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)
  • Pang, Kang-Mi (Dept. of Oral & Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Li, Bo-Han (Dept. of Oral & Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Alrashidan, Mohamed (Dept. of Oral & Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Yoo, Sang-Bae (Dental Research Institute, Seoul National University) ;
  • Sung, Mi-Ae (Department of Craniofacial Structure & Functional Biology, College of Dentistry, Seoul National University) ;
  • Kim, Soung-Min (Dept. of Oral & Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Jahng, Jeong-Won (Dental Research Institute, Seoul National University) ;
  • Kim, Myung-Jin (Dept. of Oral & Maxillofacial Surgery, College of Dentistry, Seoul National University) ;
  • Ko, Jea-Seung (Oscotech Co.) ;
  • Lee, Jong-Ho (Dept. of Oral & Maxillofacial Surgery, College of Dentistry, Seoul National University)
  • 투고 : 2009.04.28
  • 심사 : 2009.05.25
  • 발행 : 2009.05.30

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.

키워드

참고문헌

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