评价富血小板纤维蛋白单独用于上颌窦提升种植骨再生的效果

Bone regeneration effects of platelet-rich fibrin used alone in sinus floor elevation

背景:富血小板纤维蛋白作为一种富含生长因子、纤维蛋白的自体血液浓缩物,具有促进组织再生的功效。通常与自体或异体骨粉混合应用于口腔颌面部骨缺损的修复,促进骨再生,但其单独作为上颌窦提升植骨材料的成骨效果还有争议。目的:通过建立上颌窦提升同期种植模型,单独使用富血小板纤维蛋白作为骨移植材料,观察评价种植体周围骨再生的效果。方法:12-18个月龄的健康成年杂种犬12只,随机分为富血小板纤维蛋白组、自体骨组、自体血液组,每组4只。拔除双侧上颌第一磨牙,12周后行上颌窦外提升同期种植术。3组犬的上颌窦内分别植入同等体积富血小板纤维蛋白、自体骨屑、自体血液。植入后12周取材,通过大体观察、影像学及组织学分析评价骨再生效果。结果与结论:(1)所有种植体周围都有不同程度的新骨生成,新生骨与窦底骨质相连接,种植体尖端无骨形成;(2)新骨高度:富血小板纤维蛋白组为(3.135±0.288)mm,自体骨组为(3.218±0.345)mm,自体血液组为(1.898±0.157)mm,富血小板纤维蛋白组和自体血液组,自体骨组和自体血液组之间的新骨高度差异有显著性意义(P<0.05);(3)新骨密度:富血小板纤维蛋白组为(65.06±5.88)g/cm3,自体骨组为(75.34±8.18)g/cm3,自体血液组为(56.92±4.95)g/cm3。富血小板纤维蛋白组和自体骨组,自体骨组和自体血液组,富血小板纤维蛋白组和自体血液组之间的新骨密度差异有显著性意义(P<0.05);(4)结果表明,将富血小板纤维蛋白单独应用于上颌窦提升种植中,可以促进种植体周围的新骨形成,但新骨的形成量有限。

BACKGROUND： As a blood concentrate rich in growth factors and fibrin, platelet-rich fibrin （PRF） is able to significantly promote bone regeneration. PRF mixed with bone substitutes is commonly used to repair bone defects in oral maxillofacial region. But it remains controversial whether PRF as a sole material in sinus floor elevation can produce enough new bone tissues.OBJECTIVE： To evaluate the osteogenic potential of PRF as a sole grafting material in sinus floor elevation by means of an animal model.METHODS： Twelve healthy adult mongrel dogs aged 12-18 months were selected and randomized into three groups （groups A, B and C）, with four dogs in each group. Upper first molars on both side of each dog were extracted 12 weeks prior to sinus floor elevation and simultaneous implants placement. Different materials were used to fill in the space between the sinus membrane and implant. Groups A, B and C were filled with PRF, autologus bone particles and autologus blood clot respectively. After 12 weeks, specimens were harvested to analyze the new bone formation by gross observation, X-ray examination and histological evaluation.RESULTS AND CONCLUSION： New bone formation was found to embrace all the implants close to the bony sinus floor, and the tips of all implants were free from bone coverage. The new bone height of groups A, B and C were （3.135±0.288）,（3.218±0.345）, and （1.898±0.157） mm, respectively. The new bone density of groups A, B and C were （65.06±5.88）,（75.34±8.18）, and （56.92±4.95） g/cm3, respectively. There were significant differences between the new bone height in groups A and C as well as in groups B and C （P 〈 0.05）. Also, significant differences were found between the new bone density in groups A and B, B and C, A and C （P 〈 0.05）. Within the confine of this experiment, it is feasible to use PRF as a sole grafting material in the sinus floor elevation to generate new bone, but the new bone volume is limited.