A Preliminary Study to Compare the Stability of Two Different Bone Grafting Materials Used during Early Implant Placement

比較早期植體植入對兩種骨移植體材料穩定性的初期研究

劉昱菁(Yu-Ching Liu) ； 陳俊榮(Chun-Jung Chen) ； 林嫆真(Jung-Jen Lin) ； 毛念平(Lian-Ping Mau)

《臺灣牙周病醫學會雜誌》 22卷1期 (2017/03) Pp. 8-18

https://doi.org/10.6121/TAP.2017.22.1.03

摘要

Background: Buser's long-term study showed early implant placement combined with simultaneous contour augmentation using a guided bone regeneration technique was able to rebuild stable facial hard-tissue and soft-tissue contours that were esthetically pleasing. It is uncertain whether this technique can be successfully repeated by other clinicians when different grafting materials are used with similar clinical esthetic results. The purpose of this study is to evaluate the repeatability of Buser's technique of early implant placement on Asian patients and to evaluate the clinical esthetic outcome, facial bone height and facial bone thickness, when two different bone grafting materials are used. Materials and methods: The twelve patients were randomized assigned into two groups. For the control group, locally harvested autogenous bone chips were used to cover the exposed implant surface. A superficial layer of Bio-Oss was added and combined with a bioresorbable collagen membrane (Bio-Gide). For the test group, the exposed implant surface was covered with a layer of FDBA in combination with a bioresorbable collagen membrane (Bio-Gide). All the implants used in this study were SLActive Bone Level Implants (BC). After surgery, a CBCT scan was carried to determine the structure of the implant placement in combination with contoured augmentation technique. A second CT scan was carried out after implant prosthesis loading for 1 year. The differences between CT images in terms of facial bone height and thickness were recorded. Result: There was no significant difference with respect to modified plaque index (mPI), modified sulcus bleeding index (mSBI) and probing depth (PD) between the test and control group. The control group was found to have remaining mean facial bone thicknesses at 1 mm, 3 mm and 5 mm from the implant platform of 1.82 mm, 2.6 mm and 2.82 mm, respectively, while the same mean thicknesses of the test group were 1.7 mm, 1.7 mm and 2.03 mm. Furthermore, the mean facial bone height above the implant platform, when the control and test groups were compared, was found to be 1.52 mm and 1.02 mm respectively. Conclusions: This preliminary study demonstrated that Buser's technique is highly reliable and reproducible in an Asian population. The use of DBBM and FDBA both resulted in a stable facial bone height and thickness after contour augmentation.

關鍵字

anterior maxilla ； early implant placement ； guided bone regeneration ； implant buccal bone thickness

並列摘要

前言：Buser的長期追蹤文獻中指出：透過早期植體植入（early implant placement）同時合併引導骨再生手術可達到前牙美觀的效果，並可維持植體頰側骨厚度的穩定性。本篇研究的目的是探討Buser所提出的術式在臨床上對東方人是否有重現性，以及使用不同的骨移植體材料是否也能達到同樣美觀的效果及維持植體頰側骨高度、厚度的穩定性。材料與方法：臨床隨機盲化分配對照組和實驗組各6位受試者，對照組採用自體移植骨（autograft）先覆蓋在早期植體植入外露的植體表面、外側再覆蓋一層牛去礦物骨（Bio-Oss），接著最外層覆蓋兩層非交叉連結豬膠原再生膜（Bio-Gide）並縫合；實驗組則是利用冷凍乾燥異體骨（FDBA）直接覆蓋在外露的植體表面後，接著覆蓋兩層膠原再生膜並縫合。所使用的植體系統均為Straumann SL Active Bone Level Implant（BC），植體植入及引導骨再生手術後拍攝第一次電腦斷層掃描，接著贋復體承重一年後進行第二次電腦斷層掃描，觀察兩次斷層掃描影像在植體的垂直頰側骨厚度以及植體平臺距頰側骨高度的差異。結果：植牙贋復體承重一年所測得的牙菌斑指數（mPI）、牙齦溝出血指數（mSBI）以及牙周囊袋深度（PD）變化均無明顯差異性。另外，承重一年後植體的頰側骨厚度均減少，以對照組來看距離植體平臺1 mm、3 mm、5 mm的頰側骨厚度為1.82 mm、2.6 mm、2.82 mm，而實驗組則為1.7 mm、1.7 mm、2.03 mm。植體平臺至頰側齒槽骨高度的統計中發現對照組在贋復體承重後一年高度為1.52 mm，而實驗組則是1.02 mm。結論：本初期研究發現Buser的術式在東方人上顎前牙區的引導骨再生手術可重現性極高，即使是不同操作者在臨床上也能得到相似的結果。而FDBA及BioOss兩種骨移植體用於早期植體植入後承重一年追蹤發現植體頰側骨厚度及高度均保持穩定。

並列關鍵字

上顎前牙區 ； 早期植體植入 ； 引導骨再生手術 ； 植體頰側骨厚度