Clinical study of restoration of bone defect in cleft alveolus with β-tricalcium phosphate

目的 采用颗粒状β-磷酸三钙(β-TCP)修复牙槽嵴裂,观察其临床效果,探寻一种理想的可代替自体骨修复牙槽嵴裂的人工材料.方法 将24例先天性牙槽嵴裂患者分成A、B两组,A组 (10例)用自体骼骨松质骨修复牙槽嵴裂骨缺损,B组 (14例)用颗粒状β-TCP修复牙槽嵴裂隙.术后7天观察两组患者伤口愈合情况,并于术前、术后4~6个月,采用锥形束CT(CBCT)及三维重建的方法观察牙槽嵴裂骨缺损新骨形成的情况,比较两种植骨材料的植骨效果.结果 术后1周,A组1例患者出现感染症状,其余患者伤口均一期愈合,无感染、裂开及排异反应.术后4~6个月CBCT扫描及三维重建显示两种材料植入后均可形成新骨,与原裂隙两侧骨组织部分或完全连续.两种材料修复牙槽嵴裂骨缺损的临床成功率无显著差异.结论 颗粒状人工材料β-TCP的成骨效果与自体骼骨骨松质无显著差异,可以代替自体骨修复牙槽嵴裂.     

β-磷酸三钙用于牙槽嵴裂骨缺损修复的临床研究

目的采用颗粒状β-磷酸三钙(β-TCP)修复牙槽嵴裂,观察其临床效果,探寻一种理想的可代替自体骨修复牙槽嵴裂的人工材料。方法将24例先天性牙槽嵴裂患者分成A、B两组,A组(10例)用自体骼骨松质骨修复牙槽嵴裂骨缺损,B组(14例)用颗粒状β-TCP修复牙槽嵴裂隙。术后7天观察两组患者伤口愈合情况,并于术前、术后4～6个月,采用锥形束CT(CBCT)及三维重建的方法观察牙槽嵴裂骨缺损新骨形成的情况,比较两种植骨材料的植骨效果。结果术后1周,A组1例患者出现感染症状,其余患者伤口均一期愈合,无感染、裂开及排异反应。术后4～6个月CBCT扫描及三维重建显示两种材料植入后均可形成新骨,与原裂隙两侧骨组织部分或完全连续。两种材料修复牙槽嵴裂骨缺损的临床成功率无显著差异。结论颗粒状人工材料β-TCP的成骨效果与自体骼骨骨松质无显著差异,可以代替自体骨修复牙槽嵴裂。     

膜引导骨再生术在前牙区种植术中的应用

目的：评价膜引导骨再生术（GBR）在前牙区种植中的应用价值。方法：对22例前牙缺失患者按照牙槽骨唇舌向厚度不同分为两组,A组12例,牙槽嵴唇舌向厚度〈6 mm,行GBR＋牙种植术,B组10例,唇舌侧牙槽嵴厚度〉6 mm,行牙种植术,通过临床和放射学检查对比分析种植术后半年、种植体负载1年后的牙槽骨的厚度及高度变化。结果：种植术后半年A组患者牙槽嵴唇舌向宽度较术前明显增宽（P〈0.05）,种植体负载1年后,A组患者与B组患者牙槽骨唇舌向及垂直向均有少量吸收,两组间无明显差异（P〉0.05）。结论：对前牙区牙槽骨骨量不足的患者同期行GBR和种植体植入术效果好,可很好地解决骨组织不足的问题,可拓宽前牙区种植术的适应症。     

环状自体骨在严重牙槽骨吸收同期种植中的应用

目的:探讨应用环状自体骨移植对严重牙槽骨吸收同期种植的骨增量手术方法。方法:9例重度牙槽骨吸收患者接受了环状自体骨移植,同期植入12枚种植体。结果:所有种植体均成功植入,初期稳定性好,全部Ⅰ期愈合,术后X线片显示骨愈合良好,垂直骨骨高度增量3.68-6.17mm。平均骨增量高度4.70mm。结论:环状自体骨用于严重牙槽嵴的吸收并同期植入种植体手术方法简单,周期短,疗效可靠,值得临床推广。     

自体牙来源骨移植材料在口腔种植中应用的短期临床观察

目的:观察使用椅旁拔除的自体牙,即刻制备为骨移植材料,用于牙槽嵴骨增量的短期临床效果。方法:拔除患者因龋坏或牙周病无法保留的废弃牙、阻生牙,在椅旁即刻制备为粉状或块状骨移植材料,用于重建缺损牙槽嵴,同期或延期植入种植体。二期手术及种植修复完成后对治疗的预后,影像学检查和种植体存留率进行评估。结果:临床观察显示所有病例骨增量区创口愈合良好,无骨增量相关并发症的发生,全景片及CBCT显示种植体骨结合良好,所有种植体在功能性负载后3～6个月的观察期内无一例失败,种植修复取得了较好的临床效果,存留率100%。结论:椅旁即刻制备的自体牙骨移植材料,成骨效果良好,可用于牙槽嵴骨缺损的重建,有望成为继自体骨和人工骨移植材料之后,又一种新型骨替代材料。     

不同骨移植材料用于种植同期GBR术式的临床比较

目的：比较不同骨移植材料在种植同期行膜引导骨冉生（GBR）手术式的临床效果。方法：69例单牙缺失的种植修复病例,根据骨移楠材料的不同分为3组：A组采用人工骨;B组采用人工骨与自体骨混合;C组为自体骨。常规完成种植删期GBR手术式,6个月后再次翻瓣,比较其骨移植临床效果。结果：A组20例中有5例发生移植骨未格合机体暴露,B组25例中有2例发生移植骨未整合植体暴露,C组24例中有3例发生移植骨术整介植体暴露。经统计学分析,三组骨移植临床效果差异无统计学意义。结论：临床观察,三种骨移植材料GBR于术式短期内骨移植临床效果无明显差异。     

应用下颌隆突进行牙槽嵴增量和上颌窦提升：病例报告

本文报道了应用下颌隆突作为自体骨移植的供骨源进行牙槽嵴增量和上颌窦提升植骨．使种植体获得理想的植入位置。1例伴有双侧下颌舌侧隆突患者需要修复缺失的上颌磨牙和下颌前磨牙。两个缺失牙区域的牙槽嵴均存在骨量不足，种植前需要进行骨移植。下颌隆突被用于下颌牙槽嵴的侧方增量以及为增加上颌牙槽嵴垂直高度而进行的上颔窦提升。植骨术后6个月，两个植骨区均可见足够的新骨形成。植骨区新形成的骨质形态与正常骨质相一致。种植体成功植入并负重，美观和功能得到恢复。通过本病例的观察，下颌隆突可用于牙槽嵴增量和上颌窦提升。但是下颌隆突作为自体骨移植的供骨源，其疗效尚有待进一步的临床研究。     

骨片移植技术与引导性骨再生技术的牙槽嵴水平骨增量效果及患者疼痛度比较

目的：比较以生物学为导向的骨增量技术中骨片移植技术（BBA）和引导性骨再生技术（GBR）在刀刃状牙槽嵴骨增量中的临床效果及患者术中术后的疼痛VAS视觉量表。方法：收集2020年1月至2022年12月50例需通过植骨后行种植牙修复的刀刃状牙槽嵴患者，由同一位经验丰富的外科医生连续进行了50次手术，其中23例采用BBA手术（BBA组），27例采用GBR手术（GBR组）。在CBCT图像上进行测量水平牙槽骨宽度，对比手术前以及手术后半年的牙槽骨宽度，计算水平骨增量的变化。同时对患者术前和术后进行疼痛VAS视觉量表分析。结果：BBA组及GBR组对术前、术后6月的牙槽骨宽度行配对样本t检验，BBA组牙槽骨宽度增加明显大于GBR组（P<0.05）。对BBA组及GBR组的水平骨增量行独立样本t检验，BBA组水平骨增量明显大于GBR组（P<0.05）。对BBA组及GBR组的VAS疼痛视觉量表评分行独立样本t检验分析，BBA组患者术中、术后2小时、术后7天的疼痛度高于GBR组（P<0.05），两组患者术后1天及术后3天疼痛相同（P>0.05）。结论：虽然采用BBA技术的种植牙患者在...     

嵌贴式植骨术在牙槽嵴严重吸收患者牙种植术中的应用

目的:总结嵌贴式植骨方法进行缺牙后重度吸收牙槽嵴骨增量的植骨技术及其效果。方法:15例重度吸收牙槽嵴患者接受了嵌贴式植骨术,分别于植骨12～24周后植入种植体,共植入26枚种植体。术后16～24周行种植体基台连接术及烤瓷冠或烤瓷桥修复。结果:术后12周复诊二期植入种植体者,术中见植骨块吸收很少,所有患者均成功完成了种植修复。15例植骨患者中,3例出现术后感染,但仍获一定程度的骨增量效果,12例无并发症。所有病例修复后追踪24～48周,无种植体脱落。结论:嵌贴式植骨技术应用于严重吸收牙槽嵴骨增量操作简单,效果可靠。     

不同年龄组牙槽嵴裂植骨术后牙槽嵴高度的临床观察

目的：评价在不同年龄阶段髂骨松质骨移植修复牙槽嵴裂术后植入骨的变化情况。方法：根据牙槽嵴裂患者裂隙侧尖牙萌出情况，将其分为A、B两组，通过牙槽嵴裂植骨术后临床随访和拍摄X线，追踪观察植骨区牙槽嵴高度的变化。结果：尖牙萌出前植骨优于尖牙萌出后植骨，术后正畸可增高牙槽嵴的高度。结论：牙萌出可增高牙槽嵴裂患者植骨术后牙槽嵴的高度。     

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 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.     

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.     

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.     

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.     

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.     

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.