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。     

������ֲ��������������������Ӧ��

由于种植体生物相容性的不断改良和完善,目前的牙种植体均能获得理想的可预期的骨结合,在新拔除患牙的牙槽窝内即刻植入种植体已经成为一种常规的术式拔牙后即刻种植可有利于减少外科手术次数,有利于牙槽嵴骨量的保存,降低治疗费用并减少缺牙时间,更易被患者接受.但由其解剖生理因素决定,牙槽嵴在牙缺失后通常要出现唇侧骨板的吸收萎缩,这常导致种植体唇面暴露,出现美学上的问题.即刻种植的同时,在充分理解和使用引导骨再生原理的基础上配合骨增量材料的应用才能获得理想的修复效果,本文就我们的临床体会结合文献进行了分析讨论.     

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。     

Clinical efficacy of acellular dermal matrix for plastic periodontal and implant surgery: a systematic review

This review was performed to validate the clinical efficacy of acellular dermal matrix (ADM) for plastic periodontal and implant surgery. Four electronic databases and a manual search were utilized to select randomized clinical trials (RCTs) published until March 2019. Overall, 28 RCTs were included: 25 on teeth and three on implants. For plastic periodontal surgery, ADM exhibited a comparable gingival recession reduction (RecRed) and soft tissue thickness (STT) gain to connective tissue graft (CTG). Subgroup analyses revealed that ADM obtained a similar keratinized tissue width (KTW) gain to CTG within 3–6 months postoperative, but significantly less KTW gain at 1–5 years postoperative (P = 0.01, mean difference (MD) −0.86 mm). Analyses comparing ADM with free gingival graft (FGG) demonstrated similar RecRed but significantly more KTW/STT gain favouring FGG (KTW: P = 0.01, MD −1.78 mm; STT: P = 0.01, MD −0.77 mm). Significantly more RecRed and KTW/STT gain were verified in ADM + coronally advanced flap/laterally positioned flap compared with these flaps alone (RecRed: P < 0.00001, MD 0.65 mm; KTW: P = 0.001, MD 0.66 mm; STT: P < 0.00001, MD 0.59 mm). Limited data for implant surgery indicated a similar trend as for periodontal surgery. Concerning patient-reported outcomes, ADM achieved favourable aesthetic appearance, alleviation of dentinal hypersensitivity, and less surgical morbidity. In conclusion, ADM exerted comparable clinical efficacy to autogenous tissue for root coverage procedures, with good long-term stability. However, for soft tissue augmentation, ADM exhibited inferior 3–6-month postoperative outcomes compared with FGG and less long-term stability of KTW gain compared with CTG.     

人脱细胞真皮基质的结构及与MG63成骨样细胞生物相容性的研究

目的观察脱细胞真皮基质（ADM）的结构及MG63成骨样细胞在其上黏附与增殖的情况。方法ADM为实验组,膨体聚四氟乙烯（e- PTFE）膜为对照组,扫描电镜和光学显微镜下观察两组膜的结构。在两组膜上分别接种MG63成骨样细胞,并设空白对照组。采用细胞活力分析仪检测3组细胞增殖活力,酶联免疫法检测细胞内碱性磷酸酶（ALP）表达,扫描电镜观察细胞在膜上接种后第1天和第5天的黏附及增殖情况。结果ADM分为基底膜面和组织面,组织面为鳞片状的结构,基底膜面可见指突结构和毛囊孔。e- PTFE成行排列,由直径比较均一的长椭圆形的裂隙组成。与空白对照组相比,ADM和e- PTFE对MG63成骨样细胞增殖活力和ALP活性无显著影响。扫描电镜观察细胞在两种膜上生长良好,但在ADM膜上,MG63成骨样细胞伸展更充分。结论ADM适于作引导骨再生膜材料,对MG63成骨样细胞的生长无抑制作用,相比较e- PTFE,ADM具有更优良的结构及生物学性能。     

脱细胞真皮基质复合小牛脱细胞骨修复口腔上颌窦瘘

目的 评价脱细胞真皮基质复合小牛脱细胞骨修复口腔上颌窦瘘的效果。方法 选择上颌骨囊肿摘除术或上颌磨牙拔除术后口腔与上颌窦相通的9例口腔上颌窦瘘患者（缺损大于5 mm×5 mm）,采用脱细胞真皮基质复合小牛脱细胞骨进行同期植入修复缺损。结果 9例患者术后切口均一期愈合,随访6个月,口腔上颌窦相通处黏膜均未见瘘道及分泌物,无鼻塞、流脓涕等上颌窦炎症相关症状,临床检查鼓气试验及CT检查均证实创口愈合。结论 应用脱细胞真皮基质及小牛脱细胞骨修复口腔上颌窦瘘,是一种有效的治疗方法。     

脱细胞真皮基质作为引导组织再生屏障膜在体内的组织学变化研究

目的 观察脱细胞真皮基质(acellular dermal matrix,ADM)作为引导组织再生(guided tissue regeneration,GTR)屏障膜时的体内组织学变化,探索其作为GTR屏障膜的可行性。方法 在兔下颌前磨牙颊侧根面形成一开窗型牙周缺损模型,将ADM作为GTR屏障膜覆盖和固定于缺损区表面,观察术后4周和8周时ADM的降解、血管化、炎性反应等组织学变化情况。结果 术后4周时,ADM无明显降解,基本保持其原来完整结构;8周时,ADM出现轻中度降解,但结缔组织尚未突破整层ADM。结论 ADM可以作为GTR的屏障膜。?     

异种脱细胞真皮基质联合Bio-oss Collagen修复牙槽骨缺损的临床研究

目的：通过引导骨再生（GBR）技术评估异种脱细胞真皮基质（acellular dermal matrix,ADM）与Bio-ossCollagen联合应用在修复牙槽骨缺损中的作用。方法：选择拔牙术后牙槽骨缺损严重的病例18例,拔牙同期在拔牙创植入Bio-oss Collagen并覆盖异种脱细胞真皮基质（海奥生物膜）,术后2周拆线,3个月复诊并拍摄X线片。结果：术后经临床检查和X线检查,18例患者植骨区新骨形成良好,牙槽骨高度与丰满度明显改善,术区骨生成良好。结论：临床上异种脱细胞真皮基质与Bio-oss Collagen联合应用能有效修复牙槽骨缺损,改善修复前的骨条件。     

Avoiding errors and complications related to immediate implant placement in the esthetic area with a mucogingival approach

Immediate implant placement is considered the treatment of choice for single tooth replacement in the esthetic area. However, this treatment is associated with several critical drawbacks related to the inadequate assessment/management of the soft and hard peri-implant tissues and their subsequent remodeling, resulting in peri-implant soft-tissue defects that can lead to impaired esthetic outcomes in time. We describe in detail how the mucogingival approach to immediate implant placement ensures a standard result regardless of the baseline soft-hard tissue situation. Fully guided implant placement guarantees an adequate three-dimensional implant placement, the flap design makes it possible to perform bone augmentation with complete visibility of the area being treated, allows soft tissue augmentation with proper fixation of the connective tissue graft, and the placement of an immediate provisional ensures stabilization of the peri-implant tissues throughout the healing period.     

Minimal invasiveness in lateral bone augmentation with simultaneous implant placement: A systematic review

The presence of a peri-implant bone dehiscence (BD) or fenestration (BF) is a common finding after implant placement in a crest with a reduced bucco-lingual bone dimension. The presence of a residual BD is associated with a relevant incidence of peri-implant biological complications over time. Guided bone regeneration (GBR), performed at implant placement, is the most validated treatment to correct a BD. In the present systematic review, the evidence evaluating factors which could reduce the invasiveness of a GBR procedure with respect to patient-reported outcomes, intra- and post- surgical complications, was summarized. Factors included were: technical aspects, regenerative materials for GBR, and peri- and post-operative pharmacological regimens. The available evidence seems to indicate that the use of membrane fixation and flap passivation by means of a double flap incision technique may reduce the incidence of post-surgical complications. When feasible, the coronal advancement of the lingual flap is suggested. The use of a non-cross linked resorbable membrane positively impacts on patient discomfort. The adjunctive use of autogenous bone to a xenograft seems not to improve BD correction, but could increase patient discomfort. Systemic antibiotic administration after a GBR procedure does not seem to be justified in systemically healthy patients.     

Volume gain and stability of peri-implant tissue following bone and soft tissue augmentation: 1-year results from a prospective cohort study

Objectives: The aim of the present study was to evaluate the dimensional changes of peri‐implant tissues obtained by implant placement, bone and soft tissue augmentation, prosthetic reconstruction and 1 year of function using a new, non‐invasive method for volumetric measurements. Materials and Methods: In 16 patients, the missing central or lateral maxillary incisor was reconstructed with an implant‐supported single crown. Impressions were taken before (t1), after implant placement with guided bone regeneration using DBBM and a PTFE membrane (t2), after soft tissue augmentation (t3), immediately after crown placement (t4) and 1 year later (t5). The cast models were optically scanned and digitally superimposed allowing qualitative and quantitative analysis of alterations of the labial peri‐implant tissue contour. In addition, the crown length and papilla height were measured at crown placement (t4) and after 1 year (t5). Results: Fifteen patients were available for recall after 1 year. During therapy, a mean gain in distance in the labial direction of 1.27±0.67 mm was observed after the surgical procedures. One year after crown insertion, a mean loss of 0.04±0.31 mm in the labial direction was recorded. During the same period, the crown length increased by a mean of 0.22±0.57 mm and the papilla height by 0.07±0.61 mm. The degree and pattern of tissue change following crown insertion were highly variable between individuals, irrespective of the amount and quality of previously augmented tissues. Conclusions: The clinical procedures were effective in augmenting peri‐implant tissue volume that remained stable to a high degree within 1 year after crown insertion. Large inter‐individual variations regarding the tissue alterations were observed. To cite this article:
Schneider D, Grunder U, Ender A, Hämmerle CHF, Jung RE. Volume gain and stability of peri‐implant tissue following bone and soft tissue augmentation: 1‐year results from a prospective cohort study
Clin. Oral Impl. Res. 22 , 2011; 28–37.
doi: 10.1111/j.1600‐0501.2010.01987.x     

Localized edentulous ridge augmentation with upside down osteotomy prior to implant placement

Abstract –  Localized bone defects may be seen following the extraction of teeth with periapical lesion or advanced periodontal disease, or as a result of trauma. When these regions are considered for treatment with implants, localized ridge augmentation will be necessary. Autogenous bone grafts are used exclusively for ridge augmentation. This case report represents the treatment of a localized edentulous ridge with an upside down osteotomy technique at the symphysis region prior to implant placement. Systemically healthy 21-year-old female patient, who was missing a lower right incisor tooth, was scheduled for an implant treatment. However, the crestal width was only 1 mm. The augmentation was planned and the region was treated with an upside down osteotomy technique. Nine months after the augmentation procedure, the computed tomography (CT) examination of the area revealed that the width of the crest was 7 mm, and the height of the crest was in good relation with the cementoenamel junction of the adjacent teeth. Flipping a bone block graft, which was harvested from the edentulous area, upside down may provide a successful result in partially edentulous ridges, in both maxilla and mandible.     

���ֺ�������ϸ����Ƥ�����޸��ղ�����֯ȱ����Ч�۲�

目的观察脱细胞真皮基质（ADM）修复颊部软组织缺损的疗效。方法选择2010年11月至2012年11月在安徽医科大学附属口腔医院就诊的颊部软组织缺损患者38例,其中20例应用异种ADM治疗,18例应用异体ADM治疗。随访6个月,观察患者缺损修复治疗效果,并对2种ADM在组织相容性、引导组织再生及补片成活情况等方面进行临床效果评价。结果应用异种ADM修复的患者,修复膜完全成活18例,大部成活2例,修复区表面颜色多为粉红色,质地柔软,瘢痕轻微;应用异体ADM修复的患者,修复膜完全成活17例,1例患者术后补片与创缘边缘有约0.8cm脱离区,补片与基底组织面贴合,补片色泽呈红色,愈合尚可。38例患者均未出现明显局部或全身反应,进食基本不受影响,无明显异物感,张口度未见明显改变。结论异种及异体ADM对颊部软组织缺损的修复效果均较为满意。     

前牙美学区引导骨再生同期种植愈合期间边缘骨吸收的前瞻性研究

目的：研究前牙美学区引导骨再生（guided bone regeneration,GBR）同期种植愈合期间的边缘骨吸收情况。方法：纳入2015年9月—2016年4月在上海交通大学医学院附属第九人民医院口腔种植科需要行ＧＢＲ同期种植体植入患者。手术当天及二期手术阶段均拍摄平行投照根尖片及口腔颌面部锥形束CT,记录牙龈厚度（>2 mm或≤2 mm）、骨质分类及使用的膜的类型。手术当天根尖片近、远中边缘骨水平分别记为MB1及DB1,二期手术阶段分别记为MA1及DA1,2次差值记为MD1及DD1。手术当天及二期手术阶段CBCT对种植体近中及远中的测量值分别记为MB2、DB2、MA2及DA2,测量结果之差记为MD2及DD2;唇、腭侧骨吸收差值分别记为BD和LD。采用SPSS 21.0软件包对数据进行统计学分析。结果：纳入30例GBR同期种植体植入位点。根尖片上,近、远中骨吸收分别为（1.61±1.03）mm和（1.39±0.91）mm。CBCT上观察到近、远中,唇、腭侧骨吸收中位数（四分位间距）分别为1.34 mm（0.00~2.25 mm）、0.90 mm（0.00~2.00 mm）、0.71 mm（0.00~1.41 mm）和0.47 mm（0.00~1.49 mm）。根尖片与CBCT比较得出MB1/MB2和DB1/DB2的数值无显著相关性（P>0.05）,而MA1/MA2 和DA1/DA2呈中等程度相关（P<0.01）。MD1中,将不同牙龈厚度、骨质亚类及膜的类型进行比较,结果分别为P=0.86、0.02和0.83。DD1中,结果均无显著差异（P=0.74、0.40和0.40）。结论：前牙美学区GBR同期种植愈合期间存在一定程度的边缘骨吸收。CBCT对种植体边缘骨的测量不一定准确。不同牙槽骨骨质类型可能对边缘骨吸收有影响。