Canuto R A, Pol R, Martinasso G, Muzio G, Gallesio G, Mozzati M
Department of Experimental Medicine and Oncology, University of Turin, Turin, Italy.
Clin Oral Implants Res. 2013 Aug;24 Suppl A100:42-8. doi: 10.1111/j.1600-0501.2011.02363.x. Epub 2011 Dec 15.
Tooth extraction is considered as the starting point of jaw atrophy via osteoclast activity stimulation. The maintenance of dental alveolar bone depends on surgery procedure and use of materials to maintain prior space favoring bone regeneration. Among substitutes used in dentistry to fill bone defects, Ostim-Pastes (Ostim) is a nanocrystalline paste tested for treatment of severe clinical conditions. This research first investigated the effect of Ostim on alveolar healing, comparing in the same healthy subjects, an Ostim-filled socket with a not-filled one. Moreover, it also proposed a new surgical protocol for the post-extractive socket treatment using the graft materials without elevation of full-thickness flaps.
Fourteen patients were enrolled to bilateral maxillary or mandibular extraction that was performed without elevation of full-thickness flaps. In each patient, one socket was filled using Ostim, and the other one was allowed to undergo natural healing. No suture was carried out. Clinical and biologic parameters were screened at 1, 7, and 14 days.
Obtained results evidenced that nanocrystalline hydroxyapatite supports bone regeneration, increasing the synthesis of pro-osteogenic factors as bone morphogenetics protein (BMP)-4, BMP-7, alkaline phosphatase, and osteocalcin. Moreover, filling post-extractive socket with nanocrystalline hydroxyapatite paste leads to a complete epithelialization already at 7 days after extraction, despite the fact that the teeth were extracted without elevation of full-thickness flaps . The improved epithelialization is mediated by increased vascular endothelial growth factor (VEGF) expression. No significant change was observed in inflammatory parameters, with exception of an early and transient IL-1β induction, that could trigger and improve alveolar healing.
Clinical and biomolecular observations of this explorative study evidenced that nanocrystalline hydroxyapatite improves alveolar socket healing, increasing angiogenesis, epithelialization, and osteogenesis, also in absence of elevation of full-thickness flaps.
拔牙被认为是通过刺激破骨细胞活性导致颌骨萎缩的起始点。牙槽骨的维持取决于手术操作以及用于维持有利于骨再生的先前空间的材料使用。在牙科用于填充骨缺损的替代物中，奥施康定糊剂（Ostim）是一种经过测试用于治疗严重临床病症的纳米晶糊剂。本研究首先在相同的健康受试者中比较了填充奥施康定的牙槽窝与未填充的牙槽窝，调查了奥施康定对牙槽愈合的影响。此外，还提出了一种使用移植材料进行拔牙后牙槽窝治疗的新手术方案，无需掀起全厚瓣。
14例患者接受双侧上颌或下颌拔牙，手术时未掀起全厚瓣。在每位患者中，一个牙槽窝用奥施康定填充，另一个任其自然愈合。未进行缝合。在第1、7和14天筛选临床和生物学参数。
所得结果表明，纳米晶羟基磷灰石支持骨再生，增加促骨生成因子如骨形态发生蛋白（BMP）-4、BMP-7、碱性磷酸酶和骨钙素的合成。此外，用纳米晶羟基磷灰石糊剂填充拔牙后牙槽窝在拔牙后7天就导致完全上皮化，尽管拔牙时未掀起全厚瓣。上皮化的改善是由血管内皮生长因子（VEGF）表达增加介导的。除了早期短暂的白细胞介素-1β诱导外，炎症参数未观察到显著变化，白细胞介素-1β诱导可触发并改善牙槽愈合。
这项探索性研究的临床和生物分子观察表明，纳米晶羟基磷灰石可改善牙槽窝愈合，增加血管生成、上皮化和成骨，即使在未掀起全厚瓣的情况下也是如此。
