Hämmerle Christoph H F, Jung Ronald E, Yaman Duygu, Lang Niklaus P
Clinic for Fixed and Removable Prosthodontics, Center for Dental and Oral Medicine andCranio-Maxillofacial Surgery, University of Zurich, Zurich, Switzerland.
Clin Oral Implants Res. 2008 Jan;19(1):19-25. doi: 10.1111/j.1600-0501.2007.01407.x. Epub 2007 Oct 22.
Lateral ridge augmentations are traditionally performed using autogenous bone grafts to support membranes for guided bone regeneration (GBR). The bone-harvesting procedure, however, is accompanied by considerable patient morbidity.
The aim of the present study was to test whether or not resorbable membranes and bone substitutes will lead to successful horizontal ridge augmentation allowing implant installation under standard conditions.
Twelve patients in need of implant therapy participated in this study. They revealed bone deficits in the areas intended for implant placement. Soft tissue flaps were carefully raised and blocks or particles of deproteinized bovine bone mineral (DBBM) (Bio-Oss) were placed in the defect area. A collagenous membrane (Bio-Gide) was applied to cover the DBBM and was fixed to the surrounding bone using poly-lactic acid pins. The flaps were sutured to allow for healing by primary intention.
All sites in the 12 patients healed uneventfully. No flap dehiscences and no exposures of membranes were observed. Nine to 10 months following augmentation surgery, flaps were raised in order to visualize the outcomes of the augmentation. An integration of the DBBM particles into the newly formed bone was consistently observed. Merely on the surface of the new bone, some pieces of the grafting material were only partly integrated into bone. However, these were not encapsulated by connective tissue but rather anchored into the newly regenerated bone. In all of the cases, but one, the bone volume following regeneration was adequate to place implants in a prosthetically ideal position and according to the standard protocol with complete bone coverage of the surface intended for osseointegration. Before the regenerative procedure, the average crestal bone width was 3.2 mm and to 6.9 mm at the time of implant placement. This difference was statistically significant (P<0.05, Wilcoxon's matched pairs signed-rank test).
After a healing period of 9-10 months, the combination of DBBM and a collagen membrane is an effective treatment option for horizontal bone augmentation before implant placement.
传统上，外侧牙槽嵴增高术采用自体骨移植来支撑引导骨再生（GBR）的膜。然而，取骨手术会给患者带来相当大的发病率。
本研究的目的是测试可吸收膜和骨替代物是否能成功实现水平牙槽嵴增高，从而在标准条件下植入种植体。
12名需要种植治疗的患者参与了本研究。他们在拟植入种植体的区域存在骨缺损。小心掀起软组织瓣，将脱蛋白牛骨矿物质（DBBM）（Bio-Oss）的块状物或颗粒置于缺损区域。应用胶原膜（Bio-Gide）覆盖DBBM，并使用聚乳酸针固定于周围骨。将瓣缝合，使其一期愈合。
12名患者的所有部位均顺利愈合。未观察到瓣裂开和膜暴露。增高手术后9至10个月，掀起瓣以观察增高效果。始终观察到DBBM颗粒与新形成的骨整合。仅在新骨表面，一些移植材料仅部分整合入骨。然而，这些未被结缔组织包裹，而是锚定在新再生的骨中。在所有病例中，除1例外，再生后的骨量足以将种植体置于修复理想位置，并按照标准方案实现种植体表面完全骨覆盖以进行骨结合。在再生手术前，平均嵴顶骨宽度为3.2毫米，种植体植入时为6.9毫米。这种差异具有统计学意义（P<0.05，Wilcoxon配对符号秩检验）。
经过9至10个月的愈合期后，DBBM与胶原膜的联合应用是种植体植入前水平骨增高的有效治疗选择。
