Melsen B, Huja S S, Chien H-H, Dalstra M
Section of Orthodontics, Department of Dentistry, Aarhus University, Aarhus, Denmark.
Orthod Craniofac Res. 2015 May;18(2):77-85. doi: 10.1111/ocr.12058. Epub 2014 Nov 18.
To assess the effects of transcortical screws on alveolar (bone) ridge preservation following extraction.
Four adult beagle dogs had mandibular premolars extracted bilaterally. After 6 weeks, using a split-mouth design, two transcortical screws were inserted unilaterally below the alveolar crest on the experimental side in the region of the extraction. The dogs were killed after 12 weeks. The bone at the extraction sites was analyzed using μCT and 3D analysis. A cylindrical core was placed around the actual and a virtual screw placed in the identical location on the control side. The bone volume within the cylinders was quantified. An insertion of a dental implant was simulated bilaterally at the insertion site. The height of the clinical crown and the alveolar crest were determined on both sides. The bone turnover was assessed histomorphometrically on un-decalcified bucco-lingual sections stained with basic fuchsine and toluidine blue.
Comparison of the two sides revealed a significant difference both with regard to the bone volume and morphology. The transcortical screw caused an increase in bone density and less ridge atrophy. When simulating a dental implant placement on both sides, the bone preservation on the experimental side led to a need for a shorter clinical crown compared to the control side. A higher activity level of the bone in the experimental side was demonstrated histologically.
In this dog model the insertion of a mini-implant across the healing alveolar process results in increased density not only adjacent to the screws, but also in the region where a potential dental implant would be inserted. In humans, the insertion of transcortical screws may maintain bone when for various reasons insertion of a permanent dental implant has to be postponed.
评估经皮质螺钉对拔牙后牙槽嵴保存的影响。
选用4只成年比格犬,双侧拔除下颌前磨牙。6周后,采用双侧对照设计,在实验侧拔牙区域的牙槽嵴下方单侧植入两枚经皮质螺钉。12周后处死实验犬。使用显微CT和三维分析对拔牙部位的骨组织进行分析。在实际植入的螺钉周围放置一个圆柱形核心,并在对照侧相同位置放置一个虚拟螺钉。对圆柱体内的骨体积进行量化。在双侧植入部位模拟植入牙种植体。测定两侧临床冠的高度和牙槽嵴高度。通过对用碱性品红和甲苯胺蓝染色的未脱钙颊舌向切片进行组织形态计量学分析来评估骨转换情况。
两侧比较显示,在骨体积和形态方面均存在显著差异。经皮质螺钉使骨密度增加,牙槽嵴萎缩减少。在双侧模拟植入牙种植体时,与对照侧相比,实验侧的骨保存情况使得所需的临床冠较短。组织学显示实验侧骨的活性水平较高。
在该犬模型中,在愈合的牙槽突上植入微型种植体不仅会使螺钉附近的骨密度增加,而且在可能植入牙种植体的区域也会增加骨密度。在人类中,当由于各种原因必须推迟植入永久性牙种植体时,植入经皮质螺钉可能会维持骨量。