Impact of Defect Size on Vertical Bone Augmentation ＂in Vivo＂

缺損大小對活體垂直骨增生效果的影響

董醒任(Tony Shing-Zeng Dung) ； 杜裕康(Yu-Kang Tu)

《臺灣牙周病醫學會雜誌》 20卷3期 (2015/09) Pp. 169-177

https://doi.org/10.6121/TAP.2015.20.3.02

摘要

目的：本實驗的目的在探討缺損大小對兔子頭骨垂直骨增生效果的影響。材料與方法：以十二隻3~14個月年齡之紐西蘭品系兔子頭骨為動物模型。麻醉後將頭骨正中表皮垂直切開並翻開。本研究分成小缺損（實驗組）與大缺損（對照組）兩組。頭骨兩側先以直徑3或5mm環鋸（trephine drill），配合大量生理食鹽水下，鑽出1.5至2.0mm深的環狀峽口。先將周邊血混合脫鈣冷凍乾燥骨置入直徑6或10mm之鈦合金圓蓋內，待血塊凝結再將其卡入頭骨環狀峽口。3個月後將兔子犧牲，取下頭骨，以福馬林（formalin）固定後，以formicacid脫鈣，然後去掉鈦帽，組織包埋並切片後以H&E及trichrome染色。以Boleygauge測量鈦帽內正中間新骨填充高度之百分比。骨癒合程度以半定量方式評估；1，2，3分別代表垂直增生組織中約有＜25%，25~50%，＞50%新骨形成。骨填充之高度百分比用Student’spairttest分析各組配對參數數值（parametric data）平均值之統計差異。骨癒合程度之非參數數值（non-parametric data）之統計差異則以Wilcoxan matched-pairs, signed-ranks test測試。結果：結果發現大小缺損皆有新骨生成。小缺損部位骨填充高度平均93.8%，大缺損部位骨填充高度平均75.0%，兩者之間有顯著的差異（p=0.02）。大缺損部位垂直增生之新骨組織平均積分1.2，小缺損部位新骨組織平均積分1.8，兩者之間有顯著的差異（p=0.008）。結論：在本兔子頭骨研究的條件下，小的缺損促進垂直骨增生的高度與生成新骨的量皆明顯較多。大的缺損似乎需要較長的時間才能生成成熟的新骨。垂直增生新骨所需的時間與其何時適合承載，仍需進一步臨床對照研究。（臺灣牙周醫誌，20(3):169-177,2015）

關鍵字

缺損大小 ； 脫鈣冷凍乾燥骨移植 ； 垂直骨增生術 ； 動物實驗

並列摘要

＂Materials and Methods＂: Twelve 3 to 14 month-old male New Zealand white rabbits were used. Titanium caps of 3 mm or 5 mm radius were filled with demineralized freeze-dried bone and placed upside down on left or right side of the rabbits' calvaria. After 3 months of healing, the skulls were retrieved ＂en bloc＂ with the caps ＂in situ＂ and processed for histological observation. Coronal sections were cut through the center of the augmented tissue. The highest point of the augmented tissue was measured directly with a Boley gauge. Bone healing was evaluated by a semi-quantitative bone score system based on the relative proportion of newly formed bone in the caps. ＂Results＂: The small defect size was found to give a significantly greater percentage at 93.8% of bone fill than the large defect size at 75.0% (p=0.02). In terms of new bone formation, the Wilcoxon signed-rank test showed that the small defects had significant higher bone scores than the large defects (p=0.008). ＂Conclusions＂: The results from the present in vivo rabbit calvarial model show that small defects have a significant greater percentage of bone fill and higher levels of new bone formation. During vertical bone augmentation of larger defects, the process seems to take longer for the new bone to form and mature. Further studies are needed to evaluate the appropriate healing time for vertically augmented new bone in relation to implant loading. (J Taiwan Periodtontol, 20(3):169-177, 2015)

並列關鍵字

defect size ； DFDBA ； vertical bone augmentation ； in vivo