Graduate Periodontics, Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.
Int J Oral Maxillofac Implants. 2013 May-Jun;28(3):710-20. doi: 10.11607/jomi.2913.
While the ability of various grafting materials to preserve extraction socket morphology has been adequately reviewed, the quality of the grafted bone in the socket is not as well understood. This systematic review aimed to compare the proportion of vital bone and connective tissue between grafted and naturally healed sockets.
An electronic search of five databases (from 1965 to November 2011) and a hand search of peer-reviewed journals for relevant articles were performed. Human clinical trials that compared histologic components of soft and hard tissues in augmented sockets and naturally healed sites, with at least five samples per group, were included.
Eight studies (five randomized controlled trials and three controlled clinical trials) were included. The mean percentages of vital bone and connective tissue in natural healing sockets were 38.5% ± 13.4% and 58.3% ± 10.6%, respectively. Limited evidence (one to two articles for each material) implied that vital bone fraction was not different with demineralized allografts and autografts and increased by 6.2% to 23.5% with alloplasts in comparison to nongrafted sites. Four studies investigating the effect of xenografts were available, with equivocal results. The difference in the mean percentage of vital bone ranged from -22.2% (decrease) to 9.8% (increase). Connective tissue content decreased with the use of the aforementioned bone substitutes. Considerable residual hydroxyapatite and xenograft particles (15% to 36%) remained at a mean of 5.6 months after socket augmentation procedures.
Based on a limited number of prospective comparative studies, the use of grafting materials for socket augmentation might change the proportion of vital bone in comparison to sockets allowed to heal without grafting. Whether these changes in bone quality will influence implant success and peri-implant tissue stability remains unknown.
尽管各种移植材料保存拔牙窝形态的能力已得到充分评估，但对于拔牙窝中移植骨的质量却了解不足。本系统评价旨在比较移植窝和自然愈合窝中活骨和结缔组织的比例。
电子检索五个数据库（1965 年至 2011 年 11 月）和同行评议期刊的手工检索，以寻找相关文章。纳入了比较增强拔牙窝和自然愈合部位软组织和硬组织组织学成分的人类临床试验，每组至少有 5 个样本。
纳入了 8 项研究（5 项随机对照试验和 3 项对照临床试验）。自然愈合窝中活骨和结缔组织的平均百分比分别为 38.5%±13.4%和 58.3%±10.6%。有限的证据（每种材料只有一到两篇文章）表明，脱矿异体骨和自体骨的活骨比例没有差异，与未植骨部位相比，同种异体骨增加了 6.2%至 23.5%。有 4 项研究探讨了异种移植物的效果，结果不一致。活骨平均百分比的差异范围为-22.2%（减少）至 9.8%（增加）。使用上述骨替代物会降低结缔组织含量。在牙槽窝增强手术后的平均 5.6 个月，仍残留相当数量的羟基磷灰石和异种移植物颗粒（15%至 36%）。
基于少数前瞻性对照研究，与不进行移植的拔牙窝相比，牙槽窝增强使用移植材料可能会改变活骨的比例。这些骨质量的变化是否会影响种植体的成功和种植体周围组织的稳定性仍不清楚。
