| Objective: Insufficient bone mass will have a negative impact on implant implantation and long-term effects.In order to increase bone mass,various bone augmentation techniques need to be combined with bone substitute materials to achieve good clinical results.Despite the rapid development of various bone substitute materials,they all have their own limitations,such as limited sources,risk of spreading diseases,and high prices.Autologous dentin has almost the same chemical composition as alveolar bone,and has similar structure and physical and chemical properties to cortical bone,so it has recently become a research hotspot as a new type of bone substitute.This study evaluated the osteogenesis effect and safety of partially demineralized autogenous dentin matrix(PDADM)as a bone graft material for preservation of alveolar socket sites and bone augmentation surgery during implant surgery.Methods:From September 2018 to September 2020,13 patients who used PDADM as bone graft materials in Affiliated Stomatological Hospital of Dalian Medical University were used for preservation of alveolar bone sites and alveolar bone augmentation.A total of 13 patients 17 implants were implanted,aged 36-68 years old.Socket preservation with PDADM was applied in six patients,and delayed implantation of 7implants;5 patients received immediate implantation and GBR with PDADM was used to restore labial alveolar bone defect,and 6 implants were implanted.;Three patients underwent maxillary sinus floor augmentation,and PDADM was implanted into the maxillary sinus floor to increase the height of maxillary alveolar bone and implant 4implants(One patient underwent socket preservation and maxillary sinus floor augmentation at the same time).Follow-up observations were performed before surgery,immediately after surgery,3 months,and 12 months,respectively,to evaluate the healing and contour changes of the bone graft area,and perform Radiology analysis of the bone regeneration status in the bone graft area.With the consent of the patients,2patients who underwent site preservation used a trephine to obtain the bone tissue of the transplant area for pathological paraffin biopsy and histomorphological analysis.During the follow-up period,the postoperative response,satisfaction,oral hygiene and oral mucosal health of patients were quantitatively evaluated according to the standards.Results: 1.Evaluation of general conditions:(1)All cases achieved initial healing,with mild postoperative reactions,and no complications such as infection,nerve injury,and maxillary sinus perforation.(2)All implants achieved good initial stability when implanted.(3)All implants formed a good osseointegration 3-6 months after surgery,and the upper part was repaired.All patients were satisfied with the treatment effect.(4)The implants of all patients remained 100% during the follow-up period,and there was no bone resorption or gum disease.(5)During the follow-up period,the oral hygiene of the patients was regularly evaluated and intervened.The oral hygiene and mucosal health of the patients were significantly improved.2.Evaluation of bone regeneration effect:(1)The mean height(H0)immediately after socket preservation is 14.60 mm,and the mean bone height(H1)3 months after socket preservation(before implantation)is 13.39 mm.The difference is obvious.It shows that the alveolar bone will inevitably undergo resorption after socket preservation,and this unavoidable resorption also occurs in the results of socket preservation using Bio-oss and other xenograft materials.The mean bone height(H2)3 months after socket preservation(immediately after implantation)was 12.65 mm,and the mean bone height(H3)12 months after socket preservation was 12.14 mm.There was no significant difference in comparison.The use of PDADM as a bone substitute material in the socket preservation technique has a stable osteogenesis effect.(2)The mean value of bone height(H0)before maxillary sinus floor augmentation was 3.81 mm,the mean value of bone height(H1)3 months after operation was 11.22 mm,and the mean value of bone height(H2)12 months after operation was 10.99 mm.The analysis and comparison show that the height H1 3 months after operation is significantly higher than the height H0 before operation;the height H2 12 months after operation is significantly different from the height H0 before operation,and the bone mass is significantly increased after operation.PDADM as a bone substitute material for maxillary sinus floor augmentation to promote osteogenesis has a good effect..There is no significant difference between the bone height H1 at 3 months after operation and the bone height H2 at 12 months after operation,indicating that PDADM has stable osteogenesis effect.(3)The mean bone width(W0)before alveolar ridge augmentation was 6.00 mm,the mean bone width(W1)was 7.66 mm after 3 months,and the mean bone width(W2)was 7.53 mm after 12 months.The statistical analysis showed that the width W1 at 3 months after surgery was significantly increased compared with the width W0 before surgery;the comparison between the bone width W0 before surgery and the bone width W2 at 12 months after surgery showed that there was a significant difference between the two.PDADM was used as a bone replacement material.Entering the jumping gap and restoring the bone defect on the labial side achieved a good osteogenesis effect.Comparing the width of 3months after operation(W1)and the width of 12 months after operation(W2),there is no significant difference between the two,indicating that the long-term osteogenesis effect after PDADM is stable.(4)Because the dentin particles are partially demineralized,CBCT showed high-resistance projections in the bone graft regeneration area immediately after the operation.During the follow-up period,CBCT examination showed that the density of the bone graft regeneration area gradually decreased at 3months and 12 months after the operation.It is caused by the gradual absorption of dentin particles and the regenerated new bone is not fully mature.(5)Under the histological microscope,it can be seen that the dentin particles are directly combined with the new bone after 3 months of transplantation,the new bone trabeculae are arranged disorderly,and the loose connective tissue and immature braided bone infiltrate the graft absorption site.Conclusion: In this study,through clinical case observation,PDADM prepared immediately onsite after tooth extraction was used as a bone substitute material for bone augmentation surgery related to implant treatment,and good osteogenesis results were achieved.The study found that all implants formed good osseointegration.All cases completed the upper repair.No systemic or local complications occurred during and after the operation.During the one-year follow-up,all the restorations functioned normally,and the patients were consciously satisfied.Therefore,through this study,we believe that PDADM is a safe and effective bone graft material.Since it is derived from the body,there is no rejection reaction,the patient is easy to accept,and the production is simple and quick and the effect is reliable.Therefore,PDADM is expected to be an alternative bone graft material in the treatment of bone augmentation. |
PDF Full Text Request