Block M S, Gardiner D, Almerico B, Neal C
Louisiana State University, Department of Oral and Maxillofacial Surgery, School of Dentistry, New Orleans, Louisiana, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000 Jun;89(6):676-85. doi: 10.1067/moe.2000.106334.
The aim of this study was to determine the response of alveolar bone after it was augmented vertically with distraction osteogenesis, implanted with hydroxylapatite (HA)-coated implants and noncoated titanium-threaded implants, and subsequently loaded for 1 year.
Eight dogs each had 4 implants placed horizontally into an edentulous mandibular quadrant. After integration, a distraction osteogenesis device was fabricated in the laboratory. An osteotomy was made to allow the crest of the alveolar ridge to be distracted vertically. After 10 mm of vertical distraction, the distraction devices were stabilized with light cured resin. After bone fill of the distraction gap was radiographically confirmed in all dogs at 10 weeks, 2 implants were placed into the ridges. Four dogs had threaded titanium implants placed, and 4 dogs had threaded HA-coated implants placed, with 1 implant in the distracted bone and 1 implant in adjacent nondistracted bone, for both groups. After 4 months for implant integration, bridges were fabricated and secured to the implants with screws. Crestal bone levels were evaluated by radiographs through 1 year of function. Animals were killed after 1 year of loading for histologic evaluation.
The vertical ridge augmentation averaged 8.8 +/- 1.0 mm after 10 weeks of healing after distraction. Analysis of variance indicated a significantly greater change from baseline for HA-coated implants and for distracted bone sites. Histologic examination showed that bone had formed between the distracted segments creating an augmented ridge. The average thickness of the labial cortex in the distraction gap was significantly thinner than the lingual cortex in distracted bone or the lingual and labial nondistracted cortical bone. The presence of a dental implant did not significantly affect cortical bone thickness. Serial sections showed that implants remained integrated and functional without soft tissue inflammation.
Dental implants placed into alveolar ridges augmented with the technique of distraction osteogenesis were functional for the length of this study.
本研究旨在确定经牵张成骨垂直增高牙槽骨后,植入羟基磷灰石(HA)涂层种植体和未涂层钛螺纹种植体,随后加载1年时牙槽骨的反应。
8只犬每只在下颌无牙象限水平植入4枚种植体。种植体整合后,在实验室制作牵张成骨装置。进行截骨术以使牙槽嵴顶垂直牵张。垂直牵张10 mm后,用光固化树脂固定牵张装置。在10周时通过X线片确认所有犬的牵张间隙骨填充完成后,在牙槽嵴植入2枚种植体。两组中,4只犬植入螺纹钛种植体,4只犬植入螺纹HA涂层种植体,每组各有1枚种植体植入牵张骨内,1枚种植体植入相邻未牵张骨内。种植体整合4个月后,制作桥体并用螺钉固定于种植体上。通过X线片评估1年功能期内的牙槽嵴骨水平。加载1年后处死动物进行组织学评估。
牵张后愈合至10周时,垂直牙槽嵴增高平均为8.8±1.0 mm。方差分析表明,HA涂层种植体和牵张骨部位相对于基线的变化显著更大。组织学检查显示,牵张节段之间形成了骨,形成了增高的牙槽嵴。牵张间隙处唇侧皮质骨的平均厚度明显薄于牵张骨内的舌侧皮质骨或未牵张的舌侧和唇侧皮质骨。牙种植体的存在对皮质骨厚度没有显著影响。连续切片显示种植体保持整合且功能良好,无软组织炎症。
在本研究期间,采用牵张成骨技术增高牙槽嵴后植入的牙种植体功能良好。