Bio-oss植骨材料在Replace select即刻种植的应用

目的：谈讨Bio—oss植骨材料在Replace select即刻种植的临床应用。方法：拔除患牙，采用Replace select种植系统的操作方法，将Replace select种植体即刻植入拔牙创，植入Bio—oss骨粉，必要时加盖Bio—gide可吸收胶原膜；1～6个月后，进行Ⅱ期手术，1周后，完成固定修复。结果：57枚即刻种植的Replace select种植体中，上颌36枚，下颌21枚，观察最长20个月，最短6个月，种植体存留率为100％。结论：Bio—oss植骨材料在Replace select即刻种植的临床结果是满意的，其长期效果有待进一步的观察。     

牙种植手术中自体骨的收集和应用

目的：研究牙种植过程中，收集自体骨即刻移植修复种植体周围小型骨缺损的临床疗效。方法：2003年10月至2005年10月，选择14例牙种植患者，植入25颗种植体时发生17处骨缺损，其中开窗式骨缺损9处，烦（舌）侧种植体颈部暴露8处。在牙种植窝制备过程中，应用自制的集骨器收集随冷却水流出的骨屑，并将其即刻移植或与Bio—oss混合后移植修复骨缺损。结果：牙种植术后3-6个月，原缺损处局部形态饱满，X线片示种植体与周围牙槽骨形成良好的骨结合，二期手术时见缺损处巳覆盖成熟骨质，移植骨成活良好。结论：应用自制集骨器获得的收集骨修复种植体周围小型骨缺损，方法简单实用。     

Bio-Gide生物膜引导再生骨中种植体短期成功率的临床回顾

目的：评估141例通过Bio-Gide生物膜引导的再生骨中种植和负重的259枚种植体的成功率方法：选择种植术区存在骨缺损，可通过GBR技术修复骨缺损的患者141例其中123例202枚种植体周存在水平向骨吸收，种植体通过GBR可同期植入；18例57枚种植体周骨缺损量较大，存在垂直向多壁骨缺损，需先通过GBR技术引导新骨生成，6—8个月后再植入种植体。生物膜均采用可吸收性的Bio—Gide膜，骨移植物为自体骨与Bio—OSS骨粉的混合物术后1、3、6月进行X光检查及临床检查。二期手术时，对新生骨组织量进行评估：种植修复体完成后，分别于戴牙后6、12、24月定期复诊，检查种植体周围骨组织的吸收及种植体周围软组织情况：结果：二期手术时，141例253枚种植体均已与骨组织形成理想的骨结合，6枚种植体周围形成纤维愈合而失败，后经重新种植，所有种植体均顺利完成种植义齿修复。修复后随访6—24个月，种植体均能成功地恢复咬he功能。结论：Bio—Gide生物膜引导再生骨中种植体成功率为96．9％，与正常骨组织中种植修复的成功率不存在明显差异。     

引导骨再生膜技术在上颌前牙缺失伴重度骨缺损中的应用

目的：评价引导骨再生技术（GBR）在上颌前牙缺失伴重度骨缺损的种植修复效果。方法：选择30例上颌前牙缺失伴重度骨缺损患者,植入Xive种植体62枚,在骨缺损区植入Bio-Oss骨粉,Bio-Gide膜覆盖,重建牙槽骨的高度和宽度;8-10个月后二期手术,术后6周种植修复。结果：62枚种植的Xive种植体,观察最长48个月,最短12个月,种植体存留率100%。结论：骨再生引导膜技术（GBR）在上颌前牙缺失伴重度骨缺损中的临床应用效果稳定,有效。     

钛网结合异体骨移植和人骨形成蛋白在上颌前牙种植前牙槽嵴骨增量中的应用研究（附1例报告）

编者按：本刊特邀美国德克萨斯健康研究中心牙学院Bing-Yan Wang副教授介绍1例在上颌前牙牙槽骨严重缺损区实现骨增量的病例。在拔牙同期用异体骨和Bio-Mend延展膜进行引导骨再生术后未获得满意骨量的情况下,无法进行种植手术,术者用钛网结合异体骨移植材料和人骨形成蛋白在种植体植入前修复上前牙区部分牙缺失部位的牙槽骨缺损,最终获得成功。通过这种方法扩大了在上前牙牙槽骨严重骨缺损区种植的适应证,为患者提供了除自体骨移植以外的另一个选择。     

骨引导再生技术在牙槽骨骨量不足牙种植术中的应用

目的:评价骨引导再生技术在牙槽骨骨量不足患者牙种植术的应用效果.方法:对23例31颗牙槽骨骨量不足患者,种植体周围骨缺损处用人工骨粉植入及胶原生物膜覆盖.随访6-12个月,通过临床检查及x线曲面断层片,观察其临床效果.结果:随访6-12个月,种植牙形态及功能良好,x线检查未见明显骨吸收.种植牙100％成功.结论:对牙槽骨骨量不足患者,同期行GBR和种植体植入术后,可以重建缺损的骨组织,临床效果满意.     

骨劈开、骨挤压联合GBR技术同期植入种植体的临床疗效评价

目的:采用CBCT及临床检查的方法评价骨劈开、骨挤压联合GBR技术同期植入种植体的的临床疗效。方法:采用CBCT检查术前牙槽骨的形态和骨量,唇舌向牙槽骨厚度介于2.5-4mm的病例适用这种技术。方法如下:使用1.0mm细钻针作为引导钻沿种植体拟植入方向钻入所需深度,然后使用骨劈开器沿钻孔方向劈开牙槽嵴,使用BICON手用扩孔器械逐级备洞,并挤压劈开的唇侧骨板,收集自体骨骨屑,同时撑开牙槽骨增加宽度,植入种植体。在骨质缺损区暴露的种植体表面和较薄的唇侧骨板表面先铺放获得的自体骨屑,然后再铺放人工骨粉,最后以胶原膜覆盖植骨区。6个月后,CBCT复查,完成修复。随访2年。结果:40例患者接受了这种骨增量技术治疗,共植入56颗种植体,均获得成功,平均增加牙槽骨宽度3.5mm。讨论:牙缺失后常常造成骨量不足,单一技术的运用不能获得良好的骨增量效果。骨劈开、骨挤压联合GBR技术是一种综合性的微创骨增量技术,获得了肯定的临床效果。结论:骨劈开、骨挤压联合GBR技术并同期植入种植体是一种有效的骨增量种植方式。     

引导骨再生技术应用于前牙美学区种植临床效果观察

目的：评价引导骨再生技术在上前牙美学区种植中应用的临床美学效果。方法：单颗前牙种植成功病例29例,其中以引导骨再生种植修复的上前牙二期种植12例为观察组,种植体植入的同时行骨粉充填骨缺损区,再用胶原再生膜覆盖进行骨增量,有效增加牙槽骨的厚度及宽度;另外17例选用未行骨增量常规上前牙二期种植患者为对照组。两组均在术后4—6月暴露种植体完成最终修复,在牙冠戴入当天和种植牙负重6月及12月分别拍摄口内照片、DR全景片,测量和评价二组的PES指数和种植体周围骨水平,比较两组各时间段种植体周围骨水平及软组织红色美学指数统计学差异。结果：所有种植修复负重1年后的临床观察,各个时间段两组问的红色美学指数经检验无统计学差异（P〉O．05）;负重后6～12个月观察组种植体周围骨水平稳定,均位于第一螺纹上方,负重12个月后两组MBL均值差异无显著性（P〉0．05）。结论：引导骨再生种植能获得与正常骨组织种植修复相似临床美学效果。     

BIO-OSS和BIO-GIDE在骨量不足的牙种植术中的运用

目的：通过应用BIO-OSS骨移植和BIO-GIDE引导骨再生技米于牙种植术中，观察其促进部分缺失牙槽骨再生的临床效果。方法：选择拔牙区颊侧骨扳萎缩吸收或牙槽骨缺损的患者作为研究的对象，在行种植体植入的同时行骨粉充填或在植牙前先行骨粉充填骨缺损区，再用胶原再生膜覆盖在骨移植材料上或颊侧种植体暴露和骨面，观察骨组织再生情况及种植体的稳定性。结果：1-3年的放射学和临床观察，表现为种植体周骨组织或骨缺损区骨组织有不同程度的再生，种植体稳固。结论：骨移植和引导骨再生技术用于治疗牙槽骨板萎缩吸收或缺损的患者。有提高牙种植成功率、扩大适应症的作用。     

骨再生引导膜技术在上颌前牙缺失伴重度骨缺损中的应用

目的:评价引导骨再生技术(GBR)在上颌前牙缺失伴重度骨缺损的种植修复效果.方法:选择30例上颌前牙缺失伴重度骨缺损患者,植入Xive种植体62枚,在骨缺损区植入Bio-iss骨粉,Bio-Gide膜覆盖,重建牙槽骨的高度和宽度;3-6个月后二期手术,术后2周种植修复.结果:62枚种植的Xive种植体,观察最长48个月,最短12个月,种植体存留率100%.结论:骨再生引导膜技术(GBR)在上颌前牙缺失伴重度骨缺损中的临床应用结果满意.     

骨引导再生技术在种植体周围牙槽嵴重建中的应用

目的：探讨种植体周围牙槽嵴的重建方式。方法：植A种植体高出牙槽顶骨面，在其周围植入Bio-oss骨粉，以盖嵴式覆以Bio—Gide膜，钛钉固定。分别于术后3、6、8月。通过，临床、X线检查和二期术，观察创面与种植体和周围骨组织结合情况以及牙槽嵴成骨情况。结果：显效34例49枚种植体，无效3例3枚种植体。结论：骨引导再生术可有效重建种植体周围牙槽嵴．     

Clinical implication of bone regeneration in oral surgery

Bone augmentation or the alveolar ridge augmentation procedure is inevitable for functional and esthetic prosthetic oral rehabilitation. In this article, conventional alveolar ridge augmentation methods are clinically demonstrated and are reviewed with reference to literature. In addition, distraction osteogenesis (DO), which has drawn considerable attention as a regenerative medicine, was clinically demonstrated. Then, the conventional augmentation methods and distraction are compared. Indications, advantages, and disadvantages of conventional augmentation methods including bone grafts, guided bone regeneration (GBR) and GBR with titanium micromesh (TIME technique) are demonstrated. Next, the mechanisms, indications, and advantages of DO are demonstrated and compared with conventional methods. Although conventional augmentation methods are well established, there are some problems including donor site morbidity and risks of wound dehiscence and infection. DO seems to have advantages compared to conventional augmentation methods. However, there still have some clinical problems such as difficulty in vector control and technique sensitivity. For less morbidity and better efficacy in alveolar ridge bone augmentation, tissue engineering offers potential in the future. However, further basic and clinical study will be necessary for clinical application.     

帐篷螺丝技术与常规GBR在水平骨增量的临床疗效对比

如今,随着外科技术的创新以及骨替代材料的发展,国内外学者已提出多种水平骨增量技术可以重建牙槽嵴的轮廓,为种植体的初期稳定性提供可靠的保障。然而这些技术的成功也会受到一些因素的影响,本文就水平骨增量的技术要点展开论述,并通过两个病例对帐篷螺丝技术与常规GBR技术用于水平骨增量的临床疗效进行对比、分析,旨在为临床医生对严重牙槽嵴萎缩病例行水平骨增量术的方法选择提供参考。     

Bone reconstruction following implantation of rhBMP-2 and guided bone regeneration in canine alveolar ridge defects

BACKGROUND: Alveolar ridge aberrations commonly require bone augmentation procedures for optimal placement of endosseous dental implants. The objective of this study was to evaluate local bone formation following implantation of recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS) carrier with or without provisions for guided bone regeneration (GBR) as potential treatment modalities for alveolar augmentation. METHODS: Surgically induced, large, mandibular alveolar ridge saddle-type defects (2 defects/jaw quadrant) in seven young adult Hound dogs were assigned to receive rhBMP-2/ACS, rhBMP-2/ACS combined with GBR (rhBMP-2/GBR), GBR, and surgery controls. The animals were euthanized at 12 weeks post-surgery when block sections of the defect sites were collected for histologic analysis. RESULTS: Clinical complications included swelling for sites receiving rhBMP-2 and wound failure with exposure of the barrier device for sites receiving GBR (4/6) or rhBMP-2/GBR (3/7). The radiographic evaluation showed substantial bone fill for sites receiving rhBMP-2/ACS, rhBMP-2/GBR, and GBR. In particular, sites receiving rhBMP-2/GBR presented with seroma-like radiolucencies. The surgery control exhibited moderate bone fill. To evaluate the biologic potential of the specific protocols, sites exhibiting wound failure were excluded from the histometric analysis. Sites receiving rhBMP-2/ACS or rhBMP-2/GBR exhibited bone fill averaging 101%. Bone fill averaged 92% and 60%, respectively, for sites receiving GBR and surgery controls. Bone density ranged from 50% to 57% for sites receiving rhBMP-2/ACS, GBR, or surgery controls. Bone density for sites receiving rhBMP-2/GBR averaged 34% largely due to seroma formation encompassing 13% to 97% of the sites. CONCLUSION: rhBMP-2/ACS appears to be an effective alternative to GBR in the reconstruction of advanced alveolar ridge defects. Combining rhBMP-2/ACS with GBR appears to be of limited value due to the potential for wound failure or persistent seromas.     

Complications related to bone augmentation procedures of localized defects in the alveolar ridge. A retrospective clinical study

Purpose

This retrospective clinical study aims to evaluate complications after augmentation of localized bone defects of the alveolar ridge.

Methods

From standardized registrations, the following complications related to bone augmentation procedures were recorded: soft tissue dehiscence, infection, sensory disturbance, additional augmentation procedures needed, and early implant failure.

Results

A total of 223 patients (132 women, 91 men; mean age 23.5 years; range 17–65 years) with 331 bone defects had bone augmentation performed into which 350 implants were placed. Soft tissue dehiscence occurred in 1.7 % after GBR procedures, 25.9 % after staged horizontal ridge augmentation, and 18.2 % after staged vertical ridge augmentation. Infections were diagnosed in 2 % after GBR procedures, 12.5 % after sinus floor elevation (SFE) (transcrestal technique), 5 % after staged SFE, 11 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. Additional augmentation procedures were needed in 2 % after GBR procedures, 37 % after staged horizontal ridge augmentation, and 9 % after staged vertical ridge augmentation. A total of six early implant failures occurred (1.7 %), four after GBR procedures (1.6 %), and two (12 %) after staged vertical ridge augmentation.

Conclusions

Predictable methods exist to augment localized defects in the alveolar ridge, as documented by low complication rates and high early implant survival rates.

     

Preprosthetic vertical distraction osteogenesis of the mandible using an L-shaped osteotomy and titanium membranes for guided bone regeneration.

PURPOSE: Vertical osteodistraction is a new alternative method for alveolar ridge augmentation of the mandible. The purpose of this article is describe a technique using an L-shaped osteotomy and titanium membranes for guided bone regeneration (GBR) in the distraction gap. PATIENTS AND METHODS: Ten patients with severe atrophy of the edentulous molar region of the mandible underwent vertical callus distraction in 13 sites using intraoral microplate distractors. An L-shaped osteotomy with a short vertical part mesially and a longer horizontal part ending in the retromolar region was made, and the osteotomized segment was fixed to the mandibular ramus at its distal edge by a microplate, which became the center of rotation when distraction began. In this way, more callus generation could be achieved mesially than in the distal molar region. Follow-up computed tomography (CT) scans reconstructed axially to the axis of the mandible revealed semilunar excavations of the generated bone buccally in the distraction gap in the first cases. Clinical inspection on removal of the distractors showed fibrous connective tissue in the gap. Therefore, to prevent this from happening, titanium membranes covering the distraction gap were applied in subsequent cases. RESULTS: Ten patients (13 sites) were treated by vertical callus distraction. In 4 cases, GBR was achieved using titanium membranes. In all cases, the increase in alveolar height was sufficient to make dental implantation possible. In 1 patient, a fracture of the distractor occurred, and dehiscence was observed in 2 cases. These complications did not change the plan of therapy nor did they influence the results. The CT scans showed a homogenous surface on the regenerated mandible in the cases of GBR application. CONCLUSION: Both an L-shaped osteotomy and the application of titanium membranes for GBR in the distraction gap are of great value for mandibular augmentation, producing a physiologically shaped alveolar ridge.     

Bone augmentation using a synthetic bone graft in dogs

The aim of this investigation was to evaluate clinically and histologically the use of a synthetic bone graft (Ionogran®) alone and in combination with guided bone regeneration (GBR) for alveolar ridge augmentation. Five beagle dogs were used in this study. Prior to the augmentation procedure the maxillary and mandibular second, third and fourth premolars were extracted. Three months after the extractions, impressions from the area of the ridges were taken. Particles of Ionogran® were then placed under mucoperiosteal flaps in each quadrant. On the experimental sites, an expanded polytetrafluoroethylene barrier was placed between the flap and the particles. Impressions were retaken at 1 and 3 months after surgery. Three months after surgery, the animals were sacrificed and specimens were prepared for histological evaluation. Computer-assisted volumetric analyses from the casts revealed an increase in ridge volume from baseline in both groups at 1 and 3 months. There was no difference in the height of the augmentation between the test and control sites. The histological results of this study indicate that this new synthetic bone graft appears to be a safe biocompatible grafting material. There were no apparent histological differences between the graft alone and graft/GBR sites. In both groups, however, graft particles were surrounded by dense fibrous connective tissue and bone formation was limited to the graft bone interface.     

去膜化GBR技术在后牙种植中的应用

目的: 探讨植骨后未覆盖屏障膜技术对后牙区种植体颊侧较小骨缺损的临床效果。方法: 选取2017年2月—2018年7月青岛大学附属医院口腔种植中心行后牙区种植手术的患者60例,所有患者种植体未暴露且颊侧至邻牙牙槽嵴顶弧线距离>1 mm。将患者随机分为单纯植骨无生物膜组（骨粉组,30例）和植骨并覆盖生物膜组（GBR组,30例）。分别于术后即刻及术后6个月通过锥形束CT（CBCT）测量种植体肩台下0、3、6 mm处（分别设为T1、T2、T3）颊侧牙槽嵴水平骨量变化。采用SPSS 22.0软件包对两组患者的牙槽嵴水平骨量变化、种植体周围软组织评价和患者满意度进行比较。结果: 术后6个月较术后即刻各位点牙槽嵴水平骨量变化为骨粉组：T1（-0.48±0.73）mm、T2（-0.64±0.95）mm、T3（-0.28±0.80）mm,GBR组：T1（-0.35±0.66）mm、T2（-0.49±0.74）mm、T3（-0.30±0.84）mm。2组各位点的牙槽嵴水平骨量变化无显著差异（P>0.05）。术后6个月复查, 2组种植体周围软组织均健康且无显著差异（P>0.05）。患者均有较高的满意度。结论: 后牙区种植体颊侧较小骨缺损可通过单纯植骨达到与GBR术相同的临床效果,能获得健康稳定的软组织以及较高的满意度。     

Vertical guided bone regeneration with bioabsorbable barriers

BACKGROUND: Guided bone regeneration (GBR) is a very useful surgical technique to increase limited alveolar bone for implant placement. The use of non-resorbable barriers is well established; however, bioabsorbable collagen membranes may simplify the surgical technique and make it more predictable. METHODS: Vertical ridge augmentation was performed on 11 patients at the time of implant placement. The part of the implant out of bone was covered with autogenous bone/graft, and a slow-resorption collagen membrane was placed on top. Gingival tissues were closed with horizontal mattress and interrupted sutures. Second-stage surgery was performed 4 to 6 months later, and healing abutments were placed. The length of the implant out of bone was determined at stage 1 and stage 2 surgeries on a periapical x-ray 1 year after implant load. Histology was obtained from one of the cases at second-stage surgery. RESULTS: Measurements revealed that the mean implant out of bone was 3.5 mm at stage 1 and 0.5 mm at stage 2. Mean bone gain was 3 mm, which represented 83% of the exposed implant at stage 1. One year after loading, implants showed a mean marginal bone loss of 1.4 mm. Minimal complications were detected, and only one case failed. Histology from one successful case showed new trabecular bone with large cellular marrow spaces in the regenerated area. CONCLUSION: Slow-resorption collagen membranes have the potential to promote vertical ridge augmentation when used with autogenous bone at the time of implant placement.     

Clinical and histologic assessment of lateral alveolar ridge augmentation using a synthetic long-term bioabsorbable membrane and an allograft

BACKGROUND: Guided bone regeneration (GBR) is a widely used procedure for augmenting alveolar ridge width prior to placement of endosseous implants. Various graft materials and barrier membranes (non-resorbable and bioabsorbable) have been used in GBR. The aim of this study was to assess the performance of a new bioabsorbable, synthetic polyglycolic acid/trimethylene carbonate (PGA/TMC) barrier membrane with an increased absorption time in conjunction with a combination of assayed demineralized bone matrix and cortical cancellous chips uniformly dispersed in a thermoplastic biologic carrier. METHODS: At 72 potential implant sites in 38 subjects, ridge width at the crest and 4 mm apical to the crest was measured before and 6 months after a GBR procedure using the long-term (LT) PGA/TMC membrane and an allograft in a thermoplastic carrier. Before placement of endosseous implants, 48 biopsy specimens were obtained from the augmentation sites and analyzed histomorphometrically. RESULTS: The GBR procedure increased the mean ridge width at the crest from 2.4 to 5.2 mm. This 216% change from baseline was significant (P <0.001). The mean width 4 mm apical to the crest increased from 4.4 to 7.5 mm, a significant (P <0.001) 174% change. The histomorphometric analysis showed that the biopsy specimens consisted, on average, of 57% bone (36% graft material and 21% new bone) and 43% soft tissue and space. CONCLUSION: Our findings suggest that the LT PGA/TMC barrier membrane, used in conjunction with an allograft, provides lateral alveolar ridge augmentation comparable to that achieved with other materials without the necessity for bone-graft harvesting or a second procedure to remove the barrier membrane.