噴砂酸蝕合併鹼酸熱處理對牙科植體骨整合之影響評估:動物試驗

以植體來取代缺失的牙齒，自1970年代發展自今，已成為目前牙科常見的治療方式。而植牙的成功與否端視骨整合而定，而骨整合卻需等待一段不算短的時間，許多文獻指出經特殊表面理後的植體可加速骨整合縮短癒合時間，重建一個穩定且可長期承受咬合力量的人工牙根，必須建立在植體表面骨細胞的生長鈣化。我們實驗目的想評估不同表面處理的植體對於骨整合的影響。首先種植體經噴砂酸蝕合併鹼酸熱處理( Sand-blasted ,Large grit, Acid -etched combined Alkaline ,Acid , Heat surface treatment(SLA+AAH)) 的新型經覆合表面技作術人工牙根植體為實驗組，並配合經大顆礫噴砂酸蝕(Sand-blasted ,Large grit, Nobel Biocare之NP Acid –etched(SLA))表面處理植體，及另一種經陽極氧化處理的國外大廠產品(BK-NP)為對照組。主要研究分成經新型經覆合表面技作術開發出不同表面處理的鈦金屬牙科植體共一組( SLA+AAH)為實驗組，並配合大顆礫噴砂酸蝕(Sand-blasted ,Large grit, Acid –etched(SLA))表面處理植體為對照組一，國外大廠產品TiUnite表面處理(Nobel Biocare - NP)為對照組二。在本研究中，共分為4，8，12週組，每組使用三隻beagle dog，共使用9隻狗，每隻狗下顎左右兩側，隨機植入一支實驗組及二支對照組(SLA and TiUnite) 植體，並立即接上癒合樁暴露於口腔將中，另在8周組後腿，同樣隨機植入一支實驗組及二支對照組，作為移除扭力測試實驗用，以頻率分析儀(Osstell Mentor)在0，4，8，12週，在臨床上作非侵入性ISQ值測試，並同時觀察口內植體狀況。在動物犧牲後取得標本，切片觀察各組骨頭與植體的接觸(BIC)，與骨生成範圍的變化。藉由電子顯微鏡下觀察，可以觀察到經不同的植體表面處理，會造成不同的表面型態，不同粗糙度，不同孔徑大小。而在對實驗組中( SLA+AAH)，不論是在ISQ值表現，植體存活率，移除扭力測試，骨頭與植體的接觸與新骨生成範圍，相較SLA與TiUnite表面處理(Nobel Biocare - NP)為對照組，有統計上明顯差異。而就SLA+AAH與SLA及TiUnite表面來說，可能SLA+AAH表面先經SLA表面處理增加表面積，與較多的孔洞，再經酸鹼熱處理，表面有較多的類骨質鈣磷沉積，所以在扭力測試，骨頭與植體的接觸與骨生成範圍的表現都較佳。另一方面，在腿部移除扭力實驗中，因傷口緊密縫合，相較暴露於口腔中受細菌污染及咬合干擾，不論實驗組或對照組，他們在植體存活率，骨頭與植體的接觸與骨生成範圍都明顯較口腔中表現佳。就臨床上來講，粗糙化表面處理的植體仍是目前人工牙根的主流，但表面型態，不同粗糙度，不同孔徑大小及表面帶有類骨質鈣磷沉積，這些因素如何誘導更多骨細胞攀附在植體表面上，進一步加速骨整合的發生，則更需進一步的實驗證明。

關鍵字

骨整合；噴砂酸蝕合併鹼酸熱處理；大顆礫噴砂酸蝕處理；陽極氧化處理

並列摘要

Since 1970s, replacement of missing teeth with dental implant has become a popular treatment option in dental treatment. The successful implant depended on the osseointegration between implant and bone which took a period of time for healing. Various surface treatment schemes on dental implant have being developed in order to hasten osseointegration thus shorten the healing time. Surface treatment scheme using sand-blasted, large grit, acid-etched surface treatment (SLA) has been proposed used for a period of time; however, SLA treated implant still need more healing time for osteointergration. Recently, a new surface treatment scheme using alkaline, acid and heat surface treatment (AAH) surface treatment has been proposed. The purpose of this study is to evaluate the effect of two new surface treatments (Sand-blasted ,Large grit, Acid -etched combined Alkaline ,Acid , Heat surface treatment(SLA+AAH)) on osseointegartion. Three different surface treatment implants with two type screw design, one surface treatment is SLA+AAH surface treatment type, the other is SLA (Sand-blasted, Large grit, Acid etched),with same screw design and TiUnite (Nobel Biocare - NP) were compared. Nine beagle dogs were enrolled in this study, divided into 3 groups (4, 8, 12 weeks), six dental implants were inserted in each dog included two experimental groups(SLA+AAH) and two control group(SLA and TiUnite). The assessments of implants are including clinical evaluation, survival rate, resonance frequency test and photo record. Experimental parameters including resonance frequency test(ISQ), bone implant contact (BIC) ,remove torque test were used to analysis the integration of bone and implant. The dogs were sacrificed at the time interval of 4, 8, 12 weeks for further histological analysis. In 8weeks group , implants were placed in tibia for removal torque test. The results showed the value of SLA+AAH surface treatment group in resonance frequency test is slightly higher than SLA group and TiUnite group . It seems that the potential for SLA+AAH chemical modification of the implant surface may possess good biologic events during the osseointegartion process and offer some superiority to implants with the SLA and TiUnite surface. Further study is needed to distinguish the variables for hastening of osseointegartion with modality of new surface treatment.

並列關鍵字

osseointegration ； SLA+AAH ； Ti Unite resonance frequency test(ISQ) ； bone implant contact (BIC)

參考文獻

1. Schwartz O, Frederiksen K, Klausen B: Allotransplantation of human teeth. A restrospective study of 73 transplantations over a period of 28 years. International journal of oral and maxillofacial surgery 1987, 16(3):285-301.

2. Kvint S, etal : Autotransplantation of teeth in 215 patients. A follow-up study. The Angle orthodontist 2010, 80(3):446-451.

4. Branemark PI, etal : Intra-osseous anchorage of dental prostheses. I. Experimental studies. Scand J Plast Reconstr Surg 1969, 3(2):81-100.

5. Arvidson K, etal : Histological characteristics of peri-implant mucosa around Brånemark and single-crystal sapphire implants. Clinical Oral Implants Research 1996, 7(1):1-10.

6. Branemark PI: Osseointegration and its experimental background. The Journal of prosthetic dentistry 1983, 50(3):399-410.

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噴砂酸蝕合併鹼酸熱處理對牙科植體骨整合之影響評估:動物試驗

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