骨片技术在牙槽骨增量中的生物机理及临床应用

The biological mechanism and clinical application of bone shell technique in alveolar bone augmentation

导出

摘要部分缺牙患者种植牙前需要进行骨增量以保证种植体周围有充足的骨量。对于缺牙位点的牙槽嵴水平骨缺损伴或不伴轻中度垂直骨缺损的患者,骨片技术维持成骨空间效果良好,是一种可靠的、较为微创的骨增量方式。该术式使用固位钛钉将厚度约1 mm的皮质骨固定于受区,并于骨片与受区之间填入骨替代材料、覆盖屏障膜完成骨增量,骨片外侧的软组织减张缝合关闭术区,同时局部外周血释放破骨细胞及细胞因子等对骨片进行缓慢降解,骨片的刚性固定保证内部稳定的成骨空间及充足的新骨再生周期。尽管该技术具有良好的骨增量效果,但该技术敏感性高,自体骨片与同种异体骨片的应用场景和成骨过程具有一定差异,同时术中骨片、颗粒状骨替代材料的选择对于成骨生物过程、骨增量效果的可预测性具有较大影响。骨片技术的并发症具有一定的特点,比如同种异体骨片的免疫原性、软组织开裂、骨片松动等,以上并发症的预防及后续处理方式对于成骨的效率尤为关键。本文深入探讨骨片技术成骨的生物机理,对骨片材料的适应证、临床效果、骨片的分类、手术流程的管理以及并发症的预防和处理进行总结,旨在为骨片技术的应用和发展提供参考。 A portion of patients undergoing implant restoration require bone augmentation procedures to ensure that there is sufficient bone volume around the implant.For the patients with horizontal bone ridge defects at edentulous sites,with or without mild to moderate vertical bone defects,the shell technique serves as a reliable and minimally invasive bone augmentation method with effective space maintenance.The shell technique involves fixating 1 mm cortical bone blocks to the recipient site,using retention screws and filling the gap between the bone block and recipient bed with particulate bone substitute materials,and covering the barrier membrane to achieve bone augmentation.The overlying tension-free soft tissue closure seals the surgical site while local peripheral blood releases osteoclasts and cytokines that gradually degrade the bone block.The rigid fixation of the bone block ensures a stable internal environment for osteogenesis and a new bone regeneration cycle.Although this technique demonstrates favorable bone augmentation outcomes,it is highly technique-sensitive.There are certain differences in the application scenarios and osteogenic processes for autologous and allogeneic bone shells.The selection of bone blocks and particulate bone substitute materials significantly influences the osteogenic biological process and the predictability of bone augmentation results.Complications associated with the shell technique possess distinct characteristics,such as the immunogenicity of allogeneic bone fragments,soft tissue cracking,and bone fragment loosening.Their prevention and subsequent management substantially impact the success rate of osteogenesis.This article delves into the biological mechanisms of osteogenesis in the bone block technique,summarizing the indications,clinical outcomes,classification of bone blocks,and surgical workflow management,as well as complication prevention and management,aiming to provide a reference for the future application and development of the bone shell technique.

作者陈泽涛高筱萌欧阳昭广敖勇郭心瑜 CHEN Zetao;GAO Xiaomeng;OUYANG Zhaoguang;AO Yong;GUO Xinyu(Hospital of Stomatology,Sun Yat-sen University,Guangdong Provincial Clinical Research Center of Oral Diseases,Guangzhou 510033,China)

机构地区中山大学附属口腔医院广东省口腔疾病临床医学研究中心

出处《口腔疾病防治》 2026年第4期315-327,共13页 Journal of Prevention and Treatment for Stomatological Diseases

基金国家自然科学基金项目(82571155) 广州市基础与应用基础研究基金项目(2024A04J6323)。

关键词牙种植位点牙槽骨缺损骨片技术引导骨组织再生牙槽骨增量自体骨同种异体骨骨替代材料屏障膜 dental implant site alveolar bone defect bone shell technique guided bone regeneration increment of alveolar bone autologous bone allogeneic bone bone substitute materials barrier membrane