeneration,GBR)重建牙槽骨骨量不足的病例共30例,植入种植体共81颗。按照自体块状骨的供区来源分为颌骨组(16例34颗)和髂骨组(14例47颗)两组,通过临床随访及影像学检查,分别计算并比较其种植体存留率。结果 30例自体块状骨移植结合GBR后骨增量明显且愈合良好,术后均无明显供区并发症。同期或延期种植体植入,经平均7.8个月(4~18个月)骨结合期后,除1例种植体因松动拔除,其余29例均完成永久修复。种植体植入后平均随访期为26个月(9~68个月),植入的81颗种植体在随访期内存留率为98.76%。其中颌骨组升支取骨失败1颗,种植体存留率为97.06%;髂骨组失败0颗,种植体存留率为100%,两者统计学上无显著性差异(P>0.05)。结论自体块状骨移植重建牙槽骨骨量不足后种植修复,其种植体存留率,较骨量正常情况下的种植修复无明显差异。颌骨与髂骨两种供区的块状自体骨,其移植重建牙槽骨骨量不足均可取得理想的种植修复临床效果。但颌骨内取骨因避免了第二术区、减少手术时间、术后并发症小等优点,临床上应予以优先选择。     

PRP和自体骨髓基质细胞移植修复狗牙Ⅱ度根分叉病变的研究

目的：应用富血小板血浆和／或骨髓基质细胞移植修复根分又病变的动物实验,探讨其用于牙周再生治疗的可行性。方法：人工构建5只成年杂种狗慢性Ⅱ度根分叉病变模型,分别随机采用：引导组织再生治疗术 富血小板血浆 Bio-Oss(GTR／PRP／Bio-Oss)、引导组织再生治疗术 富血小板血浆 Bio-Oss 自体骨髓基质细胞(GTR／PRfl／Bio-Oss/MSCs)、引导组织再生治疗术 骨髓基质细胞(GTR／MSCs)和GTR治疗,每组各7颗牙。12周后作病理切片,HE染色观察牙周组织再生情况。结果：动物实验发现GTR组的新生牙槽骨、牙骨质和牙周膜高度与GTR／PRfl／Bio-Oss组、GTR／MSCs组无显著性差异;而GTR／PRPl／Bio-0ss／MSCs组与上3组有显著性差异。结论：在本实验条件下,MSCs和胶原膜复合,PRP与Bio-Oss复合对GTR的引导牙周组织再生作用没有显著的促进作用。     

Relationship between bone mineral density and bone stiffness in bone fracture

Objectives Using cancellous bone blocks of racehorses, the relationship between bone mineral density (BMD), which indicates bone strength, and stiffness in bone fracture occurrences was studied.Methods Two groups of cancellous bone blocks were prepared: a fractured group, using the first phalangeal bones of seven racehorses with sagittal fractures; and a nonfractured group, using the first phalangeal bones of nine autopsied racehorses without any fractures. By a peripheral quantitative computed tomography scan, the BMD values were shown as color images and evaluated. In addition, the BMD values obtained from the fractured and nonfractured groups were compared with the stiffness values obtained from a compression test.Results The difference between the average BMD values of the fractured and nonfractured groups was easily observed on the BMD color-conversion display image. The average BMD of the fractured group (472.1 mg/cm³) was significantly higher than that of the nonfractured group (284.5 mg/cm³, P = 0.005). Moreover, the average stiffness of the fractured group (5564.5 N/cm) was significantly higher than that of the nonfractured group (3808.6 N/cm, P = 0.008).Conclusion These results suggest that the occurrence of a fracture does not depend on the BMD or the bone stiffness value.     

Aneurysmal bone cyst of the zygomatic bone

Aneurysmal bone cysts are a rare finding in the facial bones and jaws. Only one previous case of this entity affecting the malar bone could be found in the literature. Ultrasound and isotope scan features of this entity are described.     

Aneurysmal bone cyst of the sphenoid bone

Aneurysmal bone cyst (ABC) is an uncommon benign lesion that rarely presents in the craniofacial region. Aneurysmal bone cysts represent nearly 1.4% of all bone tumors, and among those, only 3% are located in the cranium. In this study, we report on an ABC located in the sphenoid bone with superior nasal cavity and ethmoid extension. The presenting symptom of our patient was headache, followed by diplopia, loss of visual accuracy, and abduction restriction. We successfully resected the lesion by a combined subcranial-midfacial degloving approach without any complications or recurrence.     

Particulated bone grafts--effectiveness of bone cell supply

OBJECTIVE: The objective of this study was to measure the amount of viable bone cells present in different types of bone graft. MATERIAL AND METHODS: Bone chips were harvested from the trabecular or cortical bone of the mandible or the iliac crest and either milled or not. The average size of unmilled bone particles was 5 x 5 x 5 mm and that of milled was 2 x 2 x 2 mm. Drill sludge was obtained using either a ball reamer, a diamond ball or an implant drill (the latter from mandibular bone and of average dimension 1 x 1 x 1 mm). A measure of 0.5 g of each category was cultured in Dulbecco's modified Eagle's medium with additives for four weeks. Cell counts were performed. An analysis of the osteocalcin synthesis, the alkaline phosphatase (ALP) activity, the collagen types and the concentration of bone-specific collagen cross-links in medium supernatants was performed. RESULTS: Cells stained positively for osteocalcin and ALP in all groups. Bone-specific collagen cross-links could be quantified and collagen of types I and V was present with no difference in all groups. Unmilled spongy bone chips revealed greater cell counts than milled (P<0.05). Spongy bone chips revealed greater cell counts than cortical bone chips (P<0.05). Drill sludge obtained by hard alloy ball reamer showed the least amount of viable cells (P<0.05). CONCLUSIONS: Bone milling reduces the quantity of osteoblasts. Bone obtained by the ball reamer supplies a smaller number of cells than bone obtained by other methods. Unmilled spongy bone chips appear to offer the greatest amount of viable osteoblasts.     

Oncological treatment of bone tumours and bone metastases

The majority of patients with a malignant bone lesion will have bone metastases from a distant primary tumour. This could be apparent at diagnosis or develop later in the course of the disease. Some primary tumour types are more likely than others to develop bone secondaries. This common clinical problem requires a multidisciplinary approach in order to reduce patient suffering and maintain quality of life. Almost all patients with metastatic bone disease will have incurable cancer and this needs to be acknowledged when considering treatment options. Conversely primary malignant bone tumours are relatively rare conditions and thus need to be managed by specialist centres. Multimodality, multiprofessional treatment is required which may last for many months and can be associated with considerable toxicity. Patients with localized disease can be cured but there remains a high risk of both local recurrence and metastases.     

The effcct of eel bone powder on bone mineral density in mouse femoral bone

Improvement in bone mineral density (BMD) in the femur after administration of eel bone powder (EBP) was evaluated in ovariectomized (OVX) mice. Female ICR mice were given ovariectomies or sham operations at 9 weeks of age, then housed for 2 weeks during which they were allowed free access to a normal diet. Subsequently, the mice were divided into 3 groups: sham-operated mice fed a normal diet, OVX mice fed a normal diet, and OVX mice fed a diet containing EBP. After the mice in these 3 groups had been housed for 2 months (during which time they were allowed free access to their respective diets), they were dissected and analyzed. The BMD values in the removed femurs were measured by peripheral quantitative computed tomography (pQCT). Femoral total and femoral cancellous BMD values were higher in the EBP-treated group than in the nontreated group. Total BMD: the value in the EBP-treated group was 573 mg/cm³, and that in the non-treated group was 451 mg/cm³ (p<0.05). Cancellous BMD: the value in the EBP-treated group was 242 mg/cm³, and that in the non-treated group was 143 mg/cm³ (p<0.05). However, cortical BMD values did not significantly differ between the EBP-treated group and the non-treated group. Cortical BMD: The value in the EBP-treated group was 1891 mg/cm³, and that in the non-treated group was 1900 mg/cm³. pQCT was used to measure the cortical and cancellous BMD in the long bones. By use of a color conversion technique to display BMD, regional changes in the long bones can be expressed and easily measured. It has been well documented that EBP is effective for improvement or prevention of BMD reduction associated with OVX.     

Injectable bone

Temperature-dependent polymerising polyethylene oxide hydrogel was used as a vehicle to deliver bone marrow mesenchymal cells by injection in six nude mice, four mice acting as controls, to study generation of new bone in the cell-hydrogel complex. Mesenchymal cells were harvested by in vitro cell culture, and cells were seeded into polyethylene oxide solution. The density of the suspension was adjusted to 5 x 10(7)ml(-1). The hydrogel was obtained by adjusting the temperature to over 6 degrees C. Aliquots of 0.5 ml of the cell-hydrogel complexes were injected subcutaneously into the backs of the six experimental mice, and 0.5 ml of hydrogel alone was injected into the four controls. Generation of new bone was studied by gross inspection, radiographs, and histological examination. Two months after injection hard nodes had formed subcutaneously in all six mice, whereas in the control group the hydrogel had been absorbed completely and only soft tissue was present at the site of injection. A shadow could be seen on the radiographs of all cell-seeded mice. On histological examination of the nodes there was trabecular bone and some areas of neocartilage. This method of generating new bone might be of potential clinical use.     

Microscopy of bone cells, bone tissue, and bone healing around implants.

Newer methods of scanning microscopy using both light and electrons are particularly relevant to the study of bone cells, bone matrix organization, matrix mineralization, bone modeling and remodeling, and the adaptation of cells and matrix to implants. Most of such studies are conducted on retrieved implants, at least after the death of the related tissue. Because the retention of the tissue-implant relationship in such preserved tissue is crucial for critical evaluation of the implant, methods based on the study of flat surfaces of embedded tissue blocks are very important. Using electrons, the backscattered electrons in a scanning electron microscope can be employed to evaluate mean atomic number (density) and cathodoluminescence can identify polymers and fluorescent labels. Using light, confocal microscopical techniques permit the examination of layers deep to the block face. Confocal reflected and fluorescence methods allow the study of cell behavior upon both transparent and opaque substrates in the laboratory. Examples of the above are presented and interpretation problems discussed. Current experiments are aimed at enabling the study of bone wound healing and bone adaptation to implanted materials in vivo, through the implantation of optical quality windows and/or newly conceived and designed microscopical objective lenses.