VA Hospital, Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
Clin Implant Dent Relat Res. 2012 Mar;14(1):112-20. doi: 10.1111/j.1708-8208.2009.00235.x. Epub 2010 May 11.
Large osseous defects that fail to heal spontaneously require ridge augmentation prior to implant placement. The periosteum can act as an effective barrier membrane. Little is known about the influence of bone decortication in enhancing guided bone regeneration outcomes.
The aim of the present study was a clinical, tomographic, and histological evaluation of bone healing in large defect sites treated with cortical perforations without the use of other membranes but the periosteum.
Ten consecutive patients undergoing ridge augmentation on the pre-maxilla due to severe bone loss were followed for an average of 35 months. Recipient sites were cortico-perforated and augmented using a combination of autogenous particulate and block grafts. The periosteal membrane was preserved and it fully covered the autografts. Histological analysis was performed in four sites from a trephine core taken at the time of implant osteotomy preparation. Tomographic assessment (computed tomography [CT] scan) at baseline and post-augmentation evaluated graft volume maintenance.
Recipient sites were re-entered for implant placement showing good incorporation of the grafts with minimal volume loss. Biopsy specimens showed viable bone rich in osteoblast-like cells with little or no inflammatory cells. Clinical exam revealed absence of implant transparency, mucosal recession, mobility, bleeding on probing, or suppuration at follow-up. CT scan evaluation showed an average increased bucco-lingual width at the recipient site of 8.1 mm ± 0.9 (2.5 fold) versus a 3.2 ± 0.9 at baseline (p < .0001; CI 95%: 4.04-5.71 mm), maintaining on average 98% of the augmented width at 2.9 years.
Periosteal preservation seems to be sufficient as a barrier membrane to protect particulate or block osseous grafts provided that good primary closure is achieved. Bone decortication may enhance clinical and histological outcomes. Graft viability (biopsy specimens) and volume maintenance (CT evaluation) remained stable 35 months post-augmentation.
未能自发愈合的大骨缺损需要在植入物放置前进行牙槽嵴增高。骨膜可以作为有效的屏障膜。关于骨皮质剥除术增强引导骨再生效果的影响知之甚少。
本研究旨在通过临床、断层扫描和组织学评估，研究在不使用其他膜但保留骨膜的情况下，对大缺损部位进行皮质穿孔治疗后的骨愈合情况。
10 例因严重骨缺失而行前上颌牙槽嵴增高的连续患者，平均随访 35 个月。采用自体颗粒和块状移植物的联合应用对受区进行皮质穿孔和增高。保留骨膜并使其完全覆盖自体移植物。在植入物骨切开准备时取自钻芯的 4 个部位进行组织学分析。基线和增高后的断层扫描评估（计算机断层扫描 [CT] 扫描）评估移植物体积维持情况。
在重新进入植入部位时，发现移植物的吸收良好，体积损失最小。活检标本显示含有丰富成骨细胞样细胞的有活力的骨，炎症细胞很少或没有。临床检查显示在随访时无植入物透明度、黏膜退缩、松动、探诊出血或溢脓。CT 扫描评估显示，受区颊舌向宽度平均增加 8.1mm±0.9（2.5 倍），而基线时为 3.2mm±0.9（p<0.0001；CI95%：4.04-5.71mm），在 2.9 年时平均维持了增高宽度的 98%。
只要实现良好的初次闭合，保留骨膜作为屏障膜足以保护颗粒状或块状骨移植物。骨皮质剥除术可能会增强临床和组织学结果。在增高后 35 个月，移植物的活力（活检标本）和体积维持（CT 评估）保持稳定。
