异种脱细胞真皮基质修复骨引导再生术后软组织缺损的临床观察

Clinical observation of repairing soft tissue defect with the acellular dermal matrix in guided bone regeneration surgery

目的:观察异种脱细胞真皮基质在骨引导再生术中充当屏障膜并直接修复术后软组织不足的临床效果及对引导骨再生的影响。方法:选择在中山大学附属口腔医院种植科要求种植修复治疗,但因种植区牙槽嵴萎缩,宽度不足而需先行骨引导再生术的患者7例(其中女性5例,男性2例,平均34岁),术中用脱细胞真皮基质覆盖骨引导再生区域,并直接修补创面软组织不足,临床观察脱细胞真皮基质愈合情况。通过影像学和临床检查评价新生的引导再生骨。结果:术后2周可见创面生物膜有部分降解,骨移植材料表面有薄层胶原基质覆盖;术后3周,创面开始有少量牙龈上皮覆盖;术后4周,牙龈上皮覆盖全部创面,与周围牙龈融合。术后1年,牙种植手术中见再生骨质量好,缺牙区牙槽嵴宽度明显增宽。影像学检查显示,随愈合时间延长,骨粉颗粒高密度影像逐渐消失,与周围正常骨质间界限不清。结论:脱细胞真皮基质充当骨引导生物膜并同时修复骨增量术后软组织不足的临床效果满意。

Objective： To observe the clinical effects of using the acellular dermal matrix （ADM） as barrier membrane and for directly repairing soft tissue defect in the guided bone regeneration surgery meanwhile and the effects of the procedure on the forming of the guided regenerative bone.Methods： 7 patients （5 female,2 male,averaged age： 34 years old） requiring implant restoration in the Implant Department,Guanghua School of Stomatology Sun Yat-sen University,were included in the analysis.All patients had guided bone regeneration surgery performed prior to implant surgery due to severe atrophic alveolar ridges and inadequate width of the indicated alveolar crests .Acellular dermal matrix was applied to cover the guided regenerative field and meanwhile directly to repair soft tissue defect in the surgery.The healing condition of ADM was clinically observed.The new guided regenerative bone was assessed radiographically and determined in the implant surgery clinically.Results： At 2 week after surgery,the degradation of ADM occurred to some extent and a thin layer of collagen matrix of ADM on the surface of bone substitutes were found.At 3 week after surgery,some of epithelial cells covering the surgical area were observed.At 4 week following surgery,the newborn epithe lial cells almost occupied the whole wound area and were merged with the surrounding gingival.During implant surgery at 1 year after the guided surgery,fine regenerative bone and apparently wide alveolar crest in the edentulous area were observed.Radiographic examination showed that as healing time goes on,the hige densitive images from particles of bone substitute disappeared gradually.The boundary between the bone substitutes and surrounding normal bone was unclear.Conclusion： The clinical outcomes were satisfied that ADM was used as bone-guided biological membrane and directly used to repair soft tissue defect after alveolar augmentation surgery.