预成型钛网联合生物膜在美学区引导骨组织的再生

Guided bone regeneration using preformed titanium mesh combined with bioabsorbable membranes in aesthetic area

背景:可吸收屏障膜与不可吸收屏障膜在引导骨组织再生术中均有广泛应用,但各有优缺点。目的:探讨新型预成型钛网与不同骨增量材料的联合应用修复前牙骨量不足的临床效果。方法:将31例上颌前牙单颗缺失的患者按照不同治疗方法分为3组:TCC组(n=9)植入种植体后放置基柱,将自体骨屑、Bio-oss骨粉、浓缩生长因子相混合后植于骨缺损区,放置预成型钛网并固定,覆盖Bio-Gide生物膜;TC组(n=10)植骨方法同上,种植体周骨缺损仅做自体骨屑和Bio-oss骨粉移植;C组(n=12)将自体骨屑与Bio-oss骨粉混匀置于骨缺损区,覆盖Bio-Gide胶原膜,不放置预成型钛网及浓缩生长因子。种植手术后当天、术后6个月拍摄锥形束CT测量3组骨高度及骨宽度,组织学观察新生骨生成情况。研究方案的实施符合青岛市口腔医院的相关伦理要求,患者对试验过程完全知情同意。结果与结论:(1)术后复查仅TC组出现2例创口裂开,术后3周左右创口愈合;(2)术后6个月锥形束CT骨量分析,TCC组、TC组骨高度均显著大于C组(P<0.05);在标志点2,4,6 mm处TCC组、TC组骨宽度均显著大于C组(P<0.05);标志点8 mm处,3组之间的骨宽度变化差异无显著性意义(P>0.05);(3)苏木精-伊红染色显示:3组均可见骨小梁结构,但TCC组骨小梁更为成熟、致密,C组骨小梁较为稀疏,TC组介于两者之间;(4)结果说明,钛网具有良好的空间维持作用,能更好地维持植骨材料的稳定性,在一定程度上可增强成骨效果;浓缩生长因子具有促进软组织愈合的作用。

BACKGROUND:Absorbable and non-absorbable barrier membranes have their own merits and demerits in the guided bone regeneration.OBJECTIVE:To investigate the clinical effect of new preformed titanium mesh combined with different bone augmentation materials in anterior teeth with inadequate bone volume for dental implants.METHODS:Thirty-one patients with single maxillary anterior tooth loss were divided into three groups:Bio-Gide collagen membrane+Bio-oss bone group(C;n=12),titanium mesh+Bio-Gide collagen membrane+Bio-Oss bone group(TC;n=10),titanium mesh+concentrated growth factor+Bio-Gide collagen membrane+Bio-Oss bonegroup(TCC;n=9).Through clinical review,cone-beam CT and histological examination,osteogenic effects of the three treatment methods were compared and statistically analyzed at 0 day and 6 months after operation.The implementation of the study protocol complied with the relevant ethical requirements of Qingdao Stomatological Hospital,and each patient was fully informed of the trial process.RESULTS AND CONCLUSION:In the postoperative review,only two patients in the TC group had wound deformations,and the wound healed about 3 weeks postoperation.Six months after the operation,cone-beam CT results revealed significant differences in bone height between the TCC and TC groups and the C group(P<0.05),as well as in bone width at the mark points of 2,4 and 6 mm(P<0.05).There was no significant difference in bone width between three groups at the mark point of 8 mm(P>0.05).Hematoxylin-eosin staining of bone tissue around the implant showed that trabecular structure was visible in all three groups,but the structures was more mature and denser in the TCC group and sparser in the C group.These findings indicate that titanium mesh has good space maintenance function,better maintains the stability of bone graft material,and enhances the osteogenesis effect to a certain extent.Concentrated growth factors may promote soft tissue healing.