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牙科医学中的骨移植:自体移植、异体移植和合成材料概述

Bone Grafts in Dental Medicine: An Overview of Autografts, Allografts and Synthetic Materials.

作者信息

Ferraz Maria Pia

机构信息

Departamento de Engenharia Metalúrgica e de Materiais, Faculdade de Engenharia da Universidade do Porto, 4200-465 Porto, Portugal.

i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4099-002 Porto, Portugal.

出版信息

Materials (Basel). 2023 May 31;16(11):4117. doi: 10.3390/ma16114117.

Abstract

This review provides an overview of various materials used in dentistry and oral and maxillofacial surgeries to replace or repair bone defects. The choice of material depends on factors such as tissue viability, size, shape, and defect volume. While small bone defects can regenerate naturally, extensive defects or loss or pathological fractures require surgical intervention and the use of substitute bones. Autologous bone, taken from the patient's own body, is the gold standard for bone grafting but has drawbacks such as uncertain prognosis, surgery at the donor site, and limited availability. Other alternatives for medium and small-sized defects include allografts (from human donors), xenografts (from animals), and synthetic materials with osteoconductive properties. Allografts are carefully selected and processed human bone materials, while xenografts are derived from animals and possess similar chemical composition to human bone. Synthetic materials such as ceramics and bioactive glasses are used for small defects but may lack osteoinductivity and moldability. Calcium-phosphate-based ceramics, particularly hydroxyapatite, are extensively studied and commonly used due to their compositional similarity to natural bone. Additional components, such as growth factors, autogenous bone, and therapeutic elements, can be incorporated into synthetic or xenogeneic scaffolds to enhance their osteogenic properties. This review aims to provide a comprehensive analysis of grafting materials in dentistry, discussing their properties, advantages, and disadvantages. It also highlights the challenges of analyzing in vivo and clinical studies to select the most suitable option for specific situations.

摘要

本综述概述了牙科及口腔颌面外科中用于替代或修复骨缺损的各种材料。材料的选择取决于组织活力、大小、形状和缺损体积等因素。虽然小骨缺损可自然再生,但广泛的缺损、骨质流失或病理性骨折则需要手术干预并使用替代骨。取自患者自身身体的自体骨是骨移植的金标准,但存在预后不确定、供体部位手术以及可用性有限等缺点。对于中小型缺损,其他替代材料包括同种异体移植物(来自人类供体)、异种移植物(来自动物)以及具有骨传导特性的合成材料。同种异体移植物是经过精心挑选和处理的人类骨材料,而异种移植物则来自动物,其化学成分与人类骨相似。陶瓷和生物活性玻璃等合成材料用于小缺损,但可能缺乏骨诱导性和可模塑性。磷酸钙基陶瓷,尤其是羟基磷灰石,因其与天然骨的成分相似而得到广泛研究和普遍应用。生长因子、自体骨和治疗元素等额外成分可加入合成或异种支架中,以增强其成骨特性。本综述旨在对牙科中的移植材料进行全面分析,讨论其特性、优点和缺点。它还强调了分析体内和临床研究以选择特定情况下最合适选项的挑战。

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