自体骨移植与引导骨再生在外胚层发育不全综合征种植修复中的应用

目的:在自体骨移植、引导骨再生实现骨增量的基础上,通过种植方法对外胚层发育不全综合征导致的牙列缺损进行修复。方法:对1例牙槽骨重度萎缩的外胚层发育不全综合征患者,先后通过自体髂骨游离移植、引导骨再生技术,使患者牙槽骨实现宽度、高度上的增量和上下颌牙槽骨空间位置的改善,然后在上下颌骨牙槽骨分别植入5枚、4枚种植体,最后采用种植固定桥修复方法恢复患者牙列缺损。结果 :通过自体髂骨游离移植和引导骨再生技术,患者上下颌牙槽骨在高度和宽度的增量能满足种植体植入需要,同时唇舌向位置关系得到改善,种植体支持的上下颌固定桥修复体较理想地恢复了患者牙列的完整性,咬合关系良好。结论:对牙槽骨重度萎缩的外胚层发育不全综合征患者,综合应用自体骨移植、引导骨再生等技术,能解决患者种植修复过程中牙槽骨量严重不足的问题。     

可吸收胶原膜在即刻种植中应用的超微结构及生物力学研究

目的:评估引导骨组织再生技术在即刻种植中促进种植体周围骨缺损修复的效果及作用,为可吸收性胶原膜的临床应用提供理论依据。方法:16只成年杂种犬,双侧下颌第三、四磨牙拔除后行即刻种植,右侧使用可吸收膜覆盖骨缺损区,左侧不覆盖任何膜作空白对照。分别于术后1、2、4、6个月时各处死4只犬,取材观察。采用扫描电镜(SEM)、四环素荧光标记及生物力学测定等方法,检测即刻植入种植体周围缺损区骨组织再生修复的情况。结果:SEM和四环素荧光标记显示,实验组种植体周围骨缺损的再生修复较同期空白对照组快,术后6个月实验组缺损区呈完全骨性修复,成骨活动趋于稳定,而对照组近牙槽嵴顶仍可见尚不成熟的新生骨组织。生物力学测试结果表明,术后1、2、4个月实验组与对照间最大拔出力值间差异有显著性(P<0.05),术后6个月差异无显著性(P>0.05)。结论:可吸收胶原膜用作骨组织引导再生膜,可以促进骨缺损的早期修复。     

Timing of Implant Placement and Augmentation with Bone Replacement Material: Clinical Assessment at 8 and 16 Months

Purpose: The purpose of this study is to evaluate implants placed at different times of bone augmentation. Materials and Methods: Four implants were placed in seven dogs: one at a 6‐month bovine mineral grafted site (6‐month Bio‐Oss® grafted site [6mBio]), one at a grafted membrane‐protected simultaneously augmented (Fresh Bio‐Oss® grafted site [FrBio]) site, one at a clotted (nongrafted clotted membrane‐protected site [Clot]) membrane‐protected site, and one at a pristine (nongrafted uncovered site [Cont]) site. Implants were exposed after 6 months. The same protocol was repeated on the contralateral side, at a delay of 8 months. Peri‐implant care was performed throughout the hygienic phase (2 and 10 months, respectively) every 48 to 72 hours. Probing depth and bleeding on probing were recorded. Implant stability was determined by a Periotest® (Medizintechnik Gulden, Modautal, Germany). Statistical analysis was conducted using analysis of variance with repeated measures. Results: Average probing depth at the simultaneously grafted sites was 2.21 mm and 2.03 mm at 8 and 16 months, respectively. At the 6‐month grafted sites, it was 1.96 mm and 1.57 mm. At the Clot sites, it was 2.68 mm and 2.07 mm, and 2.21 mm and 1.82 mm at the Cont sites, respectively. The average bleeding on probing was 0.50 and 0.42 at the FrBio sites, and 0.35 and 0.07 at the 6mBio sites during the respective periods. At the Clot sites, it was 0.50 and 0.28, and at the Cont sites, 0.43 and 0.21, respectively. Probing depth significantly reduced over the time at 6mBio, Clot, and Cont sites (p < .03). Average implant stability score at the FrBio sites was ?0.24 and ?0.27, and ?0.50 and ?0.46 at the 6mBio sites, at 8 and 16 months, respectively. At the Clot sites, it was ?0.35 and ?0.46. Cont sites averaged ?0.37 at both periods. Implant stability was significantly higher (p < .005) comparing 6mBio over FrBio, 6mBio over Cont, and Clot over FrBio sites. Conclusions: Immediate and delayed augmentations are safe modes. Probing depth and bleeding indices gradually improved along time. Implant stability was higher at the delayed mode.     

Effects of Implant Design and Surface on Bone Regeneration and Implant Stability: An Experimental Study in the Dog Mandible

Background: Previous experimental studies have shown a higher degree of bone‐implant contact for surface‐enlarged implants compared with machined implants. Yet, there is insufficient evidence that such implants show higher stability and an increased survival rate. Purpose: The purpose of this investigation was to study the integration and stability of grit‐blasted implants with retention elements on the implant neck, with and without marginal bone defects, compared with machined implants without retention elements. Materials and Methods: After tooth extraction of the mandibular premolars in six dogs, two grit‐blasted, partly microthreaded Astra Tech implants and one standard Branemark implant were bilaterally placed in each dog. On one side, 3 ± 3 mm large buccal defects were created, to expose three to four implant threads. The contralateral side served as control, and no defects were made. The animals were sacrificed after 4 months of healing. Implant stability was measured using resonance frequency analysis at implant installation and after 4 months of healing. Histologic and histomorpho‐metric evaluation was made after 4 months of healing. Results: Resonance frequency analysis indicated that all implants in the test and control groups were osseointegrated after 4 months, with a tendency toward higher implant stability for the Astra Tech implants. There was a statistically significant higher increase in resonance frequency for the Astra test implants compared with their corresponding controls. Histology and histomorphometry showed well‐integrated implants with varying degrees of bone repair at the defect sites. The greater bone‐implant contact for the Astra implants was statistically significant. No significant difference between the implants in amount of bone filling the threads was recorded. Conclusions: The Astra Tech implants tested showed a higher degree of bone—implant contact and higher level of bone regenerated at defect sites compared with the Brånemark implants. Resonance frequency analysis demonstrated a significantly higher increase in the Astra test implants compared with their control groups than did the Brånemark test implants versus their controls.     

引导骨再生的理论和应用

引导骨再生(guided bone regeneration,GBR)技术的基本原理源于牙周病领域的引导组织再生技术。自引导组织再生理论(guided tissue regeneration,GTR)提出后,人们认识到在骨组织再生过程中,为了促进骨组织的再生与修复,也应采取生物隔膜阻挡无关或有干扰的组织细胞进入,保护血凝块的稳定,维持血块充填的间隙,实现缺损区的修复性再生。1引导骨再生技术的机制骨引导再生过程中要求有骨形成细胞或具有分化为骨形成细胞能力的细胞存在;有促使未分化间充质细胞分化为破骨细胞的诱导性刺激存在;有组织可以长入的支架,从而形成骨引导环境。1.1生…     

骨挤压联合骨引导再生术在上颌前牙种植中的应用

目的 评价上颌前牙区牙槽骨吸收的患者应用骨挤压联合骨引导再生术行种植体植入的临床效果。方法 16例上前牙单牙缺失伴牙槽骨萎缩的患者，应用骨挤压联合骨引导再生术植入16颗种植体，术后6个月暴露种植体，最终完成烤瓷冠修复。结果 术后无明显并发症发生，修复完成后观察7～26个月，种植体行使功能良好，无种植体丧失。结论 对上颌前牙区牙槽骨吸收的患者，应用骨挤压联合骨引导再生术行种植体植入，可改善牙槽骨质，保存骨量，临床效果良好。     

聚羟基丁酸酯膜引导即刻植入种植体周围骨组织再生的研究

目的：评价聚羟基丁酸酯（ＰＨＢ）膜引导种植体周围骨组织再生的效果。方法：在狗下颌骨即刻植入种植体的颊侧形成骨缺损,覆盖ＰＨＢ膜,与钛膜及空白对照比较,术后１、２、３个月分别取标本,采用大体观察、Ｘ线摄片、组织学、四环素荧光标记方法观察骨组织再生情况。结果：ＰＨＢ膜组种植体周围骨缺损区较空白组有更多的新生骨充填,加速了骨再生过程,与钛膜组类似。结论：ＰＨＢ有良好的生物相容性,可以用作骨组织引导再生膜     

异种脱细胞真皮基质在牙种植中引导骨再生的临床观察

目的:观察国产异种脱细胞真皮基质修复膜作为屏障膜,在牙种植的引导骨再生中应用的临床效果.方法:78例需要引导骨再生的种植病例,均为前牙区或前磨牙区单牙或连续多牙位(3牙)缺失;其中前牙52颗,前磨牙26颗.缺牙区牙槽嵴主要为唇颊侧垂直性吸收,牙槽嵴顶宽度约1～3 mm,牙槽嵴水平吸收量在2 mm以内.分为2组,一组采用...     

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．     

富血小板血浆对表面多孔性种植体周骨再生的作用

目的:研究钛合金颗粒熔附表面多孔性种植体在植入时应用富血小板血浆(PlateletRichPlasma,PRP),对种植体周围骨再生的影响。方法:钛合金颗粒熔附表面多孔性种植体30枚分别植入5条狗的双侧下颌骨,左侧种植体在植入时局部应用PRP,右侧为对照组。术后3天、1、3、6及12周分别将动物处死,进行组织学和组织形态学分析。结果:术后3天和1周时,两组的组织学表现及骨-种植体接触率(Bone-implantcontact,BIC)均相似。术后3周时,实验组可观察到骨单位已开始形成,两组的骨-种植体接触率具有显著性差异(PRP组为68.11±17.63%,对照组为44.26±31.79%)。术后6周及12周时两组无明显区别。结论:表面多孔性种植体局部应用PRP可更有利于种植体周围早期骨再生,但PRP加快种植体周围骨再生的机制还有待于进一步的研究。     

A Comparative Study of Crestal Bone Loss and Implant Stability between Osteotome and Conventional Implant Insertion Techniques: A Randomized Controlled Clinical Trial Study

Purpose: The aim of this prospective randomized controlled clinical study was to assess the crestal bone loss and the implant stability in implants that were placed by the osteotome technique compared with the conventional drilling technique. Materials and Methods: Forty‐six screw type Straumann SLA® oral implants (Straumann AG, Waldenburg, Switzerland) were inserted in the anterior segment of maxilla of 30 patients. The implant site was prepared randomly using either osteotome technique (test group) or the conventional drilling technique (control group). Radio frequency analysis (RFA) values at implant placement and after 3 months were recorded. The crestal bone loss was measured using digital subtraction radiography technique after 3, 6, and 12 months. Results: RFA demonstrated a statistically significant higher primary stability for implants in the osteotome group than that of the conventional group (p = .026) at the time of implant insertion. However, there was no statistically significant difference between both groups 3 months after the surgery (p = .06). At month 3, the osteotome group caused significantly more crestal bone loss than the conventional group (p = .04). At months 6 and 12, both groups had comparable bone levels (p = .29). Conclusion: Osteotome technique yielded higher primary stability than conventional drilling technique. However, this technique was not superior to conventional technique after 3 months.     

Soft Tissue Conditions and Marginal Bone Changes around Immediately Loaded Implants Inserted in Edentate Jaws Following Computer Guided Treatment Planning and Flapless Surgery: A ≥1‐Year Clinical Follow‐Up Study

Background: Evaluation of the clinical conditions following computer guided treatment planning and flapless surgery is still limited. Objectives: The objective was to evaluate the soft tissue conditions and marginal bone changes after 1 year of function around immediately loaded implants inserted in edentate jaws following computer guided treatment planning and flapless surgery. Material and Methods: Twenty‐nine edentate jaws (19 maxillae, 10 mandibles) treated with 165 implants using the Teeth‐in‐an‐Hour? protocol were included. In these patients, peri‐implant soft tissue conditions and radiographic marginal bone changes were evaluated after ≥1 year of functional loading (mean: 19 months). Results: The mean probing depth at case level was 2.6 mm (SD: 0.6). Bleeding on probing was recorded as a mean of 81.9% (SD: 23.0). Plaque index showed a wide range of 0–100%. The mean marginal bone change of measured sites evaluated on intraoral radiographs was ?1.2 mm (SD: 1.4). A marginal bone loss more than 1.5 mm or 2.0 mm was observed in 42% and 27% of the measured sites, respectively. A pressure‐like‐ulcer was found in 9 cases. Implants with marginal bone loss of >1.5 mm were more frequently observed in cases with an ulcer than cases where no ulcer was found. Conclusion: Although the mean marginal bone loss after function in the present study was within the range of other reports presenting mean bone loss data after immediate implant loading, our patients showed a wide range of bone loss with several sites, where the bone loss was greater than the commonly used successful level (>1.5 mm).     

拜阿蒙骨诱导人工骨治疗重度牙周炎的临床疗效

目的了解拜阿蒙（BAM）骨诱导人工骨通过引导牙周骨组织再生术治疗重度牙周炎患牙的临床疗效。方法选择45例重度牙周炎患者的患牙67颗为研究对象。患牙完成基础治疗后翻瓣刮治，根面平整，乙二胺四乙酸（EDTA）处理，牙周骨缺损区植入BAM骨诱导人工骨后，缝合结扎固定。术后6个月和12个月复查临床疗效。结果67颗重度牙周炎患牙治疗后1年，失败拔除5颗，余62颗治疗后6个月和12个月复查牙周各项指数均比治疗前有明显改善。结论重度牙周炎患牙植入BAM骨诱导人工骨治疗临床疗效满意。