Urban Istvan A, Nagursky Heiner, Lozada Jaime L, Nagy Katalin
Graduate Implant Dentistry, Loma Linda University, Loma Linda, CA, USA.
Int J Periodontics Restorative Dent. 2013 May-Jun;33(3):299-307. doi: 10.11607/prd.1407.
This prospective case series evaluated the use of a resorbable natural collagen membrane with a mixture of autogenous bone and anorganic bovine bone-derived mineral (ABBM) for lateral ridge augmentation and subsequent implant placement. A mixture (1:1) of particulated autogenous bone and ABBM was used for lateral ridge augmentation and covered with a resorbable, natural collagen bilayer membrane to treat knife-edge ridges and prepare them for implant placement. Ridge measurements were obtained pre- and postsurgery, complications recorded, and biopsy specimens examined histologically. Seventy-six implants were placed in 25 patients with 31 knife-edge ridge surgical sites. One defect had a bone graft complication (3.2%; exact 95% confidence interval: 0.1%, 16.7%). Clinical measurements revealed an average of 5.68 mm (standard deviation [SD] = 1.42 mm) of lateral ridge augmentation after a mean 8.9-month (SD = 2.1 months) graft healing period. Clinically, all treated ridges were sufficient in width for subsequent implant placement. All implants survived with an average follow-up of 20.88 months (SD = 9.49 months). Histologic analysis of nine surgical sites showed that ABBM was connected with a dense network of newly formed bone with varying degrees of maturation. Histomorphometric analysis demonstrated that autogenous bone represented a mean of 31.0% of the specimens, ABBM 25.8%, and marrow space 43.2%. The treatment of horizontally deficient alveolar ridges with the guided bone regeneration technique using autogenous bone mixed with ABBM and a natural collagen resorbable barrier membrane can be regarded as successful. Implant success and survival need to be confirmed with long-term follow-up examinations.
本前瞻性病例系列评估了可吸收天然胶原膜联合自体骨与无机牛骨衍生矿物质(ABBM)混合物用于外侧牙槽嵴增高及后续种植体植入的情况。采用颗粒状自体骨与ABBM的混合物(1:1)进行外侧牙槽嵴增高,并覆盖可吸收天然胶原双层膜,以治疗刃状牙槽嵴并为种植体植入做准备。在手术前后进行牙槽嵴测量,记录并发症,并对活检标本进行组织学检查。25例患者的31个刃状牙槽嵴手术部位共植入76枚种植体。1例出现骨移植并发症(3.2%;精确95%置信区间:0.1%,16.7%)。临床测量显示,在平均8.9个月(标准差[SD]=2.1个月)的植骨愈合期后,外侧牙槽嵴平均增高5.68 mm(SD=1.42 mm)。临床上,所有治疗后的牙槽嵴宽度足以进行后续种植体植入。所有种植体均存活,平均随访20.88个月(SD=9.49个月)。对9个手术部位的组织学分析表明,ABBM与不同成熟度的新形成骨致密网络相连。组织形态计量学分析显示,自体骨平均占标本的31.0%,ABBM占25.8%,骨髓腔占43.2%。使用自体骨与ABBM及天然胶原可吸收屏障膜的引导骨再生技术治疗水平方向牙槽嵴缺损可视为成功。种植体的成功和存活需要通过长期随访检查来确认。