Coomes Angela M, Mealey Brian L, Huynh-Ba Guy, Barboza-Arguello Concepcion, Moore William S, Cochran David L
Department of Periodontics, University of Texas Health Science Center at San Antonio Dental School, San Antonio, TX.
J Periodontol. 2014 Apr;85(4):525-35. doi: 10.1902/jop.2013.130207. Epub 2013 Jul 4.
Flapless extraction of teeth allows for undisturbed preservation of the nearby periosteum and a source of osteoprogenitor cells. Recombinant human bone morphogenetic protein 2 (rhBMP-2) has been used for different bone augmentation purposes with great osteoinductive capacity. The aim of this study is to compare the bone regenerative ability of rhBMP-2 on an absorbable collagen sponge (ACS) carrier to a collagen sponge (CS) alone in extraction sites with ≥50% buccal dehiscence.
Thirty-nine patients requiring extraction of a hopeless tooth with ≥50% buccal dehiscence were enrolled. After flapless extraction and randomization, either rhBMP-2/ACS carrier or CS alone was placed in the extraction site. After extraction, a baseline cone beam computed tomography (CBCT) scan was obtained of the site, and a similar scan was obtained 5 months postoperatively. Medical imaging and viewing software were used to compare the baseline and 5-month postoperative images of the study site and assess ridge width measurements, vertical height changes, and buccal plate regeneration.
Radiographically, CBCT analysis showed that with ≥50% of buccal bone destruction, rhBMP-2/ACS was able to regenerate a portion of the lost buccal plate, maintain theoretical ridge dimensions, and allow for implant placement 5 months after extraction. The test group performed significantly (P <0.05) better in regard to clinical buccal plate regeneration (4.75 versus 1.85 mm), clinical ridge width at 5 months (6.0 versus 4.62 mm), and radiographic ridge width at 3 mm from the alveolar crest (6.17 versus 4.48 mm) after molar exclusion. There was also significantly (P <0.05) less remaining buccal dehiscence, both clinically (6.81 versus 10.0 mm) and radiographically (3.42 versus 5.16 mm), at 5 months in the test group. Significantly (P <0.05) more implants were placed in the test group without the need for additional augmentation. The mean loss in vertical ridge height (lingual/palatal) was less in the test sites but was not significantly (P = 0.514) different between the test and control groups (0.39 versus 0.64 mm).
rhBMP-2/ACS compared to CS alone used in flapless extraction sites with a buccal dehiscence is able to regenerate lost buccal plate, maintain theoretical ridge dimensions, and allow for implant placement 5 months later.
无瓣拔牙可确保附近骨膜及骨祖细胞来源不受干扰地得以保留。重组人骨形态发生蛋白2（rhBMP - 2）因具有强大的骨诱导能力，已被用于多种骨增量目的。本研究旨在比较rhBMP - 2负载于可吸收胶原海绵（ACS）载体与单纯胶原海绵（CS）在颊侧骨缺损≥50%的拔牙位点的骨再生能力。
纳入39例需拔除患牙且颊侧骨缺损≥50%的患者。在无瓣拔牙并随机分组后，将rhBMP - 2/ACS载体或单纯CS置于拔牙位点。拔牙后，对该位点进行基线锥形束计算机断层扫描（CBCT），术后5个月进行类似扫描。使用医学影像及观察软件比较研究位点的基线图像与术后第5个月的图像，评估牙槽嵴宽度测量值、垂直高度变化及颊侧骨板再生情况。
影像学方面，CBCT分析显示，在颊侧骨破坏≥50%的情况下，rhBMP - 2/ACS能够再生部分缺失的颊侧骨板，维持理论牙槽嵴尺寸，并在拔牙后5个月允许植入种植体。在磨牙拔除后，试验组在临床颊侧骨板再生（4.75对1.85 mm）、术后5个月临床牙槽嵴宽度（6.0对4.62 mm）以及距牙槽嵴顶3 mm处的影像学牙槽嵴宽度（6.17对4.48 mm）方面表现显著更好（P <0.05）。试验组在术后5个月时，临床（6.81对10.0 mm）及影像学（3.42对5.16 mm）剩余颊侧骨缺损也显著更少（P <0.05）。试验组无需额外骨增量即可植入更多种植体，差异有统计学意义（P <0.05）。试验位点垂直牙槽嵴高度（舌侧/腭侧）的平均降低幅度较小，但试验组与对照组之间差异无统计学意义（P = 0.514）（0.39对0.64 mm）。
与单纯CS相比，在颊侧骨缺损的无瓣拔牙位点使用rhBMP - 2/ACS能够再生缺失的颊侧骨板，维持理论牙槽嵴尺寸，并在5个月后允许植入种植体。
