拔牙窝保存后的硬组织改变:在比格犬身上的实验研究
Hard tissue alterations after socket preservation: an experimental study in the beagle dog.
作者信息
Fickl Stefan, Zuhr Otto, Wachtel Hannes, Bolz Wolfgang, Huerzeler Markus B
机构信息
Private Institute for Periodontology and Implantology, Munich, Germany.
出版信息
Clin Oral Implants Res. 2008 Nov;19(11):1111-8. doi: 10.1111/j.1600-0501.2008.01575.x.
OBJECTIVES
The aim of the following experimental study was to assess bone changes in the horizontal and vertical dimension when using different socket preservation procedures.
MATERIAL AND METHODS
In five beagle dogs the distal roots of the 3rd and 4th premolar were extracted without elevation of a mucoperiosteal flap and the following treatments were assigned: Tx 1: The extraction socket was filled with BioOss Collagen (Geistlich Biomaterials, Wolhusen, Switzerland) and interrupted sutures were applied.: Tx 2: The extraction socket was filled with BioOss Collagen (Geistlich Biomaterials, Wolhusen, Switzerland) and a free gingival graft was sutured to cover the socket.: Tx 3: The extraction socket was left with its blood clot and interrupted sututes were applied.: Four month after surgery the dogs were sacrificed and from each extraction site two histological sections were selected for histometric analysis. The following parameters were evaluated: (1) the vertical dimension was determined by placing a horizontal line on the lingual bone wall. Then, the distance from this line to the buccal bone wall was measured. (2) The horizontal dimension was assessed at three different areas measured from the top of the lingual crest: 1 mm (Value 1), 3 mm (Value 3) and 5 mm (Value 5).
RESULTS
The mean vertical loss of the buccal bone plate for the Tx 1 group was 2.8+/-0.2 mm. The Tx 2 group showed vertical loss of 3.3+/-0.2 mm. The Tx 3 group demonstrated 3.2+/-0.2 mm of mean vertical loss. The horizontal dimension of the alveolar process was 4.4+/-0.3/6.1+/-0.2/7.2+/-0.1 mm at the three different levels for the Tx 1 group. The Tx 2 group depicted bone dimensions of 4.8+/-0.2/6.0+/-0.2/7.1+/-0.1 mm. The horizontal dimension of the Tx 3 group was 3.7+/-0.3/6.2+/-0.2/7.0+/-0.1 mm. When the results from the horizontal measurements were tested with the analysis of variance (ANOVA), a clear significance could be found in particular for Value 1 mm between the test groups Tx 1 and Tx 2 and the control group (Tx 3) (P<0.001). Furthermore the mean of treatment 1 (Tx 1) was slightly significantly lower than of treatment 2 (Tx 2) (P<0.05).
CONCLUSION
The findings from the present study disclose that incorporation of BioOss Collagen into the extraction socket has only limited impact on the subsequent biologic process with particular respect to the buccal bone plate. The horizontal measurement of the alveolar ridge depicted that the loss of the buccal bone plate was replaced to a certain amount by newly generated bone guided by the BioOss Collagen scaffold. It seems that the mechanical stability provided by BioOss Collagen and furthermore by a free gingival graft could act as a placeholder preventing the soft tissue from collapsing.
目的
以下实验研究的目的是评估采用不同的拔牙窝保存程序时,水平和垂直方向上的骨变化情况。
材料与方法
在五只比格犬身上,在不掀起粘骨膜瓣的情况下拔除第三和第四前磨牙的远中根,并进行以下处理:Tx 1:拔牙窝用BioOss胶原(盖氏生物材料公司,瑞士沃尔胡森)填充,并进行间断缝合。Tx 2:拔牙窝用BioOss胶原(盖氏生物材料公司,瑞士沃尔胡森)填充,并用游离龈瓣缝合覆盖拔牙窝。Tx 3:拔牙窝保留血凝块,并进行间断缝合。术后四个月处死动物,从每个拔牙部位选取两片组织切片进行组织计量分析。评估以下参数:(1)垂直方向尺寸通过在舌侧骨壁上画一条水平线来确定。然后,测量这条线到颊侧骨壁的距离。(2)水平方向尺寸在从舌侧嵴顶测量的三个不同区域进行评估:1毫米(数值1)、3毫米(数值3)和5毫米(数值5)。
结果
Tx 1组颊侧骨板的平均垂直吸收为2.8±0.2毫米。Tx 2组垂直吸收为3.3±0.2毫米。Tx 3组平均垂直吸收为3.2±0.2毫米。Tx 1组在三个不同水平处牙槽突的水平尺寸分别为4.4±0.3/6.1±0.2/7.2±0.1毫米。Tx 2组骨尺寸为4.8±0.2/6.0±0.2/7.1±0.1毫米。Tx 3组的水平尺寸为3.7±0.3/6.2±0.2/7.0±0.1毫米。当用方差分析(ANOVA)对水平测量结果进行检验时,特别是在Tx 1组和Tx 2组与对照组(Tx 3)之间的1毫米数值处,可发现明显差异(P<0.001)。此外,处理1(Tx 1)的平均值略显著低于处理2(Tx 2)(P<0.05)。
结论
本研究结果表明,将BioOss胶原植入拔牙窝对后续生物学过程的影响有限,尤其是对颊侧骨板。牙槽嵴的水平测量表明,颊侧骨板的吸收在一定程度上被BioOss胶原支架引导下新生成的骨所替代。似乎BioOss胶原以及游离龈瓣提供的机械稳定性可起到占位作用,防止软组织塌陷。