Journal of Periodontal and Implant Science

Korean Academy of Periodontology (대한치주과학회)
권호 표지

Effect of bone graft materials on bone formation in guided bone regeneration using perforated titanium membrane

천공형 티타늄막을 이용한 골유도재생술 시 수종의 골이식재가 골재생에 미치는 영향

  • 홍승범 (경희대학교 치과대학 치주과학교실) ;
  • 권영혁 (경희대학교 치과대학 치주과학교실) ;
  • 박준봉 (경희대학교 치과대학 치주과학교실) ;
  • 허익 (경희대학교 치과대학 치주과학교실) ;
  • 정종혁 (경희대학교 치과대학 치주과학교실)
  • Published : 2006.03.30
Download PDF
⟨ Previous Next ⟩

Abstract

The purpose of the present study was to evaluate the effect of bone graft materials including deproteinized bovine bone(DBB), demineralized freeze-dried bone(DFDB), freeze-dried bone(FDB) on bone formation in guided bone regeneration using perforated titanium membrane(TM). 16 adult male rabbits(mean BW 2kg) were used in this study and 4 rabbits allotted to each test group. Intramarrow penetration(diameter 6.5mm) was done with round carbide bur on calvaria to promote blood supply and clot formation in the wound area. The test groups were devided into 4 groups as follows: TM only(test 1), TM +DBB(test 2), TM +DFDB(test 3), TM +FDB(test 4). Perforated titanium membrane was contoured in rectangular parallelepiped shape(0.5mm pore diameter, 10mm in one side, 2mm in inner height), filled the each graft material and placed on the decorticated carvaria. Perforated titanium membrane was fixed with resorbable suture materials. The animals were sacrificed at 2, 8 weeks after the surgery. Non-decalcified preparations were routinely processed for histologic analysis. The results of this study were as follows: 1. Perforated titanium membrane was biocompatible. 2. Perforated titanium membrane had capability of maintaining the space during the healing period but invasion of soft tissue through the perforations of titanium membrane decreased the space available for bone formation. 3. In test 1 group without bone graft material, the amount of bone formation and bone maturation was better than other test groups. 4. Among the graft materials, the effect of freeze-dried bone on bone formation was best. 5. In the test groups using deproteinized bovine bone, demineralized freeze-dried bone, bone formation was a little. The spacemaking capability of the membrane may be crucial for bone formation. The combined treatment with the perforated titanium membrane and deproteinized bovine bone or demineralized freeze-dried bone failed to demonstrate any added effect in the bone formation. Minimization of size and numbers of perforations of titanium membrane or use of occlusive titanium membrane might be effective to acquire predictable results in the vertical bone formation.

Keywords

References

  1. Nyman S, Lindhe J, Karring T. New attachment in the human periodontium by guided tissue regeneration. J Clin Periodontol 1982;9:290-296 https://doi.org/10.1111/j.1600-051X.1982.tb02095.x
  2. Dahlin C, Linde A, Gottlow J, Nyman S. Healing of bone defects by guided tissue regeneration. Plast Reconstr Surg 1988;81:672-676 https://doi.org/10.1097/00006534-198805000-00004
  3. Buser D, Bragger U, Lang NP, and Nyman S. Regeneration and enlargement of jaw bone using guided tissue regeneration. Clin Oral Impl Res 1990;1:22-32 https://doi.org/10.1034/j.1600-0501.1990.010104.x
  4. Seibert J, Nyman S. Localized ridge augmentation in dogs: a pilot study using membranes and hydroxyapatite. J Periodontol 1990;61:157-165 https://doi.org/10.1902/jop.1990.61.3.157
  5. Cortellini P, Bartolucci E, Clauser C, Pini Prato GP. Localized ridge augmentation using guided tissue regeneration in humans. Clin Oral Impl Res 1993;4:203-209 https://doi.org/10.1034/j.1600-0501.1993.040406.x
  6. Lang NP, Hammerle CHF, Bragger U, Lehmann B, Nyman S. Guided tissue regeneration in jaw bone defects prior to implant placement. Clin Oral Impl Res 1994;5:92-97 https://doi.org/10.1034/j.1600-0501.1994.050205.x
  7. Dahlin C, Sennerby C, Lekholm U, Linde A, Nyman S. Generation of new bone around titanium implants using a membrane technique: an experimental study in rabbits. Int J Oral Maxillofac Implants 1989;4:19-25
  8. Lazzara RJ. Immediate implant placement into extraction sites: surgical and reconstructive advantages. Int J Periodont Rest Dent 1990;9:333-343
  9. Nyman S, Lang NP, Buser D, Bragger U. Bone regeneration adjacent to titanium dental implants using guided tissue regeneration: a report of two cases. Int J Oral Maxillofac Implants 1990;5:9-14
  10. Andersson B, Odman P, Widmard G, Waas A. Anterior tooth replacement with implants in patients with narrow alveolar ridge form. A clinical study using guided tissue regeneration. Clin Oral Impl Res 1993;4:90-98 https://doi.org/10.1034/j.1600-0501.1993.040205.x
  11. Lang NP, Bragger U, Hammerle CHF, Sutter F. Immediate transmucosal implants using the principle of guided tissue regeneration. I. Rationale, clinical procedures and 30-month results. Clin Oral Impl Res 1994;5:154-163 https://doi.org/10.1034/j.1600-0501.1994.050306.x
  12. Lundgren D, Sennerby L, Falk H, Friberg B, Nyman S. The use of new bioresorbable barrier for guided bone regeneration in connection with implants installation. Clin Oral Impl Res 1994;5:177-184 https://doi.org/10.1034/j.1600-0501.1994.050309.x
  13. Blumental NM. A clinical comparison of collagen membranes with e-PTFE membranes in the treatment of human mandibular buccal class II furcation defects. J Periodontol 1993;64:925-933 https://doi.org/10.1902/jop.1993.64.10.925
  14. Becker W, Becker B, Berg L. New attachment after treatment with root isolation procedure: report for treated Class III and Class II furcations and vertical osseous defects. Int J Periodont Res Dent 1988;8:2-16
  15. Pontoriero R, Lindhe J, Nyman S, Karring T, Rosenberg E, Samavi F. Guided tissue regeneration in degree II furcation-involved mandibular molar. A clinical study. J Clin Peridontol 1988;15:247-254 https://doi.org/10.1111/j.1600-051X.1988.tb01578.x
  16. Becker W, Becker B. Treatment of mandibular 3-wall intrabony defects by flap debridement and expanded polytetrafluoroethylene barrier membranes. Long term evaluation of 32 treated patients. J Periodontol 1993;64:1138-1144 https://doi.org/10.1902/jop.1993.64.11s.1138
  17. Casati MZ, Sallum EA, Caffesse RG, Sallum AW. Enamel matrix derivative and healing after guided bone re¬generation in dehiscence-type defects around implants: A histomorphometric study in dogs. J Periodontol 2002;73:789-796 https://doi.org/10.1902/jop.2002.73.7.789
  18. Linde A, Thoren C, Dahlin C, Sandberg E. Creation of new bone by osteo-promotic membrane technique. J Oral Maxillofac Surg 1993;51:892-897 https://doi.org/10.1016/S0278-2391(10)80111-9
  19. Tinti C, Vincenzi G, Cochetto R. Guided tissue regeneration in mucogingival surgery. J Periodontol 1993;64:1184-1191 https://doi.org/10.1902/jop.1993.64.11s.1184
  20. Boyne PJ. Restoration of osseous defects in maxillofacial casualities. Journal of the American Dental Association 1969;78:767-776 https://doi.org/10.1016/S0002-8177(69)84023-7
  21. Boyne PJ, Cole MD, Stringer D, Shafqat JP. A technique for osseous restoration of deficient edentulous maxillary ridges. J Oral Maxillfac Surg 1985;43:87-91 https://doi.org/10.1016/0278-2391(85)90054-0
  22. Gongloff RK, Cole M, Whitlow W, Boyne PJ. Titanium mesh and particulate cancellous bone and marrow grafts to augment the maxillary alveolar ridge. Int J Oral Maxillofac Surg 1986;15:263-268 https://doi.org/10.1016/S0300-9785(86)80083-7
  23. Lundgren D, Lundgren AK, Sennerby L, Nyman S. Augmentation of intramembranous bone beyond the skeletal envelope using an occlusive titanium barrier. Clin Oral Imp Res 1995;6:67-72 https://doi.org/10.1034/j.1600-0501.1995.060201.x
  24. Malchiod L, Scarano A, Quaranta M, Piattelli A. Rigid fixation by means of titanium mesh in edentulous ridge expansion for horizontal ridge augmentation in the maxilla. Int J Oral Maxillofac Imp 1998;13:701-705
  25. von Arx T, Kurt B. Implant placement and simultaneous peri- implant bone grafting using a microtitanium mesh for graft stabilization. Int J Periodont Rest Dent 1998;18:117-127
  26. von Arx T, Wallkamm B, Hardt N. Localized ridge augmentation using a microtitanium mesh: a report on 27 implants followed from 1 to 3 years after functional loading. Clin Oral Impl Res 1998;9:123-130 https://doi.org/10.1034/j.1600-0501.1998.090208.x
  27. von Arx T, Kurt B. Implant placement and simultaneous ridge augmentation using autogenous bone and a microtitanium mesh: a prospective clinical study with 20 implants. Clin Oral Impl Res 1999;10:24-33 https://doi.org/10.1034/j.1600-0501.1999.100104.x
  28. Leghissa GC, Zaffe D, Assenza B, Botticelli AR. Guided bone regeneration using titanium grids: report of 10 cases. Clin Oral Impl Res 1999;10:62-68 https://doi.org/10.1034/j.1600-0501.1999.100108.x
  29. Assenza B, Piattelli M, Scarano A, Iezzi G, Petron G, Piattelli A. Localized ridge augmentation using titanium micromesh. J Oral Implantol 2001;27:287-292 https://doi.org/10.1563/1548-1336(2001)027<0287:LRAUTM>2.3.CO;2
  30. van Steenberghe D, Johansson C, Quirynen M, Molly L, Albrektsson T, Naert I. Bone augmentation by means of a stiff occlusive titanium barrier. A study in rabbits and humans. Clin Oral Impl Res 2003;14:63-71 https://doi.org/10.1034/j.1600-0501.2003.140109.x
  31. Zellin G, Gritli-Linde A, Linde A. Healing of mandibular defects with different biodegradable and non-biodegradable membranes: an experimental study in rats. Biomaterials 1995;16:601-609 https://doi.org/10.1016/0142-9612(95)93857-A
  32. Jovanovic SA, Spiekermann H, Richter EJ. Bone regeneration around titanium implants in dehisced defect sites. A clinical study. Int J Oral Maxillofac Impl 1992;7:233-245
  33. Slott C, Lundgren D. Augmentation of calvarial tissue using non-permeable silicone domes and bovine bone mineral. An experimental study in the rat. Clin Oral Impl Res 1999;10:468-476 https://doi.org/10.1034/j.1600-0501.1999.100605.x
  34. Zitzmann NU, Naef R, Scharer P. Resorbable versus nonresorbable membranes in combination with Bio-Oss for guided bone regeneration. Int J Oral Maxillofac Impl 1997;12:844-852
  35. Hammerle CH, Chiantella GC, Karring T, Lang NP. The effect of a deproteinized bovine bone mineral on bone regeneration around titanium dental implants. Clin Oral Impl Res 1998;9:151-162 https://doi.org/10.1034/j.1600-0501.1998.090302.x
  36. Hurzeler MB, Kohal RJ, Naghshbandi J, Mota LF, Condradt J, Hutmacher D, Caffesse RG. Evaluation of a new bioresorbable barrier to facilitate guided bone regeneration around exposed implant threads. An experimental study in the monkey. Int J Oral Maxillofac Impl 1998;27:315-320 https://doi.org/10.1016/S0901-5027(05)80623-X
  37. Carpio L, Loza J, Lynch S, Genco R. Guided bone regeneration around endosseous implants with anorganic bovine bone mineral. A randomized controlled trial comparing bioabsorbable versus non-resorbable barriers. J periodontol 2000;71:1743-1749 https://doi.org/10.1902/jop.2000.71.11.1743
  38. Kleinschmidt JC, Marden LJ, Kent D, Quigley N, Hollinger JO. A multiphase bone implant for regenerating the calvaria. Plastic and Resconstructive Surgery 1993;91:581-588 https://doi.org/10.1097/00006534-199304000-00002
  39. Mardas N, Kostpoulos L, Karring T. Bone and suture regeneration in calvarial defects by e-PTFE membranes in demineralized bone matrix and the impact on calvarial growth. An experimental study in the rat. Journal of craniofacial Surgery 2002;13:453-462 https://doi.org/10.1097/00001665-200205000-00017
  40. Nielsen FF. Guided bone induction. A method in the treatment of diaphyseal long bone defects. Ph.D. thesis, Royal Dental college, University of Aarhus, Denmark, 128pp, 1992
  41. Stentz WC, Mealey BL, Gunsolley JC, Waldrop TC. Effect of guided bone regeneration around commercially pure titanium and hydroxyapatite-coated dental implants. II histologic anaylsis. J Periodontol 1997;68:933-949 https://doi.org/10.1902/jop.1997.68.10.933
  42. Simion M, Trisi P, Piatelli A. GBR with an e-PTFE membrane associated with DFDBA: Histologic and histochemical analysis in an implant retrieved after 4 years of loading. Int Perio Rest Dent 1996;16:339-347
  43. Piattelli A, Scarano M, Corigliano M, Piatelli M. Comparison of bone regeneration with the use of mineralized and demineralized freeze-dried bone allografts: A histologic and histochemical study in man. Biomaterials 1996;7:1127-1131
  44. Mardas N, Kostpoulos L, Stavropoulos A, Karring T. Osteogensis by guided tissue regeneration and demineralized bone matrix. J Clin Periodontol 2003;30:176-183 https://doi.org/10.1034/j.1600-051X.2003.20031.x
  45. 이윤호, 박준봉, 권영혁, 허익, 김종관. 천공형 티타늄막과 탈회동결건조골의 신생골 형성에 대한 영향. 대한치주과학회지 2004;34:163-175
  46. Stavropoulos A, Kostopoulos L, Mardas N, Nyengaard JR, Karring T. Deproteinized bovine bone used as an adjunct to guided bone augmentation(GBA). An experimental study in the rat. Clin Imp Dent Related Res 2001;3:156-165 https://doi.org/10.1111/j.1708-8208.2001.tb00136.x
  47. Stavropoulos A, Kostopoulos L, Nyengaard JR, Karring T. Deproteinized bovine bone(Bio-Oss$^{\circledR}$) and bioactive glass(Bio-gran$^{\circledR}$) arrest bone formation when used as an adjunct to guided tissue regeneration(GTR). An experimental study in the rat. J Clin Periodontol 2003;30:636-643 https://doi.org/10.1034/j.1600-051X.2003.00093.x
  48. 이진, 권영혁, 박준봉, 허익, 정종혁, 김종관. 티타늄강화 차폐막의 골유도 재생 효과. 대한치주과학회지 2004;34:711-722
  49. Schenk RK, Buser D, Hardwick WR, Dahlin C. Healing pattern of bone regeneration in membrane-protected defects: A histolgic study in the canine mandible. Int J Oral Maxillofac Impl 1994;9:13-29
  50. Hammerle C, Schmid J, Lang NP, Olah A. Temporal dynamics of healing in rabbit cranial defects using guided bone regeneration. J Oral Maxillofac Surg 1995;53:167-174 https://doi.org/10.1016/0278-2391(95)90396-8
  51. Nevins M, Mellonig JT. Enhancement of the damaged edentulous ridge to receive dental implants: a combination of allograft and the Gore-Tex membrane. Int J Perio Rest Dent 1992;18:35-45
  52. Lioubavina N, Kostpoulos L, Wenzel A, Karring T. Long-term stability of jaw bone tuberosities formed by 'guided tissue regeneration'. Clin Oral Imp Res 1999;10:477-486 https://doi.org/10.1034/j.1600-0501.1999.100606.x
  53. Lundgren A, Lundgren D, Taylor ${\AA}$. Influence of barrier occlusiveness on guided bone augmentation. An experimental study in the rat. Clin Oral Impl Res 1998;9:251-260 https://doi.org/10.1034/j.1600-0501.1998.090406.x
  54. Schmid J, Hammerle CHF, Olah AJ, Lang NP. Membrane permeability is unnecessary for guided generation of new bone. An experimental study in the rabbit. Clin Oral Impl Res 1994;5:125-130 https://doi.org/10.1034/j.1600-0501.1994.050302.x
  55. Aaboe M, Pinholt EM, Schou S, Hjorting- Hansen E. Incomplete bone regeneration of rabbit calvarial defects using different membranes. Clin Oral Impl Res 1998;9:313-320 https://doi.org/10.1034/j.1600-0501.1998.090504.x
  56. Larsson C, Thomsen P, Aronsson BO, Rodahl M, Lausmaa J, Kasemo B, Ericson LE. Bone response to surface modified titanium implants: studies on the early tissue response to machined and electropolished implants with different oxide thicknesses. Biomaterials 1996;17:605-616 https://doi.org/10.1016/0142-9612(96)88711-4
  57. 이근혁, 권영혁, 박준봉, 허익. 골유도재생술시 그물형 티타늄막의 천공수가 골형성에 미치는 영향. 대한치주과학회지 2004;34:411-424
  58. Majzoub Z, Berengo M, Giardino R, Aldini NN, Cordioli G. Role of intramarrow penetration in osseous repair: A pilot study in the rabbit calvaria. J Periodontol 1999;70:1501-1510 https://doi.org/10.1902/jop.1999.70.12.1501
  59. Lundgren AK, Lundgren D, Hammerle CHF, Nyman S, Sennerby L. Influence of decortication of the donor bone on guided bone augmentation. An experimental study in the rabbit skull bone. Clin Oral Impl Res 2000;11:99-106 https://doi.org/10.1034/j.1600-0501.2000.00002.x