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三维陶瓷块状移植物与自体块状移植物在修复萎缩上颌骨中的应用:一项随机对照临床试验。

The use of 3D ceramic block graft compared with autogenous block graft for rehabilitation of the atrophic maxilla: a randomized controlled clinical trial.

机构信息

Department of Diagnosis and Surgery, School of Dentistry, São Paulo State University - UNESP, Araraquara, SP, Brazil.

出版信息

Trials. 2022 Oct 23;23(1):903. doi: 10.1186/s13063-022-06843-3.

Abstract

BACKGROUND

Dental implant placement may require a bone graft for vertical and horizontal alveolar ridge augmentation. Due to its osteoconduction, osteoinductive, and osteogenesis, autogenous bone graft characteristics are considered the standard gold treatment. However, autografts can promote postoperative morbidity and implicate difficulties concerning the graft adaptation to the recipient's bone since it can eventually avoid gaps. To overcome these issues, this trial will compare the performance of Plenum Oss 3D fit, an alloplastic graft, and a 3D-printed patient-specific graft based on β-tricalcium phosphate to the autograft procedure.

METHODS

This is a split-mouth randomized clinical study designed to evaluate the performance of personalized (patient-specific) bioceramic bone grafts (Plenum Oss 3D fit) for bone augmentation of the atrophic anterior maxilla in comparison to the autogenous bone graft. We hypothesize that the gain and maintenance of the grafted area volume and the quality of the newly formed bone tissue after eight months postoperative with the synthetic patient-specific graft will be superior to the autogenous bone graft. To assess the quantity and the quality of bone neoformation, volumetric and histological analyses will be performed.

DISCUSSION

The fabrication of medical devices by additive manufacturing presents advantages over conventional manufacturing processes, mostly related to the precision of geometry and anatomy. Additionally, the osteoconductive proprieties of β-tricalcium phosphate enable this synthetic bone substitute as an alternative solution over autogenous graft for bone defect reconstruction. Thus, patient-specific bone grafts can potentially improve patient satisfaction, reducing the need for autogenous bone grafts, consequently avoiding implications related to this type of treatment, such as patient morbidity.

TRIAL REGISTRATION

This study is registered in REBEC (Registro Brasileiro de Ensaios Clínicos): RBR-76wmm3q; UTN: U1111-1272-7773. Registration date: 14 September 2021.

摘要

背景

牙种植体的植入可能需要进行骨移植以增加牙槽嵴的垂直和水平高度。由于其具有骨传导性、骨诱导性和骨生成性,自体骨移植物的特性被认为是标准的黄金治疗方法。然而,自体移植物会增加术后发病率,并导致移植物与受者骨骼的适应性困难,因为自体移植物最终可能会留下间隙。为了克服这些问题,本试验将比较 Plenum Oss 3D fit 同种异体移植物和基于β-磷酸三钙的 3D 打印患者特异性移植物与自体移植物在牙槽嵴萎缩的前上颌骨骨增量方面的性能。

方法

这是一项分割口腔随机临床试验,旨在评估个性化(患者特异性)生物陶瓷骨移植物(Plenum Oss 3D fit)用于比较自体骨移植治疗萎缩前上颌骨的骨增量的性能。我们假设,术后 8 个月,与自体骨移植物相比,合成的患者特异性移植物的移植区域体积的增加和维持以及新形成的骨组织的质量将更优。为了评估新骨形成的数量和质量,将进行体积和组织学分析。

讨论

增材制造制造的医疗设备与传统制造工艺相比具有优势,主要与几何形状和解剖结构的精度有关。此外,β-磷酸三钙的骨传导特性使其成为自体移植物用于骨缺损重建的替代解决方案。因此,患者特异性骨移植物可以潜在地提高患者满意度,减少对自体骨移植物的需求,从而避免与这种治疗方法相关的影响,例如患者发病率。

试验注册

本研究在 REBEC(巴西临床试验注册处)注册:RBR-76wmm3q;UTN:U1111-1272-7773。注册日期:2021 年 9 月 14 日。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f1f3/9590225/75acabed687b/13063_2022_6843_Fig1_HTML.jpg

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