Inter J Stomatol ›› 2018, Vol. 45 ›› Issue (5): 603-610.doi: 10.7518/gjkq.2018.05.018

• Reviews • Previous Articles     Next Articles

Research progress on the repair of alveolar cleft with bone tissue engineering scaffolds

Fang Yi,Siren Wang,Yanhao Chu,Yanqin. Lu()   

  1. Dept. of Orthodontics, Xiangya Stomatological Hospital, Central South University, Changsha 410008, China
  • Received:2017-10-29 Revised:2018-04-15 Online:2018-09-01 Published:2018-09-20
  • Contact: Yanqin. Lu E-mail:lu_yanqin@163.com
  • Supported by:
    This study was supported by Innovation Research Program of Graduate Students of Central South University(2017zzts914)

Abstract:

Alveolar cleft is a common craniofacial abnormality. Traditional treatments, including autogenous bone grafting, suffer from limited bone resources and high incidence of post-operative complications. These problems can be solved by bone tissue engineering, which offers a superior approach to repair the alveolar cleft. This article reviews the progress of using various scaffolds for repairing alveolar cleft.

Key words: alveolar cleft, bone tissue engineering, scaffold

CLC Number: 

  • R782.13

TrendMD: 

Tab 1

Advantages and disadvantages of bone tissue engineering scaffolds"

支架材料 优点 缺点
磷酸钙生物陶瓷支架 生物相容性、生物活性、骨传导性好,无免 脆性大,可塑性差,降解性弱,制备时间长,孔隙率难控制,
疫原性,成本低[19,20] 产量低
聚合物支架 生物降解性好,生物相容性好,加工灵活, 脆性大,力学强度差,体内强度衰减快,降解不易控制,降解
可塑性好 产物可能导致炎症
异种骨材料 骨传导性好,一定的骨诱导能力,来源广泛 有一定抗原性
复合材料支架 结合了相应组分的优点 材料间最适比例难控制,制备技术复杂
负载细胞或生长因子支架材料 成血管化和骨诱导性好 制备成本高,因子的剂量及控制其稳定、持续地释放较难

Tab 2

Research and application of single scaffolds in alveolar cleft reparation"

支架材料 实验组 对照组 应用 评价方法 研究结果 随访时间/月 参考文献
磷酸钙生 HA 自体髂骨 23例单侧牙槽嵴 锥形束计算机断层扫 移植成功。HA为100%, 67.82±10.36; Benlidayi等[21]
物陶瓷 骨松质 描(cone beam com- 自体骨移植为83.4%;裂 47.33±13.79
puted tomography, 隙区骨密度差异无统计学
CBCT) 意义
β-TCP 7例单侧牙槽嵴裂 CBCT 裂隙区骨体积平均百分比 6 De Ruiter等[22]
为73%±6%
β-TCP 对侧自体 10只荷兰奶山羊 micro-CT 缺损处重建的骨质和骨体 6 Janssen等[23]
骨移植 双侧牙槽嵴裂 积与自体骨移植侧一致
BG 1例单侧牙槽嵴裂 放射学 修复效果为Bergland Ⅰ级 12 Ezzat等[24]
聚合物 牛胶原基 1例单侧牙槽嵴裂 X线 裂隙区出现成骨,尖牙正 18 Pradel等[30]
常萌出
异种骨类 复合牛骨 15例单侧牙槽突 X线、CT X线显示有明显新骨形成, 4 徐燕等[32]
患者面部外形改善
脱蛋白牛 自体髂骨 30例牙槽嵴裂 X线、临床观察 2组骨组织变化没有明显 24 Thuaksuban等[33]
骨复合自 骨松质 差异,尖牙萌出;术后并
体骨 发症明显减少。
脱蛋白无 9例单侧牙槽嵴裂 临床观察、放射学 平均骨扩增量5.45 mm, 2 Aly等[3]
机牛骨、 修复效果评价Bergland标
自体下颌 准分级为Ⅰ级占55%、Ⅱ
体骨 级34%、Ⅲ级1%

Tab 3

Research and application of composite scaffolds in alveolar cleft reparation"

支架材料 对照组 应用 评价方法 研究结果 随访时间/月 参考文献
β-TCP/Col PLLA/PCL支架 54只SD大鼠 CT、组织学分析 新生成骨的体积比:自体骨移植组 4 Ekin等[9]
组、自体骨移植 牙槽嵴裂 45.4%、β-TCP/Col组21.5%、PLLA/
组、空白对照组 PCL组18.2%
HA/Col/自体 自体髂骨骨松质 15例单侧牙 CT 裂隙区骨体积(mL)、术中输血量 12 Takemaru等[6]
髂骨骨松质 槽嵴裂 (mL):自体骨移植组0.518±0.303、
51.5±37.9,支架组0.648±0.120、
12.4±5.13;术后12个月骨体积没有明
显差异
磷酸八钙/Col Col 6只比格犬牙 Micro-CT、X线、 缺损区被新骨充填,新骨由骨密质和 10 Matsui等[29]
槽嵴裂 苏木精-伊红染色 骨松质构成,较Col移植组新生骨体积
更大

Tab 4

Research and application of scaffolds compounding with cells and growth factors in alveolar cleft reparation"

支架材料 负载细胞、生
长因子种类
应用 对照组 评价方法 实验结果 随访时
间/月
碳酸羟 BMSC 3只比格犬双侧牙 HA X线、 组织 植骨区实验和对照组的牙齿移动距离没有差异;牙齿移动 6
磷灰石[35] 槽嵴裂,移植术 学染色 速率实验组一致,对照组不一致;对照组观察到牙根吸收
后6个月对上颌牙
加力
β-TCP[36] BMSC 6只犬双侧牙槽 β-TCP、自 荧光标记、X 侧切牙移动距离、剩余牙槽骨高度、尖牙与侧切牙间的 5
嵴裂,术后2个 体髂骨 线、组织学 新骨生成百分比:实验组(5.345±0.936) mm,73.60%±
月对上颌牙加力 分析、组织 6.51%,70.79%±7.02%;单纯支架组(6.986±1.412) mm,
形态学分析 56.31%± 7.72%,54.98%±9.22%;自体骨移植组(4.665±
0.483) mm,72.42%±8.72%,78.68% ±4.91%
β-TCP[37] MSC 10只比格犬单侧 空白对照 X线、CT、 实验组骨内矿物质含量是对照组的3倍,对照组缺损被纤 3.25
牙槽嵴裂 组织学分析 维组织充填,而实验组缺损被新生骨取代
β-TCP[38] BMSC 14只比格犬单侧 空白组、 荧光标记、 实验组新骨形成和矿化的速度较单纯自体骨移植组明显加 2
牙槽嵴裂结合上 自体髂骨 X线螺旋CT、 快,骨吸收明显减少,与自体髂骨移植结合快速扩弓组无
颌快速扩弓 组织、自 苏木精-伊红 明显差别
体髂骨移 染色、组织
植结合上 形态学分析
颌快速扩
弓组
支架材料 负载细胞、生
长因子种类
应用 对照组 评价方法 实验结果 随访时
间/月
HA-TCP[40] 未分化MSC、分化MSC 84只Lewis大鼠单侧牙槽嵴裂 HA-TCP、空白对照 CBCT、组织形态学分析、组织形态测定 骨缺损的体积和宽度:负载未分化MSC组(4.08±
1.36) mm3、(2.39 ± 0.23) mm,负载分化MSC组 (5.00±0.84)mm3、(2.53±0.22) mm,单纯支架组(5.50±1.05) mm3、(2.70±0.66) mm,空白对照组(6.86±3.21) mm3、(2.63±0.52)mm
1.5
HA-TCP[41] MSC 4只犬双侧牙槽嵴裂 对侧自体胫骨骨密质 组织形态学分析 骨形成率对照组为70%,实验组为5% 2
Col[42] 牙髓干细胞 60只Wistar大鼠牙槽嵴裂 自体髂骨、Col 苏木精-伊红染色 自体骨移植组新生骨量最多
2
胶原膜复合含HA的富血小板血浆凝胶[43] MSC 1例单侧牙槽嵴裂 CT 裂隙处有骨形成,瘘管消失 3
富含血小板的纤维蛋白、自体髂骨[44] BMSC 20只比格犬单侧牙槽嵴裂 自体髂骨、自体髂骨复合BMSC、自体髂骨和富含血小板的纤
维蛋白
CT、苏木精-伊红染色 实验组骨密度最高,新骨结构形成最好;单纯自体骨移植骨吸收率最高,骨密度最低 6
脱钙骨、硫酸钙人工骨[45] MSC 2例单侧牙槽嵴裂 CT 骨再生:1例患者34.5%,1例患者25.6% 4
牛胶原脱钙骨基质[46] 成骨细胞 8例牙槽嵴裂 自体髂骨骨松质 CBCT 裂隙区平均体积和骨化率:实验组(0.55±0.24) cm3
40.9%,对照组(0.59±0.23) cm3、36.6%
6
HA-CP、Col[47] rhBMP-2 大鼠牙槽嵴裂 单纯支架和空白对照 组织学分析、 影像学 实验组新骨形成率最高 3
牛骨骨松质[48] BMP 63例单侧牙槽突裂 自体髂骨骨松质骨 螺旋CT 治疗总有效率、牙槽骨密度(g·cm-2):实验组90%、
0.78±0.19,对照组94%、0.79±0.10,较治疗前显著上升,2组均有尖牙萌出
12
Col[7] rhBMP-2 16例单侧牙槽嵴裂 自体髂骨骨松质 CT 术后肿胀、疼痛患者:实验组37.5%,对照组87.5%;
术后平均住院时间(d)、裂隙区骨充填比、平均骨高
度(mm)、骨高度百分比:实验组1、74.4%、10.2、
65.0%,对照组3、80.2%、13.9、86.8%
12
Col[8] rhBMP-2 18例单侧牙槽嵴裂 自体髂骨
骨松质组、骨膜成形术组
CT 平均骨形成率:实验组75%,自体骨移植组78%,骨膜成形术组25.3%,新生骨骨密度实验组与自体骨移植组相似 12
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