Unit of Oral Surgery Clinica Odontoiatrica, Department of Medicine, Surgery and Dentistry, Universityof Milan, Milan, Italy.
Clin Oral Implants Res. 2013 Jun;24(6):679-87. doi: 10.1111/j.1600-0501.2012.02485.x. Epub 2012 May 3.
To compare: (i) the incidence of soft tissue dehiscences; (ii) bone resorption before and after implant placement; and (iii) the survival and success rates of implants placed in two groups of patients with severe bone defects of the jaws reconstructed with autogenous onlay bone grafts alone (control group) or in association with autogenous pericranium coverage (study group).
Forty-four patients affected by severe atrophy of the alveolar ridges underwent bone reconstruction with vertical/tridimensional autogenous onlay grafts harvested from the calvarium or the mandibular ramus. In 23 patients (study group), grafts were covered with autogenous pericranium before suturing, while in 21 patients (control group) no coverage of the grafts before suturing was performed. After a 4-7 month waiting period, 199 implants were placed (105 in the study group, 94 in the control group) and 3-4 months afterward prosthetic rehabilitation was carried out. The mean follow-up after the start of prosthetic loading was 23.9 months (range: 12-48 months).
The incidence of soft tissue dehiscences was 5,7% in the study group and 16% in the control group. The mean graft resorption before implant placement was 0.12 mm (SD ± 0.32) in the study group and 0.98 mm (SD ± 2.79) in the control group. The mean peri-implant bone resorption at the end of the follow-up period was 0.21 mm (SD ± 0.48) in the study group and 0.43 mm (SD ± 0.83) in the control group. The survival rate of implants was 99.1% in the study group and 100% in the control group, while success rate was 96.2% in the study group and 93.6% in the control group.
The use of pericranium as an autogenous membrane for the coverage of onlay bone grafts seems to reduce the risk of soft tissue dehiscences after the reconstruction of atrophic edentulous ridges to reduce peri-implant bone resorption over time, while it seems to have no significant effect in reducing bone resorption in the reconstructed areas before implant placement.
比较：（i）软组织裂开的发生率；（ii）植入物放置前后的骨吸收情况；（iii）单独使用自体骨移植片（对照组）或联合使用自体颅骨覆盖物（研究组）重建颌骨严重骨缺损后植入物的存活率和成功率。
44 名牙槽嵴严重萎缩的患者接受了垂直/三维自体骨移植片的骨重建，这些移植片取自颅骨或下颌支。在 23 名患者（研究组）中，在缝合前将自体颅骨覆盖在移植物上，而在 21 名患者（对照组）中，在缝合前不覆盖移植物。在 4-7 个月的等待期后，共植入 199 枚种植体（研究组 105 枚，对照组 94 枚），3-4 个月后进行了修复体修复。从开始修复体加载后的平均随访时间为 23.9 个月（范围：12-48 个月）。
研究组软组织裂开的发生率为 5.7%，对照组为 16%。植入物放置前移植骨的平均吸收量为研究组 0.12mm（SD ± 0.32），对照组 0.98mm（SD ± 2.79）。在随访期末，研究组的种植体周围骨吸收平均值为 0.21mm（SD ± 0.48），对照组为 0.43mm（SD ± 0.83）。研究组种植体的存活率为 99.1%，对照组为 100%，研究组的成功率为 96.2%，对照组为 93.6%。
使用颅骨作为自体膜覆盖骨移植片似乎可以降低重建萎缩无牙颌后软组织裂开的风险，减少随着时间的推移种植体周围骨吸收，而在减少植入物放置前重建区域的骨吸收方面似乎没有显著效果。
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