Meloni Silvio Mario, Jovanovic Sascha Alexander, Pisano Milena, De Riu Giacomo, Baldoni Edoardo, Tallarico Marco
Eur J Oral Implantol. 2018;11(1):89-95.
To present the medium-term results of one-stage guided bone regeneration (GBR) using autologous bone and anorganic bovine bone, placed in layers, in association with resorbable collagen membranes, for the reconstruction of horizontal bony defects.
This study was designed as an uncontrolled prospective study. Partially edentulous patients, having less than 6.0 mm and more than 4.0 mm of residual horizontal bone width were selected and consecutively treated with simultaneously implant installation and bone regeneration by using 2.0 mm of autologous bone and 2.0 mm of anorganic bovine bone that was placed in layers and then covered with a resorbable collagen membrane. Outcome measures were: implant and prosthesis failures, any complications, peri-implant marginal bone level changes, probing pocket depth (PPD) and bleeding on probing (BOP).
In total, 45 consecutive patients (20 male, 25 female) with a mean age of 52.1 years each received at least one GBR procedure, with contemporary placement of 63 implants. At the 3-year follow-up examination, no patient had dropped out and no deviation from the original protocol had occurred. No implant or prosthesis failed. In six patients (13.3%) the collagen membrane was slightly exposed 1 to 2 weeks after bone reconstruction. Four of these patients were moderate smokers. Post-hoc analysis using Fisher's exact test found significant association (P = 0.0139) between a smoking habit and early membrane exposure. Mean marginal bone loss experienced between initial loading and 30 months afterwards was 0.60 ± 0.20 mm (95% CI 0.54 - 0.66). The mean BOP values measured at the definitive restoration delivery were 1.23 ± 0.93, while 2 years later they were 1.17 ± 0.78. The difference was not statistically significant (-0.06 ± 0.76; P = 0.569). The mean PPD values measured at the definitive restoration delivery were 2.62 ± 0.59 mm, while 2 years later they were 2.60 ± 0.54 mm. The difference was not statistically significant (-0.03 ± 0.62; P = 0.765).
Within the limitations of the present study, the use of a 2.0 mm layer of particulated autologous bone on the implant threads, and a 2.0 mm layer of anorganic bovine to cover the resorbed ridge, in combination with the resorbable collagen membrane, seems to be a viable treatment option for the reconstruction of horizontal bony defects.
介绍采用自体骨和无机牛骨分层放置，并联合可吸收胶原膜进行一期引导骨再生（GBR）以重建水平骨缺损的中期结果。
本研究设计为非对照前瞻性研究。选择部分牙列缺损且剩余水平骨宽度小于6.0 mm且大于4.0 mm的患者，连续进行同期种植体植入和骨再生治疗，使用2.0 mm的自体骨和2.0 mm的无机牛骨分层放置，然后覆盖可吸收胶原膜。观察指标包括：种植体和修复体失败情况、任何并发症、种植体周围边缘骨水平变化、探诊深度（PPD）和探诊出血（BOP）。
共有45例连续患者（男性20例，女性25例），平均年龄52.1岁，均接受了至少一次GBR手术，同期植入63枚种植体。在3年随访检查时，无患者退出，也未发生与原方案的偏差。无种植体或修复体失败。6例患者（13.3%）在骨重建后1至2周胶原膜有轻微暴露。其中4例患者为中度吸烟者。采用Fisher精确检验进行事后分析发现吸烟习惯与早期膜暴露之间存在显著关联（P = 0.0139）。初始加载至30个月后的平均边缘骨丢失为0.60±0.20 mm（95%可信区间0.54 - 0.66）。在最终修复交付时测得的平均BOP值为1.23±0.93，而2年后为1.17±0.78。差异无统计学意义（-0.06±0.76；P = 0.569）。在最终修复交付时测得的平均PPD值为2.62±0.59 mm，而2年后为2.60±0.54 mm。差异无统计学意义（-0.03±0.62；P = 0.765）。
在本研究的局限性范围内，在种植体螺纹上使用2.0 mm厚的颗粒状自体骨层，并用2.0 mm厚的无机牛骨层覆盖吸收后的牙槽嵴，联合可吸收胶原膜，似乎是重建水平骨缺损的一种可行治疗选择。
