甲状旁腺激素对种植体骨结合影响的研究现状

甲状旁腺激素(parathyroid hormone,PTH)因具有调节机体钙、磷代谢的重要作用,而被广泛应用于骨质疏松症的临床治疗。研究发现PTH在骨组织代谢过程中具有促进骨形成和骨吸收的双重效应,其最终的作用效果与给药方式和剂量等因素有密切的关系。另外,PTH被证明对促进种植体骨结合具有积极作用。但是其具体作用机制、使用方法和剂量等问题仍待进一步研究。本文就目前关于甲状旁腺激素对种植体骨结合影响的研究作一综述。     

骨质疏松症及其对种植体骨结合影响的研究进展

骨质疏松症（OP）是一种常见的老年性骨代谢疾病,病因复杂且缺乏有效防治方法,剩余牙槽嵴吸收是全身性OP的局部及早期表现,种植体能否在患有OP的颌骨中形成良好的骨结合尚存争议,本文对OP的遗传学病因,代谢,愈合及其对种植体骨结合影响的研究进展和提高种植体骨结构的方法进行了综述。     

骨质疏松症及其对种植体骨结合影响的研究进展

骨质疏松症(OP)是一种常见的老年性骨代谢疾病,病因复杂且缺乏有效防治方法。剩余牙槽嵴吸收是全身性OP的局部及早期表现,种植体能否在患有OP的颌骨中形成良好的骨结合尚存争议。本文对OP的遗传学病因、代谢、愈合及其对种植体骨结合影响的研究进展和提高种植体骨结合的方法进行了综述。     

激素对种植体-骨整合的促进作用的研究进展

激素是调节骨代谢的重要角色,而骨密度和骨质疏松状况在种植体-骨整合中起着至关重要的作用.近年来,很多学者试图通过研究某种激素对骨代谢的调节作用来增强骨与种植体的结合,尤其是改善某些疾病状况下的骨-种植体结合情况,以扩大种植义齿适应证,提高种植牙的成功率.本文主要对生长素、雌激素、降钙素、糖皮质激素、胰岛素这几种与骨代谢密切相关的激素对种植体-骨整合的促进作用的研究现状及进展,作一综述.     

放疗对骨组织及种植体周围骨结合影响的研究进展

种植义齿逐渐成为牙列缺损和牙列缺失成年患者的最佳修复方法。对于头颈部恶性肿瘤患者,通常采取手术切除联合放化疗。然而,放疗对机体颌骨组织产生一定的损害,进而间接影响种植体周围的骨结合。本文将主要就放疗对骨组织的影响及放疗对种植体周围骨结合的作用作一综述。     

高脂血症对钛种植体骨结合影响的研究进展

高脂血症是常见的全身代谢性疾病,中老年人多见,发病率较高。高脂血症是种植治疗的风险因素之一,可引起种植体骨结合不良,从而影响种植义齿的临床疗效。本文针对高脂血症对钛种植体骨结合影响的研究进展作一综述。     

种植体表面处理技术对骨结合影响研究进展

种植修复在临床的推广应用，引发了种植骨结合领域的研究热潮。种植体表面经过处理，可改变其表面性能，从而促进骨结合的形成，提高种植的成功率。本文对近年来应用于临床的多种种植体表面处理技术做一综述。     

骨结合种植体骨界面组织学三维重建研究进展

种植与骨界面的骨结合被认为是骨内种植体成功的标志,而骨界面组织学的研究多为二维图像,计算机三维重建技术可以从立体角度多层次,多方位地进行研究,可以得到直观的种植与体骨界面各部位形态的计算机图像,同时获得种植周转各部位的骨结合楷。     

种植体表面修饰影响骨结合机制研究进展

<正>钛及其合金具有化学稳定性高,弹性模量等力学性能与骨组织比较匹配等优点,是广泛应用的人体硬组织修复材料。钛及其合金本质上是生物惰性     

BLB种植体表面处理对骨结合的影响

目的：探讨不同种植体表面处理对BLB种植体骨结合的影响。方法：6只Beagle犬,每犬双侧第二、三、四前磨牙即刻随机植入BLBⅠ（HA）、BLBⅢ（HA＋SLA）种植体各3颗。术后2、4、8周各处死2只动物,选取BLBⅠ为A组,BLBⅢ为B组。通过大体标本、组织形态学及骨-种植体磨片观察等手段,观察术后2、4、8周时种植体的骨结合情况。应用SPSS12.0软件包对实验结果进行F检验。结果：种植术后2、4周,B组种植体骨结合率显著高于A组（P〈0.05）;术后8周,B组与A组种植体骨结合率无显著差异。结论：BLBⅢ种植体可在一段时间内缩短种植体周围骨的生长时间,提高种植体的骨结合率。     

影响纯钛种植体骨整合界面形成的临床因素分析

目的 通过临床实践探讨影响钝钛种植体骨整合界面形成的因素,寻求防治措施,提高种植义齿的成功率。方法 对230例门诊种植病人采用Branemark纯钛种植体行延期种植术,3～6个月后行Ⅱ期手术。结合X线及术中所见,评价钝钛种植体骨整合界面形成状况。结果 在植入的520颗纯钛种植体中,获得骨整合界面的有503颗,失败17颗,成功率96.7%。结论 影响纯钛种植体骨整合界面形成的因素有术前严格选择适应证及充分的术前准备,防止骨灼烧,预防感染,防止术中种植体被污染。     

同时应用雌激素和二膦酸盐对骨质疏松大鼠种植体骨结合的累加效应

目的:研究在切除卵巢的大鼠体内,局部应用二膦酸盐(BPs)和全身应用雌激素,对有羟基磷灰石(HA)涂层的种植体骨结合的影响.方法:20只雌性大鼠接受双侧卵巢切除术12周后,在每只大鼠的双侧胫骨近端各植入1颗含有HA涂层的种植体,植入左侧胫骨的种植体携带BPs,植入右侧胫骨的种植体不含BPs.大鼠平均分成2组,其中一组接受17β-雌二醇(E)皮下注射,另一组注射安慰剂.4组大鼠分别为:对照组、雌激素组(E组)、二膦酸盐组(BPs组)、雌激素+二膦酸盐组(E+ BPs组).种植手术12周后,手术取出带有种植体的胫骨,用显微CT和推出试验来评估骨结合效果.结果:E+BPs组与空白对照组相比,种植体周围的相对骨体积增加了2.3倍,骨结合率增加了1.9倍,最大推出力增加了3.3倍.E组和BPs组种植体的固位力也增加了,但效果弱于E+BPs组.结论:全身应用雌激素和局部应用BPs对涂有HA涂层的种植体的骨结合具有累加效果.     

锶磷灰石涂层钛种植体骨结合的动物实验

目的 观察微弧氧化锶磷灰石(strontium-substituted hydroxyapatite,Sr-HA)涂层钛种植体的成骨活性,探讨锶元素掺入羟基磷灰石(hydroxyapatite,HA)涂层后对骨结合的影响.方法 分别对实验组(Sr-HA涂层种植体)和对照组(HA涂层种植体)的表面形貌进行扫描电镜观察,并采用X线衍射仪分析膜层相组成.将两组种植体各12枚植入新西兰兔双侧股骨髁下外侧、胫骨结节处,术后对实验动物进行多荧光序列标记,饲养4周和12周取材,采用组织学观察、种植-骨界面线扫描分析评价涂层的骨结合能力.结果 种植体微弧氧化膜层均呈现多级孔洞状结构;X射线衍射分析显示,锶元素的掺入引起HA的衍射峰向小角度方向偏移,晶格间距增大,稳定性下降;多荧光序列标记显示,Sr-HA涂层早期即表现出成骨活性,实验组骨矿化沉积率[(4.75±0.46)μm/d]显著高于对照组[(3.21±0.44)μm/d];组织染色及能谱分析显示,骨种植界面上有生物类骨磷灰石层形成,12周时该磷灰石层转化为成熟的骨组织并与涂层形成紧密的骨结合.结论 锶元素的掺入可提高Sr-HA涂层的生物学活性,加速其表面生物类骨磷灰石层的形成,增强膜层的成骨能力,促进膜层与骨组织的结合.     

The effect of low-intensity pulsed ultrasound on the osseointegration of titanium dental implants

Our aim was to record the effect of low-intensity pulsed ultrasound (LIPUS) on the osseointegration of endosseous dental implants in 10 New Zealand rabbits. One titanium implant with screw was inserted into the metaphyseal region of each femur and tibia in the knee joints of each rabbit, making a total of 40 implants. The area of one lateral knee joint, including implants, was irradiated with LIPUS for 10 min twice a day for 21 days. The other side acted as control, having been given "sham" irradiation. Two rabbits were killed at each of 0, 2, 4, 6, and 8 weeks after irradiation. A micro-computed tomogram (μCT), histological examination, and implant pull-out test were used to judge the reactions of the bone to the titanium implant. Histological and μCT examinations showed that osseointegration of the implants on the LIPUS-treated side happened earlier and more effectively than on the control side. The mechanical test showed that the maximal axial pull-out strength of the implants on the LIPUS-treated side was greater than that on the control side. We conclude that LIPUS has the potential to accelerate the osseointegration of dental implants.     

TM种植体的表面特征与骨整合

目的 对ＴＭ种植体的阳佳表面特征进行研究。方法 选用３种不同表面特征的ＴＭ种植体,建立山羊下颌骨种种植模型。通过骨一种植体硬组织切片,观察了骨一种植体界面。结果 粗化处理有利于骨整合的发生,低结晶度的生物生陶瓷涂层更有利于骨整合,且便于倒楔形间隙的骨形成。结论 ＴＭ种植体的表面最好采用低结晶度的生物活性陶瓷涂层。     

Effect of hyaluronic acid on the osseointegration of dental implants

The mechanism of osseointegration is related to many factors, including the quality of the bone, the biocompatibility and surface characteristics of the implant material, the surgical technique, and functional loading. The purpose of this study was to investigate the effects of hyaluronic acid gel on the osseointegration of implants placed in defined areas of the mandible in rabbits. Hyaluronic acid is known to have an osteoinductive effect during regeneration of bony defects, and we thought that it might also have a favourable effect on osseointegration, a specialised mechanism to heal bone. Ten New Zealand rabbits aged 10 weeks and weighing 2.5–3.0 kg were used, and sites for implants that were far enough from the apices of the teeth in the mandibular molar area were chosen. Two cavities were prepared in each rabbit, one (anterior) for the control implant, and one (posterior) for the implant with hyaluronic acid gel (Medical Instinct GmbH, Bovenden). New bone and the osteoid matrix content around the dental implants were evaluated histologically and histomorphometrically two months after the operation, and no significant difference was found between the two groups.     

补锌对种植体骨整合率影响的实验研究

目的：探讨微量元素锌对种植体骨整合率的作用。方法：应用家兔钛种植体动物模型，测定补锌对种植体骨整合率的影响，在家兔双侧胫骨近心端各植入1枚钛种植体后，动物随机分为补锌组和对照组，补锌组动物肌注10g/L硫酸锌，4mg/kg，1次/d。对照组则肌注等量的生理盐水，1次/d。分别于术后1、2、4、8、12周处死动物，测定种植体骨整合率，种植区骨锌含量，血清Cu/Zn值等指标，结果：补锌能够使种植区骨锌的含量在术后1-4周显著增高，从而促进种植损伤区骨的形成和钙化，提高种植体的骨整合率，结论：种植体术后早期（1-2周）适量的补锌能够提高种植体骨整合的速度和质量，且对机体代谢无明显影响，是安全的。     

低强度脉冲超声促进钛种植体骨结合的实验研究

目的 建立种植体植入动物模型,研究低强度脉冲超声(low intensity pulsed ultrasound,LIPUS)对种植体骨结合的促进作用.方法 选用雌性SD大鼠24只,每只大鼠双侧胫骨干骺端内侧植入螺纹状钛种植体.植入术后第2天对右侧胫骨种植体周围进行LIPUS刺激作为实验侧,每日20 min,左侧胫骨种植体植入部位不刺激作为自身对照侧.超声刺激后第4、8、12 周分批处死动物,每批8只,获取双侧胫骨标本.采用X线片、显微CT、组织切片等观察LIPUS对种植体骨结合的作用.结果 3个时间点种植体与骨组织之间均形成了不同程度的骨结合.显微CT组织形态计量学分析结果显示,种植体周骨结合率在实验侧第4、8、12周分别为(45.708±3.316)%、(46.231±1.954)%、(46.807±1.451)%,在对照侧分别为(43.021±3.558)%、(44.272±3.023)%、(44.894±4.215)%,第4周时差异具有统计学意义(P<0.05).种植体周骨体积分数在第4、8周,种植体周骨小梁厚度及第8周、第12周各向异性程度,实验侧均高于自身对照侧,差异有统计学意义(P<0.05).组织学切片可见实验侧种植体周新生骨组织厚度明显大于自身对照侧,骨结合量更多.结论 LIPUS可以促进种植体周围骨组织的愈合,加快种植体骨结合,并能促进骨小梁早期呈一定方向改建.

Abstract：

Objective To establish an animal model of titanium implant and to investigate the effects of low intensity pulsed ultrasound(LIPUS)on the implant osseointegration. Methods Twenty-four female Sprague Dawley(SD)rats were used. Titanium implants were inserted into tibia metaphysis bilaterally in each SD rat. Since the second day following implant surgery, LIPUS stimulation were carried out around the implant on the right side for 20 minutes per day, and implants on the left side remain untouched as self-control. Eight rats were sacrificed and tibiae specimens were harvested on the end of the 4th, 8th, and 12th week respectively. X-ray picture,micro-CT analysis and histological sections were performed to evaluate the effects of LIPUS on the implant osseointegration. Results Osseointegration at the interface between the implant and bone tissue was observed bilaterally. In the micro-CT histomorphometry analysis, the percentage of osseointegration(%OI)of experiment side were (45.708±3.316)%, (46.231±1.954)%, and (46.807±1.451)% on the end of the 4th, 8th, and 12th week. Meanwhile, the %OI of control side were (43.021±3.558)%, (44.272±3.023)%, and (44.894±4.215)% respectively. The %OI on the 4th weekend, bone volume ratio(BV/TV)on the 4th and 8th weekend,trabecular thickness(Tb. Th)and degree of anisotropy(DA)on the 8th and 12th weekend of the experiment side tibia were significantly greater than those on the control side(P<0.05). The histological examination showed that the thickness of new bone around the implant and the bone-implant contact area was obviously greater in the LIPUS treated side compared to the control side.Conclusions The LIPUS therapy may accelerate the bone healing and osseointegration at the interface between titanium implant and bone, and promote remodeling of bone trabecula on the early stage.     

用唑来膦酸处理Bio-oss和种植体促进移植物愈合及在骨质疏松条件下种植体骨结合

目的:研究唑来膦酸处理颗粒状植骨材料Bio-oss及种植体对植骨愈合和种植体骨结合的影响。方法:40只雌性SD大鼠随机分成3组:假手术组(A,n=15)、卵巢切除组(B,n=15)和唑来膦酸治疗组(C,n=10)。B、C组行双侧卵巢切除术。术后12周分别测量A组、B组大鼠股骨骨密度(BMD),组织学改变骨质疏松状态。在大鼠右侧胫骨近中干骺端植入羟基磷灰石涂层种植体,并于种植体旁制备骨缺损,Bio-oss同期植入术。C组种植体及Bio-oss在术前用唑来膦酸处理。种植术后第4、12周分2批处死动物,制作不脱钙标本切片,形态学观察及骨计量学检测。结果:卵巢切除组与假手术组比较股骨BMD显著降低(P<0.01),证实骨质疏松造模成功。种植术后4、12周,B组TCBI、BCR、NBV、ERBP均显著低于A组和C组(P<0.01);而C组除TCB显著低于A组外,其它指标均显著高于A组(P<0.01)。结论:实验性骨质疏松可延迟Bio-oss植骨愈合,降低种植体骨结合率;唑来膦酸局部应用可拮抗骨质疏松的影响,促进植骨愈合,增加种植体骨结合率。     

Systematic review of wound healing biomarkers in peri-implant crevicular fluid during osseointegration

ObjectiveTo quantify and characterize the role of biomarkers in peri-implant crevicular fluid (PICF) at each stage of healing during osseointegration.DesignThis systematic review was performed in accordance with PRISMA guidelines using several databases: MedLine (PubMed), Embase, ISI Web of Science, Scopus, and Cochrane Library. Medical subject headings and their indexers were used with no other limitations until December 2017. The dataset was extended with relevant papers from the reference lists of selected papers and from the gray literature. Data was summarized for study objectives, patient demographics, methods used to analyze PICF, biomarker concentrations, results and main findings. Methodologic quality of each included study was assessed using the checklist created by Downs and Black.ResultsElectronic search resulted in 1698 articles. After excluding the duplicates, reading titles, abstracts and reference list reviews 30 prospective studies with longitudinal follow-up were selected. In total, 52 different biomarkers were identified. The most studied cytokines were interleukin (IL)-1, IL-1β, tumor necrosis factor alpha (TNF-α), and nitric oxide (NO). The earliest PICF specimens were collected immediately after implantation, and the latest at 16 weeks prior to occlusal loading. 36 biomarkers were quantified during week 1, 49 between day 10 and week 6, and 49 between weeks 8 and 12. Only 5 articles received good quality ratings.ConclusionThe mechanism by which inflammatory and bone biomarkers are released during osseointegration has not yet been identified. However, some hypotheses based on immune-modulated reactions are being explored to investigate early and asymptomatic implant failures. Given the available clinical studies, it was not possible to further explore the performance of all biomarkers already analyzed and to extrapolate their results to propose a consultable data system based on release volume or concentration because of clinical study and data heterogeneity.