早期愈合阶段牙种植体周沟液骨代谢相关因子的检测和种植体稳定性共振频率分析

Determination of bone metabolic marker levels in perio-implant crevicular fluid and analysis of dental implants stability by resonance frequency in the early stage of healing

目的:观察牙种植体周沟液中骨保护素(osteoprotegerin,OPG)、核因子κB受体活化因子配体(receptor activator of nuclear factor kappa B ligand,RANKL)在Straumann种植体骨愈合期的动态变化,结合种植体稳定性变化情况的共振频率分析,评价种植体周沟液和共振频率分析在监测种植体周围软组织健康状况和骨组织的改建更新过程中的作用。方法:35例牙齿缺失患者非潜入式植入Straumann种植体共35枚。在术中,术后1、2、3、4、6、8、12周,取相邻天然牙龈沟液和种植体周沟液,通过酶联免疫分析法检测样本中OPG及RANKL总量的变化情况,同时用共振频率分析仪检测各时间点的种植体稳定性数值(implant stability quotient,ISQ)。结果:术后2周时种植体的OPG水平显著高于术后4、6、8、12周时的水平,术后1周时种植体周沟液中的OPG/RANKL比值显著高于天然牙龈沟液中的OPG/RANKL比值。种植体ISQ值在术后前4周出现轻微波动,4周后开始上升,术后6周和8周的ISQ值显著高于植入后第1个月内的ISQ值,术后12周的ISQ值显著高于其他各测量时间点的ISQ值。结论:术后2周种植体周沟液OPG水平的升高反应可能与种植术后早期愈合阶段成骨细胞样细胞的增殖、分化和成骨活性的激发、增强有关。共振频率分析是一种评估种植体稳定性的安全、可靠、有效的方法,共振频率分析和种植体周沟液分析可以监测种植体周围软、硬组织变化,为判断种植体负重时机,分析临床远期预后提供依据。

Objective： To investigate the changes of osteoprotegerin（ OPG） and receptor activator of nuclear factor kappa B ligand（ RANKL） level in perio-implant crevicular fluid（ PICF） and to monitor the development of the stability of Straumanntissue-level implants by resonance frequency analysis（ RFA） during the early phases of healing. Methods： A total of 35 implants（ length 10 mm） were placed. PICF samples were collected with filter paper strips at baseline,1,2,3,4,6,8,and 12 weeks post-surgery,respectively. The OPG,RANKL levels were determined by ELISA method. At the same time points,the implant stability quotient（ ISQ） values were determined with OsstellTMmentor. Results：During healing,PICF-OPG levels increased significantly 2 weeks after surgery when compared with the4th-,6th-,8th- and 12th-week reevaluation（ P〈 0.05）. The OPG / RANKL ratio in PICF was significantly higher（ P〈 0.05） than that in gingival crevicular fluid at 1 week post-surgery. ISQ slightly fluctuated within the first 4 weeks after installation. Following this,the ISQ values increased steadily for all the implants and up to 12 weeks. Significant differences were noted between the mean ISQ values at the 12 thweek and other observation time points. Conclusion： The PICF-OPG levels may be effective in monitoring the process of osseointegration. All the ISQ values indicated the stability of Straumannimplants over a 12-week healing period. RFA is a reliable and effective assistant to monitor implant stability.