植入扭矩对牙种植体骨结合影响的动物实验研究

发布时间：2018-09-08 18:54

【摘要】：一、目的：研究植入扭矩对牙种植体骨结合的影响,探索种植体最佳的植入扭矩值范围,为临床种植体植入提供可靠的科学理论依据,提高种植手术的成功率。二、方法： 1.实验动物模型制备选取全身发育良好的健康雄性成年Beagle犬6只,随机编号为1～8号。所有实验动物委托中山大学医学实验动物中心饲养。适应性饲养一周后,微创拔除双侧下颌第1、2、3、4前磨牙和第1磨牙。 2.种植体植入拔牙创愈合3个月后,行种植体植入。每只实验犬双侧下颌各植入XIVE种植体4枚,6只实验犬共植入种植体48枚。种植体的规格均为3.4/9.5mm。所有的种植体均采用埋入式愈合。 3.植入扭矩的测量及分组记录种植体完全就位时的植入扭矩值,并以此作为该种植体的最大植入扭矩值(insertion torque value, ITV)。根据种植体植入时的最大植入扭矩值将种植体分为四组：A组12枚,0NcmITV20Ncm;B组12枚,20Ncm≤ITV40Ncm;C组12枚,40Ncm≤ITV60Ncm;D组12枚,ITV≥60Ncm。 4.共振频率分析的测量在种植体完全就位后,立即使用共振频率分析仪(RFA),测量种植体的稳定性系数ISQ。分别测量种植体近中、舌侧、远中、颊侧的ISQ值。每一枚种植体的每一个方向均测量三次,记录平均值。无负重无干扰愈合三个月后,再次测量每枚种植体的近中、远中、颊侧和舌侧ISQ值。 5.顺序性荧光标记种植体植入后的第2周、第4、周第8周和第12周顺序性肌注荧光标记物盐酸四环素(Tetracycline hydrochloride,TC,黄色)、钙黄绿素(Calcein Green, CG,绿色)、茜素红(Alizarin-complen, AE,红色)、二甲酚橙(Xylend,X0,橘色)。通过测量荧光带之间的垂直距离,计算矿化沉积率,比较各植入扭矩组新骨形成的速率。 6.组织学观察和测量骨结合率种植体植入3各月后制作超硬组织切片,亚甲基蓝-酸性品红染色,光镜下观察种植体-骨结合界面的组织学形态结构,比较各植入扭矩组种植体骨结合界面组织学上的异同,同时测量种植体骨结合率。三、结果： 1.大体观察六只实验比格犬均无死亡,饮食、活动正常。48颗种植体在植入三个月内,伤口愈合良好,种植体生长良好,无种植体松动脱落,无种植体周感染。 2.植入扭矩值测量与ISQ值测量 TV与ISQ(植入时)之间的相关系数r为0.494,P0.001,可以认为ITV与ISQ之间有统计学意义,因此在本研究中ITV与ISQ二者存在直线相关关系。对A、B、C、D四组进行单因素方差分析,A组与B组P0.05,A组与C组P0.05,A组与D组P0.05,B组、C组、D组之间P0.05。以P=0.05为检验水准,认为A组与B组、C组、D组之间存在统计学差异,而B组、C组、D组之间无统计学差异。种植体植入3个月后,A、B、C、D四组进行单因素方差分析,A组、B组、C组、D组各组之间P0.05。以P=0.05为检验水准,认为A组、B组、C组、D组之间ISQ值差异无统计学意义。 3.活体顺序性荧光标记在荧光显微镜下可见大量清晰的的两种不同颜色荧光带,呈片状、网状或条线状,黄绿色为钙黄绿素,红色为茜素红,红色荧光带位于黄绿色荧光带内侧。计算各组矿化沉积率值,进行单因素方差分析,其中C组与A组、B组、D组之间矿化沉积率值差异存在统计学意义,而A组、B组和D组之间不存在统计学差异,本实验认为C组矿化沉积率由于其他三组。 4.定量组织学分析在光学显微镜下观察亚甲基蓝-酸性品红染色后种植体骨结合界面清晰,成骨细胞及细胞核、类骨质显示清楚,成骨细胞核染成蓝色,细胞基质染成淡蓝色。新生骨组织为深红色,与种植体骨界面分界清晰,原矿化骨为红色,但与新生骨分界比较模糊。B组、C组种植体骨结合率和骨面积百分数值与A组、D组之间存在统计学意义,B组和C组种植体与周围骨组织结合的程度高于A组和D组。四、结论： 1.本实验认为植入扭矩值与ISQ之间存在正相关关系。在种植体植入时,植入扭矩值越大,其ISQ值也越大。当种植体植入时的最大植入扭矩值不小于20Ncm时,种植体均能取得良好的初期稳定性。 2.最大植入扭矩值为40Ncm到60Ncm的种植体,其骨组织界面处的新骨形成速度比植入扭矩值低40Ncm和高于60Ncm的种植体更快； 3.当种植体的最大植入扭矩值为20Ncm到60Ncm之间时,种植体与周围骨组织骨性结合程度高于植入扭矩值低于20Ncm和大于60Ncm的种植体。
[Abstract]:I. purpose:
To study the effect of implant torque on the osseointegration of dental implants, and to explore the optimal range of implant torque, so as to provide a reliable scientific basis for clinical implant implantation and improve the success rate of implant surgery.
Two, methods:
1. preparation of experimental animal models
Six healthy adult Beagle dogs were selected and randomly numbered 1-8. All the experimental animals were fed by the Medical Laboratory Animal Center of Sun Yat-sen University.
2. implant placement
Three months after the extraction wound healed, implants were implanted. Four XIVE implants were implanted in each dog's bilateral mandible and 48 implants were implanted in six dogs. The implants were all 3.4/9.5mm in size.
3. measurement and grouping of implant torque
The maximum insertion torque value (ITV) of the implant was recorded when the implant was fully in place.
According to the maximum implant torque, the implants were divided into four groups: 12 in group A, 0 Ncm ITV 20 Ncm; 12 in group B, 20 Ncm < ITV 40 Ncm; 12 in group C, 40 Ncm < ITV 60 Ncm; 12 in group D, ITV < 60 Ncm.
4. measurement of resonance frequency analysis
Immediately after the implant was fully in place, the stability factor ISQ of the implant was measured with a resonance frequency analyzer (RFA). The ISQ values of the near, lingual, distal, and buccal sides of the implant were measured respectively. Each implant was measured three times in each direction and the mean value was recorded. ISQ values in the middle, far, buccal and lingual side.
5. sequential fluorescence labeling
Tetracycline hydrochloride (TC, yellow), Calcein Green (CG, green), Alizarin-complen (AE, red), xylenol orange (Xylend, X0, orange) were sequentially injected at weeks 2, 4, 8 and 12 after implantation. The rate of mineralization was compared and the rate of new bone formation in each group was compared.
6. histological observation and measurement of osseointegration rate
Three months after implantation, superhard tissue sections were made and stained with methylene Blue-Acid fuchsin. The histological morphology of the implant-bone interface was observed under light microscope. The histological differences of the implant-bone interface between the implant torque groups were compared and the implant-bone binding rate was measured.
Three, results:
1. general observation
None of the six beagles died, had a normal diet and had normal movement. Forty-eight implants healed well within three months after implantation, the implants grew well, no implant loosening and no peri-implant infection occurred.
2. measurement of implant torque and measurement of ISQ value
The correlation coefficient between TV and ISQ (implantation time) was 0.494, P 0.001. It can be considered that there is statistical significance between ITV and ISQ, so there is a linear correlation between ITV and ISQ in this study.
A, B, C, D four groups were analyzed by one-way ANOVA. A group and B group P 0.05, A group and C group P 0.05, A group and D group P 0.05, B group, C group, D group P = 0.05 as the test level, it is considered that there are statistical differences between A group and B group, C group, D group, but there is no statistical difference between B group, C group and D group.
Three months after implantation, univariate analysis of variance was performed in group A, B, C and D. There was no significant difference in ISQ among group A, group B, group C and group D.
3. in vivo sequential fluorescent labeling
Under the fluorescence microscope, a large number of clear fluorescent bands of two different colors, flake, reticulate or linear, yellow-green for calcein, red for Alizarin red, red fluorescent band located in the inside of yellow-green fluorescent band. The difference of mineralization sedimentation rate between group A, group B and group D was statistically significant, but there was no statistical difference between group A, group B and group D.
4. quantitative histological analysis
After staining with methylene Blue-Acid fuchsin under optical microscope, the implant bone interface was clear, osteoblasts and nuclei were clearly displayed, osteoblast nuclei were stained blue, and cell matrix was stained light blue. The boundaries were blurred in group B. There was statistical significance between group C and group A and group D. The degree of implant-bone bonding in group B and group C was higher than that in group A and group D.
Four, conclusion:
1. There is a positive correlation between the implant torque and ISQ. The greater the implant torque, the greater the ISQ. When the maximum implant torque is not less than 20 Ncm, the implant can achieve good initial stability.
2. The implants with the maximum implant torque ranging from 40 Ncm to 60 Ncm were able to form new bone faster at the interface of bone tissue than those with the implant torque of 40 Ncm lower or more than 60 Ncm.
3. When the maximum implant torque is between 20Ncm and 60Ncm, the degree of osseointegration between the implant and the surrounding bone tissue is higher than that between the implant torque and the implant with the maximum implant torque below 20Ncm and above 60Ncm.
【学位授予单位】：南方医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.6

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