自体块状骨结合引导骨再生技术重建前牙区骨量不足的临床研究

中国口腔颌面外科杂志 ›› 2014, Vol. 12 ›› Issue (2): 144-151.

自体块状骨结合引导骨再生技术重建前牙区骨量不足的临床研究

郑吉驷¹, 张善勇¹, 杨驰¹, 张瑛¹, 赵璟阳², 虞菲³

1.上海交通大学医学院附属第九人民医院·口腔医学院口腔外科,上海市口腔医学重点实验室,上海 200011;
2.青岛大学医学院附属医院口腔种植中心,山东青岛 266100;
3.上海交通大学医学院基础医学院,上海 200011

收稿日期:2013-03-25 修回日期:2013-11-21 出版日期:2014-03-10 发布日期:2014-11-06
通讯作者: 张善勇,E-mail: zhangshanyong@126.com
作者简介:郑吉驷(1988-),男,在读硕士研究生,E-mail: zhengjisi88@gmail.com
基金资助:
上海市科学技术委员会西医引导类项目(134119a5400); 上海交通大学医学院第七期大学生创新训练项目(2013061)

A clinical study of anterior alveolar bone reconstruction achieved through autogenous block bone in combination with guided bone regeneration(GBR) technique

ZHENG Ji-si¹, ZHANG Shan-yong¹, YANG Chi¹, ZHANG Ying¹, ZHAO Jing-yong², YU Fei³

1.Department of Oral Surgery, Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology. Shanghai 200011;
2.Department of Oral Implantology, Hospital Affiliated to Qingdao University School of Medicine. Qingdao Shandong 266100;
3.College of Basic Medicine, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2013-03-25 Revised:2013-11-21 Online:2014-03-10 Published:2014-11-06
Supported by:
Research Fund of Science and Technology Committee of Shanghai Municipality (134119a5400); The Seventh College Students Innovation Training Program of Shanghai Jiao Tong University School of Medicine (2013061).

摘要/Abstract

摘要： 目的：比较自体块状骨结合引导骨再生(GBR)技术重建前牙区骨量不足术后种植位点和非种植位点骨量变化的差异。方法：2010年12月—2011年8月间,术前全景片及CT评估14例患者(73个缺牙位点)前牙区骨量不足,于颏部或下颌支处取自体块状骨结合GBR技术重建前牙牙槽骨,并延期行种植体植入术(共植入42颗种植体)。术后即刻、3、6、9个月和最长随访时间点(平均13.8个月)行CT检查。利用Simplant 11.04软件三维重建并测量牙槽嵴顶骨宽度(alveolar crestal bone width, ACBW)、牙槽骨中部骨宽度(alveolar midway bone width, AMBW)和牙槽骨高度(alveolar bone height, ABH)。测量的所有数据按照种植位点(即种植体植入的位点)和非种植位点(即未植入种植体,后期利用桥体修复的位点)分为2组。采用SAS 9.0软件包对该2组数据进行配对t检验。结果：14例患者均顺利完成植骨和种植体植入手术,术后无头晕、头痛等不适,切口均愈合良好,42颗种植体在愈合和随访期内骨结合良好。术后2组骨改建评价显示：对种植位点的ACBW和AMBW,术后即刻骨增量和术后3个月骨吸收量有显著差异(P<0.05),而对ABH术后即刻骨增量,术后3、6个月骨吸收量有显著差异(P<0.05),其他时间段则无显著差异(P>0.05);对非种植位点的ACBW和ABH,术后即刻骨增量,术后3、6和9个月骨吸收量有显著差异(P<0.05),而对AMBW术后即刻骨增量,术后3、6个月骨吸收量有显著差异(P<0.05),其他时间段则无显著差异(P>0.05)。术后2组中ACBW、AMBW和ABH的骨量变化显示：术后即刻骨增量,术后3、6个月骨吸收量无显著差异(P>0.05);术后9个月和最长随访时间点骨吸收量存在显著差异(P<0.05)。结论：非种植位点较种植位点在种植体植入后发生更多的骨吸收,其原因是二期种植体植入手术产生的创伤和种植体能保存骨量两者相互作用所致。因此,即刻或同期植入种植体,避免二次手术,对骨量保存具有重要意义。

关键词: 种植外科, 骨量不足, 块状骨, 骨量变化

Abstract: PURPOSE: To evaluate and compare the differences of bone resorption between implant placement sites (IPS) and non-implant placement sites(NIPS) after anterior alveolar bone reconstruction achieved through autogenous block bone in combination with guided bone regeneration(GBR) technique. METHODS: From Dec. 2010 to Aug. 2011, a consecutive series of 14 patients (73 edentulous sites) with anterior alveolar bone atrophy were treated with autogenous block bone grafts in combination with GBR technique and delayed implant placement 6 months after augmentation. CT scans were performed preoperatively(T0), immediately after augmentation(T1), 3 months after augmentation (T2), 6 months after augmentation before implant placement (T3), 9 months after augmentation (T4), and the longest postoperative follow-up point (mean. 13.8 months) (T5). Alveolar crestal bone height (ACBW), alveolar midway bone width (AMBW), and alveolar bone height (ABH) were selected as measurement parameters in Simplant 11.04 software. All results were divided into two groups: implant placement sites (IPS) and non-implant placement sites (NIPS), and compared by the paired t test using SAS 9.0 software package. RESULTS: All block bone grafts and implant placement surgeries were completed successfully. Dizziness, headache and other uncomfortable conditions didn't occur and the incisions healed excellently. All implants remained clinically osseointegrated at the longest postoperative follow-up point. The bone remodelling of both groups for these three parameters were as follows: a) there were significant differences for the bone augmentation and resorption of ACBW and AMBW at T1 and T2 (P<0.05) and ABH at T1, T2 and T3 (P<0.05) in IPS; b) there were significant differences for the bone augmentation and resorption of ACBW and ABH at T1, T2, T3 and T4 (P<0.05) and AMBW at T1, T2 and T3 (P<0.05) in NIPS; c) there were no significant differences at other time periods for these three parameters of both groups (P>0.05). CONCLUSIONS: A more rapid and initial loss of alveolar bone in NIPS resulted from the mucoperiosteal flap reflection during implant placement surgery, while a less bone loss of alveolar happened in IPS due to implant placement. This reminded us of the importance of bone grafts in combination with immediate or early implant placement.

Key words: Bone deficiency, Implant surgery, Block bone, Bone remodelling

中图分类号:

R782.6

郑吉驷, 张善勇, 杨驰, 张瑛, 赵璟阳, 虞菲. 自体块状骨结合引导骨再生技术重建前牙区骨量不足的临床研究[J]. 中国口腔颌面外科杂志, 2014, 12(2): 144-151.

ZHENG Ji-si, ZHANG Shan-yong, YANG Chi, ZHANG Ying, ZHAO Jing-yong, YU Fei. A clinical study of anterior alveolar bone reconstruction achieved through autogenous block bone in combination with guided bone regeneration(GBR) technique[J]. China J Oral Maxillofac Surg, 2014, 12(2): 144-151.

参考文献

[1] Isaksson S, Alberius P. Maxillary alveolar ridge augmentation with onlay bone-grafts and immediate implants[J]. J Craniomaxillofac Surg, 1992, 20(1): 2-7.
[2] Hollinger JO, Brekke J, Gruskin E, et al. Role of bone substitutes[J]. Clin Orthop Relat Res, 1996,(324):55-65.
[3] Wang S, Zhang Z, Xia L, et al. Systematic evaluation of a tissue-engineered bone for maxillary sinus augmentation in large animal canine model [J]. Bone, 2010, 46(1): 91-100.
[4] Zhang W, Wang X, Wang S, et al. The use of injectable sonication-induced silk hydrogel for VEGF(165) and BMP-2 delivery for elevation of the maxillary sinus floor [J]. Biomaterials, 2011, 32(35): 9415-9424.
[5] Block MS, Ducote CW, Mercante DE. Horizontal augmentation of thin maxillary ridge with bovine particulate xenograft is stable during 500 days of follow-up: preliminary results of 12 consecutive patients [J]. J Oral Maxillofac Surg, 2012, 70(6): 1321-1330.
[6] Barone A, Toti P, Piattelli A, et al. Extraction socket healing in humans after ridge preservation techniques: a comparison between flapless and flapped procedure in a randomized clinical trial [J]. J Periodontol, 2014,85(1):14-23.
[7] Sbordone C, Toti P, Guidetti F, et al. Volume changes of iliac crest autogenous bone grafts after vertical and horizontal alveolar ridge augmentation of atrophic maxillas and mandibles: a 6-year computerized tomographic follow-up [J]. J Oral Maxillofac Surg, 2012, 70(11): 2559-2565.
[8] Cordaro L, Torsello F, Miuccio MT, et al. Mandibular bone harvesting for alveolar reconstruction and implant placement: subjective and objective cross-sectional evaluation of donor and recipient site up to 4 years[J].Clin Oral Implants Res,2011,22(11): 1320-1326.
[9] Nissan J, Gross O, Mardinger O, et al. Post-traumatic implant-supported restoration of the anterior maxillary teeth using cancellous bone block allografts [J]. J Oral Maxillofac Surg, 2011, 69(12): e513-518.
[10] Wakimoto M, Matsumura T, Ueno T, et al. Bone quality and quantity of the anterior maxillary trabecular bone in dental implant sites [J]. Clin Oral Implants Res, 2012, 23(11): 1314-1319.
[11] Nkenke E, Schultze-Mosgau S, Radespiel-Troger M, et al. Morbidity of harvesting of chin grafts: a prospective study [J]. Clin Oral Implants Res, 2001, 12(5): 495-502.
[12] Dasmah A, Thor A, Ekestubbe A, et al. Particulate vs . block bone grafts: three-dimensional changes in graft volume after reconstruction of the atrophic maxilla, a 2-year radiographic follow-up [J]. J Craniomaxillofac Surg, 2012, 40(8): 654-659.
[13] Nyström E, Legrell PE, Forssell A, et al. Combined use of bone grafts and implants in the severely resorbed maxilla. Postoperative evaluation by computed tomography [J]. Int J Oral Maxillofac Surg, 1995, 24(1 Pt 1): 20-25.
[14] Her S, Kang T, Fien MJ. Titanium mesh as an alternative to a membrane for ridge augmentation [J]. J Oral Maxillofac Surg, 2012,70(4):803-810.
[15] Thor A. Reconstruction of the anterior maxilla with platelet gel, autogenous bone, and titanium mesh [J]. Clin Implant Dent Relat Res, 2002, 4(3): 150-155.
[16] Esposito M, Hirsch JM, Lekholm U, et al. Biological factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology [J]. Eur J Oral Sci,1998,106(1): 527-551.
[17] Cosyn J, Sabzevar MM, De Bruyn H. Predictors of inter-proximal and midfacial recession following single implant treatment in the anterior maxilla: a multivariate analysis [J]. J Clin Periodontol, 2012, 39(9): 895-903.
[18] Ishikawa T, Salama M, Funato A, et al. Three-dimensional bone and soft tissue requirements for optimizing esthetic results in compromised cases with multiple implants [J]. Int J Periodont Restorative Dent, 2010, 30(5): 503-511.
[19] Dasmah A, Thor A, Ekestubbe A, et al. Marginal bone-level alterations at implants installed in block versus particulate onlay bone grafts mixed with platelet-rich plasma in atrophic maxilla. a prospective 5-year follow-up study of 15 patients [J]. Clin Implant Dent Relat Res, 2013, 15(1): 7-14.
[20] Johannsen A, Westergren A, Johannsen G. Dental implants from the patients perspective: transition from tooth loss, through amputation to implants - negative and positive trajectories [J]. J Clin Periodontol, 2012, 39(7): 681-687.
[21] Ortega-Martínez J, Pérez-Pascual T, Mareque-Bueno S, et al. Immediate implants following tooth extraction. A systematic review [J]. Med Oral Patol Oral Cir Bucal,2012, 17(2): e251-261.
[22] Lundgren S, Sjöström M, Nyström E, et al. Strategies in reconstruction of the atrophic maxilla with autogenous bone grafts and endosseous implants[J]. Periodontol 2000,2008,47:143-161.
[23] Nyström E, Lundgren S, Gunne J, et al. Interpositional bone grafting and Le Fort I osteotomy for reconstruction of the atrophic edentulous maxilla. A two-stage technique [J]. Int J Oral Maxillofac Surg, 1997, 26(6): 423-427.
[24] Cosyn J, De Rouck T. Aesthetic outcome of single-tooth implant restorations following early implant placement and guided bone regeneration: crown and soft tissue dimensions compared with contralateral teeth [J]. Clin Oral Implants Res, 2009, 20(10): 1063-1069.
[25] Davis WH, Martinoff JT, Kaminishi RM. Long-term follow up of transoral rib grafts for mandibular atrophy [J]. J Oral Maxillofac Surg, 1984, 42(9): 606-609.
[26] Donovan MG, Dickerson NC, Hellstein JW, et al. Autologous calvarial and iliac onlay bone grafts in miniature swine [J]. J Oral Maxillofac Surg, 1993, 51(8): 898-903.
[27] Bhandari S, Chaturvedi R. Immediate natural tooth pontic: a viable yet temporary prosthetic solution: a patient reported outcome [J]. Indian J Dent Res, 2012, 23(1): 59-63.
[28] Lin KY, Bartlett SP, Yaremchuk MJ, et al. The effect of rigid fixation on the survival of onlay bone grafts: an experimental study [J]. Plast Reconstr Surg, 1990, 86(3): 449-456.
[29] von Arx T, Buser D. Horizontal ridge augmentation using autogenous block grafts and the guided bone regeneration technique with collagen membranes: a clinical study with 42 patients [J]. Clin Oral Implants Res, 2006, 17(4): 359-366.