Wikesjö Ulf M E, Lim Won Hee, Thomson Robert C, Cook Alonzo D, Wozney John M, Hardwick W Ross
Laboratory for Applied Periodontal and Craniofacial Regeneration, Temple University School of Dentistry, Philadelphia, PA 19140, USA.
J Periodontol. 2003 May;74(5):635-47. doi: 10.1902/jop.2003.74.5.635.
Recombinant human bone morphogenetic protein-2 (rhBMP-2) technologies have been shown to significantly support alveolar bone formation. Biomaterial limitations, however, have restricted the biologic potential for onlay indications. The objective of this study was to evaluate regeneration of alveolar bone and periodontal attachment, and biomaterials reaction following surgical implantation of a space-providing, bioabsorbable, macroporous, polyglycolic acid-trimethylene carbonate (PGA-TMC) membrane combined with a rhBMP-2 construct in a discriminating onlay defect model.
Routine supraalveolar periodontal defects were created at the mandibular premolar teeth in 9 beagle dogs. Contralateral jaw quadrants in subsequent animals were randomly assigned to receive the dome-shaped PGA-TMC (100 to 120 microm pores) membrane with rhBMP-2 (0.2 mg/mL) in a bioresorbable hyaluronan (Hy) carrier or the PGA-TMC membrane with Hy alone (control). The gingival flaps were advanced to submerge the membranes and teeth and sutured. Animals were euthanized at 8 and 24 weeks postsurgery for histologic observations.
Jaw quadrants receiving the PGA-TMC membrane alone experienced exposures at various time points throughout the study. Jaw quadrants receiving the PGA-TMC/rhBMP-2 combination remained intact, although one site experienced a late minor exposure. Newly formed alveolar bone approached and became incorporated into the macroporous PGA-TMC membrane in sites receiving rhBMP-2. The PGA-TMC biomaterial was occasionally associated with a limited inflammatory reaction. Residual PGA-TMC could not be observed at 24 weeks postsurgery. Residual Hy could not be observed at any time interval. Regeneration of alveolar bone height (means +/- SD) was significantly increased in sites receiving the PGA-TMC/rhBMP 2 combination compared to control (3.8 +/- 1.3 versus 0.7 +/- 0.5 mm at 8 weeks and 4.6 +/- 0.8 versus 2.1 +/- 0.4 mm at 24 weeks; P < 0.05). Limited cementum regeneration was observed for PGA-TMC/rhBMP-2 and PGA-TMC control sites. Ankylosis compromised regeneration in sites receiving PGA-TMC/rhBMP-2.
The bioabsorbable, space-providing, macroporous PGA-TMC membrane appears to be a compatible biomaterial for bone augmentation procedures. rhBMP-2 significantly enhances alveolar bone augmentation and soft tissue healing when combined with the PGA-TMC membrane.
重组人骨形态发生蛋白-2（rhBMP-2）技术已被证明能显著促进牙槽骨形成。然而，生物材料的局限性限制了其在覆盖植入适应症方面的生物学潜力。本研究的目的是在一个有区分性的覆盖缺损模型中，评估在植入提供空间的、可生物吸收的、大孔的聚乙醇酸-碳酸三亚甲基酯（PGA-TMC）膜并结合rhBMP-2构建体后，牙槽骨和牙周附着的再生情况以及生物材料的反应。
在9只比格犬的下颌前磨牙处制造常规的龈上牙周缺损。随后将动物对侧颌骨象限随机分组，分别接受带有rhBMP-2（0.2mg/mL）的可生物吸收透明质酸（Hy）载体的圆顶形PGA-TMC（100至120微米孔隙）膜，或仅含Hy的PGA-TMC膜（对照组）。将牙龈瓣推进以覆盖膜和牙齿并缝合。在术后8周和24周对动物实施安乐死以进行组织学观察。
在整个研究过程中，仅接受PGA-TMC膜的颌骨象限在不同时间点出现了暴露情况。接受PGA-TMC/rhBMP-2组合的颌骨象限保持完整，尽管有一个部位在后期出现了轻微暴露。在接受rhBMP-2的部位，新形成的牙槽骨靠近并融入到大孔PGA-TMC膜中。PGA-TMC生物材料偶尔会引发有限的炎症反应。术后24周未观察到残留的PGA-TMC。在任何时间间隔均未观察到残留的Hy。与对照组相比，接受PGA-TMC/rhBMP 2组合的部位牙槽骨高度的再生（平均值±标准差）显著增加（8周时为3.8±1.3对0.7±0.5毫米，24周时为4.6±0.8对2.1±0.4毫米；P<0.05）。在PGA-TMC/rhBMP-2和PGA-TMC对照组部位观察到有限的牙骨质再生。在接受PGA-TMC/rhBMP-2的部位，骨粘连损害了再生。
可生物吸收的、提供空间的、大孔PGA-TMC膜似乎是一种适用于骨增量手术的生物材料。rhBMP-2与PGA-TMC膜联合使用时，能显著增强牙槽骨增量和软组织愈合。
