骨替代材料在上颌窦底外提升同期牙种植中的作用探讨

Osteogenic role of bone substitute in maxillary sinus augmentation and simultaneous implantation

目的:探讨牙种植术中上颌窦底外提升时是否需植入骨替代材料,并对比不同骨替代材料促进骨再生的作用。方法:构建兔上颌窦底外提升同期种植体植入模型,12只3月龄雄性新西兰大白兔,共24侧上颌窦,随机分为4组(n=6),即单纯血凝块组、空白脂质体-水凝胶组、载药脂质体-水凝胶组、同种异体骨粉组,3个月后将上颌窦完整取出,行micro-CT、H-E染色、Masson染色、免疫组织化学染色及骨组织磨片H-E染色等,评价不同实验组上颌窦底外提升后种植体周围骨再生效果。结果:Micro-CT、H-E染色和Masson染色显示,4组样本上颌窦底外提升后种植体周围均有不同程度的新骨形成。空白脂质体-水凝胶组较单纯血凝块组可见更多的新骨形成;与单纯血凝块组及空白脂质体-水凝胶组相比,载药脂质体-水凝胶组及同种异体骨粉组均可见更多的新骨形成,但载药脂质体-水凝胶组较同种异体骨粉组的骨基质中可见更多的新生血管。成血管指标免疫组织化学结果显示,载药脂质体-水凝胶组表达量更高;成骨指标免疫组织化学结果显示,载药脂质体-水凝胶组、同种异体骨粉组表达量更高。骨组织磨片H-E染色显示,种植体骨结合良好,载药脂质体-水凝胶组种植体周围有更多骨质包围。结论:上颌窦底外提升同期牙种植术中植入骨替代材料,既能维持上颌窦底黏膜的提升高度,又能提高成骨效率。可注射的载药脂质体-水凝胶较同种异体骨粉更适用于微创植入不规则的骨缺损部位,载药复合体通过持续缓释药物,有效发挥促血管化骨再生的作用。

PURPOSE:To explore whether it is necessary to implant bone substitute materials for maxillary sinus augmentation and simultaneous implantation,and to compare the osteogenic role of different bone substitutes.METHODS:Twelve New Zealand white rabbits(3-month,male)were used for maxillary sinus augmentation and simultaneous implantation,and 24 maxillary sinuses in 12 rabbits were randomly divided into 4 groups(n=6):blood clot group,blank liposomehydrogel group,medicine-loaded liposome-hydrogel group,and bone allograft group.At 3 months,all samples were entirely taken and the effects of dfferent bone substitutes on promoting bone regeneration were evaluated by micro-CT,H-E staining,Masson staining,immunohistochemistry(IHC),and H-E staining of bone tissue grinding slices.RESULTS:Micro-CT,H-E staining and Masson staining displayed that there were different degrees of new bone formation around the implants in 4 groups.Compared to blood clot group,more new bone formation was observed in blank liposome-hydrogel group.Compared with blood clot group and blank liposome-hydrogel group,more new bone formation was observed in medicine-loaded liposome-hydrogel group and bone allograft group.Moreover,compared to bone allograft group,more new blood vessels were observed in bone matrix in medicine-loaded liposome-hydrogel group.IHC showed the expression of angiogenesis indexes in medicine-loaded liposome-hydrogel group was highest in 4 groups.The expression of osteogenic indexes in medicine-loaded liposome-hydrogel group and bone allograft group was higher than other groups.H-E staining of bone tissue grinding slices showed that the osseointegration of the implants was good.The medicine-loaded liposomehydrogel group had more bone surrounding the implants.CONCLUSIONS:Using bone substitute in maxilary sinus augmentation surgery and simultaneous implantation not only maintains the height of maxillary sinus mucosa,but also improves the efficiency of osteogenesis.Compared to bone allograft,medicine-loaded liposome-hydrogel with injectability is more suitable for irregular bone defect by minimally invasive filling.Medicine-loaded liposome-hydrogel effectively promotes angiogenic bone regeneration by steady drug release.