异种脱钙骨基质对拔牙创愈合的作用

目的:评价异种(牛)脱钙骨基质对拔牙创愈合及牙槽嵴形态改建的作用.方法:选用18 只健康成年犬,拔除双侧下颌第四前磨牙,左侧拔牙创内充填异种脱钙骨基质作为实验组,右侧拔牙创不处理作为对照组,同体对照;拔牙后分别于第4、12、24 周各处死6 只动物,头颅标本行螺旋CT扫描,应用多平面重建技术测量拔牙创CT值及牙槽嵴吸收值;切取拔牙创组织制作HE染色切片行组织学观察.结果:各时间点实验组拔牙创CT值均显著高于对照组(P<0.05);4 周时实验组牙槽嵴吸收值低于对照组,但二者之间的差异无统计学意义(P>0.05),第12、24 周时实验组牙槽嵴吸收值均显著低于对照组(P<0.05);组织学观察可见:在4和12 周时,实验组成骨情况优于对照组,24 周时2 组无显著差异.全过程实验组均未见明显炎细胞浸润.结论:异种脱钙骨基质可以促进拔牙创的愈合,保持牙槽嵴高度,有利于后期的牙种植或义齿修复.     

拔牙后应用脱细胞真皮基质对保存牙槽嵴的影响

目的：观察脱细胞真皮基质植入拔牙创后牙槽嵴的吸收情况,评价脱细胞真皮基质对于保存牙槽嵴的影响。方法：选用本地产健康成年杂种犬16只,拔除双侧下颌第一前磨牙,左侧拔牙创植入脱细胞真皮基质作为实验组,右侧拔牙创作为空白对照。16只犬随机分为两组,分别于第4、12周处死1组动物。测量第4周、第12周拔牙处的牙槽嵴高度;拔牙创组织制作HE染色切片行组织学观察。结果：第4、12周实验组牙槽嵴高度均明显高于对照组（P〈0.01）;第4周实验组较对照组在组织学上更为成熟。结论：脱细胞真皮基质可以促进拔牙创的早期愈合,保存牙槽嵴高度。     

采用异种脱细胞真皮基质修复骨引导再生术后软组织不足的临床观察

目的:观察用异种脱细胞真皮基质直接修复牙种植引导骨再生术后牙龈组织不足的软组织修复临床效果和其生理变化特点.方法:2007年12月到2008年9月在中山大学附属口腔医院种植科接受骨引导再生术的患者7例(其中女性5例,男性2例,平均34岁),7例患者术前诊断为牙槽嵴宽度不足,植入羟基磷灰石生物陶瓷后采用异种脱细胞真皮基质直接修补软组织不足,完成引导骨再生手术后10-12个月进行牙种植手术.临床追踪异种脱细胞真皮基质愈合情况及成骨情况.结果:7例患者异种脱细胞真皮基质均顺利成活,牙槽嵴增宽3mm～5mm.引导骨骨质量好,保证牙种植术顺利进行.结论:异种脱细胞真皮基质直接修复引导骨再生术后软组织不足的临床效果满意.     

局部注射葛根素对鼠拔牙后剩余牙槽嵴吸收影响的实验研究

目的观察中药葛根素对鼠拔牙后剩余牙槽嵴吸收的影响作用。方法制作大鼠下颌中切牙缺失模型,于剩余牙槽嵴的粘膜下注射葛根素,用X线片测量大鼠相对剩余牙槽嵴高度和骨密度值,HE染色观察不同时期剩余牙槽嵴的组织学形态改变。结果实验组剩余牙槽嵴相对高度均大于对照组（P〈0.05）;除一周组外,其余各实验组剩余牙槽嵴光密度测量值均大于对照组（P〈0.01）;组织学观察可见实验组大鼠剩余牙槽嵴表面的成骨质量较对照组高,骨吸收程度较对照组少。结论将葛根素注射于拔牙窝周围能够抑制剩余牙槽嵴的吸收并保存牙槽嵴的高度。     

同种异体脱细胞真皮基质用于老年人牙槽骨再生修复的临床观察

目的：评价同种异体脱细胞真皮基质（Acellular dermis）促进老年人拔牙后牙槽骨再生修复的临床效果。方法：采用同种脱细胞异体真皮基质充填在老年人因牙根折裂而行截根拔除术后的牙槽窝内。结果：2个月后拔牙窝基本平覆,可以进行联冠修复治疗,采用同种脱细胞异体真皮基质充填后的牙槽窝平覆速度明显快于未充填同种脱细胞异体真皮基质的牙槽窝。结论：采用同种脱细胞异体真皮基质充填可加快老年人拔牙后的牙槽窝的组织修复和愈合。     

异种脱细胞真皮基质用于牙槽嵴裂植骨术的效果观察

目的探讨在牙槽嵴裂植骨术中应用脱细胞真皮基质能否提高完全性唇腭裂患者植骨术后效果。方法对63例完全性唇腭裂患者共72侧裂隙以自体髂骨松质骨行牙槽嵴裂植骨术,术中同时应用脱细胞真皮基质。术后至少3个月时按照Bergland标准评价其上颌前部咬合片,统计临床成功型所占的比例,并与按相同手术方法植骨但未应用脱细胞真皮基质的植骨效果进行比较。结果脱细胞真皮基质组的临床成功率为75%,高于对照组(51%)。其中单侧牙槽嵴裂组53侧裂隙的成功率为81%,高于对照组(56%);双侧牙槽嵴裂组19侧裂隙的临床成功率为58%,与对照组(42%)无显著性差异。结论完全性唇腭裂患者在牙槽嵴裂植骨术中应用脱细胞真皮基质可以提高手术效果。     

新型复合矿化胶原膜用于牙槽嵴保存的实验研究

目的:探讨新型复合矿化胶原膜用于犬拔牙位点牙槽嵴保存实验研究的可行性.方法:12只杂种犬拔除下颌双侧第三前臼齿,共有24个牙槽窝,将其随机分为3组,A组植入人工骨修复材料并覆盖新型复合矿化胶原膜,B组植入人工骨修复材料,C组为空白对照组.术后3个月通过大体观察、形态学测量、螺旋CT以及X射线显微CT检查评价牙槽窝愈合情况.结果:3个月时牙槽窝水平宽度和新骨小梁结构参数A组大于B组(P＜0.05),B组大于C组(P＜0.05);感兴趣区域CT值A组均高于B组和C组(P＜0.05).结论:新型复合矿化胶原膜可起到减缓牙槽嵴吸收、诱导新骨再生、保存牙槽嵴的作用.     

原核表达重组人 OP-1促进拔牙创愈合的实验研究

目的：检测原核表达基因工程重组人OP-1(rhop—1)促进拔牙创愈合，减少牙槽嵴吸收的的效能方法：采用大白兔建立拔牙创的动物模型，以明胶海绵作为裁体，将大肠杆菌原核表达的重组人OP—1与之复合后植入即刻拔除牙齿的牙槽窝内进行干预治疗，通过观察其组织学改变、钙含量及碱性磷酸酶活性测定的变化，探讨原核表达的基因工程重组产品rhOP—1是否促进拔牙创的愈合修复。结果：大体观察结果显示：两组牙槽嵴高度的吸收差异有显著性；组织学HE切片显示：实验组的骨创愈合比对照组大约提前4～6周：碱性磷酸酶(AIP)活性及钙含量测定均显示实验组均明显高于对照组，差异有统计学意义：结论：原核表达基因工程重组人骨形态发生蛋白具有良好的促进骨创愈合、减少或防止牙槽骨吸收的作用     

芦荟膏对拔牙创组织愈合的动物实验

目的: 探讨芦荟膏对拔牙创早期愈合的促进作用.方法:采用60只Wister大鼠建立拔牙创动物模型.选每只右侧上颌磨牙拔牙创为实验组,将300 s/L的芦荟膏放入拔牙创内;左侧同名牙的拔牙创为对照组,拔牙后按常规处理创面.通过肉眼观察软组织的愈合情况、测量创口面积和组织学观察.结果:组织学观察结果显示实验组愈合明显优于对照组,创口面积差异有统计学意义,实验组的拔牙创愈合比对照组平均提前15～20 d.结论:芦荟膏具有明显的促进拔牙创组织愈合的作用.     

拔牙后牙槽窝即刻植入纳米羟基磷灰石的临床观察

目的:研究拔牙后即刻植入纳米羟基磷灰石颗粒预防术后牙槽骨吸收,保持牙槽嵴高度的临床疗效。方法:选择16例需同时拔除下颌两侧相同部位后牙的患者,按左右分组,左侧为拔牙后立即填塞颗粒型纳米羟基磷灰石,右侧为拔牙后传统搔刮血块充盈对照。4周、12周分别复诊,摄X线片检查。对牙槽窝的愈合,牙槽嵴高度进行观察。结果:16例患者创口愈合良好。两组比较,12周后实验组X线片见牙槽窝处的X线阻射影与周围牙槽骨密度相近,界限不清,恢复的牙槽嵴与周围基本平齐,牙槽高度恢复良好。对照组牙槽嵴高度明显降低,实验组牙槽嵴高度降低不明显。结论:拔牙创内即刻植入纳米羟基磷灰石不影响创口愈合,能促进新骨的形成,很好地维持牙槽嵴高度,为以后进行义齿修复提供一个良好的基骨条件。     

口腔组织补片植入对牙槽窝愈合的影响研究

目的:应用螺旋CT技术观察拔牙后口腔组织补片植入牙槽窝的愈合情况,评价口腔组织补片对于牙槽窝愈合的影响。方法:选用本地产健康成年杂种犬8只,随机分为4组,建立拔牙的动物模型,左侧牙槽窝植入口腔组织补片,右侧对应牙位牙槽窝作为空白对照。分别于第2、4、12、24周处死一组动物,取头颅标本行螺旋CT扫描,应用多平面重建技术测量牙槽窝CT值。结果:第2、4、12周植入口腔组织补片组的牙槽窝CT值明显高于对照组(P<0.01)。结论:口腔组织补片可以有效促进牙槽窝的早期愈合。     

Early healing of implants placed into fresh extraction sockets: an experimental study in the beagle dog. II: ridge alterations

Aims: To describe the early phases of healing at the alveolar ridge around dental implants placed into fresh extraction sockets and to study whether (i) the dimension of the socket and (ii) a new implant surface nano-topography may have any influence.
Materials and Methods: Sixteen beagle dogs received 64 test (new surface) and control implants randomly placed at the distal socket of 3P3 and 4P4. The implant shoulder was levelled with the marginal buccal bone crest. Animals were sacrificed at 4 h, 1, 2, 4 and 8 weeks for histological examination.
Results: Bone loss occurred at the buccal crest between the 4-h and 1-week healing intervals, being more pronounced at the third premolar site [vertical bone loss between day 0 and 8 weeks 1.1 (0.5) mm]. The corresponding loss at the fourth premolar site was 0.3 (0.5) mm. Test sites containing implants with discrete crystalline deposition nano-particles' surface exhibited less buccal bone resorption than control sites at 8 weeks.
Conclusion: Dimensions of the socket influenced the process of wound healing of implants placed into fresh extraction sockets, with more bone loss in the narrower sockets; however, the implant surface nano-topography seemed to have a limited effect in the healing of this implant surgical protocol.     

Influence of implant positioning in extraction sockets on osseointegration: histomorphometric analyses in dogs

Aim: To evaluate the influence of implant positioning into extraction sockets on osseointegration. Material and methods: Implants were installed immediately into extraction sockets in the mandibles of six Labrador dogs. In the control sites, the implants were positioned in the center of the alveolus, while in the test sites, the implants were positioned 0.8 mm deeper and more lingually. After 4 months of healing, the resorptive patterns of the alveolar crest were evaluated histomorphometrically. Results: All implants were integrated in mineralized bone, mainly composed of mature lamellar bone. The alveolar crest underwent resorption at the control as well as at the test sites. After 4 months of healing, at the buccal aspects of the control and test sites, the location of the implant rough/smooth limit to the alveolar crest was 2±0.9 mm and 0.6±0.9 mm, respectively (P<0.05). At the lingual aspect, the bony crest was located 0.4 mm apically and 0.2 mm coronally to the implant rough/smooth limit at the control and test sites, respectively (NS). Conclusions: From a clinical point of view, implants installed into extraction sockets should be positioned approximately 1 mm deeper than the level of the buccal alveolar crest and in a lingual position in relation to the center of the alveolus in order to reduce or eliminate the exposure above the alveolar crest of the endosseous (rough) portion of the implant. To cite this article:
Caneva M, Salata LA, de Souza SS, Baffone G, Lang NP, Botticelli D. Influence of implant positioning in extraction sockets on osseointegration: histomorphometric analyses in dogs.
Clin. Oral Impl. Res. 21 , 2010; 43–49.     

异体脱细胞真皮基质在种植区唇侧软组织处理中的应用

目的观察异体脱细胞真皮基质(ADM)植入后增加上前牙种植区唇侧软组织厚度的疗效。方法将50例单个上前牙缺失病例随机分为实验组和对照组,前者行种植术伴种植区唇侧ADM骨膜下植入,对照组行单纯种植术。测量手术前、手术后12周种植区牙槽嵴水平宽度及种植体周围牙周指数。结果术后12周两组种植体留存率均为100％;实验组牙槽嵴宽度较术前平均增加(3．10±0．64)mm,对照组增加(0．30±0．50)mm,两组间比较,差异有统计学意义(P<0．05);术后12周实验组牙槽嵴平均宽度为(11．50±1．48)mm,对侧同名牙区牙槽嵴平均宽度为(11．60±1．60)mm,两者间差异无统计学意义(P>0．05)。结论ADM能通过增加水平向软组织量改善种植区唇侧的美学效果。     

Hard tissue formation adjacent to implants of various size and configuration immediately placed into extraction sockets: an experimental study in dogs

Objectives: To evaluate the influence of implant size and configuration on osseointegration in implants immediately placed into extraction sockets. Material and methods: Implants were installed immediately into extraction sockets in the mandibles of six Labrador dogs. In the control sites, cylindrical transmucosal implants (3.3 mm diameter) were installed, while in the test sites, larger and conical (root formed, 5 mm diameter) implants were installed. After 4 months of healing, the resorptive patterns of the alveolar crest were evaluated histomorphometrically. Results: With one exception, all implants were integrated in mineralized bone, mainly composed of mature lamellar bone. The alveolar crest underwent resorption at the control as well as at the test implants. This resorption was more pronounced at the buccal aspects and significantly greater at the test (2.7±0.4 mm) than at the control implants (1.5±0.6 mm). However, the control implants were associated with residual defects that were deeper at the lingual than at the buccal aspects, while these defects were virtually absent at test implants. Conclusions: The installment of root formed wide implants immediately into extraction sockets will not prevent the resorption of the alveolar crest. In contrast, this resorption is more marked both at the buccal and lingual aspects of root formed wide than at standard cylindrical implants. To cite this article:
Caneva M, Salata LA, de Souza SS, Bressan E, Botticelli D, Lang NP. Hard tissue formation adjacent to implants of various size and configuration immediately placed into extraction sockets: an experimental study in dogs.
Clin. Oral Impl. Res. 21 , 2010; 885–895.
doi: 10.1111/j.1600‐0501.2010.01931.x     

Collagen membranes at immediate implants: a histomorphometric study in dogs

Aim: To evaluate the influence of resorbable membranes on hard tissue alterations and osseointegration at implants placed into extraction sockets in a dog model. Material and methods: In the mandibular premolar region, implants were installed immediately into the extraction sockets of six Labrador dogs. Collagen‐resorbable membranes were placed at the test sites, while the control sites were left uncovered. Implants were intended to heal in a submerged mode. After 4 months of healing, the animals were sacrificed, and ground sections were obtained for histomorphometric evaluation. Results: After 4 months of healing, a control implant was not integrated (n=5). Both at the test and at the control sites, bone resorption occurred. While the most coronal bone‐to‐implant contact was similar between the test and the control sites, the alveolar bone crest outline was maintained to a higher degree at the buccal aspect of the test sites (loss: 1.7 mm) compared with the control sites (loss: 2.2 mm). Conclusions: The use of collagen‐resorbable membranes at implants immediately placed into extraction sockets contributed to a partial (23%) preservation of the buccal outline of the alveolar process. To cite this article:
Caneva M, Botticelli D, Salata LA, Souza SLS, Carvalho Cardoso L, Lang NP. Collagen membranes at immediate implants: a histomorphometric study in dogs.
Clin. Oral Impl. Res. 21 , 2010; 891–897.
doi: 10.1111/j.1600‐0501.2010.01946.x     

Vertical and horizontal ridge alterations after tooth extraction in the dog: flap vs. flapless surgery

Objective: To compare ridge alterations after flap and flapless tooth extraction in the vertical and horizontal dimension in the dog model. Material and methods: This study was carried out on five Beagle dogs. Four extractions were performed in the lower jaw of each dog (two per side. Pm3, Pm4). At the time of tooth extraction, flap surgery was performed on one side (control group). On the contra‐lateral side, a flapless extraction was performed (test group). Mesial sockets were left untreated on both sides. After 3 months of healing, the dogs were sacrificed and prepared for histological analysis. Results: Ten samples were evaluated on each group. The vertical difference in height between the buccal and lingual crest was 1.48 mm for the flap, and 1.22 mm for the flapless group. The horizontal dimension of the ridge was 4.41 mm (at 1 mm from the crest), 5.72 mm (at 3 mm from the crest) and 6.67 mm (at 5 mm form the crest) in the flap group. In the flapless group, the measurements were 4.5, 5.58 mm and 6.44 at 1, 3 and 5 mm from the crest, respectively. Conclusion: Evaluating ridge alterations in the vertical and horizontal dimension after 3 months of healing following tooth extraction, results for the flap and the flapless group were very similar. To cite this article:
Blanco J, Mareque S, Liñares A, Muñoz F. Vertical and horizontal ridge alterations after tooth extraction in the dog: flap vs. flapless surgery.
Clin. Oral Impl. Res. 22 , 2011; 1255–1258.
doi: 10.1111/j.1600‐0501.2010.02097.x     

Flap vs. “flapless” surgical approach at immediate implants: a histomorphometric study in dogs

Aim: To compare the remodeling of the alveolar process at implants installed immediately into extraction sockets by applying a flap or a “flapless” surgical approach in a dog model. Material and methods: Implants were installed immediately into the distal alveoli of the second mandibular premolars of six Labrador dogs. In one side of the mandible, a full‐thickness mucoperiosteal flap was elevated (control site), while contra‐laterally, the mucosa was gently dislocated, but not elevated (test site) to disclose the alveolar crest. After 4 months of healing, the animals were sacrificed, ground sections were obtained and a histomorphometric analysis was performed. Results: After 4 months of healing, all implants were integrated (n=6). Both at the test and at the control sites, bone resorption occurred with similar outcomes. The buccal bony crest resorption was 1.7 and 1.5 mm at the control and the test sites, respectively. Conclusions: “Flapless” implant placement into extraction sockets did not result in the prevention of alveolar bone resorption and did not affect the dimensional changes of the alveolar process following tooth extraction when compared with the usual placement of implants raising mucoperiosteal flaps. To cite this article:
Caneva M, Botticelli D, Salata LA, Souza SLS, Bressan E, Lang NP. Flap vs. “flapless” surgical approach at immediate implants: a histomorphometric study in dogs.
Clin. Oral Impl. Res. 21 , 2010; 1314–1319.
doi: 10.1111/j.1600‐0501.2009.01959.x     

Hyaluronic Acid Improves Bone Formation in Extraction Sockets With Chronic Pathology: A Pilot Study in Dogs

Background: Previous studies on ridge preservation focusing on fresh extraction sockets using graft materials for ridge preservation procedures have reported a delay in the tissue modeling and remodeling phases. The objective of this study is to evaluate the effect of hyaluronic acid (HA) on healing of infected sockets. Methods: Six beagle dogs were used in this study. Both mandibular third premolars were hemisected, and the distal roots were extracted. Subsequently, periodontal and endodontic lesions were induced at the remaining mesial root. After communication of the periodontal lesion, an endodontic periapical lesion was observed at 4 months, and the mesial roots of both the right and left sides were extracted. HA was applied into the socket of the test group, and no treatment was administered to the other group (control group). Three months after extraction of the mesial roots, the dogs were sacrificed, and histologic evaluations were performed. Results: The sockets were filled by mineralized bone (47.80% ± 6.60%) and bone marrow (50.47% ± 6.38%) in the control group, whereas corresponding values were 63.29% ± 9.78% and 34.73% ± 8.97% for the test group, respectively. There was a statistically significant difference between the groups. Reversal lines and a copious lineup of osteoblasts were observed in the middle and apical parts of the sockets in the test group. Conclusion: An infected socket shows delayed healing of the socket wound, and HA, because of its osteoinductive, bacteriostatic, and anti‐inflammatory properties, may improve bone formation and accelerate wound healing in infected sockets.