Yayla Mah. Yozgat Bulvari, 1487. Cad., No:55 Kecioren, Ankara, Turkey
Med Oral Patol Oral Cir Bucal. 2023 Mar 1;28(2):e148-e155. doi: 10.4317/medoral.25616.
The significant advances in the materials and biological aspects of dental implants haven't completely eradicated the implant failures. The removal of osseointegrated but otherwise failed implants present several challenges including adjacent tissues damage and necessity of bone augmentation for reimplantation. Controlled thermal necrosis has emerged as an alternative technique to aid removal of osseointegrated dental implants with minimal to no defect to healthy bone or surrounding tissues. This study aimed to evaluate the thermal necrosis-aided implant removal method in a rabbit osseointegration model.
A total of 8 male New Zealand rabbits were used in the study. Two dental implants were placed on each femur of the rabbits. Heating of the implants was performed after 7 weeks following the implantation. Heating was done by contacting the tip of an electrosurgey tool in monopolar mode at different power settings and contact durations (5W - 2 seconds, 5W - 10 seconds, and 10 W - 10 seconds). No heating was done on the control group. Implant stability right after implantation, before heat application and after heat application was determined using an Osstell™ Mentor Device. Following the removal of implants histological analyses were performed to determine the effects of heat application at cellular level.
ISQ values of the 10W-10s group was significantly lower compared to the other groups (p<0.001). No indication of progressive necrosis or irreversible damage was observed in any of the groups. However, the percent of empty-apoptotic lacunae were statistically higher in the 5W-10s and the 10W-10s groups compared the control and the 5W-2s groups.
Within the conditions of this study, we conclude that heat application with an electrosurgery tool using monopolar mode at 10W power for 10 seconds is optimal for reversing osseointegration with no extensive or progressive damage to the bone.
尽管牙科植入物在材料和生物学方面取得了重大进展，但仍未能完全消除植入物失败的问题。对于已骨整合但失败的植入物的移除，存在多个挑战，包括对相邻组织的损伤以及为重新植入而进行骨增量的必要性。可控热坏死已成为一种辅助技术，可以帮助去除已骨整合的牙科植入物，而对健康骨骼或周围组织几乎没有或没有缺陷。本研究旨在评估热坏死辅助植入物去除方法在兔骨整合模型中的应用。
本研究共使用了 8 只雄性新西兰兔。每只兔子的每根股骨上各植入 2 个牙种植体。在植入后 7 周，对植入体进行加热。加热是通过在单极模式下接触电外科工具的尖端，以不同的功率设置和接触时间（5W-2 秒、5W-10 秒和 10W-10 秒）进行的。对照组不进行加热。在植入后即刻、应用热之前和应用热之后，使用 Osstell™Mentor 设备确定植入物的稳定性。在去除植入物后，进行组织学分析以确定在细胞水平应用热的效果。
10W-10s 组的 ISQ 值明显低于其他组（p<0.001）。在任何一组中，均未观察到进行性坏死或不可逆损伤的迹象。然而，在 5W-10s 和 10W-10s 组中，空凋亡腔的百分比明显高于对照组和 5W-2s 组。
在本研究条件下，我们得出结论，使用单极模式的电外科工具在 10W 功率下加热 10 秒，对于逆转骨整合是最佳的，不会对骨骼造成广泛或进行性损伤。
