牙种植手术骨移植假说：自体骨合并钛颗粒
 

摘要：种植牙目前广泛用于临床，骨量不足是种植面临的首要难题。传统的骨移植观点都是：移植物能牵引、诱导新骨的生成并且一定能被机体缓慢吸，本文中我们提出以一种不被吸收钛粉合并自体骨来修复骨量的不足的一种假说，通过分析钛粉与自体骨混合后的优势，比如：稳定的支架作用，创造适合种植体与骨结合的微环境，减少新骨爬行替代的距离等。我们的假说有两大创新，一方面首次将钛金属用于骨移植，另一方面该假说不仅能修复骨量不足，还能从微观环境上促进新骨与钛种植体的整合。我们相信这是一种行之有效的骨移植方法，值得临床应用与推广。
 

关键词：种植牙；自体骨移植；钛颗粒；骨整合；爬行替代

0 背景
种植牙是目前广泛用于临床修复牙缺失患者的一种有效方法，其独特的优点使其越来越受广大患者欢迎[1-5]。种植牙手术最大的难点是患者骨量的不够，因而多种骨移植的方式被用于临床修复患者骨量的不足。目前临床上较长使用的是：自体骨移植，常见的包括髂骨，下颌角，颏部等处自体骨；人工骨移植,主要是基于GBR 技术的BIO-OSS 骨粉，BIO-OSS COLLAGEN 等；自体骨与人工骨的混合物[4, 6, 17, 18]。无论哪种方式都存在其缺点与不足，自体骨由于取材的限制以及容易被吸收的特点，修复效果也不是非常理想[6-10]。基于GBR的BIO-OSS骨粉等在临床上广受欢迎，但是BIO-OSS的吸收过程非常缓慢，对大块骨缺损效果不理想，而且需要患者额外的支出，因而其应用也有一定限制[9-14]。传统的骨移植观点都是：移植物能牵引、诱导新骨的生成并且一定能被机体缓慢吸收，而目前种植中的骨移植的精力主要集中于骨量的不足，而很少从骨整合内在本质上考虑新骨情况[12]。因此，脱离这种思维方式而寻找新的骨移植模式来解决临床问题，提高牙种植手术的成功率，正是我们所需要的。

2 结论
临床上我们观察到钛网和钛膜的运用可以增加骨移植的成功率。因此，我们认为我们的假说具有重要的临床意义并且有望成为基础和临床研究的热点。无机物材料的这种能够在自己的表面修饰自己，以适应机体需要而进行的生理性伪装的特性，在其它无机材料中很少见，本假说运用钛金属的特性，将钛金属用于种植牙骨量不足的骨移植，是一个伟大创新。在牙种植中，自体骨联合钛颗粒将可能成为骨移植的新方式。在种植学上不仅可以恢复骨量，还能从微观环境上促进骨与钛的整合。如果可行，将带来牙种植骨移植的新思路与观点，我们还可以尝试用钛作为载体来修复多种临床骨量不足，这些钛正如钢筋混泥土中的钢筋，具有广阔的应用前景，比如腭裂、颌骨囊肿的骨修复。但是目前尚无有关自体骨结合钛颗粒的研究报道，因而还只是一个假说。另外，钛颗粒的体积及其在混合物中所占的比例还有待讨论。近期研究的结果一定程度上支持我们的假说，亟需更多这方面的设计严谨、双盲、随机、对照和样本量大的动物实验和临床试验来完善我们的假说。
 

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