羟基磷灰石+医用胶原膜在颌骨囊肿骨腔中的应用

羟基磷灰石(hydroxyapatite,HA)是一种新型骨代用品,具有良好的生物相容性,能引导骨组织再生,已被广泛应用于临床,对口腔颌面部硬组织缺损的修复,如颌骨囊肿术后骨腔填塞取得了很好的疗效。我科自1995年以来,对27例颌骨囊肿骨腔充填HA,经5年临床随访观察,效果满意,现报告如下。     

Clinical value of oral repair membrane and β-tricalcium phosphate in the treatment of the postoperative bone defect of jaw cyst

目的 探讨口腔修复膜和β-磷酸三钙（β-TCP）在颌骨囊肿术后骨缺损修复中的临床效果。方法 对81例颌骨囊肿病例进行回顾性分析,收集临床资料,比较传统手术刮治（A组,27例）、刮治后放置修复膜覆盖创面（B组,27例）和刮治后放置骨粉充填骨缺损并覆盖修复膜（C组,27例）3种治疗方式的疗效。结果 81例患者术后均无复发。3组患者术前CT值差异无统计学意义（P<0.05）;术后3、6、12个月复查CT,3组CT值间差异具有统计学意义（P<0.05）,C组优于B组和A组（P<0.05）。结论 相对于传统的颌骨囊肿刮治疗法,应用修复膜具有较好的成骨效果,联合应用β-TCP和修复膜可获得更佳的疗效。     

灌洗疗法治疗颌骨囊肿30例

灌洗疗法治疗颌骨囊肿３０例陈启富王德蕙颌骨囊肿以手术治疗为主，作者从１９７９年开始采用灌洗疗法治疗颌骨囊肿３０例，效果满意。１．材料和方法：颌骨囊肿３０例，男１９例，女１１例，年龄４～７０岁。２９例单发，１例多发（２个囊肿），故囊肿数３１个，上颌２０...     

基底细胞痣综合征(附24例报告)

目的：总结基底细胞痣综合征（BCNS）主要临床特点及颌骨囊肿的治疗体会。方法：对1981－03－1999－09收治的24例BCNS进行临床分析。结果：24例均患有颌骨囊肿，平均初诊年龄17岁。其它主要症状发生率：多发痣37．5％，掌足陷凹29．2％，脊柱肋骨畸形70．8％，颅内钙化79．2％。颌骨囊肿引起的面部畸形是BCNS早期就诊的主要原因，具有多发性、发病年龄早及同一患者囊肿发病时间有先后等特点，手术治疗复发率22．0％。结论：颌骨囊肿是造成BCNS患者生理心理损害的主要症状之一，青春期前尤其是10岁左右患颌骨囊肿者应注意其是否患有BCNS。     

开窗负压吸引术在颌骨囊肿治疗中的应用

目的:评估开窗负压吸引术应用于颌骨囊肿治疗的临床效果。方法:选择门诊就诊的11例颌骨囊肿患者,采用开窗负压吸引术对其进行治疗,观察术后3、6个月颌骨囊肿的变化情况,对仍存留的囊肿行二期囊肿刮治术。结果:术后3个月,其中5例囊肿消失,6例缩小3/4以上。开窗负压吸引术3个月或半年后辅以刮治术,刮治术后半年的全景片显示囊肿无复发,骨质修复良好。结论:开窗负压吸引术可以显著缩小甚至消除青少年颌骨巨大囊肿,改善患者颌骨膨隆畸形,是治疗颌骨巨大囊肿切实可行的方法。     

羟基磷灰石颗粒人工骨复合煅石膏填充颌骨囊肿骨腔的临床观察

羟基磷灰石(HA)颗粒人工骨在临床应用已数年,修复骨缺损的效果良好。我们于1988年开始应用羟基磷灰石颗粒人工骨填充颌骨囊肿骨腔,取得较好的效果,但是颗粒状HA人工骨应用时塑形困难。易移位,散失,且从切口特别是裂开的切口处漏出,影响了效果。为此我们选择了煅石膏(PP)作为颗粒 HA人工骨的粘接剂,于 1992年 5月开始应用于填充颌骨囊肿骨腔,并进行了临床观察,效果良好。     

颌骨囊肿区牙齿的治疗

颌骨囊肿区牙齿的治疗李东，段建民，李德伦第四军医大学口腔医学院（７１００３２）近４年来我科收治颌骨囊肿病人１０７例，本文通过病例资料对颌骨囊肿区牙齿的治疗总结分析。１一般资料本组１０７例中，男７７例，女３０例；年龄１３～６８岁；上颌８１例，下颌２６例...     

152例牙源性颌骨囊肿治疗体会

目的研究牙源性颌骨囊肿的治疗方法。方法回顾分析比较 152例牙源性颌骨囊肿经囊肿刮治术、开窗术及颌骨切除术3种不同的手术方法。结果 152例牙源性颌骨囊肿中98例经囊肿刮治术无1例复发;开窗术50例中有22例需二期行刮治术治愈;4例牙源性颌骨囊肿行颌骨切除术及同期髂骨移植修复 术,无复发及排异反应。结论牙源性颌骨囊肿早期确诊非常重要,根据病患的个体差异制定个体化的治疗方案。?     

开窗减压配合囊肿塞治疗青少年颌骨囊肿的疗效分析

目的 分析开窗减压术配合囊肿塞治疗青少年颌骨囊肿的疗效。方法 收集整理2009年8月—2011年8月于我院口腔颌面外科行开窗减压术的青少年（13~20岁）颌骨囊肿患者（15例26个囊肿）病例资料,统计分析疗效。结果 15例患者中8例患者（53.3%）开窗效果良好,6例患者（40.0%）效果中等,1例患者（6.7%）效果不佳。93颗受累恒牙,70颗（75.3%）得以保存。结论 开窗减压术配合囊肿塞是一种有效的保守治疗青少年颌骨囊肿的方法。     

β-TCP植入与口腔修复膜覆盖治疗对颌骨囊肿术后骨缺损的修复效果分析

目的:分析β-磷酸三钙人工骨(β-TCP)植入与口腔修复膜覆盖治疗对颌骨囊肿术后骨缺损的修复效果.方法:选取2018年7月～2019年9月我院颌骨囊肿患者116例,采用随机数字表法将其分为对照组和观察组,每组各58例.对照组经囊肿摘除术刮治后对创面采用口腔修复膜覆盖治疗,观察组经囊肿摘除术刮治后放置β-TCP充填骨缺损...     

胶原膜与羟基磷灰石修复牙槽骨缺损的远期疗效观察

目的：观察国产BME-10X型医用胶原膜与羟基磷灰石(HA)联合引导组织再生治疗牙周炎、根尖囊肿造成骨缺损的I临床疗效。方法：选择18例患者的9颗Ⅱ度根分叉病变牙的9个位点、11颗近远中二、三壁骨下袋牙的16个位点、6颗根尖囊肿牙，在骨缺损区填入HA后，用胶原膜覆盖，观察1年以上的愈合情况。结果：骨下袋病变成功率75％，根分叉病变成功率77.8％，根尖囊肿成功率100％。结论：胶原膜／HA引导再生术在牙槽骨缺损修复中有一定应用价值。     

Triple bone labeling of canine mandibles

Fluorescence microscopy was used for evaluation of new bone formation in 16 canine mandibles augmented with hydroxylapatite (HA) granules. Three fluorochromes were injected at different time intervals during therapeutic radiation treatment. Oxytetracycline, DCAF, and alizarin-complexone were given intravenously to mark the bone level at these times, respectively. Oxytetracycline, which defined the baseline of bone at implantation of HA, was detectable in 42% of animals that were irradiated and in no animal of the nonirradiated control group. The marker DCAF, designating levels of bone at the start of radiation, was demonstrated in 92% of irradiated animals, and in 75% of animals in the control group. The uptake of alizarin-complexone determined the level of bone found at the end of irradiation. This marker was demonstrated in 50% of the dogs irradiated and in 75% of the control dogs. Bony trabeculae were found between and at the surface of the HA granules. New generation of bone directly on the HA granule and in the surrounding haversian systems as part of normal bone turnover was demonstrated to take place more than 5 months after implantation of HA.     

Effect of membranes and porous hydroxyapatite on healing in bone defects around titanium dental implants. An experimental study in monkeys.

The purpose of the present study was to examine the effect of treating bony craters around titanium dental implants with polytetrafluoroethylene membranes PTFE, with and without grafting of hydroxyapatite (HA), and with HA alone. 4 standardized bone defects were prepared in the alveolar ridge of edentulous areas in each of 7 monkeys. A titanium implant was then placed centrally in each defect, and in each monkey, the defects were treated with 1 of the following 4 treament modalities: 1 coverage with PTFE membrane;(2) grafting of HA and covering with a PTFE membrane;(3) HA grafting;(4) no treatment. Following a healing period of 12 weeks, all animals were sacrificed and mesiodistal ground sections of the treated areas were prepared. The histological analysis showed that all bone defects around the implants treated with PTFE membranes and 5 of the defects treated with HA and PTFE membranes were completely filled with new bone. The defects treated with HA alone and the control defects with no treatment only demonstrated new bone formation in the bottom of the defects. The results suggest that bone defects around titanium implants can be 1 treated successfully with PTFE membranes.     

The induction of bone in osteogenic composites of bone matrix and porous hydroxyapatite replicas: an experimental study on the baboon (Papio ursinus).

This study evaluated the morphogenetic properties of osteogenic composites of bone matrix and porous coralline hydroxyapatite (HA) replicas after intramuscular implantation in adult baboons (Papio ursinus). Composite implants were prepared by inserting rods of nonresorbable HA replicas, 20 mm in length, and 5 or 7 mm in diameter, into the medullary canals of 90 diaphyseal baboon bone cylinders, 20 mm in height, sequentially extracted and chemosterilized to obtain autolysed antigen-extracted allogeneic (AAA) bone matrix, preserving the bone morphogenetic protein (BMP) activity. Composites were implanted in the rectus abdominis and in the dorsal musculature of 24 adult male baboons. Before implantation, 45 composites were coated with an allogeneic fibrin-fibronectin protein concentrate (AFFP) prepared from fresh-frozen baboon plasma. Histologic analysis of undecalcified and decalcified specimens procured at 3, 6, and 9 months showed bone differentiation by induction along the endosteal surfaces of the chemosterilized matrix and within the porous spaces of the HA substratum. Bone formation was often extensive, culminating in complete penetration of the porous spaces. Histomorphometry showed that bone in the HA substratum increased at each time period. The biochemical treatment of the composite implants with AFFP did increase significantly the amount of induced bone, although only in the HA substratum. Bone differentiation was confirmed by fluorescence microscopy of the mineralization fronts after intravital double tetracycline labeling. The differentiation of bone in composites of bone matrix and porous HA replicas in extraskeletal sites of adult baboons may help to design appropriate delivery systems for the controlled therapeutic initiation of bone formation for craniofacial and orthopedic applications in man.     

Evaluation of a novel biphasic calcium phosphate in standardized bone defects: a histologic and histomorphometric study in the mandibles of minipigs

OBJECTIVE: A novel biphasic calcium phosphate (CaP) granulate consisting of hydroxyapatite (HA) and beta-tricalciumphosphate (TCP) was compared with pure HA and pure TCP and with autograft as positive control. MATERIALS AND METHODS: Four standardized bone defects were prepared in both mandibular angles of 16 minipigs and grafted with autogenous bone chips, HA, HA/TCP (60% : 40%), or TCP. Histologic and histomorphometric analysis of bone formation and graft degradation followed healing periods of 2, 4, 8, and 24 weeks. RESULTS: 2 weeks: more bone formation in defects filled with autograft than with the three CaP materials (P<0.05). 4 weeks: bone formation differed significantly (P<0.05) between all four materials (autograft>TCP>HA/TCP>HA). 8 weeks: more bone formation in defects with autograft and TCP than with HA/TCP (P<0.05), and HA/TCP had more bone formation than HA (P<0.05). 24 weeks: no difference in bone formation between the groups. Autograft and TCP resorbed quickly and almost completely over 8 weeks, whereas HA/TCP and HA showed limited degradation over 24 weeks. CONCLUSION: All defects healed with mature lamellar bone and intimate contact between bone and the remaining graft material. The rate of bone formation corresponded to the content of TCP in the CaP materials.     

Association of hyaluronic acid with a collagen scaffold may improve bone healing in critical-size bone defects

Objectives: To evaluate the effects of a 1% hyaluronic acid (HA) gel in combination with an absorbable collagen sponge (ACS) in the healing of critical‐size calvaria defects in rats. Material and methods: Thirty‐two adult Wistar rats were used. Two 5‐mm‐diameter critical‐size defects were created and the treatments were randomly distributed as follows: (1) 1% HA; (2) 1% HA gel‐soaked ACS; (3) control (blood clot); and (4) ACS. The animals were sacrificed 60 days post‐surgery, when biopsies were collected and processed for histology and histometric analysis. Bone fill was measured as the difference between the initial and the final defect sizes. Non‐parametric tests were used to analyze differences between treatments (α=1%) and a t‐test for body weight gain in each treatment group (α=5%). Results: Histological analysis showed bone formation on the edges of the defects, although very limited, and a thin layer of connective tissue occupying the midportion of the defects in the control and the ACS groups. Defects filled with a 1% HA gel and 1% HA gel+ACS had a thicker layer of connective tissue and more new bone formed in the margins of the defects. Linear histometric measures showed no significant differences in the initial defect sizes between the groups (P>0.05). The association 1% HA gel+ACS (0.96 ± 0.14 mm) had significantly greater bone fill than the control (0.5 ± 0.02 mm) and ACS (0.56 ± 0.05 mm)‐treated groups (P=0.0043 and 0.0173, respectively). Treatment with a 1% HA gel (0.7 ± 0.14 mm) showed no significant differences when compared with the other treatments. Conclusion: Within the limits of this study, a 1% HA gel associated with a collagen scaffold can improve new bone formation in critical‐size defects. However, this treatment never resulted in complete closure of the defects and healing in the major portion of the defects was characterized by fibrous tissue. To cite this article:
de Brito Bezerra B, Brazão MAM, de Campos MLG, Casati MZ, Sallum EA, Sallum AW. Association of hyaluronic acid with a collagen scaffold may improve bone healing in critical‐size bone defects.
Clin. Oral Impl. Res. 23 , 2012; 938–942
doi: 10.1111/j.1600‐0501.2011.02234.x     

Influence of bone morphogenetic protein and proportion of hydroxyapatite on new bone formation in biphasic calcium phosphate graft: Two pilot studies in animal bony defect model

PurposeThe purpose of these two pilot studies using animal bony defect models was to evaluate the influence of bone morphogenetic protein (BMP) and proportion of hydroxyapatite (HA)/beta-tricalcium phosphate (β-TCP) in biphasic calcium phosphate (BCP) graft on new bone formation.MethodsIn this study, four kinds of synthetic osteoconductive bone materials known for bone growth scaffold, OSTEON™II(HA:β-TCP 30:70), OSTEON™III (HA:β-TCP 20:80), OSTEON™II Collagen, and OSTEON™III Collagen, were prepared as BCP graft materials. In pilot study 1, three BCP materials (OSTEON™II, OSTEON™III, and OSTEON™II Collagen) were grafted in rabbit calvarial defects after impregnating in rhBMP-2. OSTEON™II without the rhBMP-2 impregnation was included in the study as the control. The amount of new bone was examined and measured histologically at 2, 4, and 8 weeks. In pilot study 2, four BCP materials (OSTEON™II, OSTEON™III, OSTEON™II Collagen, and OSTEON™III Collagen) were grafted in beagle dog mandibular defects after soaking in the rhBMP-2. The amount of total bone and new bone were measured three-dimensionally using microCT and healing process was examined histologically at 2, 4, and 8 weeks.ResultsIn pilot study 1, rhBMP-2 impregnated groups showed more new bone formation than the rhBMP-2 free group. In pilot study 2, increased new bone formation was observed in time-dependent manner after graft of BCP and BCP-collagen (OSTEON™II, OSTEON™III, OSTEON™II Collagen, and OSTEON™III Collagen) impregnated with rhBMP-2. Also, BCP with a higher proportion of HA (30% HA) showed more favorable result in new bone formation and space maintenance, especially at the 8 weeks.ConclusionFrom the results of the pilot studies, rhBMP-2 played positive roles in new bone formation and BCP could become a scaffold candidate for rhBMP-2 impregnation to induce new bone formation. Moreover, BCP with a higher proportion of HA (30% HA) could be considered more appropriate for rhBMP-2 carrier.     

Effects of a supplement containing vitamin K<Subscript>2</Subscript> (MK7) and calcium phosphate (salmon bone powder) on the femur trabecular structure in ovariectomized mice: a study using three-dimensional imaging analysis

Objectives To evaluate the effectiveness of a supplement containing vitamin K₂ (VK₂) and salmon bone powder (SBP) in improving bone trabeculae.Methods Using ovariectomized (OVX) female mice, the effects of a supplement containing naturally occurring SBP (calcium phosphate) and VK₂ (menaquinone 7) were examined. Three test groups were given SBP supplements with concentrations of 2% calcium (Ca), 5% Ca, or 2% Ca + VK₂ (50µg/100g). The control group received calcium carbonate (CC) at a concentration of 2% Ca, and a sham-ovariectomized group was given CC at a concentration of 1.2% Ca. Each group was maintained on its respective diet for 3 months. The femora were then extracted and analyzed three-dimensionally by microcomputed tomography with regard to bone structural parameters.Results No significant difference was observed in the serum Ca concentration among the five groups. The bone trabecular structure was better preserved in the OVX-2% Ca and OVX-5% Ca groups; a significantly difference (P 0.05) was observed in trabecular thickness as compared with the control group. In the OVX-2% Ca + VK₂ group, significant improvements were observed in bone volume, bone surface area, trabecular number, trabecular thickness, fractal dimension, and connectivity density (P 0.05, P 0.01). The state of the bone trabecular structure in the OVX-2% Ca + VK₂ group was better than that in the OVX-2% Ca group with a significant difference in bone surface area (P 0.05).Conclusions The results indicate that a supplement of VK₂ and SBP is effective in preventing deterioration of the bone trabecular structure in OVX mice.     

Morbidity at the iliac crest donor site following bone grafting of the cleft alveolus

We retrospectively analysed all cases of iliac crest bone graft harvest for secondary grafting of the cleft alveolus during an 11-year period. The case notes were reviewed and postal questionnaires sent to all patients. Of 73 consecutive patients, 57 (78%) were male, and the mean (S.D.) age at operation was 10 (1) years. A completed questionnaire was received from 72 patients (99%). The median stay in hospital was 3 days (range 2-5). The median time until the child could walk "normally" was 7 days (range 0-56). Thirty-seven patients (51%) had a postoperative limp, which resolved after a median of 7 days (range 3-56). There were two (3%) superficial donor site infections. The median length of scar was 60mm (range 40-100) and patient satisfaction was high, with a median visual analogue scale of 9/10 (range 2-10). Harvesting bone from the iliac crest for alveolar bone grafting is well tolerated by patients, has few important complications, and gives an aesthetically acceptable scar at the donor site.