PROSUDBA KVALITETE I KVANTITETE DOBIVENE KOSTI UPORABOM BIFAZNOG ß-TRIKALCIJFOSFATA/ HIDROKSILAPATITA PRI PODIZANJU DNA SINUSA

Doctoral thesis Croatian OPEN
Jelušić, Damir (2014)
  • Publisher: University of Zagreb. School of Dental Medicine. Department of Periodontology.
  • Subject: BIOMEDICINA I ZDRAVSTVO. Dentalna medicina. | BIOMEDICINE AND HEALTHCARE. Dental Medicine. | Stomatologija | Stomatology | dentalni implantat | podizanje dna sinusa | regeneracija kosti | beta trikalcijev fosfat | hidroksilapatit | dental implant | sinus floor augmentation | bone regeneration | beta-tricalcium phosphate | hydroxyapatite | 616.31(043.3) [udc]

Razvoj dentalne implantologije unaprijedio je različite kirurške metode regeneracije kosti, a jedna od njih jest i podizanje dna sinusa. Svrha ovoga rada bila je provedba kliničkog istraživanja u kojemu su se koristila dva različita sintetska koštana nadomjestka te analiza njihovih svojstava s obzirom na biokompatibilnost, uspješnost regeneracije kosti i utjecaj na stabilnost ugrađenih implantata. Zbog toga je obavljeno 60 zahvata podizanja dna sinusa kod 43 pacijenta podjednako podijeljenih u dvije grupe te je u jednoj obavljena augmentacija uporabom čistog ßtrikalcijeva fosfata, a u drugoj je korištena dvofazna kombinacija ß-trikalcijeva fosfata i hidroksilapatita (60 % HA i 40 % ß-TCP). Obavljene su i radiološke analize digitalnom volumnom tomografijom, histološka obrada uzoraka novostvorene kosti te ocjena stabilnosti implantata analizom rezonantne frekvencije. Radiološkom usporedbom utvrđena je nakon šest mjeseci manja homogenost (1,37 vs. 2,34) i manje smanjenje volumena (6,6 % vs. 22,2 %) dvofaznih materijala. Nakon istog razdoblja bilo je također uočeno manje smanjenje visine augmentata (3,1 % vs. 8,3 %). Histološka analiza oba materijala pokazala je urednu koštanu organizaciju augmentiranog područja. Histomorfometrijski dobiveni su usporedivi rezultati za jednofazni i dvofazni materijal, s nešto većim udjelom novostvorene kosti u grupi s dvofaznim materijalom (38,4 % vs. 36,1 %). Analiza rezonantne frekvencije pokazala je veću promjenu u grupi u kojoj je bio primijenjen dvofazni materijal (10,0 vs. 6,0). Koštani zamjenski materijali korišteni u ovom istraživanju biokompatibilni su i podupiru regeneraciju kosti na osteokonduktivnoj razini. Možemo zaključiti da je dvofazni koštani zamjenski materijal neznatno bolji od čistoga ß-TCP-a s obzirom na stabilnost volumena, radiološku gustoću augmentacije i sekundarnu stabilnost ugrađenih implantata. Zbog dugoročne ocjene rezultata bilo bi poželjno procijeniti stopu preživljavanja implantata nakon augmentacije s oba materijala u razdoblju od dvije, pet i deset godina. The development of dental implantology has resulted in the advancement of surgical protocols of bone regeneration, one of them being maxillary sinus floor augmentation. The aim of the study has been to perform a clinical trial on the use of two different synthetic bone grafts and analyse their characteristics relative to biocompatibility, bone regeneration success rate, and their impact with regards to the stability of inserted implants. In order to achieve this aim 60 surgical procedures of sinus lift have been performed on a total of 43 patients. The patients were subdivided into two groups on the basis of the material used. One group of patients underwent augmentations with pure ß- three-calcium phosphate, whereas for the other group a two-phase combination of ß- three-calcium phosphate and hydroxyapatite (60% HA and 40 % ß-TCP) was used. Radiological analysis with the use of cone beam computed tomography (CBCT), as well as the histological analysis of newly formed bone samples were performed. Radiological analysis showed a decreased homogeneity (1,37 vs. 2,34) and a less volume reduction (6,6% vs. 22,2%) after a six-month period for the two-phase materials. Furthermore, the decrease in height of the augmented area was also less pronounced following the same period (3,1% vs. 8,3%). Histological analysis of both materials has shown a regular osseous organization of the augmented area. A histomorphological comparison of both materials indicated a slightly increased proportion of the newly formed bone in the twophase material group (38,4% vs. 36,1%). Resonance frequency analysis has shown a greater change in the group in which the two-phase material was used (10,0 vs. 6,0). Bone graft substitue materials used in this study are biocompatible and support bone regeneration at the osteoconductive level. In conclusion, we observe that a slight advantage has been found for the two-phase material with respect to the pure ß-TCP regarding volume stability, radiological density of the augmented area, and secondary implant stability. In order to have a long term result assessment it would be desirable to assess implant survival rate following augmentation with both materials after longer follow-up periods of 2, 5, and 10 years.
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