Brunski J B, Puleo D A, Nanci A
Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York 12180-3590, USA.
Int J Oral Maxillofac Implants. 2000 Jan-Feb;15(1):15-46.
Research in biomaterials and biomechanics has fueled a large part of the significant revolution associated with osseointegrated implants. Additional key areas that may become even more important--such as guided tissue regeneration, growth factors, and tissue engineering--could not be included in this review because of space limitations. All of this work will no doubt continue unabated; indeed, it is probably even accelerating as more clinical applications are found for implant technology and related therapies. An excellent overall summary of oral biology and dental implants recently appeared in a dedicated issue of Advances in Dental Research. Many advances have been made in the understanding of events at the interface between bone and implants and in developing methods for controlling these events. However, several important questions still remain. What is the relationship between tissue structure, matrix composition, and biomechanical properties of the interface? Do surface modifications alter the interfacial tissue structure and composition and the rate at which it forms? If surface modifications change the initial interface structure and composition, are these changes retained? Do surface modifications enhance biomechanical properties of the interface? As current understanding of the bone-implant interface progresses, so will development of proactive implants that can help promote desired outcomes. However, in the midst of the excitement born out of this activity, it is necessary to remember that the needs of the patient must remain paramount. It is also worth noting another as-yet unsatisfied need. With all of the new developments, continuing education of clinicians in the expert use of all of these research advances is needed. For example, in the area of biomechanical treatment planning, there are still no well-accepted biomaterials/biomechanics "building codes" that can be passed on to clinicians. Also, there are no readily available treatment-planning tools that clinicians can use to explore "what-if" scenarios and other design calculations of the sort done in modern engineering. No doubt such approaches could be developed based on materials already in the literature, but unfortunately much of what is done now by clinicians remains empirical. A worthwhile task for the future is to find ways to more effectively deliver products of research into the hands of clinicians.
生物材料和生物力学方面的研究推动了与骨整合植入物相关的重大革命的很大一部分。由于篇幅限制，其他可能变得更加重要的关键领域，如引导组织再生、生长因子和组织工程，未纳入本综述。所有这些工作无疑将持续不减地进行；事实上，随着植入技术和相关疗法的临床应用越来越多，这项工作甚至可能在加速。最近一期《牙科研究进展》的特刊对口腔生物学和牙种植体进行了精彩的全面总结。在理解骨与植入物界面的事件以及开发控制这些事件的方法方面已经取得了许多进展。然而，仍然存在几个重要问题。界面的组织结构、基质组成和生物力学特性之间的关系是什么？表面改性是否会改变界面组织结构和组成及其形成速率？如果表面改性改变了初始界面结构和组成，这些变化会保留下来吗？表面改性是否会增强界面的生物力学特性？随着目前对骨-植入物界面的理解不断深入，能够帮助促进理想结果的主动式植入物的开发也将不断进步。然而，在这项活动带来的兴奋之中，必须记住患者的需求必须始终是首要的。还值得注意的是另一个尚未得到满足的需求。随着所有这些新进展的出现，需要对临床医生进行关于所有这些研究进展的专业使用的继续教育。例如，在生物力学治疗计划领域，仍然没有被广泛接受的生物材料/生物力学“建筑规范”可以传授给临床医生。而且，也没有临床医生可以用来探索“如果……会怎样”的情景以及现代工程中所做的其他类似设计计算的现成治疗计划工具。毫无疑问，可以根据文献中已有的材料开发出这样的方法，但不幸的是，临床医生目前所做的很多工作仍然是凭经验的。未来一项有价值的任务是找到方法，将研究成果更有效地交到临床医生手中。
