Quereshy Faisal A, Dhaliwal Hardeep S, El Sibel A, Horan Michael P, Dhaliwal Sukhdeep S
Department of Oral and Maxillofacial Surgery, Case Western Reserve University and University Hospitals/Case Medical Center, Cleveland, OH 44106, USA.
J Oral Maxillofac Surg. 2010 Oct;68(10):2497-502. doi: 10.1016/j.joms.2010.05.060.
The current "gold standard" in alveolar ridge augmentation is autogenous bone grafting. Autologous cortical onlay grafts provide predictable increases in bone volume when used for alveolar ridge augmentation; however, rigid fixation of the graft to the recipient site is essential. Titanium screws are commonly used to provide rigid fixation for onlay grafting but have potential drawbacks including the need for a second surgery for removal before implant placement and screw fracture during removal. The present study investigated the efficacy of resorbable fixation screws to secure autologous cortical onlay grafts to the maxilla or mandible to augment alveolar bone height and/or width before implant placement.
Eleven patients requiring alveolar ridge augmentation were enrolled in this study. All patients received autologous cortical onlay grafts. Patients were randomly assigned to receive grafts fixated with 2.0-mm resorbable (experimental) or 1.5-mm titanium (control) screws. Integration and survivability of the graft was assessed using cone-beam computed tomography. Graft resorption was calculated at 4 to 7 months postoperatively and used as a quantitative outcome measurement. Statistical analysis was performed using NCSS/PASS (Dawson edition; Kaysville, UT) for Windows XP. Data are presented as mean ± standard error of the mean. Intergroup differences were assessed using Student's t test.
Nine of the 11 patients initially enrolled completed the study. In these patients, 12 bone grafts were placed, 4 fixated with 2.0-mm resorbable screws and 8 fixated with 1.5-mm titanium screws. Integration and survivability of the grafts was 100% regardless of fixation type. Cone-beam computed tomographic data indicated that all grafts integrated regardless of fixation type. At 5 to 7 months postoperatively, cone-beam computed tomographic analysis indicated there were 28.07 ± 3.15% and 40.03 ± 3.67% bone resorption in grafts fixated with 2.0-mm resorbable and 1.5-mm titanium screws, respectively (P > .05).
These data suggest that cortical onlay graft integration and survivability are similar using 2.0-mm resorbable or 1.5-mm titanium screw fixation. Therefore, use of resorbable fixation devices in alveolar ridge augmentation will obviate screw removal, which may result in screw breakage and may be difficult if bony overgrowth occurs. Further studies need to be performed with a larger sample to confirm these data.
目前牙槽嵴增高的“金标准”是自体骨移植。自体皮质骨贴附移植用于牙槽嵴增高时可预测地增加骨量；然而，将移植骨牢固固定于受植部位至关重要。钛螺钉常用于为贴附移植提供牢固固定，但存在潜在缺点，包括在植入种植体前需要二次手术取出，以及取出过程中螺钉断裂。本研究调查了可吸收固定螺钉在植入种植体前将自体皮质骨贴附移植固定于上颌骨或下颌骨以增加牙槽骨高度和/或宽度的疗效。
11例需要牙槽嵴增高的患者纳入本研究。所有患者均接受自体皮质骨贴附移植。患者被随机分配接受用2.0毫米可吸收（试验组）或1.5毫米钛（对照组）螺钉固定的移植骨。使用锥形束计算机断层扫描评估移植骨的整合和存活率。术后4至7个月计算移植骨吸收情况，并用作定量结果测量。使用适用于Windows XP的NCSS/PASS（道森版；犹他州凯斯维尔）进行统计分析。数据以平均值±平均标准误差表示。组间差异采用学生t检验评估。
最初纳入的11例患者中有9例完成了研究。在这些患者中，共植入12块骨移植，4块用2.0毫米可吸收螺钉固定，8块用1.5毫米钛螺钉固定。无论固定类型如何，移植骨的整合和存活率均为100%。锥形束计算机断层扫描数据表明，无论固定类型如何，所有移植骨均实现整合。术后5至7个月，锥形束计算机断层扫描分析表明，用2.0毫米可吸收螺钉和1.5毫米钛螺钉固定的移植骨的骨吸收分别为28.07±3.15%和40.03±3.67%（P>.05）。
这些数据表明，使用2.0毫米可吸收或1.5毫米钛螺钉固定时，皮质骨贴附移植的整合和存活率相似。因此，在牙槽嵴增高术中使用可吸收固定装置将避免螺钉取出，而螺钉取出可能导致螺钉断裂，并且如果发生骨过度生长可能会很困难。需要进行更大样本量的进一步研究以证实这些数据。
