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用于分期局部牙槽嵴增高的钛网:临床及组织学-组织形态计量学评估

Use of titanium mesh for staged localized alveolar ridge augmentation: clinical and histologic-histomorphometric evaluation.

作者信息

Proussaefs Periklis, Lozada Jaime

出版信息

J Oral Implantol. 2006;32(5):237-47. doi: 10.1563/1548-1336(2006)32[237:UOTMFS]2.0.CO;2.

Abstract

The use of titanium mesh for localized alveolar ridge augmentation was evaluated by clinical, radiographic, laboratory, and histologic-histomorphometric evaluation. Seventeen patients participated in this study. All patients required localized alveolar ridge augmentation before placement of dental implants. An equal mixture of autogenous bone graft and inorganic bovine mineral (Bio-Oss) was used as a bone graft material. Autogenous bone graft was harvested intraorally. Titanium mesh was submerged for 8.47 months (SD 2.83). Impressions were taken intraorally before bone grafting, 6 months after bone grafting, and 6 months after implant placement. Impressions were used to measure the volume of alveolar ridge augmentation and provide linear laboratory measurements regarding the results of bone augmentation. Bone quality (type II-IV) was recorded during implant surgery. Standardized linear tomographs were taken before bone grafting and before implant placement. A biopsy was harvested with a trephine bur from the grafted area during implant surgery for histologic-histomorphometric evaluation. In all cases the grafted area had adequate bone volume and consistency for placement of dental implants. Early mesh exposure (2 weeks) was observed in 2 patients, and late exposure (>3 months) was observed in 4 patients. Volumetric laboratory measurements indicated 0.86 cc (SD 0.69) alveolar augmentation 1 month after bone grafting, 0.73 cc (SD 0.60) 6 months after bone grafting, and 0.71 cc (SD 0.57) 6 months after implant placement. This indicated 15.11% resorption 6 months after bone grafting, and no further resorption occurred after implant placement. Linear laboratory measurements indicated vertical augmentation of 2.94 mm (SD 0.86) 1 month after bone grafting, 2.59 mm (SD 0.91) 6 months after bone grafting, and 2.65 mm (SD 1.14) 6 months after implant placement. The corresponding measurements for labial-buccal augmentation were 4.47 mm (SD 1.55), 3.88 mm (SD 1.43), and 3.82 mm (SD 1.47). Radiographic evaluation indicated 2.56 mm (SD 1.32) vertical augmentation and 3.75 mm (SD 1.33) labial-buccal augmentation. Histomorphometric evaluation indicated 36.47% (SD 10.05) new bone formation, 49.18% (SD 6.92) connective tissue, and 14.35% (SD 5.85) residual Bio-Oss particles; 44.65% (SD 22.58) of the Bio-Oss surface was in tight contact with newly formed bone. The use of titanium mesh for localized alveolar ridge augmentation with a mixture of autogenous intraorally harvested bone graft and Bio-Oss offered adequate bone volume for placement of dental implants. Intraorally harvested autogenous bone graft mixed with Bio-Oss under a titanium mesh offered 36.47% new bone formation, and 15.11% resorption occurred 6 months after bone grafting.

摘要

通过临床、影像学、实验室及组织学 - 组织形态计量学评估,对钛网用于局部牙槽嵴增高术进行了评价。17名患者参与了本研究。所有患者在植入牙种植体前均需要进行局部牙槽嵴增高。自体骨移植材料与无机牛骨矿物质(Bio - Oss)按等量混合用作骨移植材料。自体骨从口腔内获取。钛网植入时间为8.47个月(标准差2.83)。在骨移植前、骨移植后6个月及种植体植入后6个月进行口腔内取模。取模用于测量牙槽嵴增高的体积,并提供关于骨增高结果的线性实验室测量数据。在种植手术期间记录骨质量(II - IV型)。在骨移植前和种植体植入前拍摄标准化线性断层扫描。在种植手术期间,用环钻从移植区域获取活检组织进行组织学 - 组织形态计量学评估。在所有病例中,移植区域有足够的骨体积和一致性以植入牙种植体。2例患者观察到早期钛网暴露(2周),4例患者观察到晚期暴露(>3个月)。实验室体积测量表明,骨移植后1个月牙槽嵴增高0.86 cc(标准差0.69),骨移植后6个月为0.73 cc(标准差0.60),种植体植入后6个月为0.71 cc(标准差0.57)。这表明骨移植后6个月吸收了15.11%,种植体植入后未再发生进一步吸收。实验室线性测量表明,骨移植后1个月垂直增高2.94 mm(标准差0.86),骨移植后6个月为2.59 mm(标准差0.91),种植体植入后6个月为2.65 mm(标准差1.14)。唇 - 颊侧增高的相应测量值分别为4.47 mm(标准差1.55)、3.88 mm(标准差1.43)和3.

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