生长因子联合引导性再生技术在口腔种植治疗中的应用

随着膜屏障和骨移植材料的发展,引导性再生技术已广泛应用于口腔种植修复及外科重建领域.将生长因子复合到生物活性材料上,利用其促进骨再生的特性而进一步提高骨诱导活性并增强骨性整合已成为目前研究的热点.     

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骨移植再生是牙周组织再生的一个重要方面,骨移植的材料经历了自体骨、异体骨、异种骨、人工合成骨等多种形式的发展变化。本文对各种骨移植材料及其应用做一综述。     

脱矿牙本质基质材料在颌骨骨缺损修复的应用

颌骨缺损会导致颌面部的功能及形态的异常。所以术后的骨缺损修复是必要的。为了避免自体骨移植所带来的二次创伤,寻找优良的骨替代材料是目前的研究热点。牙本质材料因为其易获取,制备简单,成骨效果良好而获得许多关注。并且学者发现脱矿后的牙本质成骨能力更为显著。该文将对脱矿牙本质材料的成骨基质及临床应用作一综述。     

引导组织和骨组织再生术及其生长因子在牙周骨缺损治疗中的应用

引导组织再生术和引导骨再生术广泛用于牙周骨缺损的治疗中,给牙周组织再生开辟了广泛的空间,但二者单独使用却存在一定的局限性。因此,目前的研究多趋向于将骨移植材料和膜材料与多肽生长因子联合应用于牙周骨缺损的修复。下面就引导组织再生膜材料、引导骨再生支架材料和碱性成纤维细胞生长因子的理化性质、生物学功能,以及三者联合应用于牙周骨缺损治疗中的作用作一综述。     

骨移植材料有效骨再生的评价方法及应用

随着科学技术的迅猛发展,学者们对各种各样的骨移植材料进行大量探索、研究和开发。评价骨移植材料有效骨再生的方法亦随之越来越多。其检测技术各有侧重,从不同的角度表现生物材料有效骨形成的能力。本文将从影像学检测、组织学观察、生化指标测定和移植骨生物力学等几个方面对骨移植材料有效成骨的评价方法、各种相关检测技术和指标作一综述。     

人牙周膜细胞在镁黄长石与β-磷酸三钙生物陶瓷表面的增殖和成骨向分化

由各种原因所致的牙槽骨缺失可以通过患者自身骨移植、牵张成骨和引导骨再生等方法得到修复,但这些修复方法各有利弊。近年来,生物材料的使用为牙槽骨再生提供了更多的可能性,其代表性的材料之一的β-磷酸三钙（tricalcium phosphate,TCP）已广泛用于骨再生,但其降解率低和力学性能不足,导致其临床应用受限。     

脱矿牙本质基质在骨增量中的研究进展

脱矿牙本质基质(Demineralized Dentin Matrix,DDM)具有良好的骨诱导、骨传导和成骨能力.与异种骨或者同种异体骨充填材料相比较,DDM具有独特的优势:无感染传染病的风险、不需刻意开辟第二术区、无排异反应等.对于本身需要拔除健康牙齿的患者而言,DDM作为骨充填材料更加经济、安全、方便、微创.本文将对DDM的成骨原理、制备方法、最佳使用效果以及在骨移植领域的发展前景作一综述.     

骨替代材料在口腔种植中的研究进展

牙槽骨的吸收造成种植区的骨量不足可采用骨移植材料来修复。骨移植材料分为自体骨移植材料、异种移植材料、同种异体移植材料及合成的骨替代材料。其中,骨替代材料具有来源广泛、不易引起机体排斥反应的优点。本文就临床常用的3种骨替代材料羟磷灰石、磷酸三钙、生物活性玻璃的理化特性、成骨原理和材料的优缺点等作一综述。     

GBR植骨效果的远期稳定性不优于自体骨移植

引导性骨再生术（GBR）的应用缺陷包括：屏障膜容易塌陷、吸收,不可吸收膜需要二次手术取出,容易早期暴露导致不理想的骨再生。膜的放置过程中容易导致颗粒状骨粉的移位和扩增位点凸度的丧失。尤其在不易维持成骨空间的骨缺损类型中,GBR在骨再生能力上往往具有不可预期性。因为传统的骨替代材料仅具有骨传导性而没有骨引导性,屏障膜在缺损形态不佳时难以维持一个稳定的骨再生空间。块状自体骨移植相对于使用颗粒状骨替代材料的引导性骨再生术的优势在于：具备良好的成骨特性和生物机械性能。即使在不易维持成骨空间的骨缺损类型中,块状自体骨移植能提供新骨形成改建所必需的骨源细胞,理想的外形重塑以及良好抗微动和抗吸收特性。我方观点：GBR植骨效果的远期稳定性不优于自体骨移植。     

脱矿牙本质基质的基本性能及制备

骨缺损治疗需要可降解的生物相容性好的有骨诱导能力的材料,脱矿牙本质基质(DDM)就是一种理想的骨替代材料.DDM来源于人类不行使功能的牙齿,其牙本质经过脱矿、冲洗、冻干和磨碎等工序就可制备.牙本质和牙槽骨在化学成分上非常接近,这就为以DDM作为骨的支架提供了条件.骨形态发生蛋白(BMP)是一种可诱导新生骨形成的生长因子,DDM中富含BMP.DDM在诱导新生骨的形成过程中无宿主免疫排斥反应,是一种有效的生物相容性良好的骨移植材料.DDM的制备有传统制备和超声-酸蚀制备两种方法.脱矿在传统制备中就是一个好方法,脱矿后的牙本质保存了牙本质原始结构物质.粒径也是影响成骨效果的一个因素,75～500 μm的粒径为多数学者所认同.在超声-酸蚀制备中,利用超声-酸蚀技术对DDM的表面结构进行改性,可有效地创造出利于细胞和生长因子吸附的表面结构.     

富血小板纤维蛋白促进上颌窦底提升术后骨再生研究进展

在上颌后牙区骨量不足时,常采用上颌窦底提升术获得充足的骨量,随着研究的不断深入,现普遍认为上颌窦底黏膜本身具备成骨潜力,术后的成骨模式为通过植骨材料维持稳定的空间,来自创面和窦底黏膜的间充质干细胞黏附、迁移并成骨分化,形成新骨。常规应用的植骨材料普遍缺乏骨诱导性,使得术后成骨效率低、术后反应明显,因此加速术后的骨再生并减轻患者负担是当前临床研究的热点。富血小板纤维蛋白（platelet-rich fibrin,PRF）是第二代自体血小板浓缩制品,作为组织工程材料最初被用于修复软组织损伤,现已被广泛应用于口腔种植领域。近期研究发现PRF可诱导间充质干细胞成骨分化。通过标准化流程制备的PRF具有一定的骨诱导性,同时可促进血管形成,在上颌窦底提升术中能够调控其成骨模式中的各项因素。另外,PRF制成膜使用可依靠其机械强度维持提升后的窦底黏膜。但迄今为止PRF促进骨再生的机制研究仍有欠缺,是否应该在上颌窦底提升术中常规应用PRF仍存争议。文章重点介绍PRF促进上颌窦底提升术后的骨再生机制以及PRF在不同术式中的临床应用方式及效果,旨在为临床决策及进一步研究提供参考。     

植骨材料在口腔种植中的应用概况及进展

近年来,多种传统和新型的植骨材料及手术方法在颌面部牙槽骨缺损的重建中得到广泛应用,有效解决了因炎症、外伤、肿瘤手术等原因导致的骨量不足问题,拓宽了口腔种植的适应证,提升了种植修复的临床效果。文章根据目前口腔种植领域中常用植骨材料的特点,分类讨论了自体骨、同种异体骨、异种骨及各种人工合成的骨替代材料在口腔种植中的应用现状,并简述了组织工程骨的研究现状和应用前景。     

自体骨移植与引导骨再生在外胚层发育不全综合征种植修复中的应用

目的:在自体骨移植、引导骨再生实现骨增量的基础上,通过种植方法对外胚层发育不全综合征导致的牙列缺损进行修复。方法:对1例牙槽骨重度萎缩的外胚层发育不全综合征患者,先后通过自体髂骨游离移植、引导骨再生技术,使患者牙槽骨实现宽度、高度上的增量和上下颌牙槽骨空间位置的改善,然后在上下颌骨牙槽骨分别植入5枚、4枚种植体,最后采用种植固定桥修复方法恢复患者牙列缺损。结果 :通过自体髂骨游离移植和引导骨再生技术,患者上下颌牙槽骨在高度和宽度的增量能满足种植体植入需要,同时唇舌向位置关系得到改善,种植体支持的上下颌固定桥修复体较理想地恢复了患者牙列的完整性,咬合关系良好。结论:对牙槽骨重度萎缩的外胚层发育不全综合征患者,综合应用自体骨移植、引导骨再生等技术,能解决患者种植修复过程中牙槽骨量严重不足的问题。     

Advanced and prospective technologies for potential use in craniofacial tissues regeneration by stem cells and growth factors

The processes of craniofacial tissues development and regeneration are largely dependent on sequential and reciprocal interactions between mesenchymal and epithelial components. These processes involve a series of inductive and permissive interactions that result in the determination, differentiation, and organization of craniofacial tissues. Stem cells and growth factors represent a very interesting research field for craniofacial tissues regeneration. They represent a potential key component in autologous graft for craniofacial tissues regeneration. An ideal goal of oral-craniofacial dental reconstructive therapy is to establish treatment modalities that predictably restore functional tissues. One major area of focus has been that of dental materials with marked improvements in the design of materials used to restore teeth/periodontium/bone lost as a consequence of disease or disorders. Interest in these technologies continues to increase in dental application as a substitute for traditional treatments and artificial components. Recent progress in the studies of molecular basis of tooth development, adult stem cell biology, and regeneration will provide fundamental knowledge for the realization of human craniofacial tissues regeneration in the near future.     

A Clinical and Histological Case Series Study on Calcium Sulfate for Maxillary Sinus Floor Augmentation and Delayed Placement of Dental Implants

Background: Maxillary sinus floor augmentation is a procedure that is indicated in cases when the volume of the posterior maxillary bone is inadequate. The goal of this treatment is to obtain sufficient amount of bone tissue in order to gain osseointegration of endosseous implants. Purpose: The purpose of this study was to conduct a clinical and histological analysis of calcium sulfate (CaS) as bone graft substitute in sinus floor augmentation. Material and Methods: Ten patients with edentulous maxillas were included in this study. They had moderate to severe atrophy of the posterior maxilla. Surgiplaster (Classimplant®, Rome, Italy) was used as graft material in the maxillary sinus and was covered by BioGide® (Geistlish Pharmaceutical, Wolhusen, Switzerland). After 4 months of graft healing, 40 dental implants were placed and a biopsy for histomorphometry was taken at these occasions. The specimens were viewed by light microscope, and the extent of bone regeneration and remaining graft material was evaluated. Radiographs were taken at the time of sinus augmentation and after 4 months of graft healing. Results: At the time of abutment surgery, one implant was considered as a failure and was consequently removed, giving a survival rate of 97.5% after 1 year of loading. Radiographs showed a mean of 26.5% shrinkage of the augmented area. A significant resorption of CaS was noted with a mean value of 8.8% of remaining graft material after 4 months of healing. The biopsies also revealed new bone formation with a mean value of 21.2% of the total biopsy area. Histology showed signs of an acellular substitution of CaS with bone‐like tissue. Conclusion: The results of this study show that new bone regeneration occurs in the maxillary sinus after augmentation with CaS. This enabled successful placement, integration, and loading of dental implants in the posterior maxilla, as only 1 of 40 implants was lost during 1 year of follow‐up.     

rhBMP-2、PRF和自体骨分别复合珊瑚羟基磷灰石成骨效能的比较研究

目的：通过建立动物骨缺损模型,比较重组人骨形成蛋白-2（rhBMP-2）与珊瑚羟基磷灰石（CHA）复合物、富血小板纤维蛋白（PRF）与珊瑚羟基磷灰石复合物、自体骨与珊瑚羟基磷灰石复合物以及单纯珊瑚羟基磷灰石这四种骨移植材料在骨缺损中的成骨效能。方法：在比格犬双侧胫骨干骺端制备四个相同的骨缺损区,在缺损区分别植入rhBMP-2/CHA、 PRF/CHA、自体骨/CHA及CHA （对照）;3个月后处死动物,行大体标本观察;拍牙科CT,观察各植骨区骨密度情况;制作石蜡切片、 HE染色,比较各植骨区骨组织学特点及新骨形成量。结果：大体标本见四组骨缺损间隙均完全关闭。 X线示自体骨/CHA组和PRF/CHA组骨密度较致密, rhBMP-2/CHA组致密性低于前两者, CHA组未见明显骨致密影。 HE切片见四组新生骨与宿主骨连接紧密,新生骨小梁不规则,粗细不一,排列无序;复合型骨移植材料的新生骨小梁比对照组更密集、粗大,连续性更好;四组植骨区成骨量比较：自体骨/CHA组〉PRF/CHA组〉rhBMP-2/CHA组〉CHA组。结论：复合型骨移植材料成骨效应明显优于单纯珊瑚羟基磷灰石;三种复合型材料中自体骨/CHA成骨效应最好,其次为PRF/CHA, rhBMP-2/CHA最差。     

Guided Tissue Regeneration in Class IV External Cervical Resorption: A Case Report

External cervical resorption (ECR) is a type of dental resorption that originates from the loss of the cementum's protective layer. The direct exposure of dentin to the periodontal ligament may lead to the invasion of clastic cells through an entry point on the external root surface into the dentinal tissue, causing resorption. Depending on the extension of ECR, different treatments are proposed. Although the literature presents distinct materials and methods for restoring ECR areas, an existing gap is related to care in the treatment of the supporting periodontal tissue. Guided tissue regeneration (GTR)/guided bone regeneration includes the stimulation of bone formation in bone defects using different types of membranes (resorbable and nonresorbable), regardless of its association with bone substitutes or grafts. Despite the benefits of guided bone regeneration, the application of this method in cases of ECR is still under-explored in the literature. Thus, the present case report uses GTR with xenogenic material and polydioxanone membrane in a case of class IV ECR. The success of the present case is related to the correct diagnosis and treatment plan. Complete debridement of resorption areas and restoration with biodentine were effective in tooth repair. GTR contributed to the stabilization of supporting periodontal tissues. The association of the xenogeneic bone graft with the polydioxanone membrane proved to be a viable option for restoring the health of the periodontium.