引导骨组织再生技术在牙种植修复中的临床应用研究

Clinical application of guided bone regeneration with resorbable or non-resorbable membrane in dental implants

目的评价引导骨再生技术在牙种植中引导骨再生修复的方法和效果。方法对80例牙槽骨骨缺损的患者采用植Bio-Oss小牛骨粉,盖Bio-Gide膜或钛膜,进行引导骨再生,修复骨缺损并行骨内种植体周的骨增量。结果80例患者共植入90枚种植体,38例采用钛膜,42例采用Bio-Gide胶原膜;术后部份患者伤口裂开、膜暴露;Bio-Gide膜与钛膜的伤口裂开发生率分别为7.1%与21.1%。二期手术时观察膜下骨再生情况,无感染患者膜下的新骨生成较膜暴露者多,Bio-Gide胶原膜暴露后自行愈合情况较使用钛膜者理想。88枚种植体成功地完成骨整合并成功完成义齿修复,2枚种植体因钛膜暴露及感染失败。结论Bio-Gide胶原膜及钛膜皆能有效地屏蔽软组织,引导骨再生,重建牙槽骨外形;术后无伤口裂开、膜暴露者有较好的骨再生效果;与钛膜相比,Bio-Gide胶原膜更为简便易用,出现过早裂开的比率也较少。

Objective. To assess the outcome of guided bone regeneration with resorbable or non- resorbable membrane in implant placement. Methods Guided bone regeneration procedures employing resorbable collagen membrane （Bio - Gide） and non - resorbable pure titanium membrane were used for repairing and augmentation of the resorbed alveolar ridge around endosseous implants in 80 cases of patients. In periodic follow - up, the bone regeneration was observed by successive clinical and X- ray examination. Results Ninety implants were inserted in the 80 cases with crest bone deficiencies and pure titanium membrane was used in 38 cases, Bio- Gide membrane was used in 42 cases. Postoperatively, some of these sites became exposed through the course of healing, while others remained submerged. Exposure rate of the membrane was 7.1% （3/42） for collagen membranes and 21.1% （8/38） for the pure titaniun membranes. At stage U surgery, the bone regeneration under the membrane was observed. The non- exposed sites yielded more new bone formation compared with the sites that became exposed. The exposed sites were rehealed much more ideally in the cases using Bio - Gide membrane than those using pure titanium membrane. Eighty - eight of 90 implants had ideal osseointegration at stage U surgery and were restored successfully with superstructures, while 2 of 90 implants failed because of the early exposure of the pure titaniun membranes. Conclusion Both Bio - Gide membranes and pure titaniun membranes can effectively block off soft tissue, guide bone regeneration and restore alveolar bone contour. The sites with membranes that remained submerged during healing yielded a better regenerative response as compared with sites where the membrane became exposed before stage Ⅱ surgery. Bio - Gide membranes is simple and easy to apply clinically and has less premature exposure rate than that of the pure titanium membrane.