引导骨组织再生膜应用于自身骨移植的研究现状

自身骨移植是种植术前骨增量的一种重要的技术手段。对于在常规骨移植后是否在移植物上覆盖引导骨组织再生膜,临床上存在着较大争议。笔者拟就引导骨组织再生膜在自身骨移植中的应用研究作一综述。     

Effects of ipriflavone on augmented bone using a guided bone regeneration procedure

: This study investigated the effects of ipriflavone (IP) on augmented bone using a guided bone regeneration (GBR) procedure. In 15 rabbits, two titanium caps were placed into calvarial bone for GBR. The animals were divided into three groups: the No-IP (no intake of IP), Post-IP (IP orally, 10 mg/kg/day after GBR), and Pre-IP (IP intake beginning before GBR) groups. One cap was removed from each rabbit after 3 months, and the remaining site was a control. One month after one cap removal, all the animals were euthanized, and histologic and histomorphometric analyses were performed. In all of the groups, the newly generated tissue was of varying size, and it consisted of thin pieces of mineralized bone and large marrow spaces with fat cells and some hematopoietic cells. In all of the control sites, the newly generated tissue was noted and almost filled the space under the cap. There was a significant difference between groups No-IP and Pre-IP (93.8+/-4.6% vs. 98.5+/-0.8%, P<0.05). The tissue generated at the test sites in all of the groups was resorbed, and its original shape and volume were not maintained 1 month after one cap removal. In particular, the greatest percentage, approximately 20% of the newly generated tissue, was resorbed in the No-IP group (93.8+/-4.6% vs. 73.9+/-3.7%, P<0.05), and approximately 11% and 15% in groups Post-IP and Pre-IP, respectively. The relative amount of mineralized bone generated at the control and test sites was significantly larger in groups Post-IP and Pre-IP when compared with group No-IP, except for the test site between groups No-IP and Post-IP (P<0.05). Therefore, the amount of mineralized tissue generated appeared to increase with an increase in the total IP dose. Within the limitations of this rabbit experimental model, we conclude that the daily intake of IP before or after GBR inhibits the resorption of augmented tissue and would be useful for improving the quality of newly generated bone beyond the skeletal envelope.     

异种脱细胞真皮基质引导种植体周围骨缺损再生的研究

目的评价应用异种脱细胞真皮基质引导种植体骨缺损骨再生的临床效果。方法选择2008年7月—2011年7月在我院口腔科接受种植的患者22例,共28颗种植体,其中男12例,女10例,年龄为21～62岁(平均43.8岁)。将28颗种植体植入患者的狭窄形牙槽嵴中,所有种植体的唇、颊侧面均有部分暴露,将羟基磷灰石珊瑚骨粉及自体骨混合物置于骨缺损处,将异种脱细胞真皮基质膜覆盖于骨粉表面。临床观察追踪异种脱细胞真皮基质愈合情况。结果 1例患者于手术1个月左右因局部感染,异种脱细胞真皮基质膜暴露被取出,另有1颗3年后因松动被取出。其余患者术后6个月Ⅱ期手术时,见所有种植体暴露部分完全被再生骨覆盖,种植体暴露部分长度为0。结论异种脱细胞真皮基质具有良好的生物相容性和可降解性,临床上可用作骨组织引导再生膜,促进骨缺损的再生修复。     

异种脱细胞真皮基质联合珊瑚羟基磷灰石在GBR术中的应用

目的：评价异种脱细胞真皮基质联合珊瑚羟基磷灰石在引导骨组织再生术中的应用效果。方法：17例共27颗牙缺失患者作为研究对象,其中10颗上前牙牙槽骨宽度约4mm的延期种植先行骨挤压术植入种植体再行GBR术,其余12颗延期即刻种植上前牙及5颗环状骨缺损后牙常规植入种植体后行GBR术。6-8m后观察成骨效果。结果：除一例患者右上侧切牙植体颈部唇侧暴露约1.5mm左右,其余患者植体均被新生骨包绕,成骨效果显著。结论：异种脱细胞真皮基质联合珊瑚羟基磷灰石在牙种植术中引导骨组织再生效果良好。     

膜引导齿槽突裂骨缺损区组织再生的实验动物研究

目的 :评价膜引导齿槽突裂骨再生的效果。方法 :全麻下 ,分别在每组 2只兔双上颌形成人工齿槽突裂 ,随机作 :①聚乳酸 (PLA) 胶原 rhBMP 2膜覆盖 ;②PLA膜覆盖 ;③胶原膜覆盖 ;④空白对照。分别于术后 2周 ,1、2、3、6月处死动物切取标本 ,摄X线片 ,组织学观察 ,酶组化分析。结果 :膜覆盖骨裂 ,新生骨外形良好 ,骨改建成熟早 ,特别是PLA 胶原 rhBMP 2膜组 ,可持续控释rhBMP 2并提高骨缺损区浓度 ;空白对照组 ,生成骨质量、外形不良。结论 :引导组织再生膜具有促进齿槽突裂骨修复的作用。     

口腔种植成骨材料的研究现状及进展

随着口腔种植技术的快速发展,种植修复已逐渐成为牙列缺损和牙列缺失患者的首选治疗方案。种植区牙槽骨骨量充足是种植修复成功的前提条件及关键因素。然而,临床上种植区牙槽骨骨量不足十分常见,影响种植修复体的功能发挥、美学效果及远期疗效。口腔植骨材料配合骨增量手术是目前临床常用重建缺失骨组织,使其骨量满足种植要求的方法之一。口腔植骨材料的自身特性如生物相容性、骨传导、骨诱导及骨生成等性能对植骨成功率具有至关重要的影响。该文从植骨材料的性能、分类及临床运用三个方面重点介绍口腔种植成骨材料的研究现状及最新进展,以期为成骨材料的临床选择及种植修复成功率的提高提供理论指导。     

Evaluation of an in situ formed synthetic hydrogel as a biodegradable membrane for guided bone regeneration

The aim of the present study was to test whether or not the application of an in situ formed synthetic hydrogel made of polyethylene glycol (PEG) used as a biodegradable membrane for guided bone regeneration will result in the same amount of bone regeneration as with the use of an expanded polytetrafluoro-ethylene (ePTFE) membrane. In eight New Zealand White rabbits, four evenly distributed 6 mm diameter defects were drilled into the calvarial bone. Three treatment modalities were evenly distributed among the 32 defects: hydroxyapatite (HA)/tricalciumphosphate (TCP) granules covered at the outer and inner surface with a PEG membrane (test), HA/TCP granules covered at the outer and inner surface with an ePTFE membrane (positive control) and HA/TCP granules alone without membranes (negative control). After 4 weeks, the animals were sacrificed and the calvarial bones were removed. The area fraction of newly formed bone was determined by histomorphometrical analysis of the vertical sections from the middle of the defect and by micro-computed tomography of the entire defect. Multiple regression analysis (SAS GLM) was used to model the amount of new bone formation. The quantitative histomorphometric analysis clearly revealed higher values of newly formed bone for the two membrane groups compared with the negative control group. The average area fractions of newly formed bone measured within the former defect amounted to 20.3+/-9.5% for the PEG membrane, 18.9+/-9.9% for the ePTFE membrane, and 7.3+/-5.3% for the sites with no membrane. The micro-computed tomography also showed higher values of new bone formation for the PEG and for the ePTFE groups compared with the negative control group. The GLM revealed a highly significant effect of the treatment on the amount of bone formation (P=0.0048). The values for the negative control group were significantly lower than the ones found in the PEG membrane group (P=0.0017), whereas the ePTFE membrane group showed no significant difference from the PEG membrane group. It is concluded that the PEG membrane can be used successfully as a biodegradable barrier membrane in the treatment of non-critical-size defects in the rabbit skull, and leads to similar amounts of bone regeneration as an ePTFE membrane.     

A feasibility study evaluating an in situ formed synthetic biodegradable membrane for guided bone regeneration in dogs

Purpose: The aim was (1) to evaluate the soft‐tissue reaction of a synthetic polyethylene glycol (PEG) hydrogel used as a barrier membrane for guided bone regeneration (GBR) compared with a collagen membrane and (2) to test whether or not the application of this in situ formed membrane will result in a similar amount of bone regeneration as the use of a collagen membrane. Material and methods: Tooth extraction and preparation of osseous defects were performed in the mandibles of 11 beagle dogs. After 3 months, 44 cylindrical implants were placed within healed dehiscence‐type bone defects resulting in approximately 6 mm exposed implant surface. The following four treatment modalities were randomly allocated: PEG+autogenous bone chips, PEG+hydroxyapatite (HA)/tricalcium phosphate (TCP) granules, bioresorbable collagen membrane+autogenous bone chips and autogenous bone chips without a membrane. After 2 and 6 months, six and five dogs were sacrificed, respectively. A semi‐quantitative evaluation of the local tolerance and a histomorphometric analysis were performed. For statistical analysis, repeated measures analysis of variance (ANOVA) and subsequent pairwise Student's t‐test were applied (P<0.05). Results: No local adverse effects in association with the PEG compared with the collagen membrane was observed clinically and histologically at any time‐point. Healing was uneventful and all implants were histologically integrated. Four out of 22 PEG membrane sites revealed a soft‐tissue dehiscence after 1–2 weeks that subsequently healed uneventful. Histomorphometric measurement of the vertical bone gain showed after 2 months values between 31% and 45% and after 6 months between 31% and 38%. Bone‐to‐implant contact (BIC) within the former defect area was similarly high in all groups ranging from 71% to 82% after 2 months and 49% to 91% after 6 months. However, with regard to all evaluated parameters, the PEG and the collagen membranes did not show any statistically significant difference compared with sites treated with autogenous bone without a membrane. Conclusion: The in situ forming synthetic membrane made of PEG was safely used in the present study, revealing no biologically significant abnormal soft‐tissue reaction and demonstrated similar amounts of newly formed bone for defects treated with the PEG membrane compared with defects treated with a standard collagen membrane.     

上颌前牙区骨挤压联合骨引导再生同期种植术的应用

目的：评价上颌前牙区骨挤压联合骨引导再生同期种植术的临床效果.方法：对14例上前牙缺失、牙槽骨厚度为3mm-4mm的患者,联合采用骨挤压、骨引导再生技术,植入Frialit-2种植体17颗,于植入后6个月行二期手术,同时测量牙槽嵴顶增宽的厚度,最终完成烤瓷冠修复.结果：本组共17颗种植体,术后均无明显并发症发生,牙槽嵴顶增宽的厚度平均为2.8mm±0.6 mm,修复完成后观察12-20个月,种植体行使功能良好,无一种植体松动或脱落.结论：对于上颌前牙区牙槽骨吸收的患者,采用骨挤压联合骨引导再生术后行种植体植入,可改善牙槽骨质量,获得满意的近期临床效果.     

The effect of bacterial cellulose membrane compared with collagen membrane on guided bone regeneration

PURPOSE

This study was to evaluate the effects of bacterial cellulose (BC) membranes as a barrier membrane on guided bone regeneration (GBR) in comparison with those of the resorbable collagen membranes.

MATERIALS AND METHODS

BC membranes were fabricated using biomimetic technology. Surface properties were analyzed, Mechanical properties were measured, in vitro cell proliferation test were performed with NIH3T3 cells and in vivo study were performed with rat calvarial defect and histomorphometric analysis was done. The Mann-Whitney U test and the Wilcoxon signed rank test was used (α<.05).

RESULTS

BC membrane showed significantly higher mechanical properties such as wet tensile strength than collagen membrane and represented a three-dimensional multilayered structure cross-linked by nano-fibers with 60 % porosity. In vitro study, cell adhesion and proliferation were observed on BC membrane. However, morphology of the cells was found to be less differentiated, and the cell proliferation rate was lower than those of the cells on collagen membrane. In vivo study, the grafted BC membrane did not induce inflammatory response, and maintained adequate space for bone regeneration. An amount of new bone formation in defect region loaded with BC membrane was significantly similar to that of collagen membrane application.

CONCLUSION

BC membrane has potential to be used as a barrier membrane, and efficacy of the membrane on GBR is comparable to that of collagen membrane.     

引导骨组织再生技术在牙种植修复中的临床应用研究

目的 评价引导骨再生技术在牙种植中引导骨再生修复的方法和效果。方法 对80例牙槽骨骨缺损的患者采用植Bio-Oss小牛骨粉，盖Bib-Gide膜或钛膜，进行引导骨再生，修复骨缺损并行骨内种植体周的骨增量。结果 80例患者共植入90枚种植体，38例采用钛膜，42例采用Bio-Gide胶原膜；术后部份患者伤口裂开、膜暴露；Bio-Gide膜与钛膜的伤口裂开发生率分别为7．1％与21．1％。二期手术时观察膜下骨再生情况，无感染患者膜下的新骨生成较膜暴露者多，Bio-Gide胶原膜暴露后自行愈合情况较使用钛膜者理想。88枚种植体成功地完成骨整合并成功完成义齿修复，2枚种植体因钛膜暴露及感染失败。结论 Bio-Gide胶原膜及钛膜皆能有效地屏蔽软组织，引导骨再生，重建牙槽骨外形；术后无伤口裂开、膜暴露者有较好的骨再生效果；与钛膜相比，Bio-Gide胶原膜更为简便易用，出现过早裂开的比率也较少。     

钛膜引导骨再生在骨内种植体植入中的应用

目的：总结牙种植术后使用钛膜引导骨再生临床体会。方法：对30例47枚牙种植术中发现骨缺损、骨量不足的患者采用钛膜进行骨引导再生修复骨缺损及骨增量。术后定期观察，对新骨生长情况进行连续临床和X线的观察分析。结果：30例47枚牙种植术中，39枚种植体植入部位使用了钛膜。二期手术时种植体均已与骨组织形成理想的骨融合，顺利完成种植义齿修复。39枚种植体中有15枚种植体术后2个月的X线片可见到种植体封闭螺帽上方骨密度增高影。4月后二期手术切开牙龈时可见到新骨覆盖种植体表面，以骨凿等去除新骨后方可见到封闭螺帽。结论：医用钛膜在种植术中应用有较好的引导骨再生作用，有利于种植术后骨融合期新骨的形成。不可吸收性膜的一些固有缺陷可通过临床正确的设计关在术中严格按照操作要点进行手术，可获得理想的骨再生效果。     

可吸收性引导骨再生胶原膜治疗骨缺损的实验研究

本研究是对国产吸收性胶原膜的骨引导再生,在骨缺损上应用的有效性方面进行实验研究。方法在实验动物成年犬的颌骨左右侧形成骨缺损,实验侧的骨缺损上覆盖吸收性胶原膜,对照侧没有覆盖,实验期间分别为２周、６周、１２周的取出下颌骨;     

Healing patterns in calvarial bone defects following guided bone regeneration in rats. A micro-CT scan analysis

OBJECTIVE: The objective of this study was to evaluate healing patterns of critical-size calvarial bone defects treated according to principles of guided bone regeneration using micro-CT scan analysis. Specifically, the contribution of bone, periosteum and dura mater to the amount and mineralization of newly formed bone was evaluated. MATERIAL AND METHODS: Surgically induced, critical-size calvarial bone defects in 48 adult male Wistar rats received the following: an occlusive expanded polytetrafluoroethylene (ePTFE) membrane at the exo- and endocranial aspect (OO; n = 12); an occlusive membrane at the exocranial and a perforated membrane at the endocranial aspect (OP; n = 12); a perforated membrane at the exocranial and an occlusive membrane at the endocranial aspect (PO; n = 12); and a perforated membrane at the exo- and endocranial aspect (PP; n = 12). The animals were euthanized at 4 weeks for quantitative analysis of bone volume fraction and mineralization in the region of interest (ROI) as well as in the external, middle and central area of the defect using micro-CT. RESULTS: Bone volume fraction ranged from 31.4% (OP) to 24.5% (PP). No differences were found among the groups. Bone volume fraction and mineralization in the middle area were significantly greater in group OP than in group PP, and in the central area in group OO and PO than in group PP. CONCLUSIONS: The results of this study suggest that use of occlusive ePTFE membranes enhances bone formation and maturation in the calvarial skeleton. When occlusion of endo- and exocranial tissues was compromised by membrane perforation, impaired bone formation and mineralization were observed.     

可吸收性胶原膜引导即刻植入种植体周围骨组织再生的实验研究

目的探讨可吸收性胶原膜引导即刻植入种植体周围骨组织再生的效果。方法在12只成年杂种狗下颌第3、4前磨牙新鲜拔牙创即刻植入种植体的近中形成3 mm×3 mm×5 mm骨缺损区,按自身同期对照研究设计,右侧为实验侧,骨缺损区上覆盖Co膜;左侧为空白对照侧,骨缺损区不覆盖Co膜。术后1、2、4、6个月分别处死一组动物,摘取下颌骨,采用大体观察、X线摄片、组织学观察、扫描电镜及生物力学（拔出实验）测定等方法检测缺损区骨组织再生的情况。结果实验侧种植体周围骨缺损区较空白对照侧新骨形成量多、外形好、骨成熟时间早,加速了骨组织的再生过程。结论可吸收性胶原膜具有良好的生物相容性和可降解性,可用作骨组织引导再生膜,以期促进骨缺损的再生修复,其促进作用主要表现在骨组织愈合的早期。     

异种脱细胞真皮基质修复骨引导再生术后软组织缺损的临床观察

目的：观察异种脱细胞真皮基质在骨引导再生术中充当屏障膜并直接修复术后软组织不足的临床效果及对引导骨再生的影响。方法：选择在中山大学附属口腔医院种植科要求种植修复治疗,但因种植区牙槽嵴萎缩,宽度不足而需先行骨引导再生术的患者7例（其中女性5例,男性2例,平均34岁）,术中用脱细胞真皮基质覆盖骨引导再生区域,并直接修补创面软组织不足,临床观察脱细胞真皮基质愈合情况。通过影像学和临床检查评价新生的引导再生骨。结果：术后2周可见创面生物膜有部分降解,骨移植材料表面有薄层胶原基质覆盖;术后3周,创面开始有少量牙龈上皮覆盖;术后4周,牙龈上皮覆盖全部创面,与周围牙龈融合。术后1年,牙种植手术中见再生骨质量好,缺牙区牙槽嵴宽度明显增宽。影像学检查显示,随愈合时间延长,骨粉颗粒高密度影像逐渐消失,与周围正常骨质间界限不清。结论：脱细胞真皮基质充当骨引导生物膜并同时修复骨增量术后软组织不足的临床效果满意。     

Biological properties of an anti‐bacterial membrane for guided bone regeneration: an experimental study in rats

Objective: The biosafety and efficacy of silver–hydroxyapatite–titania/polyamide nanocomposite (nAg–HA–TiO₂/PA) membrane as a guided bone regeneration (GBR) barrier were investigated based on a rat subcutaneous and critical‐size calvarial defect model. Material and methods: Thirty‐six Sprague–Dawley albino rats were divided into nAg–HA–TiO₂/PA membrane test, expanded polytetrafluoroethylene (e‐PTFE) membrane control and blank control. Inflammatory response and bone regeneration in each group were evaluated using morphological, serological, radiographic and histological techniques at 1, 4 and 8 weeks, respectively, after implantation. Results: For subcutaneous implantation, slight degradation of nAg–HA–TiO₂/PA membranes was observed by scanning electron microscope at 4 and 8 weeks. Histopathologic examination demonstrated a thinner layer of granulation tissue in the vicinity of nAg–HA–TiO₂/PA membranes than that of e‐PTFE membranes. For cranial defect implantation, the serum alkaline phosphatase level was remarkably higher in nAg–HA–TiO₂/PA group than that in e‐PTFE group. Radiographic and histomorphometric analysis showed a fully closed cranial defect for both nAg–HA–TiO₂/PA and e‐PTFE groups at 8 weeks. No remarkable difference was found between the two groups regarding the integral optical density of neo‐bone at each time interval. Conclusion: nAg–HA–TiO₂/PA membranes demonstrated better biocompatibility and similar osteoinductive activity compared with e‐PTFE membranes. nAg–HA–TiO₂/PA composite membranes provided a good prospect for further research and development in anti‐bacterial GBR membrane. To cite this article:
Zhang JC, Xu Q, Huang C, Mo AC, Li JD, Zuo Y. Biological properties of an anti‐bacterial membrane for guided bone regeneration: an experimental study in rats.
Clin. Oral Impl. Res. 21 , 2010; 321–327.
doi: 10.1111/j.1600‐0501.2009.01838.x     

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目的评价前牙区牙槽骨水平宽度不足的患者联合应用骨劈开、骨挤压和骨引导再生术行同期种植体植入的临床效果。方法 2004—2009年福州市第一医院口腔科就诊的前牙区牙缺失伴前牙区牙槽骨水平宽度不足的种植患者28例,联合应用骨劈开、骨挤压,填入骨粉,行骨引导再生术后同期植入40颗种植体,术后4～6个月内完成上部修复。术后1年,通过临床检查、全景片等观察效果。结果术前、后牙槽骨平均宽度分别为(3.2±0.89)mm、(6.5±0.75)mm,平均增加了(3.3±0.34)mm。术后牙槽骨宽度与术前相比,差异有统计意义(t=2.47,P<0.05)。术后无明显并发症发生,种植体行使功能良好,仅1例患者的1颗牙种植失败,种植近期成功率达97.5%。结论对前牙区牙槽骨水平宽度不足的患者,联合应用骨劈开、骨挤压和骨引导再生术行同期种植体植入,可增加骨量,获得种植体的同期植入,减少患者痛苦,改善种植修复的临床效果。