- 學位論文
利用迷你豬實驗評估表面處理過氧化鋯基牙科植體對骨整合之影響
Effect of Surface Treatment on osseointegration of Zirconia-based Dental Implant – A mini-pig study
摘要
目的： 本實驗乃評估新式氧化鋯基（Zirconia-based, Zr）牙科植體的動物實驗骨整合效果。 材料與方法： 利用表面處理過（Zr表處）和未表面處理（Zr未表處）之氧化鋯基牙科植體為實驗組，而表面處理過之SLA（鈦SLA）鈦金屬商品為對照組，分別植入十隻八至十二個月大迷你豬的上下顎骨。植完後分兩組，一組為八週犧牲，另一組為十六週犧牲。犧牲後取下包含植體之骨塊依序以進行共振頻率植體穩固度分析、Micro CT 骨體積分析、掃描式電子顯微鏡（SEM）分析及Masson Goldner 組織染色切片分析，其中利用共振頻率（RF）量測穩固度、Micro-CT 骨體積以螺紋間之骨植體接觸體積百分比（BIV, bone-to-implant volume）作為測量，另電子顯微鏡及Masson Goldner以螺紋間之骨植體接觸百分比（BIC, bone-to-implant contact）作為測量，其數值以（平均值 ± 標準差）計算呈現，以t檢定做統計。顯著差異值為P < 0.05。並觀察螺距間軟硬組織之生長、骨組織之生長及骨組織之成熟度。 結果： 實驗結果顯示依序以上顎： Zr表處、Zr未表處、鈦SLA；下顎：Zr表處、Zr未表處、鈦SLA來呈現數值。共振頻率植體穩固度分析中其平均共振頻率（KHz）8週組分別為上顎：8.3±1.3、10.7±0.4、10.7±1.9；下顎：11.3±0.8、11.3±0.8、9.7±1.3；在16周組分別為上顎：11.1±1.9、10.7±1.1、10.4±0.9；下顎：11.51±2.4、10.9±1.1、9.4±0.6。Micro-CT骨體積分析，其平均骨體積(%)在8週組為上顎：43.2 ± 1.2、38.8 ± 1.4、53.8 ±4.7；下顎：41.3 ± 2.4、39.3 ± 2.8、50.0 ± 8.6；在16週組為上顎：43.3 ± 1.5、39.9 ± 3.0、47.7 ±2.4；下顎：42.3 ± 1.6、43.1 ± 0.9、56.6 ±2.8； SEM分析，其平均骨植體接觸百分比BIC(%)，在8週組為上顎：88.5 ± 13.1、66.4 ± 15.7、92.5 ± 3.8；下顎：85.4 ± 11.1、68.6 ± 19.4、93.2 ± 9.2；在16週組中分別為上顎：88.8 ± 15.4、62.4 ± 18.3、93.1 ± 5.7；下顎：92.5 ± 10.3、66.9 ± 15.5、94.6 ± 6.2。Masson Goldner’s 染色法分析BIC(%)在8週組中為上顎：88.3±8.9、69.5±12.1、88.8±7.8；下顎：92.1±11.7、81.5±16.2、93.2±4.9；在16週組為上顎：92.9 ± 10.1、74.8 ± 14.4、89.5±8.2；下顎：91.4 ± 11.8、85.2 ± 11.5、94.5±7.2。在共振頻率穩固度分析中，8週組的穩固度大多數組別優於上顎未表處，16周組則沒有統計學上顯著的差異；而檢測時間點上，上顎Zr表處組與Zr未表處組在16 周優於8周。BIV結果顯示，上顎在8周及16周的骨體積量均呈現Zr表處優於Zr未表處，下顎則是鈦SLA優於Zr未表處組。BIC無論是8周、16周，SEM還是Masson Goldner，在上顎均顯示，而Zr表處組與鈦SLA沒有統計上顯著差異，且Zr表處組優於Zr未表處組。另外在Masson Goldner染色組織切片中觀察到，在8周大部分呈現紅色排列較混亂的海綿骨，為未鈣化骨；在16周均可觀察到綠色較成熟的鈣化骨，而Zr表處組其組織切片中層狀骨更為顯著。 結論： 根據以上四種骨整合的動物實驗檢測與觀察中，本實驗經過表面處理之氧化鋯基牙科植體大多數與鈦金屬植體的穩固度與骨整合結果相似。同時，得到較相似一致的共通點為：在較疏鬆的上顎骨中，若能使用表面處理過的氧化鋯植體，可獲得較佳的骨整合效果。
關鍵字
氧化鋯；牙科植體；骨整合；迷你豬並列摘要
Purpose: The objective of this study was to evaluate osseointegration using new zirconia-based dental implants in a mini-pig model. Materials and Methods: Zirconia implants with modified surface-treated and non-treated were used and compared to implants made of commercially titanium with surface-treated. Experimentally, zirconia implants were introduced into the maxilla and mandible of 10 mini-pigs. These ten mini-pigs were divided into 2 groups for sacrifice after implantation, for 8 weeks and 16 weeks. The implants could be analyzed to following. They are resonant frequency (RF) testing for implant stability, bone to implant volume (BIV%) analysis using Micro-Computed Tomography (Micro-CT). After that the samples were sectioned and analyzed bone to implant contacts (BIC) by scanning electron microscopy (SEM) and Masson Goldner’s stain were used to evaluate osseointegration. The data was expressed with mean ± standard deviation. The significant difference was ranged at P <0.05. The results counted by t-test statistics. Results: The results were presented as following order. They are upper : Zr surface-treated 、 Zr surface-untreated、titanium SLA and then lower : Zr surface-treated 、 Zr surface-untreated、titanium SLA. In the 8 weeks group, RF testing average resonant frequency (KHz) were individually get upper : 8.3 ± 1.3,10.7 ± 0.4,10.7 ± 1.9; lower: 11.3 ± 0.8,11.3 ± 0.8,9.7 ± 1.3; in the 16 weeks groups, upper: 11.1 ± 1.9,10.7 ± 1.1,10.4 ± 0.9; lower: 11.51 ± 2.4,10.9 ± 1.1,9.4 ± 0.6. Micro-CT analysis of bone volume, the average bone volume (%) at 8 weeks group showed that upper: 43.2 ± 1.2,38.8 ± 1.4,53.8 ± 4.7; lower: 41.3 ± 2.4,39.3 ± 2.8,50.0 ± 8.6; at 16 weeks group upper: 43.3 ± 1.5,39.9 ± 3.0,47.7 ± 2.4; lower: 42.3 ± 1.6,43.1 ± 0.9,56.6 ± 2.8. The SEM analysis of bone implant contact BIC (%), in the 8 weeks group were individually get upper: 88.5 ± 13.1,66.4 ± 15.7,92.5 ± 3.8; lower: 85.4 ± 11.1,68.6 ± 19.4,93.2 ± 9.2; and in the 16 weeks group, upper: 88.8 ± 15.4,62.4 ± 18.3,93.1 ± 5.7; lower : 92.5 ± 10.3,66.9 ± 15.5,94.6 ± 6.2. Masson Goldner's staining analysis BIC (%) in the group 8 weeks for the upper: 88.3 ± 8.9,69.5 ± 12.1,88.8 ± 7.8;lower: 92.1 ± 11.7,81.5 ± 16.2,93.2 ± 4.9; and in the 16 weeks group for upper : 92.9 ± 10.1,74.8 ± 14.4,89.5 ± 8.2; lower: 91.4 ± 11.8,85.2 ± 11.5,94.5 ± 7.2. At the resonant frequency stability analysis, in the 8 weeks group, majorly showed that upper Zr surface-treated group were better. 16-week group is no statistically significant difference; while the detection time point, the upper Zr surface-treated and Zr surface-untreated which at the 16 weeks were better than 8 weeks group. BIV showed that, in maxilla, 8 weeks and 16 weeks showed Zr surface-treated better than Zr surface-untreated, in mandible, titanium SLA group were better than Zr surface-untreated. BIC either 8 weeks, 16 weeks, SEM or Masson Goldner, are displayed in the maxilla, Zr surface-treated and titanium SLA were no statistically significant difference, and Zr surface-treated were better than Zr surface-untreated. Also, we observed that tissue sections in Masson Goldner staining , more sponge bone and the non-calcified bone were red color in 8 weeks group; also can be observed at week 16 the green mature bone calcification noted, and Zr surface-treated group can find more lamellar bone. Conclusions: The results demonstrated that zirconia implants with modified surfaces result in a well osseointegration which is comparable with that of titanium implants. Simultaneously, the results from our study suggest that zirconia implants with modified surfaces display good features of osseointegration especially into the bone loss maxilla.