Stentz W C, Mealey B L, Gunsolley J C, Waldrop T C
Department of Periodontics, Andrews AFB, MD, USA.
J Periodontol. 1997 Oct;68(10):933-49. doi: 10.1902/jop.1997.68.10.933.
The purpose of this study was to determine which treatment of a large osseous defect adjacent to an endosseous dental implant would produce the greatest regeneration of bone and degree of osseointegration: barrier membrane therapy plus demineralized freeze-dried bone allograft (DFDBA), membrane therapy alone, or no treatment. The current study histologically assessed changes in bone within the healed peri-implant osseous defect. In a split-mouth design, 6 implants were placed in edentulous mandibular ridges of 10 mongrel dogs after preparation of 6 cylindrical mid-crestal defects, 5 mm in depth, and 9.525 mm in diameter. An implant site was then prepared in the center of each defect to a depth of 5 mm beyond the apical extent of the defect. One mandibular quadrant received three commercially pure titanium (Ti) screw implants (3.75 x 10 mm), while the contralateral side received three hydroxyapatite (HA) coated root-form implants (3.3 x 10 mm). Consequently, the coronal 5 mm of each implant was surrounded by a circumferential defect approximately 3 mm wide and 5 mm deep. The three dental implants in each quadrant received either DFDBA (canine source) and an expanded polytetrafluoroethylene membrane (ePTFE), ePTFE membrane alone, or no treatment which served as the control. Clinically, the greatest increase in ridge height and width was seen with DFDBA/ePTFE. Histologically, statistically significant differences in defect osseointegration were seen between treatment groups (P < 0.0001: DFDBA/ePTFE > ePTFE alone > control). HA-coated implants had significantly greater osseointegration within the defect than Ti implants (P < 0.0001). Average trabeculation of newly formed bone in the defect after healing was significantly greater for HA-coated implants than for titanium (P < 0.0001), while the effect on trabeculation between treatments was not significantly different (P = 0.14). Finally, there were significantly less residual allograft particles in defect areas adjacent to HA-coated implants than Ti implants (P = 0.0355). The use of HA-coated implants in large size defects with DFDBA and ePTFE membranes produced significantly more osseointegration histologically than other treatment options and more than Ti implants with the same treatment combinations. The results of this study indicate that, although the implants appeared osseointegrated clinically after 4 months of healing, histologic data suggest that selection of both the implant type and the treatment modality is important in obtaining optimum osseointegration in large size defects.
本研究的目的是确定对于与骨内牙种植体相邻的大骨缺损，哪种治疗方法能产生最大程度的骨再生和骨结合程度：屏障膜疗法加脱矿冻干骨同种异体移植（DFDBA）、单纯膜疗法或不治疗。本研究通过组织学评估愈合的种植体周围骨缺损内骨的变化。采用双侧对照设计，在10只杂种犬的无牙下颌牙槽嵴制备6个深度为5mm、直径为9.525mm的圆柱形中央嵴顶缺损后，植入6枚种植体。然后在每个缺损中心制备一个种植位点，深度超过缺损根尖范围5mm。一侧下颌象限植入3枚商业纯钛（Ti）螺钉种植体（3.75×10mm），对侧植入3枚羟基磷灰石（HA）涂层的根形种植体（3.3×10mm）。因此，每个种植体的冠方5mm被一个宽约3mm、深5mm的环形缺损包围。每个象限的3枚牙种植体分别接受DFDBA（犬源）和膨体聚四氟乙烯膜（ePTFE）、单纯ePTFE膜或不治疗（作为对照）。临床上，DFDBA/ePTFE组牙槽嵴高度和宽度增加最大。组织学上，各治疗组之间在缺损骨结合方面存在统计学显著差异（P<0.0001：DFDBA/ePTFE>单纯ePTFE>对照）。HA涂层种植体在缺损内的骨结合明显优于Ti种植体（P<0.0001）。愈合后缺损内新形成骨的平均小梁化程度，HA涂层种植体显著高于钛种植体（P<0.0001），而不同治疗方法对小梁化的影响无显著差异（P=0.14）。最后，与Ti种植体相比，HA涂层种植体相邻缺损区域的残留同种异体移植颗粒明显更少（P=0.0355）。在大尺寸缺损中使用HA涂层种植体联合DFDBA和ePTFE膜，组织学上产生的骨结合明显多于其他治疗方案，也多于采用相同治疗组合的Ti种植体。本研究结果表明，尽管种植体在愈合4个月后临床上似乎已实现骨结合，但组织学数据表明，在大尺寸缺损中获得最佳骨结合时，种植体类型和治疗方式的选择都很重要。
