目的:本研究的目的是比较组织形态学评估的新骨形成(NB),射线测量的移植物稳定性,以及用小(Bio-Oss-S,Geistlich)或大型(Bio-Oss-L,Geistlich)粒子。
方法:使用裂口研究设计,对13例Bio-Oss-S颗粒(0.25~1mm)或Bio-Oss-L颗粒(1~2mm)患者进行了双侧上颌窦增大术.经过6个月的愈合期,在磨牙区域进行轴向骨活检,用于NB的组织学/组织形态计量学分析,包括随后分阶段的植入物放置。为了确定移植物的稳定性,上颌窦增强垂直移植物高度在鼻窦增强后立即进行影像学测量,在植入物放置时,以及扩增后2年和4年的随访。此外,在负重后1年和3年评估临床种植-修复结果(生存率/成功率/边缘骨丢失).
结果:11例患者的22个鼻窦进行口裂评估,最终可用于数据和统计分析。轴向获取的骨活检的组织形态计量学分析显示存在NB(S:25.5%±7.0%vsL:23.6%±11.9%;P=.640),残余移植物颗粒(S:19.6%±9.2%vsL:17.5%±6.3%;P=.365)以及结缔组织(S:54.9%±9.2%vsL:58.9%±12.5%;P=.283),在使用小颗粒(Bio-Oss-S)和大颗粒(Bio-Oss-L)之间没有显著差异。然而,与大颗粒移植部位(19.9%±12.9%)相比,小颗粒移植部位(27.9%±14.8%)的骨与移植物接触(BGC)明显更高(P=.021),代表了显著更高的骨传导性。两种粒径均显示出随时间(4年)约10%的显著(P<.01)垂直接枝高度降低,与植入物放置后的任何随访期相比,在鼻窦增大和植入物放置之间的时间段内移植物减少。在3年的植入后评估中,所有植入物和假体存活(100%),种植体周围边缘骨丢失(S:0.52±0.19mm;L:0.48±0.15mm)以及种植体周围健康状况(S:87.5%,L:81.2%)在使用两种不同的异种移植颗粒插入的植入物之间没有差异。
结论:使用小型和大型牛异种移植颗粒进行上颌窦增强提供了可比的骨形成,确保稳定的移植物尺寸与高植入成功率和健康的种植体周围条件相结合。然而,小粒径导致较高的BGC,提供比大粒径更高的骨传导性。
The aim of the present
study was to compare the histomorphometrically evaluated new bone formation (NB), the radiographically measured graft stability, and the clinical implant outcome for maxillary sinus augmentation grafted with deproteinized bovine bone mineral (DBBM) with either small (Bio-Oss-S, Geistlich) or large (Bio-Oss-L, Geistlich) particles.
Using a split-mouth
study design, bilateral maxillary sinus augmentation was performed in 13 patients either with Bio-Oss-S particles (0.25 to 1 mm) or Bio-Oss-L particles (1 to 2 mm). After a healing period of 6 months, bone biopsies were axially retrieved in the molar region for histologic/histomorphometric analysis of NB, including subsequent staged implant placement. To determine graft stability, the maxillary sinus augmentation vertical graft heights were radiographically measured immediately after sinus augmentation, at implant placement, and at the 2- and 4-year post-augmentation follow-ups. In addition, the clinical implant-prosthodontic outcome (survival/ success/marginal bone loss) was assessed at 1 and 3 years post-loading.
A total of 22 sinuses from 11 patients with split-mouth evaluation were ultimately available for data and statistical analysis. Histomorphometric analysis of the axially retrieved bone biopsies revealed the presence of NB (S: 25.5% ± 7.0% vs L: 23.6% ± 11.9%; P = .640), residual graft particles (S: 19.6% ± 9.2% vs L: 17.5% ± 6.3%; P = .365) as well as connective tissue (S: 54.9% ± 9.2% vs L: 58.9% ± 12.5%; P = .283), without significant differences between the use of small (Bio-Oss-S) and large (Bio-Oss-L) particles. However, there was significantly (P = .021) higher bone-to-graft contact (BGC) for the small-particle graft sites (27.9% ± 14.8%) compared to the large-particle graft sites (19.9% ± 12.9%), representing a significantly higher osteoconductivity. Both particle sizes showed significant (P < .01) vertical graft height reduction over time (4 years) of about 10%, with predominant graft reduction in the time period between sinus augmentation and implant placement compared to any follow-up periods after implant placement. At the 3-year post-loading implant evaluation, all implants and prostheses survived (100%), and the peri-implant marginal bone loss (S: 0.52 ± 0.19 mm; L: 0.48 ± 0.15 mm) as well as the peri-implant health conditions (S: 87.5%, L:81.2%) did not differ between implants inserted with the two different xenograft particles used.
The use of small and large bovine xenograft particles for maxillary sinus augmentation provides for comparable bone formation, ensuring stable graft dimensions combined with high implant success and healthy peri-implant conditions. However, small particle size resulted in a higher BGC, providing for higher osteoconductivity than with the larger particle size.