牙种植可吸收性引导骨再生膜的研究进展

引导骨再生技术用于修复种植体周围骨缺损已有20多年,其中生物膜经历了从早期不可吸收到目前可吸收膜的变化.文中综述了近年来国内外对可吸收膜材料的基础研究及临床应用进展.文献显示,胶原复合膜材料或结合有诱导组织再生的生物活性因子的生物复合膜,具有应用前景.     

富自体浓缩生长因子纤维蛋白液在口腔骨缺损种植引导骨再生后的骨量变化北大核心

背景:临床上对于富自体浓缩生长因子纤维蛋白凝胶的成骨作用已有所研究,但是对富自体浓缩生长因子纤维蛋白液的研究较少。目的:通过观察富自体浓缩生长因子纤维蛋白液体应用于上前牙唇侧骨缺损种植同期引导骨再生后骨量变化,评估富自体浓缩生长因子纤维蛋白液体联合Bio-Oss骨粉在骨增量中的应用效果。方法:选取单颗上前牙缺失伴唇侧骨缺损患者50例,随机分为试验组和对照组,各25例,2组均采用种植同期引导骨再生的手术方式。试验组使用富自体浓缩生长因子纤维蛋白液体+Bio-Oss骨粉+海奥生物膜进行引导骨再生;对照组使用Bio-Oss骨粉+海奥生物膜进行引导骨再生。结果与结论:50例患者的种植体愈合情况良好,符合种植体成功的标准。种植后即刻至6个月,2组种植体各位点的唇侧骨量变化差别无显著性意义(P>0.05);种植后6-12个月,试验组种植体各位点的唇侧骨量变化均小于对照组(P<0.05)。提示富自体浓缩生长因子纤维蛋白液体联合Bio-Oss骨粉对上前牙缺失伴唇侧骨缺损患者种植疗效较好,富自体浓缩生长因子纤维蛋白液体对减少种植体负载后唇侧骨吸收有一定的积极作用。     

数字化快速成型牙种植导板辅助修复上前牙种植：12个月随访

BACKGROUND: Dental implantation in maxillary esthetic zone is difficult to achieve desired outcomes. OBJECTIVE: To observe the feasibility of digital rapid prototyping implant template for anterior implantation. METHODS: Eighty patients scheduled to receive anterior implant treatment were enrolled. According to the wishes of patients, they were divided into two groups, with 40 cases in each group, and were given routine implant treatment (control group) and digital rapid prototyping template-aided dental restoration (observation group). After implantation, the X-axis, Y-axis and Z-axis errors of the two groups were measured, and the patients were followed up for 12 months. RESULTS AND CONCLUSION: After implantation, the errors of X, Y and Z axes in the observation group was significantly lower than those in the control group (P < 0.05); at 24 hours after implantation, patients in the two groups showed good appearance of the anterior tooth with no dental prosthesis loosing. Imaging examinations in the two groups showed no obvious bone resorption. These findings indicate that the aid therapy using digital rapid prototyping can obtain satisfactory therapeutic effect on anterior tooth restoration in the maxillary esthetic zone and precisely localize the dental implantation site.      

骨引导再生术在牙种植术中的临床应用

目的评估Bio—Gide生物膜、Bio—oss骨粉引导骨组织再生修复种植床骨缺损的作用。方法选择种植区牙槽骨存在骨缺损的11例患者．其中男性9例．女性2例．年龄18～56岁。共计ll枚种植体。植入种植体后,在骨缺损处植入Bio～oss骨粉．并用Bio-Gide生物膜覆盖．术后、Ⅱ期手术前进行口腔临床检查和X射线检查。种植修复体完成后,分别于戴牙后6、12个月定期复诊．检查种植体周围骨组织的吸收及种植体周围软组织情况。结果术后2周内有1枚种植体覆盖黏膜少许裂开．Ⅱ期手术时,1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修复。修复后随访6～12个月．种植体均能成功地恢复咀嚼功能。结论Bio—Gide生物膜、Bio-oss骨粉可以引导骨组织再生,改善种植床骨增量效果。与正常骨组织中种植修复的1年成功率不存在明显差异。     

生物膜引导骨再生在上颌窦提升中的成骨效果

背景：利用生物膜引导骨再生技术在上颌窦提升中成骨是牙种植的研究热点。 目的：探讨引导骨再生技术在上颌窦提升中的成骨效果。 方法：9只比格犬进行双侧上颌窦底提升同期牙种植,实验侧行胶原膜覆盖颊侧创口,对照侧无胶原膜覆盖。术后4,12,24周分别处死实验犬,行大体标本、力学测试及组织学检查。 结果与结论：术后12,24周时对照侧骨移植材料有移位,骨质吸收明显,种植体顶部暴露,实验侧种植体顶部骨移植材料无移位现象,有较厚的骨质覆盖。随时间的增加,种植体牵出力增加,在24周时实验侧与对照侧差异有显著性意义(P < 0.05)。组织学检查可见双侧上颌窦底植入骨粉后均可见新生骨形成,随时间延长逐渐增多、成熟,骨粉颗粒逐渐减少,术后12,24周时实验组与对照组新生骨的面积比较差异有显著性意义    (P < 0.05)。结果显示生物膜引导再生技术可减少上颌窦提升后骨的吸收,促进新骨骨形成。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

引导组织再生联合植骨修复根分叉病变的Meta分析

BACKGROUND: Numerous experimental and clinical observations have shown new attachment formation in the periodontium by guided tissue regeneration. OBJECTIVE: To evaluate the efficacy of guided tissue regeneration combined with bone grafting for the treatment of root furcation defects. METHODS: A computer-based online search combined with manual retrieval was conducted up to 2015 to screen the relevant English and Chinese literatures addressing guided tissue regeneration, bone grafting, and root furcation defects. Vertical and horizontal probing depth and attachment loss were analyzed. Meta-analysis was performed using Stata/SE version 12.0 software by extracting data from the relevant articles. Moreover, the publication bias was tested. RESULTS AND CONCLUSION: The meta-analysis results showed that at 6 months after treatment, the alterations in vertical probing depth and periodontal attachment were significantly increased after guided tissue regeneration compared with open-flap debridement (P < 0.000 01); the alterations and increment in the periodontal attachment were significantly increased after combined treatment of guided tissue regeneration and bone grafting compared with open-flap debridement (P < 0.000 01); the reduction in the vertical and horizontal probing depth and the increment in periodontal attachment were significantly increased after combined treatment of guided tissue regeneration and bone grafting compared with guided tissue regeneration (P < 0.000 01 or P = 0.01). At 12 months after treatment, the reduction in vertical probing depth and the increment in attachment loss were significantly increased after combined treatment of guided tissue regeneration and bone grafting compared with guided tissue regeneration (P < 0.000 01). These results indicate that the guided tissue regeneration combined with bone grafting in the treatment of root furcation defects is superior to guided tissue regeneration or open-flap debridement. In addition, in the latter two therapies, guided tissue regeneration shows a better therapeutic effect. However, the therapeutic effects of various types of regenerated membranes and bone grafts need further in-depth study to define the optimal treatment strategy. 中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

引导骨再生技术在治疗三叉神经痛中的应用

目的：探讨引导骨再生( GBR)技术在治疗三叉神经痛的临床效果。方法选择三叉神经第Ⅱ支眶下神经痛的患者根据治疗方法分成治疗组48例,对照组47例,治疗组在眶下神经切断撕脱的同时采用GBR技术,对照组常规行眶下神经切断撕脱术。结果经术后1~2年随访,应用GBR技术治疗三叉神经有效率明显优于对照组(P<0.01)。结论 GBR技术在治疗三叉神经中疗效确切,可作为治疗三叉神经的优先选择。     

上前牙区种植相关解剖因素CBCT研究

目的 通过对400例成人上前牙区CBCT图像进行测量统计,了解上前牙区种植相关解剖因素,为美学区种植提供参考。方法 筛选纳入400例患者CBCT图像,测量唇、腭侧不同位点的骨量并探索上前牙根和牙槽骨的位置关系。结果 唇侧骨壁厚度在根尖处较厚,在唇侧牙槽嵴顶下2 mm处较薄,在根中1/2处最薄,唇侧牙槽嵴顶下2 mm和根中1/2处骨壁厚度>1 mm所占比率在中切牙至尖牙分别为37%、30%;31%、27%;56%、34%。腭侧骨壁厚度自牙槽嵴顶向根方递增,根方骨量>5 mm所占比率在中切牙至尖牙分别为94%、82%、97%。中切牙至尖牙相对于牙槽骨的位置关系分型Ⅰ、Ⅱ、Ⅲ、Ⅳ型分别为79.5%、10.5%、1.0%、2.0%;72.0%、14.5%、3.0%、5.0%;83.0%、5.5%、0.0%、0.5%。Ⅰ亚类（根尖区唇侧骨板厚度图像精度上难以分辨）各牙位占比分别为7.0%、5.5%、11.0%。结论 上前牙区唇侧嵴顶及根中处骨板厚度普遍很薄,绝大多数位点骨厚度<1 mm,根中1/2厚度最小;腭侧骨壁厚度自嵴顶向根方递增。上前牙根和牙槽骨多数属于Ⅰ类位置关系,为美...     

引导骨组织再生技术结合碱性成纤维细胞生长因子和骨保护素修复犬牙槽骨缺损

背景：多种生长因子能有效促进牙周组织再生。 目的：观察骨保护素和碱性成纤维细胞生长因子对牙槽骨骨缺损的修复作用。 方法：在4只杂种犬下颌两侧的第3,4前磨牙根分叉区造牙槽骨缺损,每只犬的一侧为实验组,另一侧为对照组。实验组置胶原膜并于缺损部位牙龈注射携带骨保护素和碱性成纤维细胞生长因子基因的重组腺病毒,对照组仅注射重组腺病毒或不做处理。 结果与结论：缺损修复4周后,实验组和对照组在X射线和组织学等方面差异不显著。12周后,实验组X射线可见骨缺损区新生骨量明显增加,组织学见新生牙槽骨已充满根分叉区,骨小梁致密;对照组X射线可见骨缺损区新生骨量增加,但未达到根分叉顶,组织学见骨缺损区有大量新生牙槽骨但未充满根分叉区。说明引导骨组织再生技术结合骨保护素和碱性成纤维细胞生长因子可促进犬牙槽骨缺损的修复。     

人引导骨再生修复颌骨缺损的组织学观察

背景：引导骨再生对于成骨的引导及成形效果在基础研究及动物实验中已得到充分肯定,但国内有关人的颌骨骨缺损后引导骨再生中新生骨的组织学观察是一个空白。 目的：应用组织学检查了解人引导骨再生修复颌骨骨缺损的成骨效果。 方法：选取引导骨再生治疗颌骨骨缺损患者19例24个部位,于治疗后6个月行种植术中,中空钻取出术区新生骨,组织学观察,评价成骨效果。 结果与结论：所取新生骨可见不同发育阶段的骨形成。近根尖段骨中主要为板层骨,而冠方新生骨主要为纤维性骨形成,内含类骨组织及软骨性骨,极少板层骨。提示人颌骨骨缺损经引导骨再生后6个月成骨效果肯定,但远期效果还有待进一步观察。     

上前牙区延期即刻种植后的骨量变化及美学影响

背景：拔牙后牙槽骨伴有冠根向和颊舌向大量的骨吸收,导致失牙区牙槽骨骨量明显不足;对种植初期的稳定性及修复后美学效果均有一定影响,严重影响种植义齿的远期成功率。因此,即刻种植技术可以缩短种植修复时间。 目的：评价上颌前牙区行延期即刻种植及引导骨再生技术后种植修复效果。 方法：选择19例(28颗缺牙)上颌前牙缺失伴唇侧单壁骨缺损患者,分别于拔牙后4周植入奥齿泰种植体28枚,唇侧骨缺损区种植同期采用引导骨再生技术,6个月后行二期修复。 结果与结论：28枚种植体在24个月后,存留率100%。6个月后平均种植体周边缘骨高度丧失为0.1 mm,   1年平均骨高度丧失为0.6 mm,2年平均骨高度丧失为0.11 mm。红色美学分值评分满意。在上颌前牙缺失伴轻度骨缺损延期即刻种植中采用引导骨再生技术可较好的恢复种植体周围骨高度和宽度,垂直向骨吸收稳定,牙龈美学效果满意。  中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

牙周膜干细胞分化、增殖特性与牙周组织再生

背景：牙周膜干细胞是牙周组织再生工程中理想的种子细胞之一,有关牙周膜干细胞的来源、生物学特性及影响因素等研究成为热点问题。 目的：就近年来牙周膜干细胞的研究现状、生物学特性、功能影响因素及其在再生医学中的应用等研究进展作一综述,并对其应用前景及目前存在的问题进行讨论,为相关体内研究提供理论和实验依据。 方法：由第一作者在PubMed和万方数据库检索2002至2015年有关牙周膜干细胞分化、增殖特性的相关英文和中文文献。中文检索词为“牙周膜干细胞,牙周组织,增殖,分化”,英文检索词为“periodontal ligament stem cell,periodontal tissue,proliferation, differentiation”,最终纳入47篇文献。 结果与结论：牙周膜干细胞具有成纤维、成脂、成骨、成牙骨质分化的能力,细胞生长因子对牙周膜干细胞的增殖分化起重要作用,成纤维细胞生长因子、血管内皮生长因子和胰岛素样生长因子均可促进牙周膜干细胞增殖。干细胞载体生物膜材料的应用也能有效引导牙周组织再生,牙周膜干细胞的分离培养及其影响因素等还有待进一步完善,将干细胞与生物膜材料、生长因子联合应用达到理想的牙周组织功能性再生是今后的研究重点。 中国组织工程研究杂志出版内容重点：干细胞;骨髓干细胞;造血干细胞;脂肪干细胞;肿瘤干细胞;胚胎干细胞;脐带脐血干细胞;干细胞诱导;干细胞分化;组织工程     

超瓷材/复合纤维修复年轻的恒牙牙体缺损

BACKGROUND: Targis/composite fiber is a new type of non-metallic repair material that has good hardness and strength, but it is rarely reported on its application in the repair of young permanent tooth defects.     

应用浓缩生长因子行上颌窦内提升后种植体周围骨变化

背景：许多实验和临床研究报道不使用植骨材料而单纯采用患者静脉血、可吸收胶原海绵、富纤维蛋白凝块等均可促进新骨形成,那么只移植浓缩生长因子在上颌窦内提升中是否也能有效地促进骨再生？目的：以浓缩生长因子作为移植材料行上颌窦内提升,观察种植体周围骨水平的改变。方法：纳入26例患者,其中男14例,女12例,年龄35-73岁,均以自体浓缩生长因子作为移植材料行上颌窦内提升,同期植入Astra Tech种植体。按随访时间分为6-12个月组、13-18个月组与18个月以上组,按术前剩余牙槽骨高度分为≤5 mm组、5-7 mm组与≥7 mm组,按术后上颌窦提升高度分为≤2 mm组、2.0-3.0 mm组与≥3 mm组,随访观察种植体存留率与边缘骨水平变化。结果与结论：共植入种植体44 枚,修复后随访6-18个月,43枚种植体修复成功,种植体存留率为98%。不同随访时间组间近、远中边缘骨水平改变比较差异无显著性意义,显示以浓缩生长因子作为移植材料行上颌窦内提升在随访6-18个月内能形成良好骨结合。不同剩余牙槽骨高度组间的近、远中边缘骨水平改变比较差异无显著性意义,不同窦底提升高度组间的近、远中边缘骨水平改变比较差异无显著性意义,说明剩余牙槽骨高度与上颌窦提升高度对种植体周骨组织形成无明显影响。表明在上颌窦内提升时使用浓缩生长因子移植材料同期植入种植体存留率高,种植体周围牙槽骨稳定,长期效果有待进一步观察。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

牙体剩余量对纤维桩核全冠修复体折裂模式的影响

背景：研究表明,桩的植入和牙体剩余量的不同会改变残根内牙本质的应力分布模式,并对桩核修复体的折裂模式产生影响。 目的：评价进行纤维桩复合树脂核全冠修复时,在斜向加载条件下牙体剩余量对牙根折裂模式的影响。 方法：获取正畸拔除的人单根前磨牙40颗,行根管预备及填充后随机均分为4组,以通过颊侧和舌侧釉质牙骨质界中点并垂直于牙体长轴的平面为参照平面,使得牙体剩余量分别为0,1,2,3 mm,行纤维桩复合树脂核金属全冠修复。修复后进行速率为1 mm/min的45°斜向加载,记录牙根出现折裂时的折裂模式和加载-位移曲线。 结果与结论：0 mm组多发生牙颈部折裂,其余3组多发生根中部折裂,0 mm组的总折裂模式与其余3组比较差异有显著性意义(P < 0.05),1,2,3 mm组间总体折裂模式比较差异无显著性意义(P > 0.05)。在斜向加载条件下,当剩余牙体较少时,修复体易发生牙颈部折裂,纤维桩对牙根起到了保护作用,但临床失败概率增加;随着牙体剩余量的增加,折裂模式发生改变,从颈缘向根方转移。表明临床上对残根行纤维桩核冠修复时,应尽量保留冠部较多的牙体组织。 中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程     

单颗固定种植修复后牙区牙龈：牙龈厚度、龈乳头和边缘骨吸收变化1年随访

BACKGROUND: Submerged dental implants that are completely embedded into soft tissues and isolated from the oral environment reduce the potential for infection factors, and are not influenced by the bite force, to ensure the implant osseointegration. OBJECTIVE: To compare the effects of submerged and non-submerged dental implants on the recovery of oral soft tissues. METHODS: Twenty-four patients who had no contraindication of dental implants and missed one molar with the gingival thickness of more than 1.5 mm were enrolled and divided into two groups. Patients were implanted with non-submerged SS implants of OSSTEM in one group (non-submerged group) and implanted with submerged TS implants of OSSTEM in the other group (submerged group). Variation of gingival thickness, Jemt index and alveolar bone resorption were detected after 2 weeks of one- and two-stage surgery and 1 year after surgery. RESULTS AND CONCLUSION: There were no statistical differences in gingival thickness, Jemt index and alveolar bone resorption between two groups. As these two surgical methods have no difference, we would like to use submerged or non-submerged implants in the patients with corresponding indications.     

Guided bone regeneration by poly(lactic-co-glycolic acid) grafted hyaluronic acid bi-layer films for periodontal barrier applications

A novel protocol for the synthesis of biocompatible and degradation controlled poly(lactic-co-glycolic acid) grafted hyaluronic acid (HA-PLGA) was successfully developed for periodontal barrier applications. HA was chemically modified with adipic acid dihydrazide (ADH) in the mixed solvent of water and ethanol, which resulted in a high degree of HA modification up to 85 mol.%. The stability of HA-ADH to enzymatic degradation by hyaluronidase increased with ADH content in HA-ADH. When the ADH content in HA-ADH was higher than 80 mol.%, HA-ADH became soluble in dimethyl sulfoxide and could be grafted to the activated PLGA with N,N′-dicyclohexyl carbodiimide and N-hydroxysuccinimide. The resulting HA-PLGA was used for the preparation of biphasic periodontal barrier membranes in chloroform. According to in vitro hydrolytic degradation tests in phosphate buffered saline, HA-PLGA/PLGA blend film with a weight ratio of 1/2 degraded relatively slowly compared to PLGA film and HA coated PLGA film. Four different samples of a control, OSSIX^TM membrane, PLGA film, and HA-PLGA/PLGA film were assessed as periodontal barrier membranes for the calvarial critical size bone defects in SD rats. Histological and histomorphometric analyses revealed that HA-PLGA/PLGA film resulted in the most effective bone regeneration compared to other samples with a regenerated bone area of 63.1% covering the bone defect area.     

引导骨再生技术结合补肾法修复大鼠股骨骨缺损

文题释义：引导骨再生技术：是指通过生物膜屏障创造出骨组织优势生长的环境,使具有骨组织修复能力的骨细胞优先进入骨缺损腔,为骨缺损的修复、骨折愈合提供新方法。补肾法：是指中医辨证理论指导下,运用补肾中药以固秘肾气、滋养肾精及充养骨髓,从而坚固骨骼,“补肾法”思想在中医骨伤临床实践发挥了重要的指导作用。背景：引导骨再生技术作为目前应用最广泛的骨缺损修复方法之一已广泛运用于口腔医学领域,但关于引导骨再生技术在长骨骨干骨缺损中应用的研究报道很少。目的：探究引导骨再生技术结合中药补肾治疗对大鼠股骨骨缺损修复的影响,评估其成骨效能,并探讨其作用机制。方法：将36只SD大鼠随机分为6组(n=6)：空白组、引导骨再生组、补肾高剂量组、补肾中剂量组、补肾低剂量组、骨肽片(西药)组,建立大鼠股骨骨缺损模型,除空白组外,其余各组均给予引导骨再生治疗,采用引导骨再生技术植入自体骨及Bio-Gide胶原膜;补肾各剂量组分别给予0.216,0.108,0.054 g/(kg•d)的强骨胶囊灌胃治疗8周;骨肽片组予以0.58 mg/(kg•d)骨肽片灌胃治疗8周。术后第12周,以X射线检查、骨组织苏木精-伊红染色及Masson染色为主要评价指标,评估成骨情况;采用实时荧光定量RT-PCR法检测骨组织中碱性磷酸酶、核心结合因子2、血管内皮生长因子及骨形态发生蛋白2 mRNA的表达。结果与结论：①X射线检查、骨组织苏木精-伊红染色及Masson染色结果显示,各治疗组Lane-Sandhu X射线评分与Huddleston组织学评分均显著高于空白组(P < 0.001),其中补肾高剂量组和补肾中剂量组明显高于引导骨再生组(P < 0.01);②RT-PCR检测结果显示,与空白组相比较,补肾高剂量组和补肾中剂量组对骨组织中碱性磷酸酶、核心结合因子2、血管内皮生长因子及骨形态发生蛋白2 mRNA的表达有显著上调作用(P < 0.01),且明显优于引导骨再生组(P < 0.05);③提示引导骨再生技术结合中药补肾法治疗能明显促进大鼠股骨骨缺损修复、减少骨组织吸收并改善成骨效能。其作用机制可能是在膜屏障创造出骨组织优势生长的环境中,通过上调相关成骨因子及血管生成因子的表达,促进骨组织新生及血管形成。 ORCID: 0000-0003-2986-6986(谢磊)中国组织工程研究杂志出版内容重点：组织构建;骨细胞;软骨细胞;细胞培养;成纤维细胞;血管内皮细胞;骨质疏松;组织工程     

Endochondral bone formation in gelatin methacrylamide hydrogel with embedded cartilage-derived matrix particles

The natural process of endochondral bone formation in the growing skeletal system is increasingly inspiring the field of bone tissue engineering. However, in order to create relevant-size bone grafts, a cell carrier is required that ensures a high diffusion rate and facilitates matrix formation, balanced by its degradation. Therefore, we set out to engineer endochondral bone in gelatin methacrylamide (GelMA) hydrogels with embedded multipotent stromal cells (MSCs) and cartilage-derived matrix (CDM) particles. CDM particles were found to stimulate the formation of a cartilage template by MSCs in the GelMA hydrogel in vitro. In a subcutaneous rat model, this template was subsequently remodeled into mineralized bone tissue, including bone-marrow cavities. The GelMA was almost fully degraded during this process. There was no significant difference in the degree of calcification in GelMA with or without CDM particles: 42.5 ± 2.5% vs. 39.5 ± 8.3% (mean ± standard deviation), respectively. Interestingly, in an osteochondral setting, the presence of chondrocytes in one half of the constructs fully impeded bone formation in the other half by MSCs. This work offers a new avenue for the engineering of relevant-size bone grafts, by the formation of endochondral bone within a degradable hydrogel.