Scheyer Eric Todd, Heard Rick, Janakievski Jim, Mandelaris George, Nevins Marc L, Pickering Stephen R, Richardson Christopher R, Pope Bryan, Toback Gregory, Velásquez Diego, Nagursky Heiner
The McGuire Institute (Practice-based Clinical Research Network), Houston, TX, USA.
Private Practice, Houston, TX, USA.
J Clin Periodontol. 2016 Dec;43(12):1188-1199. doi: 10.1111/jcpe.12623. Epub 2016 Oct 21.
To compare the effectiveness of two-ridge preservation treatments.
Forty subjects with extraction sockets exhibiting substantial buccal dehiscences were enrolled and randomized across 10 standardized centres. Treatments were demineralized allograft plus reconstituted and cross-linked collagen membrane (DFDBA + RECXC) or deproteinized bovine bone mineral with collagen plus native, bilayer collagen membrane (DBBMC + NBCM). Socket dimensions were recorded at baseline and 6 months. Wound closure and soft tissue inflammation were followed post-operatively, and biopsies were retrieved for histomorphometric analysis at 6 months.
Primary endpoint: at 6 months, extraction socket horizontal measures were significantly greater for DBBMC + NBCM (average 1.76 mm greater, p = 0.0256). Secondary and Exploratory endpoints: (1) lingual and buccal vertical bone changes were not significantly different between the two treatment modalities, (2) histomorphometric % new bone and % new bone + graft were not significantly different, but significantly more graft remnants remained for DBBMC; (3) at 1 month, incision line gaps were significantly greater and more incision lines remained open for DFDBA + RECXC; (4) higher inflammation at 1 week tended to correlate with lower ridge preservation results; and (5) deeper socket morphologies with thinner bony walls correlated with better ridge preservation. Thirty-seven of 40 sites had sufficient ridge dimension for implant placement at 6 months; the remainder were DFDBA + RECXC sites.
DBBMC + NBCM provided better soft tissue healing and ridge preservation for implant placement. Deeper extraction sockets with higher and more intact bony walls responded more favourably to ridge preservation therapy.
比较两种牙槽嵴保存治疗方法的有效性。
纳入40例拔牙窝存在明显颊侧骨缺损的受试者，并在10个标准化中心进行随机分组。治疗方法为脱矿异体骨加重组交联胶原膜（DFDBA + RECXC）或胶原化去蛋白牛骨矿物质加天然双层胶原膜（DBBMC + NBCM）。在基线和6个月时记录牙槽窝尺寸。术后跟踪伤口闭合情况和软组织炎症，并在6个月时取活检进行组织形态计量分析。
主要终点：6个月时，DBBMC + NBCM组拔牙窝的水平测量值显著更大（平均大1.76 mm，p = 0.0256）。次要终点和探索性终点：（1）两种治疗方式之间舌侧和颊侧垂直骨变化无显著差异；（2）组织形态计量学上的新骨百分比和新骨+移植物百分比无显著差异，但DBBMC组残留的移植物明显更多；（3）1个月时，DFDBA + RECXC组的切口线间隙显著更大，更多切口线未愈合；（4）1周时较高的炎症倾向于与较低的牙槽嵴保存结果相关；（5）牙槽窝形态更深且骨壁更薄与更好的牙槽嵴保存相关。40个位点中有37个在6个月时牙槽嵴尺寸足以植入种植体；其余为DFDBA + RECXC组位点。
DBBMC + NBCM在种植体植入时能提供更好的软组织愈合和牙槽嵴保存效果。牙槽窝更深、骨壁更高且更完整对牙槽嵴保存治疗的反应更良好。
