NPHA/BMP复合物在盖髓治疗中的动物实验及临床应用

A Study on Curative Effects of NPHA/BMP Complex Used in Pulp Capping

目的 寻找一种在牙髓病治疗中能保存活髓的理想的盖髓剂。方法 采用天然型网孔羟基磷灰石 (NPHA) ,与骨形成蛋白 (BMP)组成NPHA/BMP复合物。动物实验 :以该复合物进行家兔肌内植入实验 ,以及羟基磷灰石 (HA)、NPHA分别植入家兔胫骨内的成骨效应实验。临床观察 :选择口腔门诊患者随机分为实验组 [用NPHA/BMP]10 0例 ,10 4颗牙 ;对照组 [用Ca(OH) 2 ]6 0例 ,6 0颗牙 ,分别进行盖髓治疗。结果 动物实验组织学观察证实 :NPHA植入肌肉未见诱导幼稚间充质细胞的增殖、分化以及成骨作用 ,生物相容性良好。NPHA/BMP复合物植入肌肉内 ,见明显新生骨形成 ,新生骨成长活跃且与材料呈直接界面 ,NPHA植入胫骨内观察无免疫排斥反应 ,其成骨量多于致密性羟基磷灰石。临床观察 1年随访结果 :NPHA/BMP复合物的盖髓成功率优于氢氧化钙。结论 NPHA/BMP复合物 ,生物相容性良好 ,具有传导和诱导成骨功能 ,是较理想的盖髓剂。

Objecetive To explore an ideal pulp-cap. Methods The natural porous hydroxylapatite (NPHA) and bone morphogenesis protein (BMP) were combined as NPHA/BMP complex. Animal experiment: NPHA/BMP complex was implanted into the rabbits' muscles to evaluate its osteoinduce effect. Hydroxylapatite (HA) and NPHA were implanted into the rabbits' shankbones respectively to compare their osteoconductivity.Clinical observation:The patients were randomly selected to be the experiment group (NPHA/BMP group) and the control group[Ca(OH)2 group]. The pulps were capped with NPHA/BMP and Ca(OH) 2, respectively.Results The animal experiment histopathological observation showed that NPHA implanted into the rabbits' muscles couldn't induce the multiplication and polarization of the infantile mesenchyme cell and osteoconductivity was showed. But NPHA had good biocompatibility.After the NPHA/BMP was implanted into the rabbits' muscles,new bone was formed obviously and had a direct interface with the complex.The experiment of NPHA implanted into rabbits' shankbones showed that the communicated porous structure was valuable for osteoconconductivity.NPHA could induce more new bone than the intensive hydroxylapatite.One-year follow- up showed that the NPHA/BMP was more efficacious than Ca(OH) 2. Conclusion NPHA had communicated porous structure much more like human's bone.This structure was more valuable for osteoconductivity.The animal experiment and clinical observation indicated NPHA/BMP had excellent biocompatibility and osteoinducing effect and osteoconductivity.So the NPHA/BMP complex should be an ideal pulp-cap.