Kent J N, Quinn J H, Zide M F, Guerra L R, Boyne P J
J Oral Maxillofac Surg. 1983 Oct;41(10):629-42. doi: 10.1016/0278-2391(83)90016-2.
A four-year prospective evaluation of the use of nonresorbable, particulate hydroxylapatite (HA) to augment deficient alveolar ridges was performed. The material was used alone and in combination with finely crushed autogenous cancellous bone. Implants were delivered subperiosteally by syringe injection, usually using local anesthesia for Class I to Class III ridges and general anesthesia for Class III and Class IV ridges. The improved ridge height and width were stable. Postoperative resorption with significant loss of ridge height, frequently seen with rib and iliac crest onlayed grafts, was not observed with HA augmentation. Permanent denture construction began as early as three weeks postoperatively and by four to six weeks if HA was combined with autogenous cancellous bone. It was possible to place mandibular staple implants simultaneously or following HA augmentation. Visor osteotomy techniques were improved by use of HA to produce a wider, more convex stable ridge. Although skin, mucosa, or dermal vestibuloplasties were performed as early as three months postoperatively in a small number of patients, there appeared to be a lesser need for vestibuloplasty after HA augmentation than after onlay bone grafting. In addition, prosthodontists performed fewer denture relines after HA augmentation than after onlay bone grafts. The authors believe the most significant factor accounting for these observations is the firm, nonmobile mucosal base resulting from augmentation with HA. The resultant stable, soft tissue base and improved ridge height and contour have contributed to a comfortable, retentive, stable denture for these patients. The prosthetic and surgical procedures are easier to perform and have produced superior, more permanent results than onlay bone grafts and alloplasts. Preliminary studies also point to exciting possibilities for use of HA as a bone substitute/marrow extender in maxillary and mandibular defects, cysts, and clefts and in osteotomies for orthognathic surgery.
对使用不可吸收的颗粒状羟基磷灰石（HA）来增高不足牙槽嵴进行了为期四年的前瞻性评估。该材料单独使用以及与精细粉碎的自体松质骨联合使用。种植体通过注射器经骨膜下注射植入，对于I类至III类牙槽嵴通常采用局部麻醉，对于III类和IV类牙槽嵴则采用全身麻醉。增高后的牙槽嵴高度和宽度保持稳定。未观察到HA增高后出现如肋骨和髂嵴覆盖移植时常见的术后吸收以及牙槽嵴高度显著丧失的情况。术后最早三周即可开始制作永久性义齿，若HA与自体松质骨联合使用，则在四至六周开始。可以在HA增高的同时或之后植入下颌钉状种植体。通过使用HA改进了遮阳板截骨术，以形成更宽、更凸的稳定牙槽嵴。尽管少数患者在术后三个月就尽早进行了皮肤、黏膜或真皮前庭成形术，但与覆盖骨移植相比，HA增高后似乎对前庭成形术的需求较少。此外，与覆盖骨移植相比，HA增高后修复牙医进行义齿重衬的次数更少。作者认为，解释这些观察结果的最重要因素是HA增高后形成的坚实、不可移动的黏膜基底。由此产生的稳定软组织基底以及牙槽嵴高度和外形的改善，为这些患者带来了舒适、固位良好且稳定的义齿。与覆盖骨移植和异体植入物相比，修复和外科手术操作更易于实施，且产生了更优、更持久的效果。初步研究还指出，HA作为骨替代物/骨髓扩充剂用于上颌和下颌缺损、囊肿、腭裂以及正颌外科截骨术具有令人兴奋的可能性。
