Berengo M, Bacci C, Sartori M, Perini A, Della Barbera M, Valente M
School of Dentistry, Department of Surgical Sciences, University of Padua, Padua, Italy.
Minerva Stomatol. 2006 Apr;55(4):189-98.
Many studies proposing the use of autologous bone to correct bony defects of the oral district have been published, and numerous protocols have been proposed to simplify the harvesting of particulate bone. However, no qualitative evaluation of the harvested bone has been reported. The study provides a qualitative evaluation of autologous bone harvested by 9 methods: the harvested bone was analysed through microphotography and histomorphometric analysis, measuring the surface area of bone fragments and the percentages of vital and necrotic bone.
Nine harvesting methods were employed: round bur on low-speed hand-piece (40000 rpm), bur on high-speed hand-piece, spiral implant bur on low-speed hand-piece (1000 rpm), safe scraper, Rhodes' back-action chisel, rongeur pliers, gouge shaped bone chisel, mectron piezosurgery. Ten bone harvests were taken from the retromolar bone using the 9 methods, during extraction of embedded wisdom teeth (indication to extraction was for orthodontic reasons). The histocytological preparations were analysed with microphotography and histomorphometric analysis, evaluating particle size, percentage of vital bone and number of osteocytes per unit of surface area.
Histomorphometric analysis showed that non-vital bone accounted for 100% of harvested bone, with a complete absence of osteocytes, in specimens harvested with burs and safe scraper. Percentage of non-vital bone was intermediate, with a low number of cells, in specimens harvested with back-action, gouge shaped bone chisel, spiral bur and piezosurgery. The best results were achieved with rongeur pliers and by en bloc harvesting.
The results show that the best methods to harvest vital bone are: gouge shaped bone chisel, back-action, en bloc harvesting, rongeur pliers and piezosurgery, although the latter method leaves some empty gaps in the tissue. The bone harvested with round bur on low-speed hand-piece, bur on high-speed hand-piece, spiral implant bur, or safe scraper are not suitable for grafting as indicated by the absence of osteocytes and the predominance of non-vital bone.
许多关于使用自体骨修复口腔区域骨缺损的研究已发表，并且提出了许多方案来简化颗粒骨的采集。然而，尚未有对采集的骨进行定性评估的报道。本研究对通过9种方法采集的自体骨进行了定性评估：通过显微摄影和组织形态计量分析对采集的骨进行分析，测量骨碎片的表面积以及活骨和坏死骨的百分比。
采用了9种采集方法：低速手机圆钻（40000转/分钟）、高速手机钻、低速手机螺旋种植钻（1000转/分钟）、安全刮匙、罗兹反作用凿、咬骨钳、半圆凿形骨凿、美创压电手术。在拔除埋伏阻生智齿（拔除指征为正畸原因）时，使用这9种方法从磨牙后骨采集10份骨样本。通过显微摄影和组织形态计量分析对组织细胞学制剂进行分析，评估颗粒大小、活骨百分比和每单位表面积的骨细胞数量。
组织形态计量分析表明，使用钻和安全刮匙采集的标本中，坏死骨占采集骨的100%，完全没有骨细胞。使用反作用凿、半圆凿形骨凿、螺旋钻和压电手术采集的标本中，坏死骨百分比处于中等水平，细胞数量较少。咬骨钳和整块采集获得了最佳结果。
结果表明，采集活骨的最佳方法是：半圆凿形骨凿、反作用凿、整块采集、咬骨钳和压电手术，尽管后一种方法在组织中会留下一些空隙。低速手机圆钻、高速手机钻、螺旋种植钻或安全刮匙采集的骨不适合移植，因为没有骨细胞且坏死骨占主导。
