CN110236710A - A method for promoting bone formation of bone graft material after dental implant maxillary sinus lifting - Google Patents

Abstract

The invention relates to a method for promoting osteogenesis of a bone graft material after lifting outside the maxillary sinus, and belongs to the medical field. A method for promoting bone formation of bone graft material after maxillary sinus lifting after implantation, comprising the following steps: S1, placing the carrier of bone graft material in the maxillary sinus in hyperbaric oxygen equipment; S2, pressing down the hyperbaric oxygen equipment The operation of the above parameters: oxygen content 100%, oxygen supply time 2 hours, pressure value 2ATA, pressure increase time 30 minutes, pressure stabilization time 60 minutes, pressure reduction time 30 minutes; The material carrier leaves the hyperbaric oxygen equipment; S4, repeat steps S1 to S3 every 20-30 hours, and repeat 30-60 times in total. The beneficial effect of the invention is that the healing time of the conventional maxillary sinus bone graft is shortened from 8-9 months to 5-9 weeks, which facilitates the healing and functional recovery of the early alveolar bone implant bed of patients.

Description

A method for promoting bone formation of bone graft material after dental implant maxillary sinus lifting

technical field

The invention relates to a method for promoting bone formation of a bone graft material after lifting outside the maxillary sinus, and belongs to the medical field.

Background technique

Dental implant technology has gradually replaced traditional dentition defects and edentulous patients. In clinical practice, when a patient loses teeth in the maxillary posterior region, the maxillary posterior teeth are implanted due to the existence of the maxillary sinus, the remodeling of the maxillary bone after extraction of the alveolar bone at the maxillary sinus floor, and the gasification of the maxillary sinus itself. The bone height in the area decreases, which may cause perforation of the maxillary sinus mucosa when an implant of ideal length is placed, resulting in failure of secondary infection, which limits the selection and clinical application of a reasonable implant length to a certain extent. In order to place implants of ideal length and meet reasonable biomechanical requirements, it is often necessary to elevate the maxillary sinus floor mucosa to an ideal height. This operation is called maxillary sinus lift. According to the condition of the maxillary sinus base bone, the operation can be divided into two types: internal lifting and external lifting of the maxillary sinus. The latter can solve the general problem of insufficient bone mass in the maxillary posterior region, and is routinely used in clinic.

During maxillary sinus lifting surgery, the maxillary sinus mucosa is lifted from the sinus floor, and autogenous bone or bone substitute is placed between the maxillary sinus floor and the raised maxillary sinus mucosa to increase the maxillary posterior teeth. The height from the top of the trough to the bottom of the sinus is an effective method to solve the lack of bone in the posterior part of the maxilla, and it provides a guarantee for the successful functioning of the dental implant in the later stage, and finally enables the bone graft to completely and reliably osseointegrate with the implant. Supports the restoration above the implant. Appropriate bone graft material and osteogenic performance directly affect the clinical effect of dental implants after maxillary sinus floor lifting.

It is now generally believed that autologous bone grafting is considered the best choice for bone grafting, but in order to avoid postoperative pain, swelling, infection, and nerve numbness caused by opening a second surgical area inside and outside the patient's mouth due to the use of autologous bone Scholars have been looking for graft materials that can replace autologous bone due to postoperative complications. Allograft bone, xenograft bone, various ceramic materials, and polymers have been successively used as bone substitutes in maxillary sinus floor lifting. At present, the standard external maxillary sinus lift combined with Bio-Oss bone grafting is the only way to solve the insufficient amount of bone implants caused by the huge maxillary sinus in the posterior maxillary region. Bio-Oss is derived bone that has removed protein and other organic components. As a scaffold for osteoblasts, the structure of Bio-Oss is almost the same as that of human bone. It has good biocompatibility and excellent bone conduction function. However, due to the lack of osteoinductive properties of Bio-Oss, patients need to wait for the conventional bone healing period of 8-9 months to form a relatively reliable alveolar bone bed for implants. Histological examination results show that new bone formation is good and prolongs over time , the bone structure gradually forms and matures, after which weight bearing or implant placement can be carried out. Due to the long bone formation time, the early restoration of dental implant function in patients with such jaw conditions is severely limited, and clinicians are urgently required to pursue newer biomaterials and methods to shorten the bone healing period and improve the healing effect and ability.

Contents of the invention

The main purpose of the present invention is to find an effective method to quickly promote the osteogenesis effect of Bio-Oss bone graft outside the maxillary sinus, and solve the current bottleneck problems of too long healing time and too long functional recovery.

To achieve the above object, the present invention adopts the following technical solutions:

A method for promoting osteogenesis of a bone graft material after a maxillary sinus is lifted outside the dental implant, comprising the following steps:

S1, placing the carrier of the bone graft material in the maxillary sinus in the hyperbaric oxygen device;

S2, the hyperbaric oxygen equipment operates according to the following parameters: oxygen content 100%, oxygen supply time 2 hours, pressure value 2ATA, boost time 30 minutes, pressure stabilization time 60 minutes, depressurization time 30 minutes;

S3, leaving the carrier of the bone graft material in the maxillary sinus away from the hyperbaric oxygen device;

S4, repeat step S1 to step S3 once every 20-30 hours, and repeat 30-60 times in total.

The step S4 also includes, when repeating steps S1 to S3 reaches 20 times, suspending for 100-140 hours, and then starting a new round of repeating process of steps S1 to S3.

The step S4 is preferably repeated from step S1 to step S3 once every 24 hours, for a total of 30-54 times.

The step S4 is preferably stopped for 120 hours when repeating steps S1 to S3 reaches 20 times, and then starts a new round of repeating process of steps S1 to S3.

The bone graft material is Bio-Oss. Bio-Oss bone powder is produced by Geistlich Pharmaceutical Co., Ltd. in Switzerland, and its trade name is Geistlich Bio-

The carrier is a mammal, including animals and humans. The animals are mice, rabbits, cats, dogs, pigs and the like.

The hyperbaric oxygen chamber acts on the patients after maxillary sinus lifting, by controlling the oxygen concentration and pressure of the oxygen chamber, controlling the time and speed of boosting, stabilizing and lowering the pressure, and the timing and frequency of hyperbaric oxygen therapy. It is an effective method to promote the osteogenesis effect of Bio-Oss bone graft after maxillary sinus lifting, and solve the current bottleneck problem of too long healing time and too long functional recovery of patients.

The early application of hyperbaric oxygen in the present invention is also applicable to bone grafting in the maxillary sinus and related bone regeneration and healing operations for oral and maxillary defects, and can also promote the early realization of bone healing. Various growth factors and bone graft materials are also suitable for this time window of hyperbaric oxygen action.

For traditional maxillary sinus augmentation, Bio-Oss bone graft requires at least 8-9 months of natural healing time. Current studies have confirmed that increasing the oxygen concentration is conducive to the survival of BMSCs and their differentiation into osteoblasts, can enhance the proliferation and division of osteoblasts, osteoclasts, fibroblasts and endothelial cells, and accelerate the proliferation of granulation tissue and fibrous tissue , and can accelerate the absorption of calcium, thereby accelerating the formation and maturation of bone. In the early stage of fracture, the vasoconstriction effect of hyperbaric oxygen can reduce blood flow in local tissues, reduce vascular permeability, and eliminate edema. In addition, hyperbaric oxygen can also accelerate the formation of capillaries at the site of fracture and soft tissue injury and promote the establishment of collateral circulation. Due to the increased blood supply and oxygen supply, the local nutrient supply is improved, and the callus grows rapidly, thereby promoting fracture healing. This method makes full use of the reliable evidence of hyperbaric oxygen therapy on limb fractures, and applies hyperbaric oxygen therapy to the oral and maxillary sinus lifting combined with Bio-Oss bone grafting. Postoperative swelling and wound dehiscence, on the other hand, through the control of hyperbaric oxygen therapy pressure, action time and frequency, and histomorphological analysis, hyperbaric oxygen can achieve the effect of early promoting xenograft bone formation in the maxillary sinus. The similarity of osteogenic healing state was advanced from 8-9 months to 5-9 weeks. It is convenient for the healing and functional recovery of the early alveolar bone implant bed of patients. The research on the effective time window of the application of hyperbaric oxygen-assisted Bio-Oss in maxillary sinus lifting osteogenesis is currently a blank in the world.

Compared with the traditional maxillary sinus external lifting osteogenesis technology, the beneficial effect of the present invention is that the healing time of the conventional maxillary sinus bone graft is shortened from 8-9 months to 5-9 weeks, which is convenient for the early alveolar bone implantation bed of patients. Healing and functional recovery.

The present invention will be further described below in conjunction with the accompanying drawings and specific embodiments, which are not intended to limit the present invention. All equivalent replacements in the field performed according to the disclosed content of the present invention belong to the protection scope of the present invention.

Description of drawings

Figure 1 shows maxillary sinus lift and Bio-Oss bone grafting

Figure 2A and Figure 2B are tissue block specimens taken out after hyperbaric oxygen therapy

Figure 3 shows implant placement

Figure 4 shows the positive expression of BMP-2 (bone morphogenetic protein-2) in connective tissue

Figure 5 shows the positive expression of VEGF (vascular endothelial growth factor) in connective tissue

Figure 6 shows the positive expression of Runx2 (Runt-related transcription factor 2)

Figure 7 shows the positive expression of Osteocalcin (Osteocalcin) in new bone tissue

Detailed ways

Example 1

1. Test object

The patient in this example has missing teeth in the maxillary posterior region. Due to the existence of the maxillary sinus in the maxilla, the prepared alveolar bone bed for the implant is not high enough in this edentulous area, so it is necessary to open a window on the outer wall of the maxillary sinus (Figure 1), and implant Bio-OSS bone powder. The bone window was covered with Bio-Guide. Divided into blank group, experimental group and control group.

Experimental group: T1 group (subgroup of 6-week node), after 6 weeks of hyperbaric oxygen therapy

T2 group (subgroup of 9-week node), 9 weeks of hyperbaric oxygen therapy after surgery

T3 group (subgroup of 5-week node), 5 weeks of hyperbaric oxygen therapy after surgery

Control group: patients who healed naturally with traditional methods after surgery

2. Test method

1. Extramaxillary sinus lifting surgery: local incandescent anesthesia was used in the operation area, and a 15C surgical blade was used to make an incision on the palatal side of the alveolar crest in the edentulous area of the maxillary posterior, reaching the periosteum. The incision is made in the gingival sulcus of the adjacent teeth in the mesiodistal area. According to the number of missing teeth and the size of the maxillary sinus lift window, one tooth position is extended in the mesiodistal area, and a vertical incision is made in the mesial area across the gingival symphysis; when the distal end is the free end A short vertical incision was made on the buccal side, and the trapezoidal full-thickness flap was opened to expose the lateral bone wall of the maxillary sinus. Bone wall fenestration was performed using an ultrasonic osteotome according to preoperative CBCT (dental cone surgery CT). The horizontal incision at the lower limit of the fenestration is located 2-3 mm above the base of the maxillary sinus. According to the principle of adding 2 mm to the height of the base of the maxillary sinus and the length of the implant, it is used as the horizontal incision at the upper limit of the bone wall fenestration. The window osteotomy line is determined according to the extent of bone grafting. The maxillary sinus mucosa was exposed, the periosteum peeled off the sinus floor mucosa upwards and inwards carefully, Bio-OSS small particle bone meal was packed, the Bio-Guide periosteum outside the hole wall covered the bone wall and the window was opened, and the full-thickness mucoperiosteal flap was sutured without tension .

2. Routine doctor's advice after maxillary sinus lifting: take non-steroidal anti-inflammatory drugs orally for one week, rinse mouth with chlorhexidine acetate 24 hours later, and apply local cold compresses for 48 hours; avoid swimming, blowing your nose and catching a cold; pay attention to rest.

3. Adjuvant hyperbaric oxygen therapy

24 hours after maxillary sinus lift, routine hyperbaric oxygen therapy was started. Before the patients entered the hyperbaric oxygen chamber, doctors ruled out the contraindications of hyperbaric oxygen therapy. The technical parameters of the oxygen chamber are set as follows: 100% oxygen at a pressure of 2 ATA, the pressure is increased for the first 30 minutes of treatment, the pressure is kept (stabilized) for 60 minutes, and the pressure is lowered for the last 30 minutes of treatment. (24 hours) once, 10 days as a course of treatment.

(1) For the subgroup at the 5-week node (T3 group), HBO continued for two courses of treatment for a total of 20 days, stopped for 5 days, and then ended with 10 days of hyperbaric oxygen therapy;

(2) The subgroup at the 6-week node (T1 group): HBO treatment continued for two courses for 20 days, stopped for 5 days, and continued for 17 days to stop HBO treatment;

(3) Subgroup at the 9-week node (T2 group): HBO treatment continued for two courses for 20 days, stopped for 5 days, continued HBO treatment for 20 days, stopped for 5 days, and continued for 14 days.

3. Experimental results

The patient in this embodiment is the situation of missing teeth in the maxillary posterior region. Due to the existence of the maxillary sinus in the maxilla, the prepared alveolar bone bed for the implant is not high enough in this edentulous area, so it is necessary to open a window on the outer wall of the maxillary sinus (Figure 1), and implant Bio-OSS bone powder. The bone window was covered with Bio-Guide, and after 8-9 months of natural bone healing, the implants were placed under load for functional restoration (Fig. 3). Figure 2A and Figure 2B show the preparation of the implant bed while the bone specimen tissue block was being prepared after hyperbaric oxygen therapy.

After the experiment, bone samples were taken from the treatment site for detection of morphological and biochemical indicators, and the results are shown in Figures 4 to 7.

Figure 4 is a graph showing the positive expression of BMP-2 in 200-fold connective tissue. Fig. 4A is Ctl six weeks, 48y; Fig. 4B is Treated1 (T1 group) six weeks, 72y; Fig. 4C is Treated2 (T2 group), nine weeks, 62y; Fig. 4D is Treated3 (T3 group) five weeks, 32y; Fig. 4E is Traditional (control group) 13Mons, 60y; Figure 4F is the BMP2 value of each group.

Figure 5 is the positive area of VEGF100X connective tissue. Fig. 5A is Ctl six weeks, 48y; Fig. 5B is Treated1 (T1 group) six weeks, 72y; Fig. 5C is Treated2 (T2 group), nine weeks, 62y; Fig. 5D is Treated3 (T3 group) five weeks, 32y; Fig. 5E is Traditional (control group) 13Mons, 60y; Figure 5F is the VEGF value of each group.

Figure 6 is a 200X image of Runx2, more in the nucleus, and the positive area is the cells stained brown in the image. Fig. 6A is Ctl six weeks, 48y; Fig. 6B is Treated1 (T1 group) six weeks, 72y; Fig. 6C is Treated2 (T2 group), nine weeks, 62y; Fig. 6D is Treated3 (T3 group) five weeks, 32y; Fig. 6E is Traditional (control group) 13Mons, 60y; Figure 6F is the Runx2 value of each group.

Figure 6 is a positive expression map of Osteocalcin 100X in new bone tissue. Fig. 7A is Ctl six weeks, 48y; Fig. 7B is Treated1 (T1 group) six weeks, 72y; Fig. 7C is Treated2 (T2 group), nine weeks, 62y; Fig. 7D is Treated3 (T3 group) five weeks, 32y; Fig. 7E is Traditional (control group) 13Mons, 60y; Figure 7F is the value of Osteocalcin in each group.

The results showed that, according to the differences in patient age and individual metabolism, 24 hours after maxillary sinus lifting and bone grafting, the time window of early hyperbaric oxygen for 5-9 weeks had a significant effect on promoting bone healing. Facilitate the early healing of the implanted alveolar bone bed.

Example 2

A method for promoting osteogenesis of a bone graft material after a maxillary sinus is lifted outside the dental implant, comprising the following steps:

S1, placing the carrier of the bone graft material Bio-Oss in the maxillary sinus in the hyperbaric oxygen equipment;

S2, the hyperbaric oxygen equipment operates according to the following parameters: oxygen content 100%, oxygen supply time 2 hours, pressure value 2ATA, boost time 30 minutes, pressure stabilization time 60 minutes, depressurization time 30 minutes;

S3, leaving the carrier of the bone graft material in the maxillary sinus away from the hyperbaric oxygen device;

S4, repeat step S1 to step S3 once every 24 hours, repeat 30 times in total, stop for 120 hours after the 20th time, and then start a new round of repeating process from step S1 to step S3.

The carrier is human.

Example 3

A method for promoting osteogenesis of a bone graft material after a maxillary sinus is lifted outside the dental implant, comprising the following steps:

S1, placing the carrier of the bone graft material Bio-Oss in the maxillary sinus in the hyperbaric oxygen equipment;

S2, the hyperbaric oxygen equipment operates according to the following parameters: oxygen content 100%, oxygen supply time 2 hours, pressure value 2ATA, boost time 30 minutes, pressure stabilization time 60 minutes, depressurization time 30 minutes;

S3, leaving the carrier of the bone graft material in the maxillary sinus away from the hyperbaric oxygen device;

S4, repeat step S1 to step S3 once every 24 hours, and repeat 54 times in total: stop for 120 hours after the first 20 times, then repeat the process of step S1 to step S3 for 20 times, stop for another 120 hours, and then repeat steps The process from S1 to step S3 is 14 times.

The carrier is human.

Example 4

A method for promoting osteogenesis of a bone graft material after a maxillary sinus is lifted outside the dental implant, comprising the following steps:

S1, placing the carrier of the bone graft material Bio-Oss in the maxillary sinus in the hyperbaric oxygen equipment;

S2, the hyperbaric oxygen equipment operates according to the following parameters: oxygen content 100%, oxygen supply time 2 hours, pressure value 2ATA, boost time 30 minutes, pressure stabilization time 60 minutes, depressurization time 30 minutes;

S3, leaving the carrier of the bone graft material in the maxillary sinus away from the hyperbaric oxygen device;

S4, repeat step S1 to step S3 once every 24 hours, 37 times in total, stop for 120 hours after repeating 20 times, and then start a new round of repeating process from step S1 to step S3, 17 times in total.

The carrier is human.

Claims (8)

1. a kind of method for promoting bone-grafting material to promote postoperative skeletonization outside Dental implantion maxillary sinus, it is characterised in that: including following Step:

S1, the carrier for making maxillary sinus be built into bone-grafting material are in hyperbaric oxygen equipment；

S2, hyperbaric oxygen equipment are run by parameters described below: oxygen content 100%, oxygen supply time 2 hours, pressure value 2ATA, pressure rising time For 30 minutes, voltage stabling control be 60 minutes, dip time is 30 minutes；

S3, the carrier for making maxillary sinus be built into bone-grafting material leave hyperbaric oxygen equipment；

S4, every 20-30 hours to repeat step S1 primary to step S3, and repeatedly 30-60 times altogether.

2. a kind of method for promoting bone-grafting material to promote postoperative skeletonization outside Dental implantion maxillary sinus according to claim 1, It is characterized by: the step S4 further includes, when repeating step S1 to step S3 and reaching 20 times, stop 100-140 hours, it Start the repetitive process of a new wheel step S1 to step S3 again afterwards.

3. a kind of method for promoting bone-grafting material to promote postoperative skeletonization outside Dental implantion maxillary sinus according to claim 1, It is characterized by: the step S4, it is primary to step S3 to repeat within every 24 hours step S1, repeatedly 30-54 times altogether.

4. promoting art outside Dental implantion maxillary sinus to a kind of promotion bone-grafting material described in any one of 3 according to claim 1 The method of skeletonization afterwards, it is characterised in that: the step S4 stops 120 preferably when repeating step S1 to step S3 and reaching 20 times Hour, start the repetitive process of a new wheel step S1 to step S3 again later.

5. promoting art outside Dental implantion maxillary sinus to a kind of promotion bone-grafting material described in any one of 3 according to claim 1 The method of skeletonization afterwards, it is characterised in that: the bone-grafting material is Bio-0ss.

6. promoting art outside Dental implantion maxillary sinus to a kind of promotion bone-grafting material described in any one of 3 according to claim 1 The method of skeletonization afterwards, it is characterised in that: the carrier is mammal.

7. a kind of method for promoting bone-grafting material to promote postoperative skeletonization outside Dental implantion maxillary sinus according to claim 6, It is characterized by: the mammal is behaved.

8. a kind of method for promoting bone-grafting material to promote postoperative skeletonization outside Dental implantion maxillary sinus according to claim 6, It is characterized by: the mammal is people mouse, rabbit, cat, dog or pig.