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自固化富血小板纤维蛋白基质是一种用于不同增量手术的替代生物材料:一项回顾性病例系列报告。

Auto-dentin platelet-rich fibrin matrix is an alternative biomaterial for different augmentation procedures: A retrospective case series report.

机构信息

Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.

Department of Oral Medicine, Oral Pathology, Oral and Maxillofacial Surgery, University of Tripoli School of Dentistry, Tripoli, Libya.

出版信息

Clin Exp Dent Res. 2023 Dec;9(6):993-1004. doi: 10.1002/cre2.808. Epub 2023 Nov 7.

Abstract

OBJECTIVES

Autologous dentin grafts derived from extracted teeth have shown promise as bone graft materials for promoting bone regeneration. This retrospective case series aimed to evaluate clinical, radiographic, and histologic outcomes of using autologous dentin matrices in various bone regeneration procedures.

MATERIALS AND METHODS

This case series included 26 eligible patients and encompassed 4 socket preservation cases, 5 cases of guided tissue regeneration, 5 cases of guided bone regeneration (GBR), 10 cases of sinus augmentation procedures, 2 immediate placement implants, and 2 socket shields. Dentin grafts were prepared from extracted teeth, cleaned, and processed. These grafts were combined with platelet-rich fibrin (PRF) to create adhesive dentin matrices, then covered with collagen membranes for simultaneous guided bone augmentation cases. Cone beam computed tomography (CBCT) scans were conducted before surgery and 4 months postoperatively to assess ridge dimensions. Histologic evaluation was performed through bone core biopsies for socket preservation cases at the 4-month mark.

RESULTS

A total of 42 implants were placed in 26 patients, with an average follow-up of 32 months. Notably, two implant failures occurred following lateral maxillary sinus augmentation. CBCT scans at the 4-month interval revealed bone coverage over implant platforms in the majority of cases. Histologic analysis from two cases of socket preservation demonstrated dentin granules enveloped by newly formed bone undergoing continuous remodeling. The quantitative histomorphometric assessment revealed a bone area of 42.8 ± 3.56%, a remaining graft area of 19.05 ± 4.58%, and a viable bone of 38.15 ± 7.84%.

CONCLUSIONS

The utilization of autologous dentin particles mixed with PRF proved effective as an alternative to conventional bone graft materials in GBR and maxillary sinus augmentation procedures. Larger controlled clinical trials are recommended to further substantiate these findings.

摘要

目的

从拔牙中获得的自体牙本质移植物已被证明是一种有前途的骨移植材料,可促进骨再生。本回顾性病例系列旨在评估在各种骨再生手术中使用自体牙本质基质的临床、放射学和组织学结果。

材料和方法

本病例系列纳入了 26 名符合条件的患者,包括 4 例牙槽嵴保存术、5 例引导组织再生术、5 例引导骨再生术(GBR)、10 例鼻窦提升术、2 例即刻种植体植入术和 2 例牙槽窝保护术。牙本质移植物取自拔牙,经过清洗和处理。这些移植物与富含血小板的纤维蛋白(PRF)混合制成粘性牙本质基质,然后覆盖胶原膜用于同时进行引导骨增量的病例。手术前和术后 4 个月进行锥形束计算机断层扫描(CBCT)扫描以评估牙槽嵴的尺寸。在 4 个月时通过牙槽窝保存术的骨芯活检进行组织学评估。

结果

26 名患者共植入 42 颗种植体,平均随访时间为 32 个月。值得注意的是,2 例上颌窦侧壁提升术后发生种植体失败。在 4 个月的间隔进行 CBCT 扫描显示,大多数病例中,种植体平台上有骨覆盖。来自 2 例牙槽窝保存术的组织学分析显示,新形成的骨包裹着牙本质颗粒,正在进行持续的重塑。定量组织形态计量学评估显示,骨面积为 42.8±3.56%,剩余移植物面积为 19.05±4.58%,有活力的骨面积为 38.15±7.84%。

结论

自体牙本质颗粒与 PRF 混合使用被证明是 GBR 和上颌窦提升术等传统骨移植材料的有效替代品。建议进行更大规模的对照临床试验以进一步证实这些发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f9ca/10728516/bf06d88b349a/CRE2-9-993-g004.jpg

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