Clinic of Conservative & Preventive Dentistry, Division of Periodontology & Peri-Implant Diseases, University of Zurich, Zurich, Switzerland; Department for Periodontology, Faculty of Health, Witten/Herdecke University, Witten, Germany.
Department for Orthodontics, Friedrich-Wilhelm-University Bonn, Bonn, Germany.
Ann Anat. 2020 Sep;231:151524. doi: 10.1016/j.aanat.2020.151524. Epub 2020 May 4.
To explore whether placement of a soft cortical membrane can restore and regenerate the original alveolar ridge contour in deficient sockets.
One Beagle dog was used in this proof-of-principle evaluation. In a first intervention, a standardized buccal dehiscence defect was artificially created at the distal roots of the 3rd and 4th mandibular premolars. Four weeks later, following endodontic treatment of the mesial roots, teeth were hemisected and the distal roots were extracted without raising a flap. A cortical membrane (Lamina®, Osteobiol) was placed outside of the bony envelope of the extraction socket to rebuild the buccal bone contour. Afterwards, sockets were filled with a collagen-modified porcine bone graft material (Gen-Os®, Osteobiol) to the level of the surrounding bone height. The socket orifice was closed with a porcine dermal matrix (Derma®). After four months, block specimens containing the socket-sites and remaining roots were retrieved, histologically processed and analyzed.
Surgery and post-operative healing were uneventful. Histologically, bone formation under the membrane was found, i.e. bony protrusions and ossicles by osteoblasts could be identified. Concomitantly, the membrane showed clear signs of degradation. Bone substitute was well integrated in newly formed bone and resorption of particles was found.
Three major observations were made in the present proof-of-principle study: (i) regeneration of a compromised socket seems possible when applying the presented approach, (ii) the soft cortical membrane was sufficiently stable to allow for the establishment of the contour and to inhibit soft tissue invasion and (iii) the applied xenogenic graft material was undergoing remodelling processes while allowing adequate bone regeneration.
探索在骨缺损的牙槽窝中放置柔软的皮质膜是否可以恢复和再生原有的牙槽嵴轮廓。
本研究采用原理验证方法，使用一只比格犬。首先，在第 3 和第 4 下颌前磨牙的颊侧根部人为地创建一个标准的颊侧骨开窗缺损。4 周后，在进行近中根的牙髓治疗后，将牙齿半切，并在不翻瓣的情况下拔除远中根。将皮质膜（Lamina®，Osteobiol）置于拔牙窝的骨皮质外，以重建颊侧骨轮廓。然后，用胶原蛋白改性猪骨移植材料（Gen-Os®，Osteobiol）将拔牙窝填充至周围骨高度平齐。用猪真皮基质（Derma®）封闭拔牙窝的孔口。4 个月后，取出包含拔牙窝和剩余牙根的块状标本，进行组织学处理和分析。
手术和术后愈合均顺利。组织学上，在膜下发现了骨形成，即可以识别成骨细胞形成的骨突起和小骨。同时，膜有明显的降解迹象。骨替代物与新形成的骨很好地整合，发现有颗粒吸收。
在本原理验证研究中观察到了三个主要结果：（i）应用所提出的方法似乎可以使受损的拔牙窝再生，（ii）柔软的皮质膜足够稳定，可以建立轮廓并抑制软组织侵入，（iii）应用的异种移植物材料正在经历重塑过程，同时允许足够的骨再生。
