Evaluation of filling materials in membrane-protected bone defects - A comparative histomorphometric study in the mandible of miniature pigs
Evaluation of filling materials in membrane-protected bone defects - A comparative histomorphometric study in the mandible of miniature pigs
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DOI：
10.1034/j.1600-0501.1998.090301.x
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发表时间：
1998-06-01
影响因子：
4.3
通讯作者：
Schenk, RK
中科院分区：
文献类型：
--
作者：
Buser, D;Hoffmann, B;Schenk, RK
近年来，骨移植物和骨替代物越来越多地应用于屏障膜下，以优化骨重建治疗牙槽突缺损的治疗效果。本研究对4种不同的充填材料在小型猪下颌骨相似尺寸骨缺损中的修复效果进行了评价。血凝块和自体移植物作为对照。用屏障膜覆盖缺损，让其愈合4,12或24周。组织学检查表明，骨修复通过一个程序化的成熟步骤序列进行，与骨发育和生长的模式非常相似，无论是否存在骨移植物或替代物。组织形态学分析显示，自体骨移植（autografts）在愈合初期具有最佳的导骨性能，在愈合4周时，39%的新成骨位于膜覆盖缺损内。此外，此时87%的移植物表面已经被骨覆盖。自体移植物的这两个数值均显著高于4种替代骨填充物（P <等于0.05）。在12周时，这些差异不再明显，所有5种填充材料显示相似的值。在所测试的骨替代物中，磷酸三钙（TCP）在愈合24周时显示出明显更高的骨填充率。由此可见，在早期愈合阶段，在屏障膜下填充自体移植物的部位明显表现出最好的效果。就降解和替代而言，TCP显示出最有希望的结果。然而，这种填充物需要在更苛刻的动物模型中进一步测试。珊瑚衍生的羟基磷灰石颗粒和脱矿冻干同种异体骨移植物的效果较差。
In recent years, bone grafts and bone substitutes have been increasingly utilized underneath barrier membranes to optimize the treatment outcome of bone reconstructive therapy for defects in the alveolar process. In the present study, 4 different filling materials were evaluated in bone defects of similar dimensions in the mandible of miniature pigs. Blood clots and autografts were used as controls. The defects were covered with barrier membranes and allowed to heal for 4, 12 or 24 weeks. Histologic examination demonstrated that bone repair progressed through a programmed sequence of maturation steps closely resembling the pattern of bone development and growth regardless of whether bone grafts or substitutes were present or not. Histomorphometric analysis showed that autologous bone grafts (autografts) had the best osteoconductive properties during the initial healing period, with 39% of newly formed bone inside the membrane-covered defects at 4 weeks of healing. In addition, 87% of the graft surfaces were already covered by bone at this time. Both values were significantly higher for autografts than for the 4 alternative bone fillers (P less than or equal to 0.05). At 12 weeks, these differences were no longer apparent, with all 5 filling materials showing similar values. Among the tested bone substitutes, tricalcium phosphate (TCP) showed a significantly higher percentage of bone fill at 24 weeks of healing. It can be concluded that sites filled with autografts clearly demonstrated the best results underneath barrier membranes in the early phase of healing. As far as degradation and substitution are concerned, TCP showed the most promising results. This filler, however, needs to be tested further in a more demanding animal model. Less favorable results were obtained for coral-derived hydroxyapatite granules and for demineralized freeze-dried bone allografts.