Bioss和羟基磷灰石骨粉在种植外科牙槽窝位点保护中的应用研究

Study of Bioss and Hydroxyapatite Materials on Protecting Teeth Socket in Implant Surgery

目的：利用牙槽窝保护技术,在拔牙后牙槽窝中即刻植入Bioss骨粉或羟基磷灰石骨材料。后期完成种植手术,同期取牙槽窝骨标本,行影像学及组织学检测,对比不同材料保护牙槽窝的临床意义。方法：选择本院口腔颌面外科门诊患者50例,因创伤致牙脱位、断裂,牙槽窝骨折者25例,牙周病15例,残根伴根尖囊肿6例,咬合致牙折4例。患者在局麻下微创拔除病灶牙根,刮净牙槽窝,分别植入Bioss骨粉或羟基磷灰石骨粉,表面用可吸收胶原膜覆盖,严密缝合创口。5~6月后局麻下用环钻钻取牙槽窝上方骨柱,行硬组织切片检测,对比新骨形成和人工骨代谢情况。结果：50例患者中,牙槽窝骨质均得到有效保护,牙槽嵴的宽度均满足临床种植需求。刚植入人工骨粉时,数字牙片显示牙槽窝的骨密度高,人工骨颗粒清晰,到3个月时,骨粉密度渐变淡,颗粒也渐渐变得模糊。由标本硬组织切片来看,无论是羟基磷灰石还是Bioss人工骨粉,在牙槽窝中均有新骨形成,在人工骨粉颗粒间有骨质形成,越往根部,骨质形成越多,骨结构越成熟。Bioss骨粉植入的牙槽窝标本,其新骨形成量多,人工骨代谢更快。结论：利用牙槽窝保护技术,将Bioss或羟基磷灰石人工骨粉在拔牙后即刻植入牙槽窝中,均可以有效保护牙槽骨量,维持牙槽骨形态,顺利完成种植手术,软硬组织美学效果良好。Bioss骨粉的成骨效果好于羟基磷灰石人工骨粉。

Objective Bioss and hydroxyapatite materials was filled into teeth socket after extraction immediately,then the bone sample was extraed from teeth socket while the denture implantation. The sample was determined with iconography and histology. The protective effect of different materials on teeth socket was compared. Methods Fifty out-patients were enrolled in this study,including 25 cases of teeth dislocation,teeth abruption and socket fracture,15 cases of paradentosis,6 cases of residual root complicated periapical cyst,4 cases of odontagma. The focus tooth root was extracted under focal anesthesia and the socket was scraped clearly,then Bioss or hydroxyapatite materials was filled into the socket,and the surface of socket was covered with adsorbable collagen coating,finally,the incision was exactly sewed up. The bone sample of extraction socket were drilled with hole saw after 5 to 6 months,then the biopsy of bone sclerous tissue was used to evaluate the new bone formation and artificial bone metabolism. Results The teeth socket sclerotin were protected from absorption in all 50 patients,the width of alveolar ridge was suitable for implantation. The digital film showed that the high density of bone in socket and the clear granules of artifical bone were found,and the density and granules of the bone was decreased until 3 months later. In teeth socket filled with Bioss or hydroxyapatite materials,the new bone formed among the granules of artifical bone dust,the sclerotin density and architecture was more and more dense and mature along the teeth root. Furthermore,the new bone formation was more and artificial bone metabolism was faster in teeth socket filled with Bioss compared with hydroxyapatite. Conclusion Bioss and hydroxyapatite materials could protect socket from absorption in imlant surgery,moreover,the effect of Bioss on bone formation was better than that of hydroxyapatite.