Contribution of the PDL to Osteotomy Repair and Implant Osseointegration
Contribution of the PDL to Osteotomy Repair and Implant Osseointegration
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PDL 对截骨修复和种植体骨整合的贡献
DOI：
10.1177/0022034517707513
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发表时间：
2017-07-01
影响因子：
7.6
通讯作者：
Helms, J. A.
中科院分区：
文献类型：
--
作者：
Pei, X.;Wang, L.;Helms, J. A.
我们的目的是明确拔牙后保留在牙槽中的牙周膜（PDL）的命运，然后确定该组织是否有助于放置在这些新鲜拔牙牙槽中的即刻种植体的骨整合。小鼠进行上颌第一磨牙拔除，通过截骨术去除残留的PDL，并放置钛种植体。截骨术是以这样一种方式创建的，腭表面没有PDL残留，而颊，近中和远侧表面保留PDL纤维。在手术后的多个时间点，使用一组分子、细胞和组织形态计量学测定分析组织。我们发现PDL残留物矿化并直接促进拔牙部位新骨形成。与通过截骨术去除PDL的拔牙部位区域相比，保留PDL纤维的区域产生了明显更多的新骨。在即刻种植体周围，保留的PDL残留物直接促进了新骨形成和骨整合。因此，我们得出结论，PDL残留物本身具有成骨性，如果组织健康，则可以合理地得出结论，应避免在立即植入种植体之前刮除拔牙窝。这一建议符合当前的趋势，即在立即植入种植体之前对拔牙窝进行微创手术操作。
Our objective was to clarify the fate of the periodontal ligament (PDL) retained in the socket after tooth extraction, then determine if this tissue contributed to the osseointegration of immediate implants placed in these fresh extraction sockets. Mice underwent maxillary first molar extraction, the residual PDL was removed by an osteotomy, and titanium implants were placed. The osteotomy was created in such a way that the palatal surface was devoid of PDL remnants while the buccal, mesial, and distal surfaces retained PDL fibers. At multiple time points after surgery, tissues were analyzed using a battery of molecular, cellular, and histomorphometrical assays. We found that PDL remnants mineralized and directly contributed to new bone formation in the extraction site. Compared with regions of an extraction site where the PDL was removed by osteotomy, regions that retained PDL fibers had produced significantly more new bone. Around immediate implants, the retained PDL remnants directly contributed to new bone formation and osseointegration. Thus, we conclude that PDL remnants are inherently osteogenic, and if the tissue is healthy, it is reasonable to conclude that curetting out an extraction socket prior to immediate implant placement should be avoided. This recommendation aligns with contemporary trends toward minimally invasive surgical manipulations of the extraction socket prior to immediate implant placement.