骨移植和组织工程支架材料在上颌窦提升口腔种植修复中的应用

Application of bone grafting and tissue engineering scaffold in oral implantation involving maxillary sinus elevation

背景:骨萎缩和上颌窦的持续气化可以引起上颌骨后牙的高度不足,在此部位进行牙种植体植入非常困难,增加上颌骨的骨量将有利于种植体植入物,采用骨移植材料进行上颌窦提升以弥补骨量不足是目前公认的方法。目的:分析骨移植材料、人工作骨材料以及组织工程支架材料在上颌窦提升中的应用效果。方法:以"上颌窦提升,种植体,自体骨,异体骨,人工骨,组织工程支持材料"为中文关键词,以"maxillary sinus elevation,dental implants,autologous bone,allograft,artificial Bone,scaffold"为英文关键词检索PubMed和万方数据库有关上颌窦提升移植材料应用的相关文献,分析各移植材料对上颌窦提升后新骨形成、种植体稳定性和骨-种植体结合率的影响。结果与结论:自体骨是上颌窦提升中骨移植材料的金标准,可保证种植体周围骨量及种植的长期稳定性,但自体取骨造成供区二次损伤,容易产生感染。同种异体骨可作为自体骨的替代材料,可生成新生骨并保证种植体植入,达到足够的稳定性。人工骨材料如羟基磷灰石、β-磷酸三钙、双相复合磷酸钙等具有良好的骨传导性,可达到高骨-种植体接触率。组织工程骨移植物将干细胞、细胞因子与生物支架材料相结合用于上颌窦提升,可促进新骨形成,提高骨量,使种植体成功植入且稳定性良好。

BACKGROUND： The persistence of bone atrophy and maxillary sinus gasification can cause a deficiency in the height ofmaxillary posterior teeth. It is very difficult to place dental implants at this site. Increasing bone mass in the maxilla is beneficialfor dental implantation, and it is a currently accepted method to lift the maxillary sinus to compensate for bone loss.OBJECTIVE： To analyze the application effect of bone graft material, human working bone material and tissueengineering scaffold material in maxillary sinus elevation.METHODS： “Maxillary sinus elevation, dental implant, autologous bone, allograft, artificial bone, scaffold” were used asthe key words in Chinese and English to retrieve relevant articles concerning materials used in maxillary sinus elevationincluded in PubMed and WanFang. Then, we analyzed the effects of different bone grafting materials on new boneformation, implant stability and bone-implant binding rate after maxillary sinus elevation.RESULTS AND CONCLUSION： Autologous bone is the gold standard of bone graft material in maxillary sinus elevation,which can ensure the bone mass and the long-term stability of implantation around the implant, but it is easy to causesecondary damage to the donor area and to produce infection. Allogeneic bone can be used as an alternative material ofautogenous bone, such as deproteinized bovine bone minerals, inorganic bovine bone, etc., which can generate new boneand ensure dental implantation to achieve sufficient stability. Artificial bone materials such as hydroxyapatite, beta-tricalciumphosphate, biphasic calcium phosphate compound, etc. have good bone conduction and can achieve a high bone-implantcontact rate. Tissue-engineered bone grafts that can combine stem cells and cytokines with bio-scaffolds for maxillary sinuselevation can promote new bone formation, increase bone mass, and ensure dental implantation to achieve good stability.