Department of Dentistry, Tzu Chi General Hospital - Xindian Branch, New Taipei City, Taiwan, Republic of China.
School of Dentistry, Tri-Service General Hospital, Taipei City, Taiwan, Republic of China.
J Periodontol. 2017 Jun;88(6):593-601. doi: 10.1902/jop.2017.160446. Epub 2017 Mar 10.
The aim of the study is to determine if bone quality evaluation of surgically obtained bone core specimens using a stereomicroscope is reliable for determining bone quality at implant recipient sites.
Bone quality was presurgically assessed in 122 edentulous ridges obtained from 62 patients using periapical radiographs and categorized according to the Lekholm and Zarb classification. During surgery, bone specimens were trephined, and bone types were immediately classified using a stereomicroscope. Microarchitectural characteristics of bone cores were evaluated after being scanned using microcomputed tomography (micro-CT).
Bone types of implant sites categorized from radiography and stereomicroscope had statistically similar distribution but poor interrater agreement. Using micro-CT, maxillae and mandibles showed significant differences in microarchitectural characteristics of bone cores. Bone volume (BV), total volume (TV), and trabecular thickness (Tb.Th) increased, whereas bone surface density (BS/BV) and open porosity (Po.[Op]) decreased in mandibular bone cores compared with those in maxillary bone cores. Moreover, micro-CT values of BV/TV and Po.(Op) statistically correlated with bone types assessed by stereomicroscopy, particularly in mandibles (adjusted means of BV/TV of Type 2 to 4 versus Type 1 decreasing from -9.88%, -15.09%, -29.31%; those of Po.(Op) ranged from 9.77%, 15.06%, 29.52% in an upward trend). However, such correlations were not found in maxillae or when bone types were classified using periapical radiographs.
Caution is needed when using presurgical periapical radiographs to predict bone quality at implant recipient sites. Surgically preserved bone core specimens, whenever obtainable, might offer additional information to accurately assess bone quality, particularly at mandibular implant sites.
本研究旨在确定使用立体显微镜对手术获得的骨芯标本进行骨质量评估是否可用于确定种植体受植部位的骨质量。
62 名患者的 122 个无牙颌牙槽嵴在术前使用根尖片进行骨质量评估，并根据 Lekholm 和 Zarb 分类进行分类。手术中，使用骨钻获取骨标本，使用立体显微镜立即对骨类型进行分类。使用微计算机断层扫描（micro-CT）扫描后评估骨芯的微观结构特征。
根据放射线和立体显微镜分类的种植体部位的骨类型分布具有统计学相似性，但评估者间的一致性较差。使用 micro-CT，上颌骨和下颌骨的骨芯微观结构特征存在显著差异。与上颌骨相比，下颌骨的骨体积（BV）、总容积（TV）和骨小梁厚度（Tb.Th）增加，而骨表面密度（BS/BV）和开孔隙率（Po.[Op]）降低。此外，BV/TV 和 Po.（Op）的 micro-CT 值与使用立体显微镜评估的骨类型呈统计学相关，尤其是在下颌骨（调整后的 Type 2 至 4 与 Type 1 的 BV/TV 分别下降了-9.88%、-15.09%、-29.31%；Po.（Op）从 9.77%、15.06%、29.52%呈上升趋势）。然而，在上颌骨或使用根尖片进行骨类型分类时，未发现这种相关性。
在预测种植体受植部位的骨质量时，使用术前根尖片需谨慎。只要有可能，手术保存的骨芯标本可能会提供额外的信息，以准确评估骨质量，尤其是在下颌种植体部位。
