The Outcome of Ridge Augmentation Using an Allograft Bone Block Prior to Implant Placement in the Posterior Atrophic Ridge - A Retrospective Case Series Study

在後牙萎縮骨脊以同種異體移植骨塊進行植體植入前之骨脊增大術的結果－系列病例研究

蔡幸娟(Hsing-Chuan Tsai) ； 黃國精(Kuo-Ching Huang) ； 陳俊榮(Chun-Jung Chen) ； 林玫吟(Mei-Yin Lin) ； 官語晨(Yu-Chen Kuan)

《臺灣牙周病醫學會雜誌》 22卷1期 (2017/03) Pp. 19-27

https://doi.org/10.6121/TAP.2017.22.1.04

摘要

Background: Ridge augmentation is necessary to increase the height and width of the ridge in order to facilitate subsequent reconstruction in areas where the alveolar bone has atrophified or where the implant cannot be placed in an ideal prosthetic position. Many types of bone graft materials have been used to increase the bone volume during guide bone regeneration procedures. Research has shown that the application of a bone block graft has a better outcome than the use of a particulate bone graft when treating large bony defects. According to the literature, the use of an autograft bone block and of an allograft bone block, when used for ridge augmentation, results in alveolar bone height gains of 3.6 to 4.75 mm and 4.3 mm, respectively. However, acquiring an autograft bone block needs an increased surgical area, which will result in greater patient discomfort and an increased probability of postoperative complications; furthermore, the volume of bone available intraorally is limited. In such circumstances the use of an allograft bone block is able to overcome the problem of donor side morbidity and provides another treatment option. The aim of this study is to explore the survival rate of allograft bone blocks placed in atrophic posterior alveolar ridges before implant placement, to explore the changes that occur in such grafts and to assess implant survival rate. Material and methods: A total of five patients, who had six alveolar bone defect sites, received ridge augmentation using allograft bone blocks before implantation between 2011 to 2013 at our Department of Dentistry, Chi Mei Center; all subjects met our criteria for this study. Allograft bone blocks (FDBA bone block) were introduced into the bony defects and the site was filled with particulate bone graft material (FDBA) around the block; the site was then covered with a collagen membrane (Ez-cure^(TM) collagen membrane) and primary closure achieved. Implantation was performed on an average at 6.2 months postoperative. Panoramic radiography was carried out before the operation, after ridge augmentation and after implant placement. Statistical analysis was performed by paired Wilcoxon's signed rank test. Results: The allograft bone block survival rate was 100%. The postoperative complications included late exposure of one site, but none of them resulted in any infection. The average increase in vertical alveolar bone height was 7.25 mm. Implantation was performed an average of 6.2 months after surgery and fourteen implants were inserted. The mean follow up period was 30 months after implant placement and the implant survival rate was 100%. Conclusion: The use of allograft bone blocks when carrying out ridge augmentation of atrophic alveolar ridges before implant placement is a reliable treatment option. However, further research is needed on the long-term survival of such implants and these studies should be supported by large patient numbers.

關鍵字

allograft bone block ； ridge augmentation ； dental implant ； retrospective study

並列摘要

背景：在齒槽骨萎縮的區域或植體無法置放在理想的贋復位置時，常必須進行骨脊增大術（ridge augmentation）增加齒槽脊的高度及寬度以利後續重建。許多骨移植材料也被運用在引導骨再生術來增加垂直或水平齒槽骨高度，研究指出在大範圍的骨缺損，使用骨塊來增高效果會比骨粉來的好，根據研究，使用鈦網跟引導骨再生術來進行骨脊增大術的結果，所增加的齒槽骨高度分別為2.56～5.8 mm及2.5～7 mm，而使用自體骨塊跟同種異體骨塊移植所增加的齒槽骨高度分別為5 mm及4.3 mm。然而自體骨塊移植，骨塊的取得會增加手術區域造成病人較大的不適感及術後併發症機率上升，且口內收集到的骨量（bone volume）是有限制的。而同種異體骨塊移植可以克服術後donor side morbidity的問題，提供治療的另一個選擇。本篇研究之目的在臨床上後牙齒槽骨脊萎縮處，於植體放置前以同種異體移植骨塊進行骨脊增大術，來探討同種異體骨塊移植之存活率、骨塊垂直高度變化量、植體存活率以及術後併發症。方法：本回溯性（retrospective）研究收集本院牙科於2011至2013年間因後牙齒槽骨脊萎縮，於植體放置前以同種異體移植骨塊來進行骨脊增大術之患者，排除資料不全者，共計5位患者（年齡介於35至54歲），其中一位患者是雙側下顎後牙齒槽骨脊萎縮，共6個部位局部齒槽骨缺損。患者對於上述缺牙區域皆以人工植牙做贋復。參與患者皆接受同種異體移植骨塊來進行骨脊增大手術，術中將同種異體移植骨塊（OraGraft, LifeNet Health）修形來符合骨缺損的形狀後置入並以骨釘固定並於周圍置放顆粒性骨移植物（FDBA）作充填，再覆以膠原蛋白再生膜（Ez-cure^（TM） collagen membrane, Biomatlante），並以CV-5和5-0 Nylon將翻瓣縫合以達初級閉合（primary closure）。平均術後6.2個月進行植牙。於術前、骨塊移植術後、植牙手術後，皆有拍攝環口攝影片來紀錄。經測量骨頭的高度後，進行統計分析。結果：5位患者共6個部位進行同種異體骨塊移植，骨塊的存活率是100%，術後併發症包括：一個移植區產生early exposure的情形，另一個移植區產生late exposure，但皆無造成感染發炎，平均齒槽骨垂直高度增加7.25 mm。平均術後6.2個月進行植牙手術，共置放14根植體，皆以植體支持之固定補綴物贋復，於植體置放後平均追蹤30個月，植體的存活率是100%。結論：在齒槽骨脊萎縮的區域，若須以植牙贋復，使用同種異體骨塊移植來進行骨脊增大術，是一項值得信賴的治療選擇，但仍需要更長期、大量樣本數的研究來支持。

並列關鍵字

同種異體移植骨塊 ； 骨脊增大術 ； 人工植牙 ； 回溯性研究