珊瑚羟基磷灰石修复种植体周不同类型骨缺损的效果观察

Clinical and radiographic evaluation of coralline hydroxyapatite treatment in different types of peri-implant bone defects

目的研究珊瑚羟基磷灰石(CHA)修复种植体周围不同类型骨缺损引导成骨的效果及种植体负重后短期内引导骨的临床变化。方法以植入区有骨缺损(裂隙状、开窗式和水平型)的49例患者(58枚种植体)为实验组,植入种植体同时用CHA生物陶瓷充填缺损,覆盖可吸收性膜。另选择受植区骨量充足的58例患者(90枚种植体)作为对照组,进行标准牙种植手术。观察二期手术时实验组不同类型缺损引导新生骨质情况,影像学评价CHA的密度及种植体周围骨水平的变化,比较组内(不同类型骨缺损之间)和组间(实验组与对照组)负重后24个月种植成功率和种植体存留率。结果至二期手术,骨结合率实验组和对照组分别为94.8%和96.7%;负重后6～24个月种植成功率为实验组94.5%,对照组97.7%;实验组种植体存留率达100%,49枚种植体周引导骨量充足,骨引导成功率为89.1%,不同缺损类型之间的骨引导和预后情况:开窗式>裂隙状>水平型,但差异无统计学意义;影像学显示,随着时间的延长CHA的密度逐渐降低,组间和组内种植体周边缘骨吸收量无显著差异。结论 CHA具有良好的组织相容性和骨引导再生作用,能有效地修复牙种植术中的小面积骨缺损,并在短期内可获得与正常骨组织种植修复相似的种植成功率、存留率以及边缘骨水平。

Objective To evaluate the effects of coralline hydroxyapatite （CHA） served as bone graft in patients with different types of peri-implant osseous defects, and to compare the survival and success rates of implants placed with or without CHA. Methods Forty nine patients with fifty eight peri-implant osseous defects （including dehiscence, fenestration, and horizontal type） were treated with CHA combined with resorbable membranes （the test group）, while fifty nine patients with ninty implants were inserted into adequate volume of nonaugmented bones （the control group）. When patients took the second stage surgery, examinations were performed to observe the effects of bone regeneration and changes of bone density of bone grafts. The survival/success rates and marginal bone levels of implants were compared between the test and the control group, and also studied in different types of bone defects in the test group. Results The osseointegration rates were 94.8% and 96.7% respectively in the test and control group at the second stage surgery. In follow-up （6-24 months after loading）, the success rate of the test implants was 94.5% and the control ones 97.7%. In the test group, the survival rate was 100%, the bone regeneration success rate 89.1%, and forty nine implants achieved complete bone fill. The dehiscence type of peri-implant osseous defects had better bone regenaration effect and prognosis than the horizontal type, but inferior to the fenestration type, however the differences between the three typs were not statistically significant. Radiographic observation revealed that density of the coralline hydroxyapatite reduced with the time. No significant differences of marginal bone loss were observed between the test and control groups, and among the three types of the test group. Conclusions Coralline hydroxyapatite with good biocompatibility is an ideal bone graft substitute to induce bone regeneration and repair the bone defects effectively. Treated with coralline hydroxyapatite, the implants with peri-implant defects had similar survival/success rates and crestal bone levels as those implanted in adequate volume of bones.