采用Bio-Oss胶原骨联合Bio-Gide胶原屏障膜行引导骨再生术修复牙龈瘤电切术后牙槽骨缺损的临床效果

目的探讨采用Bio-Oss胶原骨联合Bio-Gide胶原屏障膜行引导骨再生术修复牙龈瘤电切术后牙槽骨缺损的临床效果。方法将64例存在牙槽骨缺损的牙龈瘤患者随机分为研究组和对照组,各32例,所有患者高频牙龈电凝刀切除牙龈瘤后均保留累及牙齿。研究组创口植入Bio-Oss胶原骨并覆盖Bio-Gide胶原屏障膜,对照组创口覆盖牙周塞制剂。术后随访1年,比较两组保留牙齿的牙髓敏感度(PS)、牙松动度、牙周附着丧失(PAL)情况,并采用X线片观察牙槽骨变化。结果牙龈瘤电切术中得以保留的研究组47枚牙龈瘤术前累及牙齿和对照组42枚牙龈瘤术前累及牙齿,术毕均有不同程度牙槽骨缺损,但无松动。64例牙龈瘤患者术后1年均无复发。术后1、3、6、12个月,研究组保留牙齿的PS、牙松动度和PAL改善情况均优于对照组(均P<0.05),研究组保留牙齿的PS、牙松动度、PAL改善情况随着时间的推移无明显变化,而对照组保留牙齿的PS、牙松动度、PAL改善情况随着时间的推移持续加重。X线片可见研究组牙槽骨稳定无吸收,对照组牙槽骨呈进展性吸收。结论Bio-Oss胶原骨和Bio-Gide胶原屏障膜联用行引导骨再生术,能有效地修复牙龈瘤电切术后的牙槽骨缺损,改善牙周状况,对牙周、牙髓病变起到积极的预防作用。

Systematic evaluation of three porcine-derived collagen membranes for guided bone regeneration

Guided bone regeneration is one of the most common surgical treatment modalities performed when an additional alveolar bone is required to stabilize dental implants in partially and fully edentulous patients.The addition of a barrier membrane prevents non-osteogenic tissue invasion into the bone cavity,which is key to the success of guided bone regeneration.Barrier membranes can be broadly classified as non-resorbable or resorbable.In contrast to non-resorbable membranes,resorbable barrier membranes do not require a second surgical procedure for membrane removal.Commercially available resorbable barrier membranes are either synthetically manufactured or derived from xenogeneic collagen.Although collagen barrier membranes have become increasingly popular amongst clinicians,largely due to their superior handling qualities compared to other commercially available barrier membranes,there have been no studies to date that have compared commercially available porcine-derived collagen membranes with respect to surface topography,collagen fibril structure,physical barrier property,and immunogenic composition.This study evaluated three commercially available non-crosslinked porcine-derived collagen membranes(Striate+TM,Bio-Gide®and CreosTM Xenoprotect).Scanning electron microscopy revealed similar collagen fibril distribution on both the rough and smooth sides of the membranes as well as the similar diameters of collagen fibrils.However,D-periodicity of the fibrillar collagen is significantly different among the membranes,with Striate+TM membrane having the closest D-periodicity to native collagen I.This suggests that there is less deformation of collagen during manufacturing process.All collagen membranes showed superior barrier property evidenced by blocking 0.2–16.4µm beads passing through the membranes.To examine the immunogenic agents in these membranes,we examined the membranes for the presence of DNA and alpha-gal by immunohistochemistry.No alpha-gal or DNA was detected in any membranes.However,using a more sensitive detection method(real-time polymerase chain reaction),a relatively strong DNA signal was detected in Bio-Gide®membrane,but not Striate+TM and CreosTM Xenoprotect membranes.Our study concluded that these membranes are similar but not identical,probably due to the different ages and sources of porcine tissues,as well as different manufacturing processes.We recommend further studies to understand the clinical implications of these findings.

口腔胶原膜对两种骨再生相关细胞的作用

目的评价猪来源的脱细胞胶原膜在用于口腔引导骨再生时对成纤维细胞、成骨细胞的作用。方法将成纤维细胞、成骨细胞分别接种在胶原膜表面,培养一定时间后通过扫描电镜和荧光共聚焦显微镜分别观察两种细胞在胶原膜上的生长迁移特点。结果成纤维细胞与成骨细胞在膜表面均能良好附着,且生长状态良好。①将成纤维细胞接种在膜片的光滑面后,细胞没有向膜内迁移,仅沿膜表面生长;而接种在膜片的粗糙面后,细胞表现出向膜内部迁移的趋势。②将成骨细胞接种在膜片的粗糙面后,细胞黏附在胶原纤维上,形态舒展,状态良好。结论胶原膜的光滑面能够对成纤维细胞发挥有效的屏障作用,同时成骨细胞能够在其粗糙面良好黏附。

新型胶原膜的研制及降解性能初探

目的:研制一种新型天然无交联胶原膜,探索其酶稳定性。方法:采用溶剂挥发法制备Ⅰ型胶原膜,用SEM、能谱仪、傅里叶红外光谱检测膜的结构及成份特征。SEM观察用Ⅰ型胶原酶体外降解后膜的孔隙变化。结果:Ⅰ型胶原膜结构致密,可见典型的胶原酰胺键吸收峰。在体外降解的40 min内,Ⅰ型胶原膜的孔隙小于2μm,而Bio-Gide膜孔隙大于10μm且相互贯通。结论:溶剂挥发法制备的新型胶原膜结构致密,体外胶原酶降解时孔隙变化缓慢,屏障作用增强。

一种新型胶原屏障膜在大鼠颅骨极限骨缺损区屏障作用的实验研究

目的:研究新型胶原膜在动物体内的屏障作用。方法:建立SD大鼠颅骨双侧5 mm极限骨缺损(CSD)模型,随机分为实验组(覆盖新型胶原膜)、对照组(覆盖Bio-Gide胶原膜)、空白对照组(不覆盖膜)。术后4、8周取样,行Micro-CT扫描,分析重建影像及各骨参数,通过组织学HE染色观察新骨形成和膜的降解情况。结果:8周时实验组和对照组的缺损区均有较连续的新骨形成,空白对照组只在缺损区边缘有新骨形成。4周时新型胶原膜结构完整,Bio-Gide膜降解显著;8周时新型胶原膜显著降解,而Bio-Gide膜基本丧失膜结构。结论:覆盖新型胶原膜可以促进大鼠颅骨CSD区新骨形成,其降解速率显著慢于Bio-Gide膜,新型胶原膜可能在体内发挥更持久的屏障作用。

阻生齿拔除同期植骨术中用医用胶原蛋白海绵作为屏障膜对邻牙远中成骨效果的影响

目的:探讨并分析对下颌第三磨牙低位阻生并毗邻第二磨牙患者进行阻生齿拔除同期植骨术中用医用胶原蛋白海绵作为屏障膜对其第二磨牙远中成骨效果的影响。方法:选择2018年7月至2019年6月期间苏州口腔医院接诊的20例下颌第三磨牙低位阻生并毗邻第二磨牙患者作为研究对象。随机将其分为观察组(n=10)与对照组(n=10)。对两组患者均进行阻生齿拔除同期植骨术。术中为观察组患者使用医用胶原蛋白海绵作为屏障膜,为对照组患者使用可吸收生物膜作为屏障膜,然后比较两组患者术后发生拔牙窝感染的情况、创口愈合的情况、第二磨牙远中的牙周探诊深度(PD)及牙槽骨的高度。结果:两组患者均手术成功。术后2周,对照组患者未发生拔牙窝感染,其创口愈合良好;观察组患者中有9例患者的创口愈合良好,有1例患者发生轻度拔牙窝感染,经对症治疗后其创口于术后4周完全愈合。术后6个月,两组患者下颌第二磨牙远中的牙槽窝均较为平坦。术后6个月,两组患者第二磨牙远中的PD相比,差异无统计学意义(P>0.05)。术后6个月,两组患者下颌第二磨牙远中牙槽骨高度的增加量相比,差异无统计学意义(P>0.05)。结论:对下颌第三磨牙低位阻生并毗邻第二磨牙患者进行阻生齿拔除同期植骨术的过程中,采用医用胶原蛋白海绵作为屏障膜可有效地预防其术后出现第二磨牙远中牙槽骨吸收的情况,促进其第二磨牙远中骨组织的再生及修复。