不同材料在牙槽窝位点保护中成骨效应的基础及临床应用研究

发布时间：2018-07-11 18:05

本文选题：牙槽窝 + 保护　；参考：《武汉大学》2013年博士论文

【摘要】：牙槽骨是牙齿存在的基础,也是缺牙后义齿修复的基础。临床上有许多病人在拔除牙齿后,牙槽骨出现明显吸收,严重影响到各种修复体的制作,特别是种植牙,更需要丰满的牙槽嵴。为了减少或防止拔牙后牙槽骨的吸收,保持牙槽窝位点的形态和骨量,国内外学者做了大量研究。保持拔牙窝位点牙槽嵴骨量的方法,是目前研究的热点,在拔牙后新鲜的牙槽窝内植入不同材料,采用不同方法防止牙槽窝部位骨吸收。本试验就是选取犬作为实验动物,通过拔除其下颌前磨牙的一个牙根,保留另外一个牙根,同期在牙槽窝内植入自体回收碎骨屑和不同比例自体骨与人工骨混合骨粉,表面覆盖胶原膜。术后8、12周取标本作硬组织切片检查及影像学检查；将胶原膜与明胶海绵制成条状植入兔前牙拔牙窝内,8-12周后行组织学检测,对比牙槽窝成骨效果；总结临床上行牙槽窝植骨保护并完成种植手术的病例,用环钻环切牙槽窝骨柱,并行硬组织切片制作,检测骨形成与人工骨代谢比例。第一部分：不同植骨方式在牙槽窝位点保护中成骨效应的实验研究通过不同的方式在拔牙后牙槽窝中植骨,对比研究牙槽窝位点骨质保护效果,探寻合理的牙槽窝保护方式。选择三条杂交狗,分别拔除下颌左、右P2、P3、P4前磨牙近中根,保留远中根,并行根管治疗。在拔牙窝中分别植入自体回收碎骨屑、纯羟基磷灰石以及不同比例的自体骨屑与人工骨的混合物,表面覆盖胶原膜。第三只狗在左右下颌牙槽窝中即刻植入种植体,并在颊侧造成的5x2mm的骨缺损处植入不同骨质。术后8周、12周时取出下颌标本行影像学、组织学检测。结果发现：标本大体观察可见牙槽窝顶部有轻微凹陷。12周时骨密度高于8周时。组织学表明,植入人工骨比例越高,人工骨残余率越高。12周植入75%骨屑和25%人工骨组新骨形成率为55.3±5.6,8周时为45.5±7.2,均高于其他组(P0.05)。由实验可以得出结论：拔牙后牙槽窝即刻植入自体回收碎骨屑和不同比例羟基磷灰石混合骨可以有效保护牙槽窝位点骨量,特别是75%自体回收碎骨屑和25%羟基磷灰石组与骨屑和羟基磷灰石各占50%的植骨方式,新骨形成量最多,骨质较硬,牙槽窝骨量保护效果最好。为了减少自体骨的需求,临床可以考虑用回收碎骨屑和羟基磷灰石各占50%的植骨方式来保护牙槽窝。第二部分胶原蛋白膜和明胶海绵用于兔牙槽窝保护的实验研究本实验是为了探究胶原蛋白膜和明胶海绵对拔牙后牙槽窝的保护作用。实验选用的六只大耳白家兔分别拔除左右下颌切牙。1号和2号家兔在左下颌牙槽窝内填入牙槽窝形态的明胶海绵条,右牙槽窝填入牙槽窝形态的胶原蛋白膜条;3号和4号家兔左牙槽窝内空置不作处理,右牙槽窝内填入胶原蛋白膜；5号和6号家兔左牙槽窝内填入明胶海绵,右牙槽窝内不作处理。在实验后第8、12周分别处死1、3、5号兔子和2、4、6号兔子,进行x线片、组织病理学切片对比分析。结果显示：拔牙后第8周,1号兔子右侧牙槽窝密度略高于左侧,3、5号兔子左侧牙槽窝密度略高于右侧。拔牙后12周,双侧X线片显示牙槽窝内骨密度明显增加,且2、4号兔子右侧高于左侧,6号兔子左侧高于右侧。X线观察明胶海绵和胶原蛋白膜组兔牙槽骨密度无明显差异。术后第8周,填有明胶海绵、胶原蛋白膜的牙槽窝内都有纤维性成骨现象,双侧牙槽窝内均充满粗大的骨小梁,右侧较左侧成骨活跃。明胶海绵组成骨细胞呈网格状,有新生骨形成,骨小梁较粗大密集,而空白组牙槽窝内大部分由脂肪组织填充骨小梁相对细小散乱,骨小梁的成熟度较低。术后第12周,明胶海绵组和胶原蛋白组均可见明显的纤维组织填充并有成熟的骨组织梁,而空白组牙槽窝内主要是脂肪组织,只有少量的纤维组织。组织学切片显示明胶海绵组和胶原蛋白组均有明显的成骨现象。由实验可以得出结论：与空白对照组相比,明胶海绵和胶原蛋白膜对兔牙槽窝都有一定的保护作用,两者对于牙槽窝保护作用未见明显差异。此两种材料简单易得,可以成为临床常用的牙槽窝保护方法。第三部分牙槽窝位点保护技术在种植外科的应用研究选择我院口腔颌面外科门诊病人50人,其中男性22人,女性28人。因创伤致牙脱位、断裂,牙槽窝骨折者25例,牙周病15例,残根伴根尖囊肿6例,咬合致牙折4例。病人在局麻下微创拔除病灶牙根,刮净牙槽窝,分别植入Bioss骨粉和羟基磷灰石骨粉人工骨,其中使用Bioss骨粉的有20人,使用羟基磷灰石的有30人。植入后,牙槽窝表面用可吸收胶原膜覆盖,严密缝合创口。5-6月后局麻下用环钻钻取牙槽窝上方骨柱,行硬组织切片检测,对比新骨形成和人工骨代谢情况。结果显示：50例病人中,牙槽窝骨质均得到有效保护,牙槽嵴的宽度均满足临床种植需求。刚植入人工骨粉时,数字牙片显示牙槽窝的骨密度高,人工骨颗粒清晰,到3个月时,骨粉密度渐变淡,颗粒也渐渐变得模糊,人工骨粉与自体骨衔接面也逐渐模糊。由骨柱标本所制作的硬组织切片来看,无论是羟基磷灰石还是Bioss人工骨粉,在牙槽窝中均有新骨形成,在人工骨粉颗粒间有骨质形成,越往根方,骨质形成越多,骨结构越成熟。Bioss骨粉植入的牙槽窝标本,其新骨形成量多,人工骨代谢更快。利用Bioss和羟基磷灰石人工骨粉,在拔牙后即刻在牙槽窝中植入骨粉。临床追踪50例病人,术后无一失败,均成功完成种植修复,术后种植体无松动,软硬组织美学效果良好。
[Abstract]:Alveolar bone is the basis of tooth existence, and it is also the basis of denture repair after tooth deficiency. There are many patients in clinic after removing teeth, the alveolar bone appears obvious absorption, seriously affecting the production of various restorations, especially the implant teeth, more need plump alveolar ridge. In order to reduce or prevent the absorption of alveolar bone after tooth extraction, keep the alveolar site. A large number of studies have been made by scholars at home and abroad. The method of maintaining the bone mass of the alveolar ridge at the tooth socket loci is a hot spot at present. Different materials are implanted in the fresh alveolar fossa after extraction, and different methods are used to prevent the alveolar bone resorption. This experiment is to select the dogs as experimental animals by removing their mandibular premolars. One tooth root, the other root was retained, the autogenous bone crumbs were implanted in the alveolar bone and the bone powder mixed with the artificial bone in the same period, and the collagen membrane was covered on the surface. After 8,12 weeks, the specimens were examined for hard tissue section examination and imaging examination, and the collagen membrane and gelatin sponge were inserted into the tooth socket of the anterior teeth of the rabbit, 8-12 After weeks, histological examination was performed to compare the osteogenesis effect of alveolar fossa, and to summarize the cases of alveolar bone graft protection and completion of the implant surgery. The bone column of the alveolar nest was cut through the ring drill ring, and the hard tissue section was made, and the proportion of bone formation and artificial bone metabolism was detected.
Part one: Experimental Study on the osteogenesis effect of different bone grafting methods in the protection of alveolar fossa sites.
In different ways, bone graft in alveolar fossa after tooth extraction was used to compare the effect of bone protection in alveolar loci and to explore a reasonable way to protect the alveolus. Three hybrid dogs were selected to remove the middle root of mandibular left, right P2, P3, P4 anterior molar and the distal root and root canal treatment. Third dogs were implanted in the left and right mandibular alveolar fossa and implanted with the implant in the left and right mandibular alveolar fossa, and the bone defects were implanted in the buccal side of the 5x2mm. 8 weeks after the operation, the image of the mandibular mark was taken out and the histological examination was taken out at 12 weeks.
The results showed that the bone density was higher than 8 weeks at.12 weeks at the top of the alveolar fossa. Histology showed that the higher the ratio of artificial bone, the higher the residual rate of artificial bone, the rate of.12 weeks implanted into 75% bone and the new bone formation rate of 25% artificial bone group was 45.5 + 7.2 at 55.3 + 5.6,8 weeks, all higher than that of the other groups (P0.05).
It can be concluded from the experiment that the bone mass of alveolar loci can be effectively protected by implantation of autogenous recycled bone debris and different proportion of hydroxyapatite in the alveolar fossa after tooth extraction, especially in the 75% bone fragments and 25% hydroxyapatite group and bone crumbs and hydroxyapatite, which each occupies 50% of the bone graft, and the amount of bone formation is the most. In order to reduce the need of autogenous bone, it is possible to protect the alveolus by using the bone graft and the hydroxyapatite with 50% bone graft in order to reduce the need of autogenous bone.
The second part is an experimental study on the protective effect of collagen membrane and gelatin sponge on rabbit alveolar fossa.
The experiment was to explore the protective effect of collagen membrane and gelatin sponge on the alveolar fossa after tooth extraction. Six rabbits were selected to remove the gelatin sponge in the left and right mandibular incisors.1 and No. 2 rabbits in the alveolar fossa of left mandible. The right alveolar fossa was filled with the form of collagen membrane in the alveolar fossa; 3 No treatment was done in the left alveolar fossa of rabbit and No. 4. Collagen membrane was filled in the right alveolar fossa. The left alveolar fossa in No. 5 and 6 rabbits was filled with gelatin sponge and the right alveolar fossa was not treated. 1,3,5 rabbits and 2,4,6 rabbits were sacrificed at week 8,12 after the experiment. X-ray films were performed and histopathological sections were compared and analyzed.
The results showed that eighth weeks after extraction, the density of the right alveolar fossa on the right side of rabbit was slightly higher than that on the left side. The density of the left alveolar fossa in 3,5 rabbit was slightly higher than that on the right. 12 weeks after extraction, bilateral X-ray showed that the bone density increased obviously in the alveolar fossa, and the right side of 2,4 rabbit was higher than that on the left side, and the left side of No. 6 rabbit was higher than that on the right. The X-ray film of gelatin sponge and collagen membrane was observed by X-ray. There was no significant difference in the density of the alveolar bone in the group of rabbits. Eighth weeks after the operation, there was a gelatin sponge filled with fibrous osteogenesis in the alveolar nest of the collagen membrane. Both the bilateral alveolar fossa was full of large bone trabeculae, and the right side was more active than the left side. The gelatin sponge formed a gridding bone cell, the new bone formed and the bone trabecula was thicker and dense than the blank group. Most of the trabecular bone trabeculae filled with fat tissue were relatively small and scattered, and the maturity of bone trabecula was low. Twelfth weeks after the operation, the gelatin sponge group and the collagen group showed obvious fibrous tissue filling and mature bone tissue beam, while the main fat tissue in the blank group was only a small amount of fibrous tissue. The gelatin sponge group and collagen group showed obvious osteogenesis.
It can be concluded from the experiment that gelatin sponge and collagen membrane have certain protective effects on the alveolar fossa of rabbits compared with the blank control group, and the protection of the alveolar fossa is not obviously different. These two materials are simple and easy to get, and can be used as a common method of protecting the alveolar nest in clinical.
The third part is the application of alveolar fossa site protection technology in implant surgery.
There were 50 patients in the outpatient department of oral and maxillofacial surgery in our hospital, including 22 men and 28 women. There were 25 cases of tooth dislocation, fracture, alveolar fracture, 15 cases of periodontitis, 6 cases of root apical cyst and 4 cases of occlusal fracture. The patients were minimally invasive removal of the root of the tooth and the alveolar fossa under local anesthesia. The patients were implanted with Bioss bone powder and hydroxyapatite bone powder respectively. In artificial bone, there were 20 people using Bioss bone powder and 30 people using hydroxyapatite. After implantation, the surface of the alveolar surface was covered with absorbable collagen membrane. After close suture, the bone column of the alveolar ridge above the alveolar bone was drilled under local anesthesia for.5-6 months, and the new bone formation and artificial bone metabolism were compared.
The results showed that both of the 50 patients were effectively protected in the alveolar bone, and the width of the alveolar ridge met the needs of clinical cultivation. When artificial bone powder was implanted, the digital teeth showed a high bone density in the alveolar fossa and a clear particle of artificial bone. At 3 months, the bone powder density gradually became pale, and the particles gradually became blurred. The artificial bone powder joined the bone with the autogenous bone. The surface also gradually blurred. From the hard tissue sections of the bone column specimens, the new bone formed in the alveolar fossa, whether it was hydroxyapatite or Bioss artificial bone powder. The bone formed between the artificial bone powder particles, the more the root square, the more bone formed, the more mature the bone structure was implanted in the alveolar fossa with.Bioss bone powder, with a large amount of new bone formation. Artificial bone metabolism is faster.
With Bioss and hydroxyapatite artificial bone powder, bone powder was implanted in the alveolar bone immediately after tooth extraction. 50 patients were traced and no failure after the operation. The implant was successfully completed. The implant was not loosened after the operation, and the aesthetic effect of soft and hard tissue was good.
【学位授予单位】：武汉大学
【学位级别】：博士
【学位授予年份】：2013
【分类号】：R783.1

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