Clinical Efficacy of GBR Technique Combined with Temporary Bridgework-Guided Gingival Contouring in Treating Upper Anterior Tooth Loss with Labial Bone Defects

Objective:To investigate the clinical effect of the guided bone regeneration(GBR)technique combined with temporary bridgework-guided gingival contouring in treating upper anterior tooth loss with labial bone defects.Methods:From July 2023 to April 2024,80 patients with upper anterior tooth loss and labial bone defects were admitted to the hospital and selected as evaluation samples.They were divided into an observation group(n=40)and a control group(n=40)using a numerical table lottery scheme.The control group received treatment with the GBR technique,while the observation group received treatment with the GBR technique combined with temporary bridges to guide gingival contouring.The two groups were compared in terms of clinical red aesthetic scores(PES),labial alveolar bone density,labial bone wall thickness,gingival papillae,gingival margin levels,and patient satisfaction.Results:The PES scores of patients in the observation group were higher than those in the control group after surgery(P<0.05).The bone density of the labial alveolar bone and the thickness of the labial bone wall in the observation group were higher than those in the control group.The levels of gingival papillae and gingival margins were lower in the observation group after surgery(P<0.05).Additionally,patient satisfaction in the observation group was higher than in the control group(P<0.05).Conclusion:The GBR technique combined with temporary bridge-guided gingival contouring for treating upper anterior tooth loss with labial bone defects can improve the aesthetic effect of gingival soft tissue,increase alveolar bone density and the thickness of the labial bone wall,and enhance patient satisfaction.This approach is suitable for widespread application in healthcare institutions.

Comparative study of chitosan/fibroin–hydroxyapatite and collagen membranes for guided bone regeneration in rat calvarial defects: micro-computed tomography analysis

This study aimed to utilize micro-computed tomography （micro-CT） analysis to compare new bone formation in rat calvarial defects using chitosan/fibroin-hydroxyapatite （CFB-HAP） or collagen （Bio-Gide） membranes. Fifty-four （54） rats were studied. A circular bony defect （8 mm diameter） was formed in the centre of the calvaria using a trephine bur. The CFB-HAP membrane was prepared by thermally induced phase separation. In the experimental group （n= 18）, the CFB-HAP membrane was used to cover the bony defect, and in the control group （n= 18）, a resorbable collagen membrane （Bio-Gide） was used. In the negative control group （n= 18）, no membrane was used. In each group, six animals were euthanized at 2, 4 and 8 weeks after surgery. The specimens were then analysed using micro-CT. There were significant differences in bone volume （BV） and bone mineral density （BMD） （P〈O.05） between the negative control group and the membrane groups. However, there were no significant differences between the CFB-HAP group and the collagen group. We concluded that the CFB-HAP membrane has significant potential as a guided bone regeneration （GBR） membrane.

Real-time-guided bone regeneration around standardized critical size calvarial defects using bone marrow-derived mesenchymal stem cells and collagen membrane with and without using tricalcium phosphate: an in vivo microcomputed tomographic and histologic e

The aim of the present real time in vivo micro-computed tomography （pCT） and histologic experiment was to assess the efficacy of guided bone regeneration （GBR） around standardized calvarial critical size defects （CSD） using bone marrow-derived mesenchymal stem cells （BMSCs）, and collagen membrane （CM） with and without tricalcium phosphate （TCP） graft material. In the calvaria of nine female Sprague-Dawley rats, full-thickness CSD （diameter 4.6 mm） were created under general anesthesia. Treatment-wise, rats were divided into three groups. In group 1, CSD was covered with a resorbable CM; in group 2, BMSCs were filled in CSD and covered with CM; and in group 3, TCP soaked in BMSCs was placed in CSD and covered with CM. All defects were closed using resorbable sutures. Bone volume and bone mineral density of newly formed bone （NFB） and remaining TCP particles and rate of new bone formation was determined at baseline, 2, 4, 6, and 10 weeks using in vivo pCT. At the lOth week, the rats were killed and calvarial segments were assessed histologically. The results showed that the hardness of NFB was similar to that of the native bone in groups I and 2 as compared to the NFB in group 3. Likewise, values for the modulus of elasticity were also significantly higher in group 3 compared to groups 1 and 2. This suggests that TCP when used in combination with BMSCs and without CM was unable to form bone of significant strength that could possibly provide mechanical ＂lock＂ between the natural bone and NFB. The use of BMSCs as adjuncts to conventional GBR initiated new bone formation as early as 2 weeks of treatment compared to when GBR is attempted without adiunct BMSC therapy.

Evaluation of Bone Regeneration of Simvastatin Loaded Chitosan Nanofiber Membranes in Rodent Calvarial Defects

Chitosan nanofiber membranes have been known to have a high degree of biocompatibility and support new bone formation with controllable biodegradation. The surface area of these membranes may allow them to serve as local delivery carriers for different biologic mediators. Simvastatin, a drug commonly used for lowering cholesterol, has demonstrated promising bone regenerative capability. The aim of this study was to evaluate simvastatin loaded chitosan nanofiber membranes for guided bone regeneration (GBR) applications and their ability to enhance bone formation in rat calvarial defects. Nanofibrous chitosan membranes with random fiber orientation were fabricated by electrospinning technique and loaded with 0.25 mg of simvastatin under sterile conditions. One membrane was implanted subperiosteally to cover an 8 mm diameter critical size calvarial defect. Two groups: 1) Control: non-loaded chitosan membranes;2) Experimental: chitosan membranes loaded with 0.25 mg of simvastatin were evaluated histologically and via micro-computed tomography (micro-CT) for bone formation at 4 and 8 weeks time points (n = 5/group per time point). Both groups exhibited good biocompatibility with only mild or moderate inflammatory response during the healing process. Histologic and micro-CT evaluations confirmed bone formation in calvarial defects as early as 4 weeks using control and experimental membranes. In addition, newly-formed bony bridges consolidating calvarial defects histologically along with partial radiographic defect coverage were observed at 8 weeks in both groups. Although control and experimental groups demonstrated no significant statistical differences in results of bone formation, biodegradable chitosan nanofiber membranes loaded with simvastatin showed a promising regenerative potential as a barrier material for guided bone regeneration applications.

高模量高强度丝素蛋白GBR膜的制备及性能评估

目的拟制备一种高模量和高强度的可降解丝素蛋白引导骨再生(GBR)膜,以解决骨缺损修复成骨空间维持问题。方法提纯丝素蛋白后利用蒸发-热压法制备膜材,使用拉伸测试、体外模拟、细胞共培养等方法评估其理化性质与生物性能。结果制得丝素蛋白GBR膜,体外模拟12 h降解率为35.3%,湿态弹性模量达45 MPa,拉伸强度达8.39 MPa,7 d细胞生存率近100%。结论所制得可降解GBR膜具有高模量和高强度,以及优异的生物相容性,有望为解决骨缺损修复成骨空间维持问题提供材料基础。

Mg-based absorbable membrane for guided bone regeneration(GBR): a pilot study

A novel calcium-phosphate(Ca–P)-coated magnesium(Mg) membrane used for guided bone regeneration(GBR) was studied.The microstructural characterization, electrochemical test, immersion test,fluorescence labeling analysis and histopathological evaluation were carried out.The results showed that Ca–P coating could obviously improve the corrosion resistance of the pure Mg membrane.The in vivo results showed that Mg membrane coated with Ca–P would take 8 weeks to be completely absorbed.However, Mg membrane was completely absorbed within 1 week.Histopathological evaluation showed that the Ca–P-coated Mg membranes were significantly better than Ti membranes at the early implantation time(4 weeks), and with the time prolonging,the performance of the coated Mg membrane was not as good as pure Ti membranes(but still better than blank group) at 8 and 12 weeks.The coated biodegradable Mg membrane had a good promising application in GBR.But further studies have to be done to further decrease the degradation rate of pure Mg membrane.

以带蒂筋膜瓣为膜材料应用GBR技术修复兔骨缺损的血管化作用及成骨方式研究

目的研究带蒂筋膜瓣作为膜材料应用于膜引导性骨再生技术修复骨缺损的过程中血管化进程及成骨效果方法24只5月龄新西兰大白兔雌雄不限,制备双侧尺骨1cm骨缺损模型,自体红骨髓(au-tologous red bone marrow,ARBM)接种于骨诱导活性材料(Osteoinductive absorbing material,OAM)制备组织工程骨。将非细胞型组织工程复合物植入骨缺损区,右侧单纯可吸收生物膜包裹设为A组,左侧带血运深筋膜瓣包裹设为B组。各组在4、8、12、16周后进行X线检查、光密度比值测量、大体观察和组织学检查、交界区血管图像计量分析,将数据作统计学处理,用以比较骨缺损修复情况。结果X线片、大体形态和组织学观察显示,植入物内部血管的长入、骨小梁及软骨组织形成的数量和速度、成熟骨结构的形成、骨干结构的重塑、骨髓腔的再通、植入物的吸收降解,筋膜瓣组均明显优于生物膜组。光密度比值测量显示,术后8、12、16周两组间比较及同组内各时间点间比较差异均有统计学意义(P<0.05),术后4、8、12、16周,骨修复交界区单位面积内血管再生面积筋膜瓣组明显多于生物膜组,差异有统计学意义(P<0.05)。从术后12周,筋膜瓣组随着成熟骨结构形成,血管结构减少或消失。结论带血运筋膜瓣具有明显的促组织工程骨血管化作用并通过促血管化而促进成骨并具备膜引导性骨再生(guided bone regeneration,GBR)技术的骨修复特点,即早期促进外骨痂生长。

作为GBR屏障膜的新型胶原膜的体内植入效果分析

目的探讨Ⅰ型胶原和矿化Ⅰ型胶原合成的胶原膜作为GBR屏障膜在动物体内植入后,诱导早期膜下成骨的能力。方法实验于2013年10月—2014年3月在沈阳军区总医院动物实验中心完成。选取小型巴马猪双侧下颌骨,分别于下颌骨骨体处用牙科裂钻制备8 mm×8 mm全层骨缺损3个,分别应用实验胶原膜覆盖、Bio-gide@覆盖、无覆盖膜骨缺损区。术后1个月处死动物,在处死前1、2周分别肌肉注射四环素溶液与二甲酚橙溶液。固定样本后,制备硬组织切片。分别在荧光显微镜及光学显微镜下(甲苯胺蓝、亚甲基蓝-酸性品红染色)观测膜的降解程度及膜下新骨生成能力,评价材料膜下骨形成量和骨成熟程度。结果实验组胶原膜具备良好的屏障作用,膜下新生骨矿化程度良好;骨小梁排列整齐,但新生骨量少于Bio-gide@覆盖组;无覆盖膜骨缺损区新生骨组织骨小梁排列混乱,新生骨量少。结论新型胶原膜在1个月时体内无明显降解,具备良好的膜下成骨能力,下一步需进行实验组胶原膜的改性,以增加胶原膜膜下成骨量。

引导性骨再生膜在骨缺损应用中的研究进展

引导骨再生(GBR)技术是一种利用屏障膜实现骨组织再生的治疗方法。其良好的屏蔽作用可快速诱导骨形成,有效促进骨再生。在长骨骨缺损修复中,缺损处覆盖材料的选择对修复效果至关重要,而屏障膜则是影响GBR疗效的主要决定因素。屏障膜使骨缺损处形成相对稳定的空间,防止纤维组织生长嵌入骨缺损处造成骨不连续,选择性地使损伤处新生骨组织再生、长入,修复受损伤骨组织,从而达到骨性愈合。本文将从屏障膜的分类及各类膜的研究进展等方面进行综述,以期为研发理想的GBR技术治疗骨缺损提供参考。

新型GBR胶原膜的早期动物体内植入实验研究

目的：探讨新型国产GBR胶原膜体内植入后,诱导早期膜下成骨的能力。方法：实验于2013年10月~2014年3月在沈阳军区总医院动物实验中心完成。选取小型巴马猪,于双侧下颌骨骨体处用牙科裂钻制备8mm×8mm全层骨缺损3个,分别应用实验胶原膜、Bio-gide@、无覆盖膜覆盖骨缺损。术后1个月处死动物,分别在处死前1、2周分别肌肉注射四环素溶液与二甲酚橙溶液。固定样本后,制备硬组织切片。分别在荧光显微镜及光学显微镜下（甲苯胺蓝、亚甲基蓝-酸性品红染色）观测膜的降解程度及膜下新骨生成能力,评价材料膜下骨形成量和骨成熟程度。结果：实验组胶原膜具备良好的屏障作用,膜下新生骨矿化程度良好;骨小梁排列整齐,但新生骨量少于对照组。结论：新型国产胶原膜在1个月时无明显降解,具备良好的膜下成骨能力,需进行实验组胶原膜的改性,以增加膜下成骨量。

小肠黏膜下层可吸收生物膜在牙槽骨缺损修复中的应用效果评价

目的:探讨小肠黏膜下层(small intestinal submucosa,SIS)可吸收生物膜在牙槽骨缺损修复的临床疗效。方法:选择2020年1月—2022年1月接受引导骨再生术(guided bone regeneration,GBR)的102例牙槽骨缺损患者,采用计算机随机数字生成器分为Bio-Gide组(51例,采用Bio-Gide可吸收生物膜)和SIS组(51例,采用SIS可吸收生物膜)。比较2组围术期相关指标、血钙、血磷、生物相容性、牙周附着丧失(periodontal attachment loss,PAL)长度、牙髓敏感度、牙松动度、牙槽骨骨量及不良事件。采用SPSS 24.0软件包对数据进行统计学分析。结果:2组手术时间、术中出血量、术后第1天疼痛视觉模拟量表(VAS)评分、术后第5天VAS评分,术前、术后1 d、术后12 d血钙、血磷水平,术前、术后3个月、术后6个月、术后12个月PAL长度,术后3、6、12个月牙髓敏感度及牙松动度1级、2级百分率,术后12个月骨宽度增加量、骨高度增加量,不良事件发生率相比,差异均无统计学意义(P>0.05)。与Bio-Gide组相比,SIS组创口愈合时间、生物膜吸收时间显著缩短(P<0.05),术后12 d排异反应发生率显著降低(P<0.05)。结论:SIS可吸收生物膜、Bio-Gide可吸收生物膜在牙槽骨缺损修复GBR中的效果及安全性相当,但前者生物相容性更佳,后者可提供更长时间的屏障功能。

美学区应用不可吸收性屏障膜进行骨增量的5年临床观察

本文报告了1例使用异种骨和致密型聚四氟乙烯(dense polytetrafluoroethylene,dPTFE)膜与生物可吸收性胶原膜Bio-Gide双层覆盖的引导骨再生(guided bone regeneration,GBR)伴软组织增量的美学区连续牙列缺损种植修复的病例。患者因外伤导致上颌前牙区连续多颗牙缺失伴有较严重的水平向和轻微的垂直向骨丧失。在导板辅助下植入种植体的同时,使用去蛋白牛骨矿物质(deproteinized bovine bone mineral,DBBM)+dPTFE+Bio-Gide进行GBR,6个月后先后通过同种异体脱细胞真皮基质AlloDerm+隧道瓣和结缔组织瓣(connective tissue graft,CTG)+改良隧道瓣进行软组织增量,临时修复体牙龈塑形后,完成最终美学修复,恢复了患者的功能和美观。戴牙5年后的临床随访可见,DBBM+dPTFE+Bio-Gide的GBR获得了理想的骨增量效果,AlloDerm/CTG+隧道瓣的软组织增量为最终的美学修复提供了令人满意的临床效果。

以带蒂筋膜瓣为MGBR屏障膜的促成骨作用及作用方式

目的研究带蒂筋膜瓣为引导性骨再生技术屏障膜的促成骨作用及其作用方式.方法 50只成年新西兰大白兔,雌雄不限,尺骨造2cm骨缺损模型,利用显微外科技术在骨缺损邻近制备一个带有无名血管蒂所属毛细血管网的筋膜瓣(带蒂筋膜瓣),使其包裹由自体骨髓基质干细胞与含骨形态发生蛋白的骨诱导活性材料构建的非细胞型组织工程骨并充填骨缺损,A组为单纯非细胞型组织工程骨组(对照组),B组为带蒂筋膜瓣包裹非细胞型组织工程骨组(实验组),术后第4、8、12、16周进行骨修复区X射线检查、大体观察和组织学检查、骨形态计量分析,第8、12、16周进行生物力学测定分析.结果 X线片、骨形态计量分析,植入物内部骨小梁及软骨组织形成的数量和速度、成熟骨结构的形成、骨干结构的重塑、骨髓腔的再通、植入物的吸收降解,B组均明显优于A组.术后4、8、12、16周新生骨小梁面积占修复总面积比值比较,以及B组内不同时间点比较差异均有统计学意义(P<0.05).生物力学测定分析显示,术后8、12、16周两组间比较及同组内各时间点间比较差异均有统计学意义(P<0.05).结论以带蒂筋膜瓣为引导性骨再生技术屏障膜具有明显促成骨作用,其促成骨作用具有明显的引导骨再生作用特点.

GBR技术在颌骨囊肿手术中的临床应用观察

目的:观察膜引导骨再生技术(guide bone regeneration,GBR)在颌骨囊肿术后对颌骨缺损修复的临床疗效。方法:小型颌骨囊肿50例,囊肿大小为1.5 cm×1.5 cm^3.0 cm×3.0 cm,均采用颌骨囊肿摘除术治疗。术中将颌骨囊肿完整摘除,确认未与鼻底及上颌窦穿通后,将人工骨粉与自体静脉血混合充填入颌骨囊肿骨缺损区,再以生物膜覆盖,常规缝合切口。结果:术后2周拆线,除5例外切口均愈合良好;术后6个月复查全景片,充填材料复合体密度与颌骨密度趋于一致;术后1年,充填材料与周围颌骨生长完全融合,不能分辨,原囊肿区可见正常的骨小梁网纹结构。结论:GBR技术对修复小型颌骨囊肿术后的局部骨质缺损安全有效。

摩尔比对三元共聚物和GBR膜的性能影响

本研究合成了一系列不同摩尔比的丙交酯/乙交酯/三亚甲基碳酸酯(DLLA/GA/TMC)三元共聚物(PLGTMC),并用于制备引导骨再生(GBR)可吸收膜。通过凝胶渗透色谱和核磁氢谱对共聚物进行表征,并进行差示扫描量热、X-射线衍射和拉伸测试,研究了摩尔比对共聚物和GBR膜热性能、结晶性能和力学性能的影响。结果表明共聚物和GBR膜玻璃化转变温度和拉伸强度随TMC含量增加呈现降低趋势,结晶性和断裂伸长率随TMC含量增加呈现增加趋势,其中TMC含量为25%的GBR膜有望用于下一步的动物及临床试验。

数字化技术联合富血小板纤维蛋白新型牙周再生技术治疗后牙舌侧根分叉病变6年随访1例

常规牙周再生术对牙周炎非包含性骨缺损患牙的治疗效果有限,本文报道1例采用数字化技术联合富血小板纤维蛋白的新型牙周再生手术治疗下颌第一磨牙远中舌侧根分叉病变病例。术后患者牙周临床指数获得明显改善,牙槽骨得到良好修复再生。

功能等级引导骨再生膜的研究进展

引导骨再生(GBR)是一种利用屏障膜实现骨组织再生的治疗方法。GBR膜的应用作为GBR术的关键,可以封闭骨缺损区,阻止非成骨细胞长入,为骨组织的再生创造一个良好的环境。然而,目前市面上的GBR膜往往缺乏骨诱导潜力和抗菌活性。为了实现屏障膜的多种功能需求,许多学者致力于研究具有梯度空间结构和功能的复合膜。本文将回顾功能等级GBR膜的研究进展并对其未来发展方向进行展望,为GBR膜的进一步研究提供思路。

引导骨组织再生技术在后牙颊侧轻度骨缺损种植中的应用效果

目的分析后牙颊侧轻度骨缺损种植中应用引导骨组织再生技术的临床效果。方法选取2020年10月—2021年12月本院收治的213例后牙颊侧轻度骨缺损患者临床资料,根据治疗方式不同分为对照组(上前牙二期种植修复)101例与观察组(引导骨组织再生技术)112例。修复3个月后对比:①两组种植修复成功率及口腔健康状况;②比较两组成骨效果;③美学效果评估[白色美学评分(white aesthetics score,WES)、红色美学评分(red aesthetics score,PES);④随访6月记录不良反应。结果观察组种植修复成功率明显高于对照组,OHIP-I评分比对照组低(P<0.05)。治疗前两组牙槽骨厚度比较无差异(P>0.05);治疗后牙槽骨厚度明显增加,观察组治疗后牙槽骨厚度、成骨厚度均高于对照组(P<0.05)。治疗后观察组WES、PES评分均比对照组高(P<0.05)。观察组不良反应总发生率低于对照组(P<0.05)。结论引导骨组织再生技术可提高患者种植牙修复成功率,促进成骨生长,增加美观度并可降低不良反应发生率。

异种脱细胞真皮基质引导即刻种植种植体周围骨缺损再生能力的实验研究

目的:运用异种脱细胞真皮基质进行引导骨组织再生术(guided bone regeneration,GBR)评价修复种植体周围骨缺损能力,为临床应用提供指导。方法:在4只成年Beagle犬下颌第2、3、4前磨牙新鲜拔牙创即刻植入种植体,并在颊侧形成3mm×3mm×5mm骨缺损区,按自身同期对照研究设计,右侧为实验侧,骨缺损区上覆盖海奥膜;左侧为空白对照侧,骨缺损区不覆盖海奥膜。术后1、4个月分别处死一组动物,摘取下颌骨,采用大体观察、X线摄片、组织学观察测定等方法检测缺损区骨组织再生的情况。结果:实验侧种植体周围骨缺损区较空白对照侧新骨生成量多,加速了骨组织的再生过程。结论:异种脱细胞真皮基质具有良好的生物相容性和可降解性,可用作骨组织引导再生膜,促进骨缺损的再生修复。

引导组织再生生物膜应用于拔牙术后牙槽骨缺损修复的临床研究

目的:观察和评价引导组织再生生物膜应用于牙槽骨缺损修复的有效性和安全性。方法:采用随机、开放、平行、阳性对照(Bio-Gide可吸收生物膜)临床试验设计。主要评价指标为骨缺损部位的影像学检查,次要评价指标为:手术伤口愈合情况、排异反应、骨代谢变化、骨感染征象。安全性评价指标为不良反应发生率。结果:本临床试验共入组40例受试者,完成试验39例,脱落1例。主要有效性评价指标影像学检查有效率:试验组89.47%、对照组95.00%。次要疗效评价2组材料植入后伤口愈合时间均小于12d,2组均无排异反应、无骨代谢变化、无骨感染征象。不良事件发生率试验组:5.00%,对照组:0.00%。结论:引导组织再生生物膜应用于拔牙术后牙槽骨缺损修复的疗效和安全性非劣效于Bio-Gide可吸收生物膜。