3D打印仿生钛网及聚氨酯涂层对钛网暴露后骨增量效果的生物学性能研究

Biological properties of 3D printed bionic titanium mesh and polyurethane coating on the effect of bone augmentation after titanium mesh exposure

目的观察蛛网型个性化钛网暴露后的骨增量效果,并探究对钛网进行聚氨酯涂层是否可降低感染率。方法实验选取6只比格犬,对犬下颌双侧第二、三前臼齿虚拟拔除,构建骨缺损模型,设计、打印截骨导板及蛛网结构个性化钛网,分别对钛网进行酸蚀及聚氨酯涂层处理。对比格犬双侧下颌骨行牙槽骨骨缺损引导骨再生(guided bone regeneration,GBR),术后2周在术区滴食诱食剂建立钛网暴露模型,3个月处死6只比格犬,通过观察、CBCT分析、体视显微镜观察分析各组钛网暴露后牙槽骨骨增量效果。结果12个钛网暴露位点的3种结果:(1)钛网脱落,软组织愈合;(2)钛网在位,暴露持续存在;(3)钛网在位,软组织愈合。其中2个酸蚀位点及1个聚氨酯涂层位点出现不同程度感染症状。CBCT、体积比计算及体视显微镜观察得出:钛网脱落组成骨35%±13%;钛网暴露愈合组48%±8%的成骨明显高于暴露持续存在组的27%±10%(P<0.05)。钛网暴露后愈合组高于钛网暴露后脱落组(P>0.05)。结论个性化钛网早期暴露后依旧可以形成新生骨,暴露后愈合的成骨效果最佳。经聚氨酯涂层后感染率稍低于酸蚀组,两组的差异为16.6%。

Objective To observe the bone augmentation effect of spiderwebshaped customized titanium mesh after exposure,and to investigate whether polyurethane coating of titanium mesh could reduce the infection rate.Methods Six Beagle dogs were selected,and the second and third premolars on both sides of the mandibles were virtually removed to construct the bone defect models.The spiderweb-structured customized titanium meshes and osteotomy guides were designed and printed.The titanium meshes were treated with acid etching and polyurethane coating,respectively.Guided bone regeneration(GBR)was performed in the mandibles of Beagle dogs bilaterally.The titanium mesh exposure models were established by feeding bait 2 weeks after GBR.Six Beagle dogs were executed 3 months later.The effect of alveolar bone augmentation after titanium mesh exposure in each group was analyzed by gross observation,CBCT analysis and microscope observation.Results There were 3 kinds of results at 12 sites of titanium mesh exposure:(1)Titanium mesh detachment with soft tissue healing;(2)Titanium mesh in place with persistent exposure;(3)Titanium mesh in place with soft tissue healing.Among them,2 acid etching sites and 1 polyurethane coating site showed different degrees of infection symptoms.The results of CBCT volume ratio calculation and microscope showed that 35%±13%osteogenesis in the titanium mesh detachment group,and 48%±8%osteogenesis in the titanium mesh exposed healing group was significantly higher than the 27%±10%in the exposed persistence group(P<0.05).The titanium mesh exposed healing group was higher than the titanium mesh detachment group(P>0.05).Conclusion Customized titanium mesh can still form new bone after early exposure,the best osteogenesis results were achieved with post-exposure healing.The infection rate after polyurethane coating was slightly lower than that of acid etching group,and the difference between the two groups was 16.6%.