Tehemar Sherif, Hanes Philip, Sharawy Mohamed
Department of Oral Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
Clin Implant Dent Relat Res. 2003;5(3):193-211. doi: 10.1111/j.1708-8208.2003.tb00202.x.
Advanced periodontal disease as well as failed endodontic teeth are the most common reasons for tooth removal and simultaneous implant placement.
To determine whether the addition of a bone substitute graft material and/or a guided bone regeneration membrane added to the site of an immediately placed implant would increase the development of lamellated bone, particularly in the presence of bone defects.
Four treatment modalities associated with the immediate placement of hydroxyapatite-coated endosteal screw implants into extraction sockets of healthy (C/H) and periodontally diseased teeth (T/PD) were tested. Five dogs with healthy teeth and five dogs with naturally occurring periodontitis were chosen for the study. Each dog received eight implants after extraction of four mandibular and four maxillary premolars. Four implants were submerged for 3 months and four for 6 months. The implants were either inserted alone (subgroup A); surrounded by a GORE-TEX membrane (subgroup B; W.L. Gore & Associates Inc., Flagstaff, AZ, USA); surrounded by PepGen P-15 (Dentsply Friadent CeraMed Dental Co. Denver, CO, USA) at coronal area (subgroup C); or surrounded by a combination of graft material and the ePTFE membrane (subgroup D). Implants in group A were osseointegrated in both C/H and T/PD groups with similar bone-implant contact ratios (BICRs).
ePTFE membrane significantly improved the BICR of the 6-months implants, whereas graft material significantly increased the BICR at 3 months and maintained the gain thereafter. The graft material and membrane combination further improved the BICR and significantly increased lamellated bone in crestal bone of all implants.
This study provides experimental evidence in support of use of graft material with immediately placed implants, particularly in presence of bone defects that initially reduce the BICR such as in periodontitis. Adding an ePTFE membrane to graft material resulted in a greater replacement of woven bone by lamellated bone. Clinical trials in humans are recommended as a follow-up of this experimental study.
晚期牙周病以及根管治疗失败的牙齿是拔牙及同期种植的最常见原因。
确定在即刻种植位点添加骨替代移植材料和/或引导骨再生膜是否会增加板层骨的形成，尤其是在存在骨缺损的情况下。
测试了四种与将羟基磷灰石涂层的骨内螺纹种植体即刻植入健康（C/H）和牙周病牙齿（T/PD）拔牙窝相关的治疗方式。选择五只健康牙齿的狗和五只患有自然发生的牙周炎的狗进行研究。每只狗在拔除四颗下颌和四颗上颌前磨牙后接受八颗种植体。四颗种植体植入后埋入3个月，四颗埋入6个月。种植体要么单独植入（A组）；用GORE-TEX膜包裹（B组；美国亚利桑那州弗拉格斯塔夫的W.L. Gore & Associates公司）；在冠方区域用PepGen P-15（美国科罗拉多州丹佛的登士柏菲亚特陶瓷牙科公司）包裹（C组）；或用移植材料和ePTFE膜联合包裹（D组）。A组的种植体在C/H组和T/PD组中均实现了骨整合，骨-种植体接触率（BICR）相似。
ePTFE膜显著提高了6个月种植体的BICR，而移植材料在3个月时显著增加了BICR，并在此后维持了增加的幅度。移植材料和膜的联合进一步提高了BICR，并显著增加了所有种植体嵴顶骨中的板层骨。
本研究提供了实验证据，支持在即刻种植时使用移植材料，尤其是在存在最初会降低BICR的骨缺损（如牙周炎）的情况下。在移植材料中添加ePTFE膜会使编织骨被板层骨更大程度地替代。建议作为本实验研究的后续进行人体临床试验。
