中国组织工程研究

中国组织工程研究 ›› 2018, Vol. 22 ›› Issue (6): 846-851.doi: 10.3969/j.issn.2095-4344.0057

• 组织工程口腔材料 tissue-engineered oral materials • 上一篇    下一篇

两种骨代用品植入智牙拔牙窝恢复牙槽骨高度

李医丹1，许  诺2，李月玲1，俞  明1，陈  劼1，李晓杰3
  

  1. 1上海市嘉定区牙病防治所，上海市  201800；2大连医科大学中山学院，辽宁省大连市 116000；3大连医科大学口腔医学院，辽宁省大连市  116044
  • 收稿日期:2017-11-19 出版日期:2018-02-28 发布日期:2018-02-28
  • 通讯作者: 李晓杰，博士，副教授，大连医科大学口腔医学院，辽宁省大连市116044
  • 作者简介:李医丹，男，1978年生，辽宁省大连市人，汉族，硕士，主治医师，主要从事口腔外科及口腔修复方向临床及科研工作。
  • 基金资助:
    上海市嘉定区卫生和计划生育委员会科研项目(2013-KYXM-09)：下颌智齿拔除后Bio-Oss Collagen恢复牙槽骨高度的初步研究

Implanting two kinds of bone substitutes into the sockets after wisdom tooth extraction to recover alveolar bone height

Li Yi-dan1, Xu Nuo2, Li Yue-ling1, Yu Ming1, Chen Jie1, Li Xiao-jie3
  

  1. 1Dental Institute of Jiading District, Shanghai 201800, China; 2Zhongshan College of Dalian Medical University, Dalian 116000, Liaoning Province, China; 3School of Stomatology, Dalian Medical University, Dalian 116044, Liaoning Province, China
  • Received:2017-11-19 Online:2018-02-28 Published:2018-02-28
  • Contact: Li Xiao-jie, M.D., Associate professor, School of Stomatology, Dalian Medical University, Dalian 116044, Liaoning Province, China
  • About author:Li Yi-dan, Master, Attending physician, Dental Institute of Jiading District, Shanghai 201800, China
  • Supported by:
    the Scientific Research Project of the Health and Family Planning Committee of Jiading District in Shanghai, No. 2013-KYXM-09

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摘要：

文章快速阅读：

 

文题释义：
Bio-Oss骨替代材料：是从牛骨中提取的纯无机骨质，具有多空性和骨引导性，为新骨的生长提供框架结构，但其颗粒之间松散，塑形比较困难，费用高昂。
Bio-Oss Collagen骨替代材料：由90%的Bio-Oss颗粒和10%的块状猪胶原纤维构成，在其引导下形成新骨，是较理想的骨代替植入材料。动物实验研究证实，牙齿拔除后牙槽窝内植入Bio-Oss Collagen骨替代材料可促进新骨形成及有效维持牙槽突的外形；用Bio-Oss骨替代材料填塞牙槽窝并在上方覆盖Bio-Oss Collagen骨替代材料，不仅能有效减轻牙槽骨吸收的程度，而且能促进牙龈上皮的爬行覆盖，这对于第二磨牙远中牙槽骨已有部分骨高度降低，形成三壁骨的拔牙创骨高度恢复有着重要的意义。
引导骨组织再生：其原理是利用生物膜的物理屏障功能将骨缺损区与周围组织隔离，创造一个相对封闭的组织环境，使骨组织的再生功能得到最大程度的发挥。它的应用为牙周病治疗、牙种植区骨量不足及其他骨缺损的修复、骨折愈合提供了一个新的有效途径。生物膜大致可分为可吸收性和不可吸收性膜两种，可吸收性膜材料与骨替代材料的联合应用是目前技术发展的重要方向。
 
背景：研究证实Bio-Oss骨替代材料在预防骨吸收方面具有一定的作用，可减缓骨吸收、减少骨吸收量，恢复牙槽脊高度，但多数临床研究时间集中于1-3个月。
目的：对比两种骨代用品植入智牙拔牙窝后，对拔牙窝牙槽骨高度及牙周组织健康状况的影响。
方法：将40例要求拔出下颌阻生齿患者随机分组2组，实验组(n=20)拔牙窝内植入Bio-Oss Collagen骨替代材料，对照组(n=20)植入Bio-Oss大颗粒骨替代材料，植入后1，3，12个月复查锥形束CT，检查拔牙窝牙槽骨高度、骨质变化及第二磨牙松动度，同时观察拔牙创关闭、牙龈黏膜愈合状态及植入骨材料有无外溢。
结果与结论：①植入后1个月，两组拔牙创牙龈黏膜均愈合良好，无红肿，实验组骨替代材料无外溢，对照组有2例骨材料溢出，两组拔牙窝内无骨组织生成，牙齿均有一度松动；②植入后3个月，实验组拔牙创牙龈无红肿，植入材料逐渐分解，有部分骨组织生成，牙齿松动度有所改善；对照组拔牙创牙龈无红肿，部分植入材料分解，未见明显骨组织生成，牙齿松动度无明显改善；③植入后12个月，实验组拔牙创牙龈无红肿，第二磨牙远中有明显新骨生成，骨小梁清晰，新生骨与周围骨组织融为一体，牙槽嵴顶位于釉牙骨质界下方3 mm左右，牙齿松动度恢复至拔牙前水平，咀嚼功能正常；对照组拔牙创牙龈无红肿，第二磨牙远中有新骨生成，骨小梁排列不齐，牙槽嵴顶位于釉牙骨质界下方3 mm左右，牙齿松动度恢复至拔牙前水平，咀嚼功能无异常；④实验组植入后1，3个月的牙槽嵴顶至釉牙骨质界的骨质高度高于对照组(P < 0.01)，两组植入后12个月的牙槽嵴顶至釉牙骨质界的骨质高度无差异；⑤结果表明，下颌阻生智齿拔除后即刻植入Bio-Oss Collagen骨替代材料，有利于牙槽骨高度和骨质恢复，能明显改善第二磨牙牙周组织健康，但远期效果尚需进一步观察。

关键词: 口腔材料, 下颌智齿, Bio-Oss Collagen, Bio-Oss骨替代材料, 下颌第二磨牙, 组织工程, 生物材料

Abstract:

BACKGROUND: Bio-Oss bone substitutes have been shown to prevent bone resorption by slowing bone resorption, reducing bone resorption, and restoring the height of the alveolar ridge. However, most clinical studies focus on the efficacy within 1-3 months.
OBJECTIVE: To compare the effects of two kinds of bone substitutes on the height of alveolar ridge and the periodontal tissue health status after implantation into the extraction socket of the wisdom tooth.
METHODS: Forty patients with impacted mandibular teeth were randomly divided into two groups: Bio-Oss Collagen material was implanted in experimental group (n=20), and Bio-Oss bone replacement materials in control group (n=20). Cone-beam CT was retrospectively reviewed at 1, 3 and 12 months after implantation. Alveolar bone height, bone changes and the second molars mobility were examined. Meanwhile, healing status of tooth extraction and gingival mucosa as well as the material spills were observed.
RESULTS AND CONCLUSION: (1) At 1 month after implantation, the gingival mucosa of both groups healed well without swelling. There was no spillover in the experimental group, while there were two cases of bone material spill in the control group. No tissues generated in the extraction socket and tooth loosening was observed in both groups. (2) At 3 months after implantation, the materials gradually degraded with no swelling and with generation of partial bone tissues in the experimental group, and the tooth mobility was improved. In the control group, there was also no swelling in the gums, and the materials degraded partially, but there was no presence of new bone and no improvement in the tooth mobility. (3) At 12 months after implantation, there was no swelling in the gums of the experimental group, obvious new bone tissues formed in the second molar with the presence of bone trabecula. The new bone tissues were integrated with the surrounding bone tissues. The crest of the alveolar ridge was located about 3 mm below the enamel cementum, the tooth mobility was restored to the level before extraction, and the chewing function recovered. In the control group, there was no swelling in the gums, and new bone tissues formed in the distal part of the molar, but the trabecular arrangement was not aligned. The crest of the alveolar was located about 3 mm below the enamel cementum, the tooth mobility returned to the pre-extraction level, and the chewing function was normal. (4) The height of the alveolar bone at 1 and 3 months after implantation was significantly higher in the experimental group than the control group (P < 0.01), while there was no significant difference between the two groups at 12 months after implantation. To conclude, implantation of Bio-Oss Collagen immediately after removal of the impacted wisdom tooth of the mandible is beneficial to alveolar bone height and bone quality recovery, and significantly improves the periodontal health of the second molar, but the long-term effect needs further observation.

Key words: Bone Transplantation, Periodontium, Alveolar Bone Loss, Molar, Third, Tissue Engineering

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