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    Lenny Grau
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    Cicatrización ósea posterior a la regeneración guiada

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    1988 - Healing of bone defects by guided tissue regeneration

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    Cicatrización ósea posterior a la regeneración guiada

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    32 views5 pages

    1988 - Healing of Bone Defects by Guided Tissue Regeneration

    Uploaded by

    Lenny Grau
    Cicatrización ósea posterior a la regeneración guiada

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 5
    Healing of Bone Defects by Guided Tissue Regeneration Christer Dahlin, D.D. Sture Nyman, D.D.S., Odont. Dr. Gothenburg, Soeden In this study we describe a principle for the accom= plishment of bone regeneration based on the hypothesis that different cellular components in the tissue have varying rates of migration into a wound area during healing. By a mechanical hindrance, using a membrane technique, fibroblasts and other soft connective-tissue cells are prevented from entering the bone defect so that the presumably slower-migrating cells with osteogenic potential are allowed to repopulate the defect. Defects of standard size were created bilaterally through the man- dlibular angles of rats, On one side of the jaw the defect was covered with Teflon membranes, whereas the defect ‘on the other side served as control. Histologic analysis afier healing demonstrated that on the test (membrane) side, half the number of animals showed complete bone healing after $ weeks and all animals showed complete healing after 6 weeks. Little or no sign of healing was evident on the control side even after an observation period of 22 weeks. Regeneration of bone defects remains a signif. icant problem in surgery. Ingrowth of connective tissue into such defects often occurs, and this prevents the formation of new bone tissue, caus- ing anatomic aberrations and functional distur- bances and a need for reentry operations. In other situations, such as periodontal disease, bone destruction occurs and the tissue does not regenerate, even though progression of the dis- ease has been arrested. Numerous methods have been developed in an attempt to stimulate osteogenesis. The most common has been to implant fresh autogenous bone grafts harvested from the patient's ribs, iliac crest, or anterior tibia.'~? Another method uses bone powder implants‘ or various commer- cially available allografis** and different calcium phosphates.”® In recent years, much research Anders Linde, M.Sc., D.D.S., Odont. Dr., Jan Gottlow, D.D.S., and has been concentrated on the osteogenic poten- tial of demineralized bone powder implants.'"~"” The use of such implants has been based on the hypothesis that demineralized bone matrix in- duces mesenchymal cells to transform into oste- oblasts and chrondroblasts, leading to a subse- quent formation of new bone. This stimulatory effect seems to be due to local morphogenic factors inherent in the implanted bone matrix. The techniques just discussed, which are em- ployed to stimulate osteogenesis locally, have had varying rates of success. Since connective-tissue formation occurs at a rapid rate and thus in the clinical situation often creates an obstacle to os- teogenesis in bone defects, it seemed worthwhile to explore the potential of a new principle, namely, to mechanically prevent connective-tis: sue ingrowth by a membrane technique. A simi- lar technique has recently been developed and has been used successfully by Nyman and coworkers’ to regenerate a new attachment apparatus in teeth with advanced loss of the periodontal tissues. MATERIALS AND METHODS In the present study, thirty 5-month-old male albino Sprague-Dawley rats (body weight 450 to 500 gm) were used. During operative proce- dures, the animals were sedated with an intra- peritoneal solution (3.8 ml/kg body weight) con- sisting of 25% Hypnorm vet. (Janssen Pharma- ccuticals, Beerse, Belgium), 25% Dormicum (Hoffman-La Roche, Basel, Switzerland), and 50% sterile water. Mucoperiosteal flaps were vaised bilaterally at both the buccal and lingual aspects of the angles of the mandible. With the From the Laboratory of Oral Biology, Department of Histology, and the Department of Periodontology, Faculty of Odontology, at the Gothenburg University. Received for publication December 18, 1986; revised June 28,1987 \Wol. 81, No. 5 / HEALING OF BONE BY GUIDED REGENERATION 673 use of a trephine burr, a standardized round through-and-through osseous defect (5 mm in diameter) was created similarly on both sides of the jaw. The size of the defect was chosen to be appropriate with respect to the size of the ramus of a rat mandible and has been used previously by others." ‘On the right side of the jaw, the defect was covered both buccally and lingually with a porous (0.45 um) polytetrafluoroethylene membrane (Gore-Tex, W. L. Gore and Associates, Flagstaff, Ariz.) extending 2 to 3 mm outside the edges of the defect. The membrane was fixed by means of transosseous silk sutures. The flap was care~ fully repositioned on the outer side of the mem- brane and was sutured so that the membrane was Fia. 1. Gross appearance of five representative animals after different periods of healing (from above: 8, 6, 9, 18, and 22 weeks). Bone healing had already occurred after 8 weeks on the test side (lf), although still with rather thin bone. From 6 ‘weeks on, solid bone healing was seen. On the contralateral control side (right), where no memabranes were placed, the defects ‘were sill not ossified even after 22 weeks of healing, although they were somewhat diminished in diameter. Note the increase in cortical bone mass (errowhgads, left) beneath the membrane away from the defect in areas with previously intact bone. The small hole seen above the defects on the test side (arrox, left) represents a remnant due to the transosseous silk suture which was placed to stabilize the membrane. 674 totally covered. The periosteum thus came to be located on the peripheral surface of the mem- brane without any direct contact with the bone. The defect on the left side of each animal served as a control in that no membrane was placed. Twenty-four of the rats were divided into three groups with healing periods of 8 weeks (n = 8), 6 weeks (n = 8), and 9 weeks (n = 8), respectively. The result of healing was evaluated macroscopically after free dissection of the bone as well as histologically by light microscopy. The animals were sacrificed after their respective healing period with an overdose of Hypnorm, and block biopsies were prepared. The blocks were fixed, decalcified, and embedded in paraf- fin, Serial horizontal sections (4 um) through the defects were stained with hematoxylin and eosin, van Gieson’s stain, and toluidine blue and sub- {jected to microscopic examination. The remaining six animals were divided into two groups with healing periods of 13 weeks (n =4) and 22 weeks (n = 3), respectively. Healing 4n these two groups of animals was evaluated ‘macroscopically after free dissection of the bone. Statistical analysis was performed by a version, of the Wilcoxon signed-rank test.?°*! ResuLts ‘The gross appearance from representative specimens of the bone defects from test and control areas after different periods of healing is seen in Fig. 1. Complete bone healing of the circular defect had occurred already after 3 weeks on the side of the mandible where in- growth of connective tissue was prevented by the membranes. On the contralateral control side, where membranes had not been placed, the de- fects were still not ossified even after 22 weeks of healing, although they had diminished some- what in diameter. The result during the first 9 weeks of healing after surgery, evaluated by light microscopy, is shown in Table I. After 3 weeks, complete bone healing had occurred on the membrane side in three animals, whereas healing in the test areas of three other animals had taken place by com- plete closure of the defect but with thin bone or pronounced bone mass in the defect in conjunc- tion with minor ingrowth of connective tissue. Such ingrowth was most likely the result of a small displacement of the membrane, resulting in ingrowth of connective tissue through the split, between the membrane and the bone. Two ani. PLASTIC AND RECONSTRUCTIVE SURGERY, May 1988 TABLE 1 Bone Regeneration in the Surgically Produced Mandibular Defects S weeks fe = 8) +8 HO 8 +1 Zo 2a Fe 6 weeks (n= 8) +8 +0 +0 +2

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