The Biological Complication after Guided Bone Regeneration Using Titanium Mesh and Synthetic Absorbable Membrane-A Case Report and Histological Results

使用鈦網及合成性再生膜進行引導骨再生術造成術後併發症－病例報告及組織學結果

林承俊(Cheng-Jyun Lin) ； 陳俊榮(Chun-Jung Chen) ； 毛念平(Lian-Ping Mau)

《中華民國家庭牙醫學雜誌》 9卷1期 (2014/06) Pp. 27-35

https://doi.org/10.6566/JFD/2014.9(1).27

摘要

本病例報告之目的在探討使用合成性可吸收再生膜進行引導骨再生術時，所引起的生物性併發症。患者為28歲女性，無全身性疾病及不良習慣，右側上顎第一小臼齒至第一大臼齒因長期缺牙導致骨量不足，經評估後決定進行引導骨再生術及階段性植牙。手術以自體移植骨及異體移植骨（SinboneHT®），並配合鈦網和聚乳酸再生膜（Epi-Guide®）來完成。一周後發現手術區有腫脹情形，而在十一天後發現有瘻管產生；於是先投以全身性抗生素治療，並定期以生理食鹽水大量沖洗後，症狀才漸漸緩解。術後六個月時仍可見到未完全癒合之瘻管及隱約可見的鈦網，在重新進入手術區並移除鈦網後，尚可見到未吸收完全的骨粉顆粒。在徹底清創後，在右側上顎第一小臼齒及第一大臼齒位置各植入一植體並在骨再生位置取一骨頭樣本，與所刮除下來的軟組織進行組織學檢驗，於顯微鏡下發現噬中性白血球、異物巨細胞及淋巴球證實有發炎性異物反應存在。患者於植牙後三個月完成贗復治療並經十個月追蹤，在X光片上皆無明顯骨破壞發生；在後續的門診追蹤中，患者並無任何不適或症狀。由本病例我們結論此併發症發生於聚乳酸可吸收性再生膜分解時所導致之不可預期性的反應，此一反應可能會導致進行引導骨再生術後組織的不良反應。

關鍵字

引導骨再生術 ； 合成性再生膜 ； 聚乳酸 ； 鈦網

並列摘要

The purpose of this case report describes a biologic complication related to synthetic absorbable membrane in guided bone regeneration (GBR). A healthy 28-year-old patient asked for restoring upper posterior partially edentulous areas. Clinical examination and radiographs showed missing of teeth 3 through 5 and teeth 13 through 14. Ridge augmentation was planned on her right maxillary edentulous ridge, and GBR was performed by Titanium mesh along with polylactic acid (PLA) membrane. Implants were placed six months later. One week after ridge augmentation, gingival swelling and sinus tract with mild pus discharge were observed on the buccal gingiva. Antibiotic administration was kept for one month. However, the titanium mesh was slowly exposed and very few graft particles can be found one month after the surgery. Closely follow-up and oral hygiene care were kept during whole healing phase since there were no signs of infection. Six months later, two implants were placed uneventfully and an implant-supported fixed partial denture was fabricated and loaded 5 months later. Histological result showed new bone formation with lots of soft tissue surrounding. Three-years following showed a very successfully clinical outcome. We concluded that this complication was an unpredictable reaction to the polylactic acid membrane. Such a reaction can affect soft and hard tissue healing following GBR. Long-term follow-up is needed to determine stability of the results.

並列關鍵字

Guided bone regeneration ； Synthetic Absorbable Membrane ； PLA ； Titanium mesh