BMP复合材料修复骨下袋的临床应用研究

目的：探讨BMP复合材料修复牙周病骨下袋骨缺损的临床应用效果。方法：采用BMP复合材料（BMP和骨粉）植入有严重骨内缺损的牙周病患者的骨下袋内，分析包括术前术后（六个月一年）根尖片以及术后1周、2周、3周、4周、3个月和6个月、1年复查各项指标。结果：术后6个月及1年PD与AL与基线比均明显减少（P〈0．01）；术后6个月及1年X片显示原缺损区密度升高，植入区与周围组织问没有明显的界限。结论：BMP复合材料修复牙周病骨下袋骨缺损具有良好的临床应用效果。     

APBSC与TEB犬体内埋植诱导成骨的实验研究

目的：研究APBSC-TEB复合埋植于犬的腹部皮下组织,在TGF-β1和BMP的诱导下成骨,为牙周骨缺损骨修复作准备。方法：新鲜猪髂骨脱蛋白、脱钙制成TEB,浸入自犬提取的APBSC种子细胞悬液中,制备成APBSC-TEB复合物,埋植于犬腹部皮下组织,在不同时间观察成骨情况。结果：实验组术后1周APBSC细胞与移植前没有变化;术后2周,APBSC细胞壁触突向胶元纤维和成纤维细胞中伸展;术后1个月,TEB被机体吸收,代之以少量的骨小梁形成,APBSC已演变为成骨细胞。3～5个月,骨小梁增多,其间也有大量的结缔组织成分。对照组为结缔组织,没有成骨细胞形成。结论：APBSC-TEB复合移植于非骨部位,在TGF-β1和BMP的诱导下可以形成骨样组织。     

Bio-oss复合BMP修复牙种植体周围骨缺损的骨组织学定性与定量分析

目的:分析和评价以无机牛骨(deproteinizednaturalbovinemineral, Bio-oss)作为载体材料复合骨形成蛋白(bonemorphogenicprotein, BMP)修复牙种植体周围骨缺损的效果。方法: 60只兔子随机分成两组,在兔子的股骨预备种植窝后制造标准开放式骨缺损,宽3mm、高4mm、厚3mm,然后植入羟基磷灰石涂层的3. 3mm×8mmBLB种植体,一组骨缺损填入Bio-oss,另一组填入Bio-oss/BMP复合骨。于术后2、4和6个月取样本,制作带种植体的硬组织切片,进行组织学形态学观察,骨结合百分率测定和计算机组织图像定量分析。结果:两组的骨缺损处均有新骨形成,Bio-oss/BMP组与单独植入Bio-oss相比,新骨形成更早、新生骨量更多、骨的矿化程度更高。2、4和6个月的骨结合百分率均高于Bio-oss组。结论:Bio-oss是BMP理想的载体材料,Bio-oss/BMP复合骨可更快更有效的促进骨组织再生,并形成理想的种植体-骨结合界面。     

扫描电镜观察骨形成蛋白与生物活性玻璃陶瓷复合材料种植后的组织学反应

本研究采用扫描电镜观察了骨形成蛋白(BMP)与生物活性玻璃陶瓷(BGC)复合材料在狗牙槽中种植后2周到6个月的组织学反应,发现BGC可作为BMP的载体,复合材料有良好的骨诱导性,复合物与诱导骨可形成完整的骨性结合。     

钛种植体与单纯珊瑚及复合BMP珊瑚代用品结合的实验研究

目的　研究单纯珊瑚与复合BMP的珊瑚表面贴附移植后与同期植入的钛种植体形成骨结合的情况。方法　将单纯珊瑚与复合BMP的珊瑚置于去皮质的犬髂骨表面 ,同时植入钛种植体 ,用种植体固定人工骨 ,不同时间取材 ,观察种植体与人工骨的骨结合情况。结果　种植体与单纯珊瑚与复合BMP的珊瑚均可以形成骨结合。单纯珊瑚 12周时 ,种植体与珊瑚之间形成结构不规则的骨界面 ;同时 ,材料有大量的吸收。珊瑚复合BMP时新骨明显增多 ,形成粗的骨小梁 ,骨髓腔变小 ,6周时与种植体之间已经形成基本完善的骨界面 ;且材料总体吸收量较少。结论　天然珊瑚具有良好的生物相容性 ,可以与钛种植体形成骨性结合 ;BMP、珊瑚复合材料植入可以加快成骨 ,延缓吸收。此复合材料可以应用于种植外科     

倍骼生治疗颌骨囊肿术后骨缺损的临床研究

目的:观察应用生物活性骨修复材料倍骼生PerioGlas誖治疗颌骨囊肿术后的骨缺损情况,评价修复效果。方法:以26例颌骨囊肿住院病例作为实验组,应用PerioGlas誖充填术后死腔;另20例作为对照组,采用碟形手术加碘仿纱条填塞法消除死腔。术后随访1、3、6个月,以X线片平均灰度值比较其骨密度变化。结果:实验组与对照组术后1、3、6个月骨密度平均灰度值有显著性差异。结论:用倍骼生PerioGlas誖充填死腔术后反应小,成骨速度快,缩短成骨过程,有利于骨缺损区的快速修复,是一种较理想的骨缺损修复材料。     

煅石膏、骨形成蛋白及羟基磷灰石三元复合人工骨修复骨缺损的实验研究

以煅石膏(PLP）作为颗粒型羟基磷灰石(HA)人工骨粘接成形剂和骨形成蛋白(BMP)的载体，制成三元复合人工骨．分别用HA—bBMP、HA—PLP和单纯HA植入狗下颌骨实验性骨缺损中，采用组织学、定量组织学、免疫组织化学、X线摄片和扫描电镜观察的方法评价该复合人工骨的生物学性能。术后1，2，4，8和16周观察发现，HA—bBMP—PLP复合人工骨具有明显的骨诱导活性．PLP可充当BMP缓慢释放系统载体．增强BMP骨诱导活性，和作为颗粒型HA的粘接成形剂．使复合人工骨具有一定的可塑性和成形性，可达到准确的植入，植入后早期可有效防止HA颗粒移动。本研究证实．HA—bBMP—PLP三元复合人工骨不但可限制植入后HA颗粒的早期移动，更重要的是可以迅速增加新骨形成量．从形态和功能上大大提高了复合人工骨修复骨缺损的质量。     

BMP与透明质酸钠复合物对放疗后种植体骨愈合影响的实验研究

目的　 (1)观察放疗对狗下颌种植体周围骨形成蛋白 (BMP)分布与活性的影响 ;(2 )观察局部应用BMP与透明质酸钠复合物对放疗后种植体骨愈合作用的影响。方法　 4只成年雄性杂种狗 ,拔除双侧下颌第 3、4前磨牙和第 1磨牙 ,形成无牙区。拔牙后 3个月 ,用电子直线加速器照射一侧下颌无牙区 ,单一剂量 15Gy。另一侧不接受照射 ,作为对照。放疗后 3个月 ,狗双侧下颌无牙区植入纯钛种植体各 4枚 ,其中每侧各 2枚种植体在局部使用BMP与透明质酸钠的复合物。种植术后 1 5个月和 3个月分别处死 2只动物取材。结果　 (1)放疗侧种植体周围骨的BMP免疫染色范围和强度均明显弱于非放疗侧 ;(2 )局部应用BMP与透明质酸钠的复合物后 ,放疗侧种植体 -骨接触率和骨小梁体积百分比有明显增加。结论　 (1)放疗后种植体周围BMP明显减少 ,活性显著下降 ;(2 )局部应用BMP与透明质酸钠复合物可以加快放疗后狗下颌骨的再生和重建 ,提高放疗后狗下颌纯钛种植体的种植体 -骨接触率和骨小梁体积百分比。     

透明质酸钠凝胶复合TGF-β1修复兔下颌骨缺损的实验研究

目的:评价透明质酸钠凝胶(HA)复合重组人类转化生长因子(TGF-β1)修复兔下颌骨缺损的效果.方法:建立兔下颌骨缺损的动物模型,制备10mm×6mm×3mm骨缺损,应用TGF-β1/HA作为实验组,单纯HA载体材料和空白组作为对照组,修复下颌骨缺损.通过大体解剖、X线片、骨密度检测、钙含量测定、骨小梁百分比测定和微血管标记分析修复效果.结果:空白组和单纯HA组在不同时期成骨情况无明显差异.用TGF-β1/HA复合材料者与单纯HA载体相比,各指标均有显著差异性(P＜0.05).结论:TGF-β1/HA复合材料能促进骨缺损修复,具有良好的临床应用前景.     

生物活性多肽修饰的碳磷酸钙骨水泥修复牙周骨缺损的实验研究

目的　探讨生物活性多肽处理的碳磷酸钙骨水泥 (carbonatedcalciumphosphatebonecement,CCPBC)修复牙周骨缺损的可能性与效果。方法　 4只健康家犬牙周用手术方法去骨 ,缺损约1cm× 1cm ,每只犬分别用羟基磷灰石 (hydroxyapatite ,HA)、倍骼生、CCPBC以及用多肽处理的CCPBC直接修复缺损 ,术后 1～ 3个月进行X线片检查及组织形态学观察。结果　实验条件下 ,HA组和倍骼生组均有不同程度的材料丢失 ,HA组缺损处为软组织修复 ,倍骼生组牙槽骨侧残余材料周围有少量新生骨组织 ;CCPBC组能有效维持牙周骨缺损间隙 ;CCPBC经多肽处理组 ,材料周围有较多的新骨形成 ,修复效果优于其他组。结论　CCPBC经过生物活性多肽修饰后具有一定的成骨活性 ,其在牙周骨缺损修复中的应用前景 ,值得关注。     

Dimensional stability of the alveolar ridge after implantation of a bioabsorbable bone graft substitute: a radiographic and histomorphometric study in rats

This study evaluated reconstruction of the alveolar ridge after molar extraction in rats with bioabsorbable bone repair scaffolds. The material was prepared from the unsaturated polyester poly(propylene glycol-co-fumaric acid) (PPF), which may be cured in situ to form a porous scaffold. The intention is to use this material either as a stand-alone bone graft substitute or as an extender to autograft harvested from mandibular reconstruction sites. The bioactivity of the graft substitute was investigated in a rat residual ridge resorption model. PPF bone repair material was injected into the defect site, where it cross-linked in situ in the presence of a hydroxyapatite (HA) filler and effervescent agents. The PPF-based material develops porosity during an in situ cure by generating carbon dioxide during the effervescent reaction of citric acid and sodium bicarbonate. The incorporation of HA promotes osteoconduction within the bone repair scaffold. In this study, bioactivity of the porous scaffold was evaluated as a function of HA particle size (micrometer-sized vs nanometer-sized particles). The maxillary or mandibular molars on the right side were extracted from 96 adult Sprague-Dawley rats. A 2-mm round bur was used to create a uniform trench defect measuring 2 mm in diameter, 2 mm in depth, and 4 mm in length at each extraction site. The defect site was (1) treated with PPF bone repair material containing nanometer-sized HA, (2) treated with PPF material containing micrometer-sized HA, (3) treated with demineralized freeze-dried bone allograft, or (4) left untreated. Rats were sacrificed at 2, 4, 7, and 12 weeks postoperative. Resorption of the residual alveolar ridge was assessed by radiographic outcomes. Bone ingrowth through the defect site was measured by histomorphometric outcomes. Mandibular and maxillary ridge heights increased for all treatments used in this study. There were no clinical indications that addition of either of the PPF bone repair materials retarded hard- or soft-tissue healing of the extraction sites. Although not statistically significant, the mandibular defects treated with PPF containing nanometer-sized HA healed at a faster rate as determined by ridge height and new bone formation measurements when compared with the other treatments. These findings suggest the feasibility of using PPF bone graft substitutes for oral-maxillofacial applications.     

Alveolar ridge augmentation using nonresorbable hydroxylapatite with or without autogenous cancellous bone

A four-year prospective evaluation of the use of nonresorbable, particulate hydroxylapatite (HA) to augment deficient alveolar ridges was performed. The material was used alone and in combination with finely crushed autogenous cancellous bone. Implants were delivered subperiosteally by syringe injection, usually using local anesthesia for Class I to Class III ridges and general anesthesia for Class III and Class IV ridges. The improved ridge height and width were stable. Postoperative resorption with significant loss of ridge height, frequently seen with rib and iliac crest onlayed grafts, was not observed with HA augmentation. Permanent denture construction began as early as three weeks postoperatively and by four to six weeks if HA was combined with autogenous cancellous bone. It was possible to place mandibular staple implants simultaneously or following HA augmentation. Visor osteotomy techniques were improved by use of HA to produce a wider, more convex stable ridge. Although skin, mucosa, or dermal vestibuloplasties were performed as early as three months postoperatively in a small number of patients, there appeared to be a lesser need for vestibuloplasty after HA augmentation than after onlay bone grafting. In addition, prosthodontists performed fewer denture relines after HA augmentation than after onlay bone grafts. The authors believe the most significant factor accounting for these observations is the firm, nonmobile mucosal base resulting from augmentation with HA. The resultant stable, soft tissue base and improved ridge height and contour have contributed to a comfortable, retentive, stable denture for these patients. The prosthetic and surgical procedures are easier to perform and have produced superior, more permanent results than onlay bone grafts and alloplasts. Preliminary studies also point to exciting possibilities for use of HA as a bone substitute/marrow extender in maxillary and mandibular defects, cysts, and clefts and in osteotomies for orthognathic surgery.     

Lateral alveolar ridge augmentation using a synthetic nano-crystalline hydroxyapatite bone substitution material (Ostim): preliminary clinical and histological results

OBJECTIVES: The purpose of this preliminary two-center clinical prospective study was to evaluate the tissue composition of augmented sites after the use of a nano-crystalline hydroxyapatite (ncHA) bone substitution material by clinical and histological examinations. MATERIAL AND METHODS: A synthetic ncHA augmentation material was used without any additives in 14 patients requiring lateral ridge augmentation 6-7 months before (10 patients) or at implant placement (four patients). The ncHA material was covered by a titanium mesh for space maintenance. Clinical and radiographic parameters were evaluated and bone biopsy cores, obtained 6-7 months following augmentation, were assessed histologically and histomorphometrically. RESULTS: One patient showed gingival swelling, redness and pain at the augmentation site requiring removal of the titanium mesh 6 weeks postoperatively. In seven patients, a premature exposure of the titanium mesh without any inflammatory symptoms was noted. The width of the fixed gingival and the alveolar ridge height did not change significantly at least 6 months following augmentation (P>0.5), whereas a significant gain in alveolar ridge width (P=0.01) was noted. After a median period of prosthetic loading of 24 months, no implant was considered to be a failure. Histology revealed ncHA remnants in peripheral and central parts of biopsy cores obtained from seven patients after at least 6 months without histological symptoms of inflammation, whereas histomorphometry of bone cores revealed no significant differences of the mean percentage area of ncHA in peripheral (23.4%) and central (15.1%) parts of biopsy cores (P=0.262). The mean percentage area of bone colonizing the defect was 52.3%. CONCLUSIONS: Small amounts of ncHA were found after at least 6 months in bone biopsies. The former defect space was filled with bone. The alveolar ridge width gain was found to be significant after lateral augmentation utilizing ncHA, providing a quantitatively and qualitatively sufficient site for primary stable implant placement.     

Alveolar ridge augmentation with Bio-Oss: a histologic study in humans

The aim of the present study was to investigate the healing of alveolar ridge defects augmented with cancellous bovine bone mineral. In six partially edentulous patients, bone augmentation was necessary prior to implant placement because of severe alveolar ridge resorption. The defect sites, all located in the maxilla, were filled with Bio-Oss and covered with the resorbable collagen membrane Bio-Gide. Biopsies were obtained from the defect sites 6 to 7 months following grafting and were processed for ground sectioning. The histologic analysis revealed that the Bio-Oss particles occupied 31% of the total biopsy area. An intimate contact between woven bone and Bio-Oss was detected along 37% of the particle surfaces. A mixed type of bone was found; it contained woven bone and parallel-fibered bone, which demonstrates features of remodeling activity. Signs of resorption of the grafting material were observed in the histologic sections, which indicates that the material takes part in the remodeling process. It is suggested that Bio-Oss may be a very suitable material for staged localized ridge augmentation in humans.     

空气喷磨机去除窝沟龋的扫描电镜观察

使用美国空气喷磨机（ＫＣＰ１０００），选用２７μｍ颗粒，８．２６８×１０＾５Ｐａ（１２０ｐｓｉ）气压，喷磨时间５～１０ｓ作为实验参数喷除新鲜离体人牙Ｈｅ面窝沟龋，扫描电镜观察显示，ＫＣＰ去龋干净，形成的釉质窝洞线角及洞缘圆钝，洞底粗糙不平，呈密集，不规则的凹凸状结构，实验结果提示ＫＣＰ能有效去除窝沟龋，产生的形态学改变特别适合应用复合树脂的粘接。     

锶磷灰石生物特性的初步研究

目的:锶磷灰石是一种新型的磷灰石类陶瓷,本研究通过动物试验初步探讨其在生物体内的一些特性,为临床的广泛应用提供理论基础。方法:24只新西兰大白兔分为3组,双侧下颌角均造成约6 mm@12 mm@4 mm的缺损,用不同浓度(10%,5%,0)的锶磷灰石修复,术后1月,3月,6月时随机处死1组进行大体观察、X线摄片、组织病理、核素扫描(发射计算机断层术分析),评价其生物学性能。结果:锶磷灰石复合人工骨所致感染和排斥反应均较轻,组织切片上反映随材料的降解,新生骨大量长入现象比羟磷灰石更为明显,且周边软组织内有部分成骨现象,X线片上显示随时间的延长,材料和骨之间的密合度逐渐增加,6月时已几乎融为一体,同时锶磷灰石修复侧较羟磷灰石修复侧核素浓聚现象有明显的差异。结论:锶磷灰石有良好的组织相容性、骨引导性及生物降解性,能提高新骨生成量,具有更好的骨缺损修复效果,并可能有一定程度的骨诱导性。     

The effect of therapeutic radiation on canine alveolar ridges augmented with hydroxylapatite.

The purpose of this investigation was to evaluate the effect of radiation on hydroxylapatite (HA) implanted subperiosteally for alveolar ridge augmentation in dogs. All bicuspids and molars were extracted from 16 dogs. After 6 weeks, nonporous HA granules were implanted subperiosteally on the alveolar ridge. Following 4 months of healing, 12 dogs (experimental group) underwent therapeutic radiation therapy (Co60, 4,000 rad [40 Gy]) to the head and neck region. Four dogs were not irradiated and served as controls. Four animals (three experimental and one control) were killed at 5,6,7, and 8 months after HA augmentation. Light microscopic evaluation showed that approximately 25% of HA granules were encased by bone while the others were surrounded by fibrous connective tissue. Dissolution of the HA was observed. Microparticles of HA were phagocytized as part of a granulomatous inflammatory reaction. This reaction decreased significantly as time elapsed after implantation. Osteoclastic activity was seen at the junction of HA and periosteum and as part of bone remodeling. Dissolution of the HA granules and the granulomatous inflammatory reaction were not significantly increased by therapeutic radiation. The radiation did not cause development of dehiscence or osteonecrosis.     

Clinical-radiographic and histological evaluation of two hydroxyapatites in human extraction sockets: a pilot study

After tooth extraction the healing process involves bone resorption and soft tissue contraction, events that can compromise the ideal implant placement with functional and aesthetic limitations. Following tooth extraction, a socket preservation technique can limit bone resorption. This study evaluated two different types of hydroxyapatite (HA) grafting materials placed into fresh extraction sockets, 6 months after tooth extraction, histologically, clinically and radiographically. Ten extraction sockets from 10 patients were divided in two groups: 5 sockets received a biomimetic HA and 5 received nanocrystalline HA. After 6 months, before implant placement, samples from the grafted area were harvested and evaluated clinically, radiographically and histologically. The percentages of bone, osteoid areas and residual material in the two groups were not statistically different. All samples showed great variability with extensive bone formation and total material resorption or amounts of osteoid tissue that filled the spaces between the residual material particles. The authors did not find any differences between biomimetic and nanocrystalline HA and assume that, within the limits of this study, both these materials could be applied into fresh extraction sockets to limit bone resorption. A control material and a much larger sample size are needed to confirm these findings.     

Histological evaluation of alveolar ridge augmentation using injectable calcium phosphate bone cement in dogs

Summary  Alveolar ridge augmentation is an important procedure to restore tooth loss. Several types of graft materials have been used for augmenting the alveolar ridge. An injectable calcium phosphate cement (CPC) has been applied to periodontal bone defects and has shown favourable results. Thus, this CPC may work as an effective graft material for alveolar ridge augmentation. The aim of this study was to evaluate the effectiveness of the CPC for large-scaled (about 7 × 8 × 6 mm) ridge augmentation in dogs. Alveolar ridge defects were created bilaterally in the maxilla of six beagle dogs. The CPC was applied to one of the bilateral maxillary defects. The untreated defect on the contralateral side served as control. The animals were sacrificed at 6 months after surgery and decalcified histological specimens of the alveolar ridge were prepared histometrically and evaluated under a light microscope. Newly formed and reconstructed alveolar ridges covering the CPC were observed in all experimental sites. In the control sites, only slight newly bone formation was observed. Histomorphometrical analysis indicated that the CPC grafted group exhibited significantly ( P  = 0·0001) increased area and height in new bone formation compared with those of the control group. The results indicate that the CPC appears to be an effective material for alveolar ridge augmentation and may act as a space maintainer to conduct new bone formation.     

软衬材料在上颌骨缺损早期修复中的应用

目的：观察软衬材料应用于上颌骨缺损早期修复的临床效果。方法：应用软衬材料对6例上颌骨缺损患者进行甲期修复,并与同期在上颌骨切除术后3个月以上,进行常规硬性基托修复的患者进行比较,比较两组患者的主观感觉、面型。结果：应用软衬材料进行早期修复的患者主观感觉好,口角无明显歪斜,面型较理想。结论：软衬材料应用于上颌骨缺损早期修复,能在术后早期恢复患者的生理功能,减轻面部畸形,改善其生存质量。