目的:比较单相(100%β-TCP)和双相(60%HA和40%β-TCP)骨替代材料(BSM)的生物相容性,骨传导性和植入物稳定性使用组织学,放射学和共振频率分析。
方法:对60例患者进行67次窦底抬高手术。一个患者组(单相骨替代物[MBS],30名患者,32鼻窦)通过使用单相材料(Biosorb®,Sybron植入解决方案,不来梅,德国),而第二组(双相骨替代物(BBS),30名患者,35个鼻窦)接受了双相材料(Maxresorb®,博蒂斯生物材料,柏林,德国)。在增强后和6个月后放置植入物之前立即拍摄锥形束CT图像。收获了树莓,在准备植入床时。植入物放置后和6个月后立即进行共振频率分析。对所有增强窦进行描述性分析(n=67)。为了对各组进行统计比较,每位双侧治疗患者的一个窦被随机排除,产生30个MBS接枝的鼻窦和30个BBS接枝的鼻窦(n=60)。
结果:所有鼻窦的组织形态计量学分析显示,两组在新骨基质方面具有可比性(MBS36.16±19.37%,BBS38.42±12.61%),残留BSM(MBS30.26±11.7%,BBS32.66±12.57%)和非矿化组织(MBS34.29±18.32%,BBS28.92±15.04)%)(分别为P>0.05)。BBS的放射体积明显更稳定(MBS的体积损失为22.2%,BBS为6.66%;P<0.001),6个月后BBS的移植物均一性高于MBS(P<0.05)。共振频率分析表明,6个月后BBS的植入物稳定性商比MBS高(MBS78.31±5.81,BBS80.42±6.31;Mann-WhitneyU检验,P<0.05,分别)。
结论:单相和双相材料均显示出良好的生物相容性和骨传导性,对植入物稳定性具有令人满意的支持。在6个月的愈合期后,BBS在体积维持和放射学移植物均匀性方面保持更稳定。
OBJECTIVE: To compare a monophasic (100% ß-TCP) and a
biphasic (60% HA and 40% ß-TCP) bone substitute material (BSM) regarding biocompatibility, osteoconductivity and implant stability using histological, radiological and resonance frequency analysis.
METHODS: Sixty-seven sinus floor elevations were performed in 60 patients. One patient group (monophasic bone substitute [MBS], 30 patients, 32 sinuses) was augmented by the use of the monophasic material (Bioresorb® , Sybron Implant Solutions, Bremen, Germany), while the second group (
biphasic bone substitute (BBS), 30 patients, 35 sinuses) received a
biphasic material (Maxresorb® , Botiss Biomaterials, Berlin, Germany). Cone beam CT images were taken immediately after augmentation and prior to implant placement after 6 months. Trephines were harvested, while the implant bed was prepared. Resonance frequency analysis was performed immediately after implant placement and 6 months later. Descriptive analysis was performed on all augmented sinus (n = 67). For statistical comparison of the groups, one sinus of each bilaterally treated patient was randomly excluded, resulting in 30 sinuses grafted with MBS and 30 sinuses grafted with BBS (n = 60).
RESULTS: Histomorphometrical analysis of all sinuses displayed comparable results for both groups regarding new bone matrix (MBS 36.16 ± 19.37%, BBS 38.42 ± 12.61%), residual BSM (MBS 30.26 ± 11.7%, BBS 32.66 ± 12.57%) and non-mineralized tissue (MBS 34.29 ± 18.32%, BBS 28.92 ± 15.04) %) (P > 0.05, respectively). Radiological volume of BBS was significantly more stable (volume loss of 22.2% for MBS, 6.66% for BBS; P < 0.001), and homogeneity of the graft after 6 months was higher for BBS than that for MBS (P < 0.05). Resonance frequency analysis endorsed a higher implant stability quotient for BBS after 6 months than that for MBS (MBS 78.31 ± 5.81, BBS 80.42 ± 6.31; P < 0.05, Mann-Whitney U-test, respectively).
CONCLUSIONS: Both monophasic and
biphasic materials show good biocompatibility and osteoconductivity with satisfactory support on implant stability. BBS remains more stable in terms of volume maintenance and radiological graft homogeneity after a healing period of 6 months.