| Background:In recent years, with the rapid development and wide application of oral implant technology, implants in maxillary sinus also were have obtained great progress. But oral implant in maxillary sinus region is facing great risks. In a fairly long period of time, the maxillary posterior region implant failure rate is significantly higher than maxillary anterior region and mandible posterior region. The reason of that is closely related to available bone, so that need some bone graft material as a scaffold, guide or inducing new bone formation, completed the reconstruction of the structure and function, had organizational structure and mechanical characteristics similar to natural bone and obtained good clinical effect.Now commonly in clinical will use coralline hydroxyapatite, CHA and bovine derived hydroxyapatite, BDHA as the representative of xenogeneic bone material use in maxillary sinus graft. The two kinds of materials are main of hydroxyapatite, but some differences can be observed find in clinical work. BDHA is formed with bovini bone extraction of bone protein, and its mixed with autologous bone can make blood is fixed, is beneficial to osteoblast attachment bone and activation of this reaction, but in the long-term clinical practice found it not easy to completely absorbed in body, some scholars therefore categorical that BDHA likes a semi-permanent materials. Another common bone substitution materials is CHA. CHA made from natural coral and through hydrothermal reaction to put HA on the surface. In clinical work find that it can absorb quickly.BDHA and CHA can achieve and requirements easily.They inserted in body can obtain stable and induce body to produce new osteoid tissues, get up to more than90%success rate of implant treatment process. Doctors and patients enjoy to use them. But them in maxillary sinus lifting process had different performance,There without related documents and reports and worth further research and analysis.Objective:In view of this two different material clinical performance are different in maxillary sinus lifting, so the design of clinical trial to use physical morphology and physicochemical properties and imaging analysis about CHA and BDHA changes after in the maxillary sinus graft. To study the absorption and renovation in the postoperative, summar data and provide and provide a reference of the operation time selection for maxillary sinus grafting.Methods:Using scanning electron microscopy and Fourier Transform Infrared Spectrometer to determine CHA and BDHA physical morphology and physicochemical properties.23patients which had finished maxillary sinus lift and implant were selected in Guang dong Provincial stomatological hospital at2007-2011.One group was grafted with as the main part of CHA (Group A), and the another group was augmented with as the main part of BDHA (B group). Implants were placed and then the final restorations were finish on schedule.These panoramic radiographs which will be take in five different clinical times, The measured vertical heights were evaluated to assess whether there was the height loss and change with panoramic radiographs.And gray values changes also will be measured.All data using SPSS13.0software for analysis.Results:1.Scanning electron microscopy results:In30and100times, two different bone substitute material surface have different sizes gaps and walking texture; In1000and3000times, CHA surface structure walks more disorder, with lots of surface gaps and processes; BDHA surface with more uniform texture orientation and surface gap.2.Elements of the two kinds of materials are basically the same, but CHA calcium to phosphorus ratio was7.83±0.05and BDHA is1.89±0.05.3.Crystalline carbonate degradation of CHA is higher than BDHA, but the crystallization of the hydroxyapatite is lower than BDHA.4.In this study, a total of23patients were studied. The patients were satisfied with the treatment, and no implant loosening and shedding. There are2cases after restoration appear prosthesis off,1case in A group,1case in B group.5.result analysis(1) vertical reconstruction analysis between with the two different bone substitute material after maxillary sinus liftingIn this experiment, through calculate the difference of the vertical distance measurement of A, B groups at T1and T2, data contrast between the two groups have no statistical difference.(P>0.05)At T3time,vertical change height of corresponding sitesin the two groups are statistically significant change (P<0.05); A, B changes in percentage are statistically significant changes (P<0.05). Between T2-T3period A group material alterations is much larger than B group materials. At T3time, A and B groups in each point (P1, P2, P3) have no significant difference between the amount of change.(P>0.05)At T4time,vertical change height of corresponding sitesin the two groups are statistically significant change (P<0.05); A, B changes in percentage are statistically significant changes (P<0.05). Between T3-T4period A group material alterations is much larger than B group materials. At T4time, A and B groups in each point (P1, P2, P3) have no significant difference between the amount of change.(P>0.05).At T5time, A, B groups P1, P3points had no significant changes (P>0.05); and height change of the two groups in P2point exist statistically significant change (P<0.05); and in A and B group, P1, P2, P3changes no statistical differences.(2) gray value change analysis between with the two different bone substitute material after maxillary sinus liftingIn T1, T2, T3period,A, B groups X-ray gray have no significant difference (P>0.05); and T4, T5period two groups X-ray gray value have differences (P<0.05).In A groups,bone graft area gray value existed significant differences between different periods(P<0.05); In B groups,bone graft area gray value existed significant differences between T1and different periods(P<0.05), and others periods of B group without no obvious difference of gray value (P>0.05).Conclusion:1The main components of CHA and BDHA are basically the same, are HA and calcium carbonate.But the composition of the two components of the ratio is different,CHA is main component of carbonate;and BDHA is main component of HA. 2Analysis showed that CHA and BDHA have vertical absorption and change after inserted6months,and with times went that changes gradually reduced;CHA changes is significantly greater than BDHA.3Analysis showed that CHA has gray value reduced after inserted6months,and with times went that tends to autologous bone leve; And BDHA has no obvious change. |
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