血浆基质在口腔种植垂直骨增量中的应用

Application of plasmatrix in vertical bone augmentation for implant placement

垂直骨增量手术在临床上依然面临巨大挑战,通常存在难以恢复理想的牙槽骨高度、并发症等各种难题,技术敏感性较高。血浆基质是来源于自体血液的产物,能够有效促进组织再生区域的血管化,并且可招募干细胞、降低炎症反应、促进垂直骨增量的骨再生。本文根据目前国内外对垂直骨增量研究的现状,按照预期牙槽嵴增量的高度将垂直骨缺损分为3类:Ⅰ类:需要的垂直骨增量高度小于4 mm;Ⅱ类:需要的垂直骨增量高度介于4~8 mm;Ⅲ类:需要的垂直骨增量高度大于8 mm。在Ⅰ类垂直骨增量手术中直接将血浆基质骨块放置于缺损区,覆盖血浆基质膜后减张缝合;在Ⅱ类垂直骨增量中使用血浆基质骨块放在缺损区,并采用钛钉进行固定,再覆盖可吸收胶原膜和血浆基质膜,减张缝合;对于Ⅲ类垂直骨增量,在制备的血浆基质骨块中要加入其他活性成分(例如骨形成蛋白、自体骨碎屑等),并且要利用钛钉等固定装置进行固定,在骨块表面覆盖可吸收胶原膜和血浆基质膜,再进行减张缝合;针对不同的垂直骨增量类型,应用上述方法可取得理想的垂直骨增量效果。本文旨在为口腔临床医生全面了解血浆基质、简化垂直骨缺损分类及操作提供参考和指导。

Vertical bone augmentation surgery still faces considerable challenges in clinical practice due to various problems,such as difficulty in restoring the ideal alveolar bone height and biological complications,and because it is highly technically sensitive.Plasmatrix is derived from patients’own blood,and it can effectively promote the vascularization of the regenerated area,recruit stem cells,and reduce inflammation when used in vertical bone augmentation.Based on studies published worldwide,this article first divides vertical bone augmentation into 3 categories according to the height of the expected alveolar ridge,namely,type Ⅰ,the required vertical bone gain is less than 4 mm;type Ⅱ,the required vertical bone gain is between 4-8 mm;and type Ⅲ,the required vertical bone gain is greater than 8 mm.In the type Ⅰ vertical bone augmentation,the plasmatrix bone block is directly placed in the defect area and covered with the plasmatrix membrane before tension-free suturing;in the type Ⅱ vertical bone augmentation,the plasmatrix bone block should be placed in the defect area and fixed with titanium nails and then covered with an absorbable collagen membrane and plasmatrix membrane with a tension-free suture;in the type Ⅲ vertical bone augmentation,additional active ingredients(such as bone morphogenetic protein,autologous bone,etc.)should be added to the plasmatrix bone block and strong fixation(such as titanium nails)should be used.Absorbable collagen and plasmatrix membranes should be used to cover the surface of the bone block,and the flap should be sutured.According to different types of vertical bone augmentation categories,the above methods optimize the vertical bone augmentation effect.This article aims to provide a reference and guidelines for oral clinicians to fully understand plasmatrix and simplify the classification and operation of vertical bone augmentation.