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GBR及延期加载对骨环植骨同期种植影响的动物实验研究

Effects of GBR and Delayed Loading on Bone Ring Grafting with Simultaneous Implant Insertion: an Experimental Study on Beagle Dogs

  • 摘要: 目的 通过在Beagle犬下颌前磨牙区行自体骨环植骨同期种植,评价引导骨再生术(guided bone regeneration, GBR)及延期加载对骨环植骨技术的影响。方法 利用锥形束CT(cone beam CT,CBCT)对6只Beagle犬下颌双侧第二前磨牙位(P2)和第四前磨牙位(P4)进行术前牙槽骨量测量后,制造双侧下颌P2、P4缺失模型,在每只动物的4个缺牙位点中随机选3个作为实验组并制造颊侧骨壁缺损,剩余1个缺牙位点作为对照组不做骨壁缺损处理。愈合3个月后,从每只动物的3个实验组位点随机选取2个作为GBR组,行GBR结合骨环植骨同期种植,另外一个作为不做GBR(nGBR)组,行骨环植骨同期种植,对照组仅做常规种植体植入。术后3个月记录临床观察结果,并对种植体周围垂直骨吸收量进行测量。术后3个月利用基台进行咬合加载,加载3个月后对种植体周围垂直骨吸收量和种植体周龈沟深度进行测量。结果 术后3个月,骨环植骨成功率为 83.3%,种植体成活率为 100%。GBR组延迟愈合的例数多于未行GBR组,延迟愈合可导致垂直骨吸收量增加。术后3个月安放基台,与对照组相比,延期加载对骨环植骨垂直骨吸收和牙龈组织的健康均无影响。结论 GBR并非骨环植骨的必要操作,且其可能会增加延期愈合的机率和感染的风险,导致骨环植骨失败。骨环植骨愈合后可有与正常骨相同的抵抗载荷的能力。

     

    Abstract: Objective To determine the effects of guided bone regeneration (GBR) and delayed loading on autogenous bone ring grafting. Methods Autogenous bone ring augmentation with simultaneous implant insertion was performed in the mandibular premolars region of six Beagle dogs. The Bone quality of four mandibular premolars 〔second premolar (P2) and fourth premolar (P4)〕 were detected using cone beam CT (CBCT). The P2s and P4s of bilateral mandible were extracted, with three extracting sites being randomly selected to create buccal defects and the remaining one serving as control. GBR and bone ring grafting with simultaneous implant insertion was performed on two of the three experimental sites with buccal defects 3 months later, while the other one was treated with bone ring grafting with simultaneous implant insertion. Routine implant placement was performed in the control group. Vertical bone resorption and sulcus deep around the implants were measured three months after occlusal loading with abutment. Results Three months after operations, 83.3% of bone rings grafts were successful and 100% of implants survived. Delayed healing appeared more in the dogs with GBR compared those treated with bone ring grafting with simultaneous implant insertion, resulting in an increase in vertical bone resorption. Compared with the control group, delayed loading had no effects on vertical bone resorption and the health of gingiva tissues after autogenous bone ring transplant. Conclusion GBR is not a preferred procedure for bone ring grafts, which may increase the risk of delayed healing and site infections, leading to failure of implants. Healed bone ring grafts can resist loadings as normal.

     

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