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칼슘포스페이트 나노-크리스탈이 코팅된 골이식재와 자가골을 병행 이용한 상악동 거상술
SINUS FLOOR GRAFTING USING CALCIUM PHOSPHATE NANO-CRYSTAL COATED XENOGENIC BONE AND AUTOLOGOUS BONE

방강미    (서울대학교 치의학대학원 구강악안면외과   ); 이보한    (서울대학교 치의학대학원 구강악안면외과   ); 알라쉬단    (서울대학교 치의학대학원 구강악안면외과   ); 유상배    (서울대학교 치학연구소   ); 성미애    (서울대학교 치의학대학원 두개악안면구조 및 기능생물학   ); 김성민    (서울대학교 치의학대학원 구강악안면외과   ); 장정원    (서울대학교 치학연구소   ); 김명진    (서울대학교 치의학대학원 구강악안면외과   ); 고재승    ((주)오스코텍   ); 이종호    (서울대학교 치의학대학원 구강악안면외과  );
  • 초록

    Purpose: Rehabilitation of the edentulous posterior maxilla with dental implants often poses difficulty because of insufficient bone volume caused by pneumatization of the maxillary sinus and by crestal bone resorption. Sinus grafting technique was developed to increase the vertical height to overcome this problem. The present study was designed to evaluate the sinus floor augmentation with anorganic bovine bone (Bio- $cera^{TM}$ ) using histomorphometric and clinical measures. Patients and methods: Thirteen patients were involved in this study and underwent total 14 sinus lift procedures. Residual bone height was ${\geq}2mm$ and ${\leq}6mm$ . Lateral window approach was used, with grafting using Bio- $cera^{TM}$ only(n=1) or mixed with autogenous bone from ramus and/or maxillary tuberosity(n=13). After 6 months of healing, implant sites were created with 3mm diameter trephine and biopsies taken for histomorphometric analysis. The parameters assessed were area fraction of new bone, graft material and connective tissue. Immediate and 6 months after grafting surgery, and 6 months after implantation, computed tomography (CT) was taken and the sinus graft was evaluated morphometric analysis. After implant installation at the grafted area, the clinical outcome was checked. Results: Histomorphometry was done in ten patients.Bio- $cera^{TM}$ particles were surrounded by newly formed bone. The graft particles and newly formed bone were surrounded by connective tissue including small capillaries in some fields. Imaging processing revealed $24.86{\pm}7.59%$ of new bone, $38.20{\pm}13.19%$ connective tissue, and $36.92{\pm}14.51%$ of remaining Bio- $cera^{TM}$ particles. All grafted sites received an implant, and in all cases sufficient bone height was achieved to install implants. The increase in ridge height was about $15.9{\pm}1.8mm$ immediately after operation (from 13mm to 19mm). After 6 months operation, ridge height was reduced about $11.5{\pm}13.5%$ . After implant installation, average marginal bone loss after 6 months was $0.3{\pm}0.15mm$ . Conclusion: Bio- $cera^{TM}$ showed new bone formation similar with Bio- $Oss^{(R)}$ histomorphometrically and appeared to be an effective bone substitute in maxillary sinus augmentation procedure with the residual bone height from 2 to 6mm.


  • 주제어

    Calcium phosphate nano-crystal coated xenograft .   Sinus floor grafting .   Histomorphometric analysis.  

  • 참고문헌 (14)

    1. Froum SJ, Wallace SS, Cho SC, Nicolas E, Tarnow DP: Histomorphometric comparison of a biphasic bone ceramic to anorganic bovine bone for sinus augmentation: 6- to 8- month postsurgical assessment of vital bone formation. A pilot study. The International Journal of Periodontics & Restorative Dentistry 28 : 273, 2008 
    2. Valentini P, Abensur D, Densari D, Graziani J, Hammerle C: Histological evaluation of Bio-Oss in a 2-stage sinus floor elevation and implantation procedure. Clin Oral Implants Res 9 : 59, 1998 
    3. Buser D, Mericske-Stern R, Bernard JP, Behneke A, Behneke N, Hirt HP, Belser UC, Lang NP: Long-term evaluation of non-submerged ITI implants. Part 1: 8-year life table analysis of a prospective multi-center study with 2359 implants. Clin Oral Implants Res 8 : 161, 1997 
    4. Traini T, Degidi M, Sammons R, Stanley P, Piattelli A: Histologic and elemental microanalytical study of anorganic bovine bone substitution following sinus floor augmentation in humans. J Periodontol 79 : 1232, 2008 
    5. Zijderveld SA, Schulten EA, Aartman IH, Ten Bruggenkate CM: Long-term changes in graft height after maxillary sinus floor elevation with different grafting materials: radiographic evaluation with a minimum followup of 4.5 years. Clin Oral Implants Res. 2009 
    6. Sung SJ, Chung HJ, Park HJ, Kim OS, Kim YJ: The effect of the Ca-P coated DBBP on osseous regeneration in the rat calvarial bone defect. The Journal of the Korean Academy of Periodontology 34 : 475, 2004     
    7. Yildirim M, Spiekermann H, Biesterfeld S, Edelhoff D: Maxillary sinus augmentation using xenogenic bone substitute material Bio-Oss in combination with venous blood. Clin Oral Implants Res 11 : 217, 2000 
    8. Froum SJ, Tarnow DP, Wallace SS, Rohrer MD, Cho SC: Sinus floor elevation using anorganic bovine bone matrix(OsteoGraf/N) with and without autogenous bone: A clinical, histologic, radiographic, and histomorphometric analysis-Part 2 of an ongoing prospective study. Int J Periodontics Restorative Dent 18 : 528, 1998 
    9. Lee Y-M, Shin S-Y, Kim J-Y: Bone reaction to bovine hydroxyapatite for maxillary sinus floor augmentation: Histologic results in humans. Int J Periodontics Restorative Dent 26 : 471, 2006 
    10. Boyne PJ, James RA: Grafting of the maxillary sinus floor with autogenous marrow and bone. J Oral Surg 38 : 613, 1980 
    11. Daculsi G: Biphasic calcium phosphateconcept applied to artificial bone, implant coating and injectable bone substitute. Biomaterials 19 : 1473, 1998 
    12. Moy PK, Lundgren S, Holmes RE: Maxillary sinus augmentation: histomorphometric analysis of graft materials for maxillary sinus floor augmentation. J Oral Maxillofac Surg 51 : 857, 1993 
    13. Fugazzotto P, Vlassis J: Long-term success of sinus augmentation using various surgical approaches and grafting materials. Int J Oral Maxillofac Implants 13 : 52, 1998 
    14. Wallace SS, Froum SJ: Effect of maxillary sinus augmentation on the survival of endosseous dental implants. A systematic review. Ann Periodontol 8 : 328, 2003 

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