van Orten Andreas, Goetz Werner, Bilhan Hakan
Private Dental Practice Do24, Dortmunder Str. 24-28, 45731 Waltrop, Germany.
Policlinic of Orthodontics, Centre for Dental Care, Basic Science Research in Oral Biology, Friedrich-Wilhelms University, Welschnonnenstr. 17, 53111 Bonn, Germany.
Bioengineering (Basel). 2024 Jun 28;11(7):665. doi: 10.3390/bioengineering11070665.
In recent years, the significance of maintaining the alveolar ridge following tooth extractions has markedly increased. Alveolar ridge preservation (ARP) is a commonly utilized technique and a variety of bone substitute materials and biologics are applied in different combinations. For this purpose, a histological evaluation and the clinical necessity of subsequent guided bone regeneration (GBR) in delayed implantations were investigated in a prospective case series after ARP with a novel deproteinized bovine bone material (95%) in combination with a species-specific collagen (5%) (C-DBBM). Notably, block-form bone substitutes without porcine collagen are limited, and moreover, the availability of histological data on this material remains limited. Ten patients, each scheduled for tooth extraction and desiring future implantation, were included in this study. Following tooth extraction, ARP was performed using a block form of C-DBBM in conjunction with a double-folded bovine cross-linked collagen membrane (xCM). This membrane was openly exposed to the oral cavity and secured using a crisscross suture. After a healing period ranging from 130 to 319 days, guided trephine drilling was performed for implant insertion utilizing static computer-aided implant surgery (s-CAIS). Cores harvested from the area previously treated with ARP were histologically processed and examined. Guided bone regeneration (GBR) was not necessary for any of the implantations. Histological examination revealed the development of a lattice of cancellous bone trabeculae through appositional membranous osteogenesis at various stages surrounding C-DBBM granules as well as larger spongy or compact ossicles with minimal remnants. The clinical follow-up period ranged from 2.5 to 4.5 years, during which no biological or technical complications occurred. Within the limitations of this prospective case series, it can be concluded that ARP using this novel C-DBBM in combination with a bovine xCM could be a treatment option to avoid the need for subsequent GBR in delayed implantations with the opportunity of a bovine species-specific biomaterial chain.
近年来,拔牙后维持牙槽嵴的重要性显著增加。牙槽嵴保存(ARP)是一种常用技术,多种骨替代材料和生物制剂以不同组合应用。为此,在使用新型脱蛋白牛骨材料(95%)与种属特异性胶原蛋白(5%)(C-DBBM)进行ARP后的前瞻性病例系列研究中,对延迟种植中后续引导骨再生(GBR)的组织学评估和临床必要性进行了调查。值得注意的是,不含猪胶原蛋白的块状骨替代材料有限,而且关于这种材料的组织学数据也很有限。本研究纳入了10名计划拔牙并希望未来进行种植的患者。拔牙后,使用块状C-DBBM结合双层牛交联胶原膜(xCM)进行ARP。该膜开放暴露于口腔,并使用十字缝合法固定。在130至319天的愈合期后,利用静态计算机辅助种植手术(s-CAIS)进行引导环钻术以植入种植体。从先前接受ARP治疗的区域获取的芯样进行组织学处理和检查。所有种植均无需进行引导骨再生(GBR)。组织学检查显示,在C-DBBM颗粒周围的不同阶段,通过贴壁膜内成骨形成了松质骨小梁晶格,以及残留极少的较大海绵状或致密小骨。临床随访期为2.5至4.5年,在此期间未发生生物学或技术并发症。在本前瞻性病例系列的局限性内,可以得出结论,使用这种新型C-DBBM与牛xCM联合进行ARP可能是一种治疗选择,可避免延迟种植中后续GBR的需要,并提供了牛种属特异性生物材料链的机会。