與骨整合相關的骨頭－植體交界面的初期傷口癒合：(Ⅰ)植體的材料性質與細胞互動對交界面的影響

Early Wound Healing at bone-implant Interface Related to Osseointegration.: Part (Ⅰ) the Influence of Material Property and Cellular Interaction to Interface

何政昇(Albert Cheng-Sheng Ho)

《臺灣牙周病醫學會雜誌》 16卷1期 (2011/03) Pp. 59-90

摘要

隨著電子顯微鏡的出現，臨床牙醫師們對於骨整合的了解已經由micrometer (μm)的層級進展到nanometer (nm)的層次，而骨整合的詮釋也由所謂的在骨頭與植體之間存在著功能與結構的直接街接的觀念到電子顯微鏡下的觀察，在骨頭與植體之間的交界面仍有一些amorphous layer，包括proteoglycan及混合一些immature fiber與filament。凸顯出一個事實：即使被公認親和性相當高的鈦合金，對緊緊相鄰的骨頭而言，也會產生某種程度的異物排斥反應。也因此令人好奇的是，在植體植入齒槽骨後，究竟骨頭與植體間的互動爲何？交界面如何在傷口癒合的過程中達到最後所謂的骨整合？如何藉由植體表面的設計處理與細胞互動的證據，來影響傷口癒合的速度，進而影響日後植體負荷的時間？植體初期穩定度又如何影響傷口癒合的進度及植體負荷的時間？如果釐清交界面間骨頭與植體的互動與癒合，將有助於進一步了解臨床上植體負荷的適當時間與治療計畫的安排，也能容易掌握長期成功的植體治療。在本文的第一部份，將由基礎研究來思考骨整合的定義與本質，並先針對植體金屬及表面結構與周圍生物環境的互動做一探討。此外，也進一步討論在交界面remodeling中的主要細胞與其細胞世代，相信將有助於釐清材料性質與植體表面處理對交界面骨整合的影響。

關鍵字

交界面 ； 骨整合 ； 植體負荷 ； 初期穩定度

並列摘要

With the emerging development of electron microscope, the disclosure of osseointegration was upgraded from the level of micrometer to the level of nanometer for clinicians. The definition of osseointegration was also switched from the concept of direct functional and structural connection between bone and implant to the findings described as an amorphous interfacial layer with proteoglycans, infiltrated immature filaments and fibers under the observations of electron microscope. It reveals a fact that there still seems to have some kind of foreign body rejection when bone was next to the highly compatible titanium alloy implant. It is so curious to find out the interaction between implant and alveolar bone after implantation. How bone-implant interface achieves the final osseointegration during the process of wound healing? How the evidences of interaction between surface design and treatment of implant and cellular response, influence the proper time of implant loading? How primary stability influences the time frame of wound healing and further the proper time of implant loading? If the interaction between bone and implant could be elucidated, it helps more understand the proper time of implant loading and well-designed treatment planning for clinicians as well as the long-term success of implant treatment can be easily under control. In the first part of this review, the definition and nature of osseointegration will be explored based on basic research, and the interaction between implant metal property as well as surface texture and the surrounding biologic environment will be discussed further. Besides, those major cells and their cell cascades during the interface remodeling are also revealed. It will help clarify the influence of metal property surface treatment to the osseointegration at the interface.

並列關鍵字

interface ； osseointegration ； implant loading ； primary stability