Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University, Madrid, Spain.
Faculty of Dentistry, McGill University, Montreal, Quebec, Canada.
Clin Implant Dent Relat Res. 2021 Aug;23(4):530-542. doi: 10.1111/cid.12996. Epub 2021 Jun 9.
The need of decortication on the recipient site remains unclear for bone regeneration. To our knowledge, there are no human clinical trials that studied the influence of decortication on cancellous allogeneic block grafting.
The aim of the present study is to evaluate the influence of perforating the cortex of the recipient site on cancellous allogeneic block graft integration and revascularization in the maxilla.
Twenty-six patients referred for lateral bone augmentation were included in this clinical trial. Patients received freeze-dried bone allograft cancellous blocks obtained from the iliac crest; cortical perforations of the recipient bed were performed in the test group while in the control group it was left intact. After a 4-month healing period another surgery was performed to place dental implants, and a bone biopsy was collected using a trephine. All samples underwent micro-CT scans, and were processed for histomorphometric and immunohistochemical analysis. Implant survival comparisons were made using a repeated measures analysis of variance (ANOVA) while all other variables were compared using the analysis of covariance (ANCOVA).
One hundred and nineteen implants were placed into 110 augmented sites. One hundred percent implant survival rate was reported during 24 months follow-up period. No differences were reported in bleeding on probing at 1 (5.6 vs 9%) and 2 years (13.2 vs 12.1%), probing pocket depth at 1 (3.4 ± 0.95 vs 3.6 ± 1.12 mm) and 2 years (3.8 ± 1.02 vs 4.1 ± 1.46 mm), and marginal bone loss at 1 (0.2 ± 0.52 vs 0.3 ± 0.57 mm) and 2 years (0.6 ± 0.91 vs 0.5 ± 0.87 mm). No statistically significant differences were found in the micro-CT and histomorphometric analysis in terms of newly formed bone (25.7 ± 11.2% vs 22.3 ± 9.7%), soft tissue (33.0 ± 14.7% vs 36.5 ± 15.7%), remnant allograft (39.3 ± 20.4% vs 41.2 ± 22.7%), and bone mineralization (57.2 ± 10.6% vs 53.8 ± 8.7%). Perforating the cortex of the recipient site had no significant effect on angiogenesis as shown by immunohistochemical analysis of CD34 positive blood vessels (39.21 ± 10.53/mm vs 34.16 ± 12.67/mm ).
Cancellous allogeneic bone block grafts are a clinically acceptable alternative for horizontal bone augmentation. Cortical perforations of the recipient site in the maxilla did not improve angiogenesis nor bone formation within the block graft.
对于骨再生，在受体部位进行去皮质化的需求仍不清楚。据我们所知，没有人类临床试验研究过在松质异体骨块移植中去皮质化对骨再生的影响。
本研究旨在评估在牙槽骨外侧骨增量中，受体部位皮质穿孔对松质异体骨块移植整合和再血管化的影响。
本临床试验纳入了 26 名因侧方骨增量而就诊的患者。患者接受了从髂嵴获取的松质冷冻干燥同种异体骨块；实验组进行了受体床皮质穿孔，而对照组则保持完整。经过 4 个月的愈合期，再次进行手术植入牙种植体，并使用环钻采集骨活检。所有样本均进行了 micro-CT 扫描，并进行了组织形态计量学和免疫组织化学分析。使用重复测量方差分析（ANOVA）比较种植体存活率，而使用协方差分析（ANCOVA）比较所有其他变量。
110 个扩增部位共植入了 119 个种植体。在 24 个月的随访期间，报告了 100%的种植体存活率。在第 1 天（5.6%比 9%）和第 2 年（13.2%比 12.1%）的探诊出血、第 1 天（3.4±0.95 毫米比 3.6±1.12 毫米）和第 2 年（3.8±1.02 毫米比 4.1±1.46 毫米）的探诊袋深度以及第 1 天（0.2±0.52 毫米比 0.3±0.57 毫米）和第 2 年（0.6±0.91 毫米比 0.5±0.87 毫米）的边缘骨吸收方面，均未发现统计学差异。在新形成骨（25.7%±11.2%比 22.3%±9.7%）、软组织（33.0%±14.7%比 36.5%±15.7%）、残留同种异体骨（39.3%±20.4%比 41.2%±22.7%）和骨矿化（57.2%±10.6%比 53.8%±8.7%）方面，micro-CT 和组织形态计量学分析也未发现统计学差异。
松质同种异体骨块移植是一种临床可接受的水平骨增量替代方法。在牙槽骨外侧骨增量中，对受体部位进行皮质穿孔并不能改善骨块内的血管生成或骨形成。
