Kheur Mohit G, Kheur Supriya, Lakha Tabrez, Jambhekar Shantanu, Le Bach, Jain Vinay
Professor, Department of Prosthodontics, M. A. Rangoonwala College of Dental Sciences and Research Centre, Pune, India.
Head, Department of Oral Pathology and Microbiology, Dr. D. Y. Patil Dental College and Hospital, Pimpri, Pune, India.
J Oral Maxillofac Surg. 2018 Apr;76(4):761-769. doi: 10.1016/j.joms.2017.11.002. Epub 2017 Dec 2.
The absence of an adequate volume of bone at implant sites requires augmentation procedures before the placement of implants. The aim of the present study was to assess the ridge width gain with the use of allografts and biphasic β-tricalcium phosphate with hydroxyapatite (alloplast) in ridge split procedures, when each were used in small (0.25 to 1 mm) and large (1 to 2 mm) particle sizes.
A randomized controlled trial of 23 subjects with severe atrophy of the mandible in the horizontal dimension was conducted in a private institute. The patients underwent placement of 49 dental implants after a staged ridge split procedure. The patients were randomly allocated to alloplast and allograft groups (predictor variable). In each group, the patients were randomly assigned to either small graft particle or large graft particle size (predictor variable). The gain in ridge width (outcome variable) was assessed before implant placement. A 2-way analysis of variance test and the Student unpaired t test were used for evaluation of the ridge width gain between the allograft and alloplast groups (predictor variable). Differences were considered significant if P values were < .05.
The sample included 23 patients (14 men and 9 women). The patients were randomly allocated to the alloplast (n = 11) or allograft (n = 12) group before the ridge split procedure. In each group, they were assigned to a small graft particle or large graft particle size (alloplast group, small particle in 5 and large particle size in 6 patients; allograft group, small particle in 6 and large particle size in 6). A statistically significant difference was observed between the 2 graft types. The average ridge width gain was significantly greater in the alloplast group (large, 4.40 ± 0.24 mm; small, 3.52 ± 0.59 mm) than in the allograft group (large, 3.82 ± 0.19 mm; small, 2.57 ± 0.16 mm). For both graft types (alloplast and allograft), the large particle size graft resulted in a greater ridge width gain compared with the small particle size graft (P < .05).
Within the limitations of the present study, we suggest the use of large particle alloplast as the graft material of choice for staged ridge split procedures in the posterior mandible.
种植部位骨量不足时，在种植体植入前需要进行增量手术。本研究的目的是评估在牙槽嵴劈开手术中，使用同种异体骨和双相β-磷酸三钙与羟基磷灰石（人工骨）时，不同颗粒大小（小颗粒，0.25至1毫米；大颗粒，1至2毫米）的牙槽嵴宽度增加情况。
在一家私立机构对23例下颌骨水平方向严重萎缩的受试者进行了一项随机对照试验。患者在分阶段牙槽嵴劈开手术后植入49颗牙种植体。患者被随机分配到人工骨组和同种异体骨组（预测变量）。在每组中，患者被随机分配为小颗粒移植或大颗粒移植（预测变量）。在种植体植入前评估牙槽嵴宽度增加情况（结果变量）。采用双向方差分析和学生独立t检验评估同种异体骨组和人工骨组之间牙槽嵴宽度增加情况（预测变量）。如果P值<0.05，则认为差异具有统计学意义。
样本包括23例患者（14例男性和9例女性）。在牙槽嵴劈开手术前，患者被随机分配到人工骨组（n = 11）或同种异体骨组（n = 12）。在每组中，他们被分配为小颗粒移植或大颗粒移植（人工骨组，5例小颗粒和6例大颗粒；同种异体骨组，6例小颗粒和6例大颗粒）。观察到两种移植类型之间存在统计学显著差异。人工骨组的平均牙槽嵴宽度增加显著大于同种异体骨组（大颗粒，4.40±0.24毫米；小颗粒，3.52±0.59毫米），同种异体骨组（大颗粒，3.82±0.19毫米；小颗粒，2.57±0.16毫米）。对于两种移植类型（人工骨和同种异体骨），大颗粒移植比小颗粒移植导致更大的牙槽嵴宽度增加（P<0.05）。
在本研究的局限性内，我们建议使用大颗粒人工骨作为下颌后部牙槽嵴劈开手术的首选移植材料。
