Meijndert L, Raghoebar G M, Schüpbach P, Meijer H J A, Vissink A
Department of Oral and Maxillofacial Surgery and Maxillofacial Prosthetics, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Int J Oral Maxillofac Surg. 2005 Dec;34(8):877-84. doi: 10.1016/j.ijom.2005.04.017. Epub 2005 Jun 22.
The purpose of this study was to investigate the quality of bone at grafted implant sites in the anterior maxilla. Grafting of these sites was necessary because of insufficient bone volume in a buccopalatinal direction (width at the top of the crest 1-3mm). Reconstruction was performed with chin bone (N=5), chin bone and a resorbable Bio-Gide GBR membrane (N=5) or Bio-Oss spongiosa granules in combination with a Bio-Gide GBR membrane (N=5). Biopsies were taken prior to implantation, i.e. 3 months after grafting with chin bone, and 6 months after grafting with Bio-Oss. Evaluation was done by assessing the histological and histomorphometric characteristics of full-length biopsies taken from the actual implant site. Both areas with non-vital bone and areas with apposition of bone and remodelling phenomena were observed in the chin bone group at the time of placement of the implants. Similar results were observed at implant sites reconstructed with a chin bone graft covered by a membrane. In the chin bone group without and with a GBR membrane, the mean total bone volume (TBV) was 55.2+/-6.8% and 57.7+/-11.5%, respectively; the marrow connective tissue volume (MCTV) was 44.8+/-6.8% and 42.3+/-11.5%, respectively. Remnants of the resorbable GBR membrane were not detected. In the Bio-Oss((R)) group, at implant placement some newly formed bone was observed in the connective tissue surrounding the Bio-Oss((R)) particles (mean TBV (newly formed bone) 17.6+/-14.5%), but most particles were surrounded by connective tissue. No convincing signs of remodelling were observed (mean remaining Bio-Oss volume 40.5+/-9.3%; mean MCTV 41.9+/-13.1%). No implants were lost during follow up (12 months). At the time of placement of the implants the grafting material (either chin bone or Bio-Oss is still not fully replaced by new vital bone. In case of Bio-Oss, most of the grafting material is even still present. Despite these differences, the 1-year clinical results were very good and comparable between the various grafting techniques applied.
本研究的目的是调查上颌前部种植体植入部位的骨质量。由于颊腭向骨量不足（嵴顶宽度为1 - 3mm），这些部位需要进行植骨。分别采用颏骨（N = 5）、颏骨与可吸收的Bio - Gide引导骨再生（GBR）膜联合使用（N = 5）或Bio - Oss松质骨颗粒与Bio - Gide GBR膜联合使用（N = 5）进行重建。在种植前取活检样本，即颏骨植骨后3个月以及Bio - Oss植骨后6个月。通过评估取自实际种植部位的全长活检样本的组织学和组织形态计量学特征来进行评价。在植入种植体时，颏骨组观察到了无活力骨区域以及有骨附着和重塑现象的区域。在用膜覆盖的颏骨移植重建的种植部位也观察到了类似结果。在未使用和使用GBR膜的颏骨组中，平均总骨体积（TBV）分别为55.2±6.8%和57.7±11.5%；骨髓结缔组织体积（MCTV）分别为44.8±6.8%和42.3±11.5%。未检测到可吸收GBR膜的残留。在Bio - Oss组，种植体植入时，在Bio - Oss颗粒周围的结缔组织中观察到一些新形成的骨（新形成骨的平均TBV为17.6±14.5%），但大多数颗粒被结缔组织包围。未观察到令人信服的重塑迹象（Bio - Oss剩余平均体积为40.5±9.3%；平均MCTV为41.9±13.1%）。随访（12个月）期间无种植体丢失。在植入种植体时，移植材料（无论是颏骨还是Bio - Oss）仍未完全被新的有活力骨替代。对于Bio - Oss，大部分移植材料甚至仍然存在。尽管存在这些差异，但1年的临床结果非常好，且所应用的各种移植技术之间具有可比性。
