Laboratory for Applied Periodontal & Craniofacial Regeneration, Departments of Periodontics and Oral Biology, Georgia Health Sciences University College of Dental Medicine, Augusta, GA 30912, USA.
Clin Oral Implants Res. 2013 May;24(5):497-504. doi: 10.1111/j.1600-0501.2011.02419.x. Epub 2012 Jan 26.
Implant dentistry in the posterior maxilla often requires bone augmentation. The gold standard, autogenous bone graft, requires additional surgery with associated morbidity, while bone biomaterials may not support relevant bone formation. Recombinant human bone morphogenetic protein-2 (rhBMP-2) in an absorbable collagen sponge (ACS), however, induces significant, clinically relevant bone formation in several settings including the maxillary sinus floor.
The objective of this study was to compare local bone formation and osseointegration following maxillary sinus augmentation using rhBMP-2/ACS or a particulate autogenous cancellous bone graft obtained from the iliac crest in conjunction with immediate placement of dental implants.
Bilateral sinus augmentation using an extraoral approach including rhBMP-2 (0.43 mg/ml)/ACS or the autogenous bone graft, alternated between left and right sinus cavities in five adult male Yucatan mini-pigs, was performed. Two 12-mm dental implants were inserted into the sinus wall protruding approximately 8 mm into the sinus cavity. Surgical sites were closed and sutured in layers; block biopsies collected for histometric analysis at 8 weeks.
rhBMP-2/ACS induced bone of significantly greater and consistent quality compared with the iliac crest autogenous bone graft; bone density averaging 51.9 ± 3.0% vs. 32.9 ± 2.5% (P = 0.01). However, there were only numerical differences in augmented bone height (9.3 ± 0.5 vs. 8.6 ± 0.7 mm) and bone-implant contact (37.4 ± 3.0% vs. 30.7 ± 5.9%) between treatments.
rhBMP-2/ACS induces bone of superior quality compared with an iliac crest particulate autogenous cancellous bone graft when used for maxillary sinus augmentation, and should perhaps be considered the new standard for this indication.
上颌后牙种植常需要骨增量。金标准是自体骨移植，需要额外的手术，且相关发病率高，而骨生物材料可能无法支持相关的骨形成。然而，可吸收胶原海绵中的重组人骨形态发生蛋白-2（rhBMP-2）在包括上颌窦底在内的多个部位可诱导显著的、具有临床相关性的骨形成。
本研究旨在比较 rhBMP-2/ACS 或取自髂嵴的颗粒状自体松质骨移植联合即刻植入牙种植体用于上颌窦提升时的局部骨形成和骨整合。
采用经口腔入路双侧上颌窦提升术，包括 rhBMP-2（0.43mg/ml）/ACS 或自体骨移植，将其交替应用于 5 只成年雄性尤卡坦小型猪的左右上颌窦。将 2 个 12mm 牙种植体植入窦壁，向窦腔突出约 8mm。手术部位分层缝合关闭；8 周时采集块状活检标本进行组织计量学分析。
rhBMP-2/ACS 诱导的骨质量明显优于且一致性优于髂嵴自体骨移植，骨密度平均为 51.9%±3.0%比 32.9%±2.5%（P=0.01）。然而，两种治疗方法的骨增量高度（9.3±0.5mm 比 8.6±0.7mm）和骨-种植体接触率（37.4%±3.0%比 30.7%±5.9%）仅存在数值差异。
与使用髂嵴颗粒状自体松质骨移植相比，rhBMP-2/ACS 用于上颌窦提升可诱导出质量更高的骨，或许应被视为该适应证的新标准。
