两种异种骨在双侧下颌智齿位点保存后配对比较及组织学观察

Paired comparison of two types of xenografts used in extraction socket preservation of bilateral mandibular wisdom teeth,and the histological observation

目的:脱蛋白猪骨矿物基质(DPBM,The Graft)与脱蛋白牛骨矿物基质(DBBM,Bio-Oss)在位点保存后配对比较并观察二者成骨情况,为临床应用提供参考。方法:选取17例双侧下颌智齿阻生患者,将二者随机植入左右两侧,均覆盖屏障膜。分别于术后即刻(T_0)、12周(T_(12))、24周(T_(24))拍摄锥形束CT,测量两组牙槽窝颊舌侧骨壁厚度及相应高度、宽度。利用SPSS21.0对两侧牙槽窝前12周(T_0-T_(12))、后12周(T_(12)-T_(24))、总24周(T_0-T_(24))时各指标的改变值做配对t检验及单因素方差分析;24周时取部分患者植骨术区少量骨块,经H E染色,镜下观察两种异种骨成骨情况。结果:配对t检验显示双侧牙槽窝颊舌侧骨壁厚度、高度及宽度改变值在T_0-T_(12)、T_(12)-T_(24)、T_0-T_(24)时差异无统计学意义。单因素方差分析显示在T_0-T_(12)与T_(12)-T_(24)时,Graft侧舌侧厚度、高度改变值,Bio-Oss侧舌侧高度改变值差异有统计学意义;在T_(12)-T_(24)与T_0-T_(24)时,Graft侧舌与Bio-Oss侧舌侧厚度、舌侧高度、宽度改变值差异有统计学意义,其余差异均无统计学意义。组织学观察显示,24周时两种异种骨材料周围均有新形成的骨组织及纤维结缔组织紧密结合,受检区均未发现炎性反应。结论:The Graft与Bio-Oss用于下颌智齿位点保存后,在牙槽窝骨壁吸收速率及程度上表现相似;且较薄的舌侧骨壁垂直向、水平向吸收远多于颊侧骨壁,骨吸收多发生于前12周;The Graft与Bio-Oss均具有良好的生物相容性,骨引导性。

Objective：To evaluate deproteinized porcine bone mineral（DPBM, The Graft） and deproteinized bovine bone mineral（DBBM, Bio-Oss） in extraction socket preservation of bilateral mandibular wisdom teeth with the method of paired comparison, and observation to the osteogenesis with histological observation, providing reference for clinical application. Methods：17 cases were selected in this study, whose third molars required removal. Both sides were implanted the two xcnografts randomly. All the alveolar sockets were covered with barrier mambranes. After immediate surgery（T0）,12 weeks（T12）, 24 weeks（T24）, patients were taken CBCT respectively. Measured the thickness,height, width of both sides of the buccal and lingual alveolar bone wall. Compared the change amount of the above data during T0-T12, T12-T24 and T0-T24 using SPSS21.0 software with paired samples t-test and one-way ANOVA analysis with SNK; 24 weeks after surgery,histological observation of osteogenesis with HE stain for partial the operative region. Results：Paired samples t-test showed that there were no significant difference on the change amount of buccal and lingual alveolar bone thickness, height and width on both sides during T0-T12, T（12）-T24 and T0-T24. One-way ANOVA analysis showed that during T0-T12 and T12-T24, there were significant difference on the change amount of lingual bone thickness, height at Graft side and only lingual bone height at Bio-Oss side. During T12-T24 and T0-T24, there were significant difference on the lingual bone thickness, height,width at Graft side and lingual bone thickness, height, width at Bio-Oss side, there were no significant difference on the other index. Histological observation showed that the Graft bone particulate material combine with new bone and fibrous connective tissue closely, which was similar to Bio-Oss. It was found no inflammatory reaction in all the specimens. Conclusions：The Graft is similar to Bio-Oss in the rate and extent of alveolar bone absorption after alveolar socket preservation for mandibular wisdom teeth. And the absorbtion of thinner lingual bone wall in vertical and horizontal amount is far more than the buccal, the absorption occur in the first 12 weeks mostly. Both of The Graft and Bio-Oss have favourable biocompatible and osteoconductive.