Batas Leonidas, Anagnostou Eleftherios, Vouros Ioannis
Private Practitioner and Research Associate, Department of Preventive Dentistry, Periodontology and Implant Biology, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Histopathologist Scientific Coordinator, Department of Pathology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
J Oral Maxillofac Surg. 2020 Dec;78(12):2195-2207. doi: 10.1016/j.joms.2020.07.209. Epub 2020 Jul 31.
The atrophic alveolar ridge has been a challenge in implant dentistry; various techniques using the principle of guided bone regeneration (GBR) have been applied in the past 2 decades.The aim of this study was to introduce and evaluate-clinically, histologically, and radiographically-a novel technique of regenerating a new bone in the atrophic alveolar ridge, which is based on the GBR principles, the double layer technique (DLT). Six patients with partially edentulous jaws with a residual bone width less than or equal to 4 mm in the maxilla were subjected to GBR. The sites were grafted using a DLT. At first, sites were grafted with allogenic bone and then a second layer of deproteinized bovine bone was placed. Next, grafted sites were covered with a resorbable membrane tucked with 2 titanium pins. Cone-beam computed tomography scans were obtained before and 5 months after DLT. In the latter case and during implant site preparation, trephine biopsies were obtained and processed for histologic and histomorphometric evaluation. In all cases, implants were successfully installed and primary stability was established. Implant diameter ranged from 3.8 to 4.1 mm. In all cases, radiographic findings showed increased alveolar ridge width before and after surgery. The new tissues consisted mostly of a variable amount of new trabecular bone, some loose connective tissue, blood vessels, and occasional inflammatory cells. All 15 implants placed had 100% survival rate after a 5-year follow-up. On the basis of these preliminary results, it seems that the double layer GBR technique may achieve satisfactory results from a clinical, radiographic, and histologic perspective favoring placement of dental implants in the atrophic maxillary alveolar ridge.
萎缩性牙槽嵴一直是种植牙科领域的一项挑战；在过去20年里，人们应用了各种基于引导骨再生（GBR）原理的技术。本研究的目的是从临床、组织学和影像学方面介绍并评估一种基于GBR原理的双层技术（DLT），该技术用于在萎缩性牙槽嵴中再生新骨。对6例上颌部分牙列缺失且剩余骨宽度小于或等于4毫米的患者进行GBR治疗。采用DLT技术对这些部位进行植骨。首先，用同种异体骨对部位进行植骨，然后放置第二层脱蛋白牛骨。接下来，用2根钛钉固定的可吸收膜覆盖植骨部位。在DLT术前和术后5个月进行锥形束计算机断层扫描。在术后5个月及种植部位制备过程中，获取环钻活检组织并进行组织学和组织形态计量学评估。在所有病例中，种植体均成功植入并获得了初期稳定性。种植体直径范围为3.8至4.1毫米。在所有病例中，影像学检查结果显示手术前后牙槽嵴宽度增加。新组织主要由数量不等的新小梁骨、一些疏松结缔组织、血管和偶尔的炎性细胞组成。在5年的随访后，所有植入的15枚种植体的存活率均为100%。基于这些初步结果，从临床、影像学和组织学角度来看，双层GBR技术似乎可以取得令人满意的效果，有利于在萎缩性上颌牙槽嵴中植入牙种植体。
