Davies John E
Bone Interface Group, Faculty of Dentistry and Institute for Biomaterials and Biomedical Engineering, University of Toronto, 4 Taddle Creek Road, Toronto, Ontario, Canada M5S 3G9.
J Dent Educ. 2003 Aug;67(8):932-49.
If dental implantology is an increasingly successful treatment modality, why should we still need to understand the mechanisms of peri-implant bone healing? Are there differences in cortical and trabecular healing? What does "poor quality" bone mean? What stages of healing are most important? How do calcium phosphate-coated implants accelerate healing? What is the mechanism of bone bonding? While there are still many aspects of peri-implant healing that need to be elucidated, it is now possible to deconvolute this biological reaction cascade, both phenomenologically and experimentally, into three distinct phases that mirror the evolution of bone into an exquisite tissue capable of regeneration. The first and most important healing phase, osteoconduction, relies on the recruitment and migration of osteogenic cells to the implant surface, through the residue of the peri-implant blood clot. Among the most important aspects of osteoconduction are the knock-on effects generated at the implant surface, by the initiation of platelet activation, which result in directed osteogenic cell migration. The second healing phase, de novo bone formation, results in a mineralized interfacial matrix equivalent to that seen in the cement line in natural bone tissue. These two healing phases, osteoconduction and de novo bone formation, result in contact osteogenesis and, given an appropriate implant surface, bone bonding. The third healing phase, bone remodeling, relies on slower processes and is not considered here. This discussion paper argues that it is the very success of dental implants that is driving their increased use in ever more challenging clinical situations and that many of the most important steps in the peri-implant healing cascade are profoundly influenced by implant surface microtopography. By understanding what is important in peri-implant bone healing, we are now able to answer all the questions listed above.
如果牙种植学是一种越来越成功的治疗方式，为什么我们仍然需要了解种植体周围骨愈合的机制呢？皮质骨和松质骨的愈合有差异吗？“质量差”的骨是什么意思？愈合的哪些阶段最为重要？磷酸钙涂层种植体如何加速愈合？骨结合的机制是什么？虽然种植体周围愈合仍有许多方面需要阐明，但现在有可能从现象学和实验上将这种生物反应级联反卷积为三个不同阶段，这三个阶段反映了骨演变成能够再生的精细组织的过程。第一个也是最重要的愈合阶段，即骨传导，依赖于成骨细胞通过种植体周围血凝块的残留物向种植体表面募集和迁移。骨传导最重要的方面之一是种植体表面通过血小板活化引发的连锁反应，这会导致定向的成骨细胞迁移。第二个愈合阶段，即新生骨形成，会产生一种矿化的界面基质，类似于天然骨组织中黏合线处所见的基质。骨传导和新生骨形成这两个愈合阶段会导致接触性骨生成，并且在合适的种植体表面条件下会实现骨结合。第三个愈合阶段，即骨重塑，依赖于较慢的过程，在此不作讨论。这篇讨论文章认为，正是牙种植体的成功促使其在越来越具有挑战性的临床情况下得到更多应用，并且种植体周围愈合级联中的许多最重要步骤都受到种植体表面微观形貌的深刻影响。通过了解种植体周围骨愈合中的重要因素，我们现在能够回答上述所有问题。
