Trautvetter Wolfram, Kaps Christian, Schmelzeisen Rainer, Sauerbier Sebastian, Sittinger Michael
Laboratory for Tissue Engineering, Department of Rheumatology, Charité Campus Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany.
J Oral Maxillofac Surg. 2011 Nov;69(11):2753-62. doi: 10.1016/j.joms.2011.02.096. Epub 2011 Jun 16.
Augmentation of the maxillary sinus with allogenic or alloplastic materials, as well as autologous bone grafts, has inherent disadvantages. Therefore, the aim of our study was to evaluate the long-term clinical repair effect of autologous periosteal bone grafts on atrophic maxillary bone.
In the present retrospective cohort study, augmentation of the edentulous atrophic posterior maxilla was performed using autologous tissue-engineered periosteal bone grafts based on bioresorbable polymer scaffolds and, in a 1-step procedure, simultaneous insertion of dental implants. The clinical evaluation of 10 patients was performed by radiologic assessment of bone formation, with a follow-up of 5 years. Bone formation was further documented by measuring the bone height and by histologic examination.
Excellent clinical and radiologic results were achieved as early as 4 months after transplantation of the periosteal bone grafts. The bone height remained significantly (P < .05) greater (median 14.2 mm) than the preoperative atrophic bone (median 6.9 mm) during the 5-year observation period. Histologically, the bone biopsy specimens of 2 patients obtained after 6 months showed trabecular bone with osteocytes and active osteoblasts. No signs of bone resorption, formation of connective tissue, or necrosis were seen.
Our results suggest that the transplantation of autologous periosteal bone grafts and implantation of dental implants in a 1-step procedure is a reliable procedure that leads to bone formation in the edentulous posterior maxilla, remaining stable in the long term for a period of at least 5 years.
使用同种异体材料、人工合成材料以及自体骨移植对上颌窦进行增高均存在固有缺点。因此，本研究的目的是评估自体骨膜骨移植对萎缩性上颌骨的长期临床修复效果。
在本回顾性队列研究中，使用基于生物可吸收聚合物支架的自体组织工程骨膜骨移植对上颌后牙区无牙萎缩骨进行增高，并在一步操作中同时植入牙种植体。通过对骨形成的影像学评估对10例患者进行临床评估，随访5年。通过测量骨高度和组织学检查进一步记录骨形成情况。
骨膜骨移植后最早在4个月时就取得了优异的临床和影像学结果。在5年观察期内，骨高度显著（P < .05）高于术前萎缩骨（中位数6.9 mm）（中位数14.2 mm）。组织学上，6个月后获取的2例患者的骨活检标本显示有含骨细胞和活跃成骨细胞的小梁骨。未见骨吸收、结缔组织形成或坏死迹象。
我们的结果表明，一步法进行自体骨膜骨移植和牙种植体植入是一种可靠的方法，可导致上颌后牙区无牙区骨形成，至少在5年的长期内保持稳定。
