Buser D, Hoffmann B, Bernard J P, Lussi A, Mettler D, Schenk R K
Department of Oral Surgery, School of Dental Medicine, University of Berne, Switzerland.
Clin Oral Implants Res. 1998 Jun;9(3):137-50. doi: 10.1034/j.1600-0501.1998.090301.x.
In recent years, bone grafts and bone substitutes have been increasingly utilized underneath barrier membranes to optimize the treatment outcome of bone reconstructive therapy for defects in the alveolar process. In the present study, 4 different filling materials were evaluated in bone defects of similar dimensions in the mandible of miniature pigs. Blood clots and autografts were used as controls. The defects were covered with barrier membranes and allowed to heal for 4, 12 or 24 weeks. Histologic examination demonstrated that bone repair progressed through a programmed sequence of maturation steps closely resembling the pattern of bone development and growth regardless of whether bone grafts or substitutes were present or not. Histomorphometric analysis showed that autologous bone grafts (autografts) had the best osteoconductive properties during the initial healing period, with 39% of newly formed bone inside the membrane-covered defects at 4 weeks of healing. In addition, 87% of the graft surfaces were already covered by bone at this time. Both values were significantly higher for autografts than for the 4 alternative bone fillers (P < or = 0.05). At 12 weeks, these differences were no longer apparent, with all 5 filling materials showing similar values. Among the tested bone substitutes, tricalcium phosphate (TCP) showed a significantly higher percentage of bone fill at 24 weeks of healing. It can be concluded that sites filled with autografts clearly demonstrated the best results underneath barrier membranes in the early phase of healing. As far as degradation and substitution are concerned, TCP showed the most promising results. This filler, however, needs to be tested further in a more demanding animal model. Less favorable results were obtained for coral-derived hydroxyapatite granules and for demineralized freeze-dried bone allografts.
近年来，骨移植材料和骨替代物在屏障膜下的应用越来越广泛，以优化牙槽突缺损骨重建治疗的效果。在本研究中，对小型猪下颌骨中尺寸相似的骨缺损使用了4种不同的填充材料进行评估。血凝块和自体骨用作对照。缺损处覆盖屏障膜，使其愈合4、12或24周。组织学检查表明，无论是否存在骨移植材料或替代物，骨修复都通过一系列程序化的成熟步骤进行，这一过程与骨发育和生长模式非常相似。组织形态计量学分析表明，自体骨移植材料（自体骨）在愈合初期具有最佳的骨传导性能，在愈合4周时，膜覆盖缺损内新形成骨的比例为39%。此外，此时87%的移植材料表面已被骨覆盖。自体骨的这两个数值均显著高于4种替代骨填充材料（P≤0.05）。在12周时，这些差异不再明显，所有5种填充材料的值相似。在所测试的骨替代物中，磷酸三钙（TCP）在愈合24周时的骨填充百分比显著更高。可以得出结论，在愈合早期，填充自体骨的部位在屏障膜下的效果明显最佳。就降解和替代而言，TCP显示出最有前景的结果。然而，这种填充材料需要在要求更高的动物模型中进一步测试。珊瑚衍生的羟基磷灰石颗粒和脱矿冻干骨同种异体移植的效果较差。
