自体骨髓移植治疗拔牙窝的临床和组织形态计量学评估。
Clinical and histomorphometric evaluation of extraction sockets treated with an autologous bone marrow graft.
机构信息
São Leopoldo Mandic Research Center - Dental School, Campinas, Brazil.
出版信息
Clin Oral Implants Res. 2010 May;21(5):535-42. doi: 10.1111/j.1600-0501.2009.01891.x. Epub 2010 Mar 11.
PURPOSE
The aim of this study was to evaluate the potential of an autologous bone marrow graft in preserving the alveolar ridges following tooth extraction.
MATERIALS
Thirteen patients requiring extractions of 30 upper anterior teeth were enrolled in this study. They were randomized into two groups: seven patients with 15 teeth to be extracted in the test group and six patients with 15 teeth to be extracted in the control group. Hematologists collected 5 ml of bone marrow from the iliac crest of the patients in the test group immediately before the extractions. Following tooth extraction and elevation of a buccal full-thickness flap, titanium screws were positioned throughout the buccal to the lingual plate and were used as reference points for measurement purposes. The sockets were grafted with an autologous bone marrow in the test sites and nothing was grafted in the control sites. After 6 months, the sites were re-opened and bone loss measurements for thickness and height were taken. Additionally, before implant placement, bone cores were harvested and prepared for histologic and histomorphometric evaluation.
RESULTS
The test group showed better results (P<0.05) in preserving alveolar ridges for thickness, with 1.14+/-0.87 mm (median 1) of bone loss, compared with the control group, which had 2.46+/-0.4 mm (median 2.5) of bone loss. The height of bone loss on the buccal plate was also greater in the control group than in the test group (P<0.05), 1.17+/-0.26 mm (median 1) and 0.62+0.51 (median 0.5), respectively. In five locations in the control group, expansion or bone grafting complementary procedures were required to install implants while these procedures were not required for any of the locations in the test group. The histomorphometric analysis showed similar amounts of mineralized bone in both the control and the test groups, 42.87+/-11.33% (median 43.75%) and 45.47+/-7.21% (median 45%), respectively.
CONCLUSION
These findings suggest that the autologous bone marrow graft can contribute to alveolar bone repair after tooth extraction.
目的
本研究旨在评估自体骨髓移植在拔牙后保存牙槽嵴的潜力。
材料
本研究纳入了 13 名需要拔除 30 颗上颌前牙的患者。他们被随机分为两组：实验组 7 名患者，15 颗牙需要拔除；对照组 6 名患者，15 颗牙需要拔除。血液科医生在实验组患者拔牙前立即从髂嵴采集 5ml 骨髓。拔牙后，掀起颊侧全厚瓣，将钛螺钉置于颊侧至舌侧板，并用作测量参考点。实验组的牙槽窝用自体骨髓移植，对照组则不做移植。6 个月后，重新打开牙槽窝，测量厚度和高度的骨丢失量。此外，在植入物放置前，采集骨芯并进行组织学和组织形态计量学评估。
结果
实验组在厚度方面的牙槽嵴保存效果更好（P<0.05），骨丢失量为 1.14+/-0.87mm（中位数 1），而对照组的骨丢失量为 2.46+/-0.4mm（中位数 2.5）。对照组颊侧板的骨丢失高度也大于实验组（P<0.05），分别为 1.17+/-0.26mm（中位数 1）和 0.62+0.51mm（中位数 0.5）。对照组有 5 个部位需要进行扩张或骨移植补充手术才能植入种植体，而实验组则不需要。组织形态计量学分析显示，对照组和实验组的矿化骨量相似，分别为 42.87+/-11.33%（中位数 43.75%）和 45.47+/-7.21%（中位数 45%）。
结论
这些发现表明，自体骨髓移植可以促进拔牙后牙槽骨的修复。
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