两种胶原膜暴露于口腔环境中降解作用的对照研究

The comparative study of degradation of two collagen barrier membranes following exposure to the oral environment

目的:本研究通过将两种胶原膜实验性的暴露于动物口腔环境中,探讨其生物降解作用的差别,为两种材料的临床应用提供相关实验依据。方法:健康成年日本大耳白兔8只,体重3.5～4.0kg,雌雄不拘。通过2种外科手术方法制备动物模型。方法1:使用3mm牙龈环切刀,沿上颚中线两侧对称制备圆形粘膜穿孔,潜行分离圆孔周围2mm粘膜组织,将直径5mm的圆形Bio-Gide和海奥胶原膜置入缺损区。方法2:制备边长5mm角形粘膜瓣,潜行分离粘膜瓣周围2mm粘膜组织,将直径5mm的两种胶原膜置入粘膜瓣下,重新复位粘膜瓣并使用可吸收缝线严密缝合。按上述方法在每只动物上颚制备6个缺损,共计48个缺损区,按照随机分组原则,将两种胶原膜按暴露与非暴露分为4组,每组为12个实验样本。术后7天和28天各处死4只动物行大体、组织学观察及图形分析检测膜材料降解吸收替代百分比。结果:1)大体观察:术后7天,两种胶原膜的非暴露组创口已基本愈合,可见炎症反应;两种胶原膜的暴露组呈凹陷状愈合;术后28天,各组的缺损区已愈合,表面无炎症性反应。2)组织学观察:术后7天,两种胶原膜的不同组别均可见大量炎性细胞,但非暴露组相对于暴露组炎症反应较轻,不同处理条件下均可见成纤维细胞浸润;术后28天,两种胶原膜的暴露组炎性细胞减少,成纤维细胞数量增多,两种胶原膜的非暴露组可见炎性细胞浸润、毛细血管增生,成纤维细胞数量增多。3)Bio-Gide胶原膜和海奥口腔修复膜在暴露和非暴露两种处理方式下两者的降解吸收效果无显著性差异(P>0.05),但两种胶原膜在暴露条件下降解吸收的程度均高于于非暴露条件(P<0.05)。结论:1)Bio-Gide胶原膜和海奥口腔修复膜在引导骨再生(GBR)技术中均能起到良好的屏障作用。2)生物胶原膜暴露于口腔环境中将会导致膜的降解吸收加速,增加膜下新生组织感染的风险。

Objective： The purpose of the present study was to evaluate the bio-degradation effect of two collagen membrane which experimentally exposed to the oral environment of study animals,so as to provide some references for the clinical application.Methods： The animal model was established by operating on palate with two surgical process in 8 healthy adult Japanese white rabbits,which weighted 3.5～4.0kg,either male or female.Method1： Using 3mm gum ring cutter,creating circular mucosal perforations bilaterally symmetrical along the palatal midline,sneak separating the mucosal tissues with 2 mm around the hole.Bio-Gide collagen membrane and Heal-All collagen membrane discs with 5 mm diameters were placed under the perforations.Method2： Creating angular mucosal flap with 5 mm side length,sneak separating the mucosal tissues with 2 mm around the flap.The two collagen membranes were placed under the mucosal flap,replaced the mucosal flap and tightly sutured using absorbable sutures.Creating 6 perforations on palate in each animal with above methods,therefore 48 perforations totally.According to the principle of randomization,the two kinds of collagen membrane were divided into 4 groups for the 12 samples each by exposed and non-exposed.The change of both membrane materials were evaluated by gross observation,histological study and computer graphic analysis in the 7th,28th days after four animals were sacrificed.Results： 1）The gross observation showed that the non-exposed group of two membranes had almost healed and the exposed group showed depression-like healing in the 7th days after operation.Each group had almost healed and showed no signal of inflammation on the surface in the 28th days.2）The histological observation showed that lots of inflammatory cells were found in two membranes in both groups,but the inflammatory reaction in the non-exposed group was milder than the inflammatory reaction in exposed group,the fibroblast invasion existed in different treatment conditions in the 7th days after operation;after 28 days,inflammatory cells in the exposed group of two membrane decreased,the number of fibroblasts increased.The non-exposed group of two membranes had many inflammatory cells and capillary invaded,the number of fibroblasts increased than the 7th days group.3） Bio-Gide collagen membrane and Heal-All collagen membrane showed no significant differences in degradation in the two conditions（P0.05）,but the extent of degradation of the exposed group in the two membranes were higher than the non-exposed group under the conditions of degradation（P0.05）.Conclusions： 1） In guided bone regeneration （GBR） technique,the early exposure of collagen membranes will lead to the acceleration of degradation.The integrity of collagen membranes will be destructed.The amount of new bone tissue will indirectly reduce.So how to avoid the dehiscence of the soft tissue flap and the exposure of membranes is the key to the success of guided bone regeneration.2） Bio-Gide collagen membrane and Heal-All collagen membrane have approximately the same good effect in guided bone regeneration.