Nersasian R R, Johnson M, Giunta J
Oral Surg Oral Med Oral Pathol. 1978 May;45(5):661-77. doi: 10.1016/0030-4220(78)90138-x.
This study showed that scleral heterografts in the oral cavity work. Such grafts demonstrate the following characteristics: (1) attach firmly to submucosal, periosteal, and bony tissues; (2) remain firm and fibrotic in nature, indicating the possibility of a stressbearing tissue; (3) show little or no scarring or contracture; (4) show minimal, or no- host antigenic response based on clinical acceptance; (5) appear to become vascularized and cellular, blending with adjacent collagen. As projected by this study, scleral heterografts might well be used to obliterate bony undercuts and perhaps to obtund cystic cavities and other major bony defects. Further studies of layering of the sclera are essential before any definitive result can be determined in large bony defects. In those areas in which no bone regeneration would be feasible, such as in the mylohyoid region of the mandible, this application does present a possibility for removing undercuts as opposed to removing overlying bone. The tenacity of adherence to submucosal tissues, periosteum, and bone makes scleral heterografting even more intriguing in the possible obliteration of oroantral fistulas. We might theorize that the sclera would not only attach to the buccal and palatal flaps but also show a rather firm and tenacious adherence to the bony walls of the antral defect. The availability of human bank sclera for use as presently made by periodontists and as pioneered by Klingsberg is somewhat limited. From our study, an extrapolation would indicate that, because of the comparably low and antigenicity of bovine sclera and human sclera, an investigation in this area should be completed in order to determine whether scleral heterografts can replace scleral homografts in human periodontal surgery. Sclera is easily preserved in anhydrous glycerine (as preserved by King and associates19) and can certainly be stored in banks. In our opinion, the final application of scleral heterografts, human or bovine, the role of antigenicity, and the ability of osteoblasts to invade either a single piece or layers of sclera warrant further study.
本研究表明，口腔内的巩膜异种移植物是有效的。此类移植物具有以下特点：（1）牢固附着于黏膜下组织、骨膜和骨组织；（2）质地坚韧且呈纤维化，表明有可能成为承重组织；（3）几乎无瘢痕形成或挛缩；（4）基于临床接受情况，显示出最小的或无宿主抗原反应；（5）似乎会血管化并形成细胞，与相邻的胶原组织融合。正如本研究所推测的，巩膜异种移植物很可能用于消除骨倒凹，或许还可用于填充囊性腔隙及其他主要的骨缺损。在确定大型骨缺损的最终结果之前，对巩膜分层进行进一步研究至关重要。在那些无法进行骨再生的区域，如下颌骨的下颌舌骨肌区域，这种应用确实为去除倒凹提供了一种可能，而不是去除覆盖的骨组织。巩膜对黏膜下组织、骨膜和骨的附着韧性，使得巩膜异种移植在可能消除口腔上颌窦瘘方面更具吸引力。我们可以推测，巩膜不仅会附着于颊瓣和腭瓣，而且会相当牢固且坚韧地附着于上颌窦缺损的骨壁。目前牙周病医生所使用的以及由克林斯伯格开创的人库巩膜的可获得性在一定程度上是有限的。从我们的研究推断，由于牛巩膜和人巩膜的抗原性相对较低，应该完成该领域的一项调查，以确定巩膜异种移植物是否能够在人类牙周手术中替代巩膜同种移植物。巩膜很容易保存在无水甘油中（如金及其同事所保存的那样），并且肯定可以储存在库里。我们认为，巩膜异种移植物（人或牛）的最终应用、抗原性的作用以及成骨细胞侵入单层或多层巩膜的能力都值得进一步研究。
