钛膜和胶原膜联合应用引导种植体周骨缺损骨再生的临床研究

目的:评价钛膜与胶原膜联合应用引导骨缺损骨再生的临床效果.方法:将34颗种植体植入30例患者的狭窄形牙槽嵴或唇颊骨壁缺损拔牙窝,所有种植体的唇、颊侧面部分暴露,种植体周骨缺损空间维持能力较差.测量种植暴露部分的最大长度,将羟基磷灰石珊瑚骨粉置于骨缺损处,采用钛膜覆盖稳定骨移植材料,然后将胶原膜覆盖于钛膜表面,无张力缝合伤口,术后六个月行Ⅱ期手术,取下钛膜,检查骨缺损骨再生的状况,再次测量种植暴露部分的最大长度.结果:2例患者于手术3个月左右因钛膜局部暴露,将钛膜取出.钛膜暴露率为6.6%.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:在空间维持能力较差的骨缺损处,钛膜和胶原膜联合应用引导骨再生可获得理想结果.钛膜和胶原膜联合应用可显著降低钛膜的暴露率,延迟发生膜暴露的时间,从而使引导骨再生的结果更加具有可预测性.     

上颌前牙区单牙种植钛膜引导成骨的美学效果观察

目的上颌前牙单牙种植采取不可吸收性无孔纯钛膜进行引导骨再生,对成骨效果以及修复后软组织美学效果进行观察。方法 2004年6月至2009年12月,在北京大学口腔医学院种植中心,20例上颌前牙单牙缺失种植患者（男12例,女8例,年龄19~56岁,平均34.0岁）。种植体植入后唇侧颈缘出现裂开性骨缺损或唇侧骨板厚度小于等于0.5mm,采用少量自体碎骨和Bio-Oss骨粉充填骨缺损后,以钛膜覆盖植骨区,并用小膜钉固定。愈合5~6个月行Ⅱ期手术,取出钛膜,测量种植体唇侧骨板的厚度。Ⅱ期术后2个月进行种植修复。使用PES（pink esthetic score）评分对种植修复体周围软组织进行评价。结果 20例病例中,没有一例出现伤口的裂开及感染。20颗种植体均获得骨结合。种植体植入时,唇侧骨板的厚度平均0.23mm,种植Ⅱ期手术暴露种植体取出钛膜时,测量唇侧骨板的厚度为1.5mm~3.5mm,平均2.33mm,平均增加2.10 mm。PES平均得分为10.05±1.57。结论在上颌前牙区单牙种植时,采取钛膜引导成骨,解决种植体唇侧颈部骨板裂开性骨缺损及厚度不足效果可靠,牙龈软组织的近期效果良好。     

纯钛膜结合自体骨修复种植牙美观区骨缺损的临床研究

目的：评价无孔纯钛膜结合自体碎骨整复种植牙美观区骨缺损的临床效果,并探讨其临床应用技巧.方法：8例前牙美观区缺失伴唇颊侧牙槽骨凹陷畸形要求种植修复患者,采用自体碎骨屑移植充填骨缺损区,无孔纯钛膜覆盖治疗,共计植入种植体19枚.术后6个月行种植Ⅱ期手术,同时取出钛膜.结果：除一例术后1月局部钛膜暴露外,余软组织瓣均愈合良好,术后6个月骨缺损区呈完全骨性修复.结论：纯钛膜具有良好的生物相容性,能有效地防止自体移植碎骨移位、纤维结缔组织长入,其塑形性好,能维持较大的骨再生修复空间.     

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。     

钛膜在上颌前牙区骨缺损延期即刻种植术中的临床应用观察

目的：通过钛膜在前牙区骨缺损的延期即刻种植术的应用,观察其成骨效果。方法：选取12例前牙区骨缺损病例,拔除患牙4-6周后,植入种植体,钛膜覆盖骨缺损区,6个月后二期手术观察成骨效果并完成冠修复。结果：共植入Frialit-2种植体16个,钛膜19片。2片钛膜术后2周发生部分暴露,予以再次缝合关闭创面。其余钛膜固位良好。术后6个月成骨效果满意。16个种植体均稳固,修复效果良好。结论：钛膜具有良好的引导骨再生作用,在前牙区骨缺损延期即刻种植中可发挥良好的成骨作用。     

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。     

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。     

可吸收性胶原膜结合无机牛骨修复种植牙骨缺损的临床研究

目的：应用可吸收性生物膜Bio-gide结合无机牛骨Bio-oss修复临床牙种植中的骨缺损，解决种植区的骨量不足问题。方法：在牙种植外科中将Bin-oss充填在暴露的种植体周围，表面覆盖可吸收性胶原膜Bio-gide，6个月后进行二期手术，暴露骨缺损区，观察并测量骨缺损的修复情况，并通过临床检查及x线曲面断层片，评价其在临床种植体周围骨缺损中引导骨组织再生的效果。结果：二期手术发现骨缺损区都获得了高水平的新骨形成，骨缺损重建百分率达90％。术后及承载6-36个月的跟踪随访，结果显示88个植入骨缺损区的ITI种植体，有2颗脱落，种植体存活率达97％。结论：Bio-oss与Bio-gide联合应用于临床ITI种植体周围骨缺损，可以成功的引导骨组织再生，重建缺损的骨组织，新生骨与种植体形成骨性结合。     

胶原膜促进骨融合期种植体周骨再生的临床观察

目的：分析种植术后使用胶原膜引导骨再生的方法。方法：对30例种植术中发现骨量不足的骨缺损区和即刻种植术中种植体与拔牙创间骨间隙较大区域采用医用胶原膜覆盖并严密缝合周围软组织，术后1周、1月、2月和上部结构连接前拍片，对新骨生长情况进行连续临床和X线的观察分析。结果：30例患者植入种植体47枚，其中39枚种植体植入后使用了胶原膜。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：医用胶原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。     

应用钛膜及胶原膜治疗种植体周骨缺损的比较研究

目的：比较钛膜及胶原膜修复种植体周骨缺损的临床效果及并发症.方法：98例患者在行牙种植术时应用了骨引导再生术,应用钛膜46例,胶原膜50例,同时使用两种膜2例,共植入141枚种植体,术后6个月暴露种植体,最终完成烤瓷冠修复.结果：应用两种膜均获得了良好的骨修复效果,胶原膜组成骨效果满意及基本满意率共为96.16%,钛膜组成骨效果满意及基本满意率共为91.67%.结论：胶原膜及钛膜均具有良好的骨引导再生作用,临床中可根据患者的实际情况作出选择.     

Single stage surgery combining transmucosal implant placement with guided bone regeneration and bioresorbable materials

The aim of the present clinical study was to test whether peri-implant bone defects can successfully be filled with bone by applying bioresorbable materials for guided bone regeneration (GBR) procedures in conjunction with implants in the transmucosal healing position. Three women and 7 men ranging in age from 32 to 68 years (median 54.5) needed tooth replacement with dental implants. Eight to 14 weeks following careful tooth extraction, implants of the ITI Dental Implant System were placed at the extraction sites. At this time, all implants presented dehiscence defects of the alveolar bone partly exposing the rough titanium plasma sprayed (TPS) surfaces. GBR procedures were performed using deproteinized bovine bone mineral (Bio-Oss) as a membrane-supporting material and a bioresorbable collagen membrane (Bio-Gide) as a barrier. The membranes and the flaps were adjusted to fit around the necks of the implants, thus leaving the implants extending transmucosally into the oral cavity. Clinical measurements were taken at 6 sites around each implant (mesio-buccal, buccal, disto-buccal, disto-lingual, lingual, mesio-lingual) using a calibrated periodontal probe. These included: i) defect depth measured from the shoulder of the implant to the first bone-to-implant contact, ii) infrabony defect component measured from the bone crest to the first bone-to-implant contact, iii) defect width measured from the crest to the implant body in a direction perpendicular to the long axis of the implant. The Wilcoxon Matched Pairs Signed Rank Test was applied to detect differences over time. At baseline, the mean defect depth per patient amounted to 3.6 mm (Standard Deviation 1.6 mm, range 1.8-6.8 mm). The deepest extensions of the defects were located at the buccal aspects (mean 7.8 mm, SD 1.9 mm). At re-entry, the mean defect had decreased to 2.5 mm (SD 0.6 mm). This difference was statistically significant (P < 0.01). Initially, in 62% of sites the depth ranged from 0-3 mm, in 23% it ranged from 2-4 mm, and in 15% it amounted to more than 6 mm. Six to 7 months later, at re-entry, 95% of sites were 3 mm and less in depth and 5% ranged from 4-6 mm. Defect resolution, as assessed by the amount of coverage of the initially exposed rough implant surface, reached a mean value of 86% (SD 33%). One hundred percent resolution was accomplished at 8 out of 10 implants, 60% at one and 0% at another implant. The tissue at the latter implant showed signs of infection and inflammation during the healing phase. It is concluded that bioresorbable materials in GBR procedures at transmucosal implants can lead to successful bone regeneration into peri-implant defects.     

异种脱细胞真皮基质引导即刻种植种植体周围骨缺损再生能力的实验研究

目的：运用异种脱细胞真皮基质进行引导骨组织再生术（guided bone regeneration,GBR）评价修复种植体周围骨缺损能力,为临床应用提供指导。方法：在4只成年Beagle犬下颌第2、3、4前磨牙新鲜拔牙创即刻植入种植体,并在颊侧形成3mm×3mm×5mm骨缺损区,按自身同期对照研究设计,右侧为实验侧,骨缺损区上覆盖海奥膜;左侧为空白对照侧,骨缺损区不覆盖海奥膜。术后1、4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生成量多,加速了骨组织的再生过程。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,可用作骨组织引导再生膜,促进骨缺损的再生修复。     

可吸收胶原膜在即刻种植中引导骨组织再生作用的研究

目的:通过动物实验研究可吸收胶原膜在即刻种植骨缺损区引导骨组织再生的作用。方法:8只实验用犬,拔除双侧下颌第二、三、四前磨牙,每个拔牙窝植入1枚种植体,并在种植体颈部对应牙槽骨上制备半环状骨缺损,将每只实验犬口内的6处骨缺损随机分为3组,每组两处,并给予不同处理。A组:骨缺损中植入珊瑚羟基磷灰石,并用可吸收胶原膜覆盖;B组:骨缺损中单纯植入珊瑚羟基磷灰石;C组:骨缺损中不植入任何材料,作为空白对照组。3个月后处死所有实验动物,制作含单个种植体的骨标本,进行大体观察、生物力学测定、组织形态学观察及测定。结果:3组标本骨缺损区均可见新骨生成,A组种植体颈部骨缺损区无软组织长入,新生骨量多,骨质成熟,成骨效果最好;B组次之,部分标本骨缺损区有软组织长入,新生骨量及骨质均不如A组。C组最差。结论:可吸收胶原膜生物相容性良好,可降解,可阻止软组织向骨缺损区长入,对骨组织再生有促进作用。     

Healing of dehiscence-type defects in implants placed together with different barrier membranes: a comparative clinical study

OBJECTIVE: Premature exposure of membranes used in guided bone regeneration (GBR) results in decreased bone formation. The effect of an expanded polytetrafluoroethylene (e-PTFE) and two collagen membrane on bone healing of buccal dehiscence defects around implants in cases with and without premature membrane exposure was clinically evaluated. METHODS: Three groups were established: Group OS (Ossix, n=73 implants, 41 patients), Group BG (Bio-Gide, n=53 implants, 28 patients) and Group GT (e-PTFE, Gore-Tex, n=34 implants, 17 patients). Defect height and width were measured at the time of implant placement and at second stage surgery. Surface area was calculated as half ellipses. When several implants were placed simultaneously, a mean of their defect width and height was calculated. RESULTS: Mean percentage reduction of defect area (92.2+/-13.78% Group OS, 94.6+/-6.69% Group BG, and 97.3+/-4.91% Group GT) and height (81.6+/-23.19%, 85.4+/-12.26%, and 93.4+/-9.39% respectively) did not show statistically significant differences between groups. Differences between groups were not statistically significant for all parameters when cases without spontaneous membrane exposure were compared. However, differences were significant when spontaneous membrane exposure occurred. Mean percentage reduction of defect area among cases where membrane exposure occurred was 91.5+/-10.86% Group OS, 71.5+/-8.61% Group BG, and 73.7+/-13.97% Group GT. Mean percentage reduction of defect height among cases with membrane exposure was 76.4+/-18.28%, 53.4+/-9.86%, and 49.4+/-11.05%, respectively. CONCLUSIONS: Premature exposure of membranes and subsequent and consequent exposure of implants results in impaired bone healing. Certain barrier membranes, as used in group OS, are apparently capable of supporting gingival healing even when prematurely exposed that could be advantageous in GBR procedures.     

聚四氟乙烯膜及几丁质膜在即刻种植中应用的实验研究

目的通过动物实验，比较研究国产聚四氟乙烯膜、几丁质膜和钛加强的聚四氟乙烯膜在牙即刻种植中引导种植体周围骨缺损区新骨生成的作用。方法12条杂种狗，拔除左侧下颌四个前磨牙，即刻植入4枚长10mm种植体，3枚种植体分别覆盖几丁质膜、聚四氟乙烯膜、钛加强的聚四氟乙烯膜，另一枚种植体不盖膜作为对照。术后于2、4、8、12周取材，通过X线、组织学定性及定量观察骨缺损的修复情况。结果盖膜的三组从第2周开始就有明显的骨再生，到第12周时骨缺损区已完全为新骨充填；对照组在任何时间点，新骨的量明显少于盖膜的三组；盖膜的三组之间新骨量没有明显的差异。结论聚四氟乙烯膜、几丁质膜和钛加强的聚四氟乙烯膜均能引导种植体周围骨缺损区的骨再生。     

新型GBR胶原膜的早期动物体内植入实验研究

目的:探讨新型国产GBR胶原膜体内植入后,诱导早期膜下成骨的能力。方法:实验于2013年10月~2014年3月在沈阳军区总医院动物实验中心完成。选取小型巴马猪,于双侧下颌骨骨体处用牙科裂钻制备8mm×8mm全层骨缺损3个,分别应用实验胶原膜、Bio-gide^@、无覆盖膜覆盖骨缺损。术后1个月处死动物,分别在处死前1、2周分别肌肉注射四环素溶液与二甲酚橙溶液。固定样本后,制备硬组织切片。分别在荧光显微镜及光学显微镜下(甲苯胺蓝、亚甲基蓝-酸性品红染色)观测膜的降解程度及膜下新骨生成能力,评价材料膜下骨形成量和骨成熟程度。结果:实验组胶原膜具备良好的屏障作用,膜下新生骨矿化程度良好;骨小梁排列整齐,但新生骨量少于对照组。 结论:新型国产胶原膜在1个月时无明显降解,具备良好的膜下成骨能力,需进行实验组胶原膜的改性,以增加膜下成骨量。     

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     

Comparative analysis of collagen membranes for the treatment of implant dehiscence defects

Guided bone regeneration (GBR) evolved from the concept of guided tissue regeneration (GTR) and has been used for reconstructing sites with bone deficiencies associated with dental implants. For GBR, the use of absorbable collagen membranes has been increasing, but, at present, scientific information on the use of collagen membranes for GBR is limited. This study was aimed to clinically and histomorphometrically compare two collagen membranes, Bio-Gide(R) and BioMend ExtendTM, for the treatment of implant dehiscence defects in eight mongrel dogs. Implant dehiscence defects were surgically created in edentulous ridges, followed by the placement of three endosseous implants bilaterally in the mandible. Each implant dehiscence defect was randomly assigned to one of three treatment groups: (1) control (no membrane), (2) porcine dermis collagen barrier (Bio-Gide) or (3) bovine tendon collagen barrier (BioMend Extend). Dogs were sacrificed at 4 and 16 weeks (four dogs each) after treatment. Histomorphometric analysis included percentage linear bone fill (LF), new bone-to-implant contact (BIC) and area of new bone fill (BF). The results of the study revealed no significant differences among groups for any parameter at 4 weeks. However, at 16 weeks, more LF, BIC, and BF were noted in the membrane-treated groups than controls. BioMend Extend-treated defects demonstrated significantly greater BIC than control (P < 0.05) at this time point. BIC at 16 weeks was significantly greater than 4-week BIC (P < 0.05). Membrane exposure occurred in 9 out of 15 sites examined, resulting in significantly less LF and BIC than the sites without membrane exposure (P < 0.05). The results of this study indicate that: (1) GBR treatment with collagen membranes may significantly enhance bone regeneration, manifested at late stage (16 weeks) of healing; and (2) space maintenance and membrane coverage were the two most important factors affecting GBR using bioabsorbable collagen membranes.