Vertical Ridge Augmentation Using Guided Bone Regeneration (GBR) in Three Clinical Scenarios Prior to Implant Placement: A Retrospective Study of 35 Patients 12 to 72 Months After Loading 在种植体植入前的三种临床情况下使用引导骨再生（GBR）进行垂直牙脊增量：对 35 名患者进行的装载后 12 至 72 个月的回顾性研究
Istvan A. Urban, DMD, MD¹/Sascha A. Jovanovic, DDS, MS²/Jaime L. Lozada, DDS Istvan A. Urban, DMD, MD¹/Sascha A. Jovanovic, DDS, MS²/Jaime L. Lozada, DDS
Abstract 摘要
Purpose: The aims of the current study were to: (1) evaluate the results of vertical guided bone regeneration (GBR) with particulate autogenous bone grafts, (2) determine clinically and radiographically the success and survival rates of 82 implants placed in such surgical sites after prosthetic loading for 12 to 72 months, and (3) compare defects that were treated simultaneously with sinus augmentation and vertical GBR to other areas of the jaw treated with vertical GBR only. Materials and Methods: Eighty-two implants were inserted in 35 patients with 36 three-dimensional vertical bone defects. The patients were divided into three groups: single missing teeth (group A), multiple missing teeth (group B), and vertical defects in the posterior maxilla only (group C). All group subjects were treated simultaneously with sinus and vertical augmentations. All patients were treated with vertical ridge augmentation utilizing titanium-reinforced polytetrafluoroethylene (e-PTFE) membranes and particulated autografts. After removal of the e-PTFE membrane, all sites received a collagen membrane. Results: At membrane removal, mean vertical augmentation was . Mean combined crestal remodeling was at 12 months, which remained stable through the 6 -year followup period. There were no statistically significant differences between the three groups in mean marginal bone remodeling. One defect had a bone graft complication (2.78%, : . The overall implant survival rate was with a cumulative success rate of . Conclusions: (1) Vertical augmentation with e-PTFE membranes and particulated autografts is a safe and predictable treatment; (2) success and survival rates of implants placed in vertically augmented bone with the GBR technique appear similar to implants placed in native bone under loading conditions; (3) success and failure rates of implants placed into bone regenerated simultanously with sinus and vertical augmentation techniques compare favorably to those requiring only vertical augmentation. INT J ORAL MAXILLOFAC IMPLANTS 2009; 目的：本研究旨在(1）评估使用颗粒状自体骨移植物进行垂直引导骨再生（GBR）的效果；（2）从临床和影像学角度确定在此类手术部位植入 82 个种植体，在假体植入 12 至 72 个月后的成功率和存活率；（3）比较同时使用上颌窦增量术和垂直引导骨再生术治疗的缺损与仅使用垂直引导骨再生术治疗的其他颌骨部位的缺损。材料和方法：为 35 名有 36 个三维垂直骨缺损的患者植入了 82 个种植体。患者被分为三组：单颗牙齿缺失（A 组）、多颗牙齿缺失（B 组）和仅上颌后部垂直缺损（C 组）。所有 组患者都同时接受了上颌窦和垂直隆起治疗。所有患者都接受了利用钛增强聚四氟乙烯（e-PTFE）膜和颗粒状自体移植物进行的垂直脊增量治疗。去除 e-PTFE 膜后，所有部位均接受胶原蛋白膜治疗。结果：去除膜后，平均垂直增量为 。12 个月时，平均综合骨嵴重塑率为 ，在 6 年的随访期间保持稳定。三组患者的平均边缘骨重塑率没有明显的统计学差异。一个缺损发生了植骨并发症（2.78%， : 。总体种植体存活率为 ，累积成功率为 。结论：(1) 使用 e-PTFE 膜和颗粒状自体移植物进行垂直增量是一种安全且可预测的治疗方法；(2) 在加载条件下，使用 GBR 技术将种植体植入垂直增量骨中的成功率和存活率与植入原生骨中的种植体相似；(3) 使用窦和垂直增量技术将种植体植入同时再生的骨中的成功率和失败率与仅需进行垂直增量的种植体相比更为理想。国际口腔颌面外科植入物杂志，2009 年；
Key words: autogenous bone graft, barrier membranes, guided bone regeneration, sinus augmentation, vertical ridge augmentation 关键词：自体骨移植、屏障膜、引导骨再生、窦增量、垂直脊增量
ertical and horizontal augmentation using guided bone regeneration (GBR) has become a major treatment option to provide optimal bone support 使用引导骨再生技术（GBR）进行垂直和水平增量已成为提供最佳骨支持的主要治疗方法之一。
for osseointegrated dental implants. The application of GBR for horizontal augmentation is well documented, with high rates of implant success and low complication rates. The application of GBR for supracrestal regeneration was introduced and the surgical technique described in and the first animal and human histologic studies demonstrated successful vertical bone augmentation. Complications reported with vertical augmentation have involved membrane exposure and/or subsequent infection, with rates ranging between and The long-term results of vertical GBR following 1 to 5 years of prosthetic loading were examined in a retrospective multicenter study evaluating 123 implants ; vertical bone regeneration of more than was achieved only with the use of autogenous bone chips. These authors reported an overall success rate of , leading them to conclude that bone 用于骨结合牙种植体。GBR 在水平增量方面的应用有据可查，种植成功率高，并发症发生率低。 在 中介绍了用于上嵴再生的 GBR 和手术技术，首次动物和人体组织学研究也证明了垂直骨增量的成功。 据报道，垂直骨增量术的并发症包括骨膜暴露和/或随后的感染，发生率在 和 之间。在一项多中心回顾性研究中，对 123 个种植体 进行了评估，结果表明垂直 GBR 在 1 到 5 年的修复负荷后可获得长期效果；只有使用自体骨片才能实现超过 的垂直骨再生。这些作者报告的总体成功率为 ，因此他们得出结论认为，骨质再生是一种有效的修复方法。
that has been vertically augmented using GBR techniques responds to implant placement in a fashion similar to native bone. In another study, the GBR technique for vertical augmentation was used in combination with a sinus lift procedure for posterior maxillary reconstruction. However, the implant survival and success rates were and , respectively, which conflicted with previously reported results on vertical and horizontal GBR. 4,9 There are few reports of vertical GBR, and they present conflicting results and relatively high complication rates. 使用 GBR 技术进行垂直增量后，种植体植入后的反应与原生骨相似。在另一项研究中，将 GBR 垂直增量技术与上颌后路重建的上颌窦提升术结合使用。 然而，种植体的存活率和成功率分别为 和 ，这与之前报道的垂直和水平 GBR 结果相冲突。4,9关于垂直 GBR 的报道很少，且结果相互矛盾，并发症发生率相对较高。
The aims of this retrospective study were to: (1) evaluate results of vertical GBR with particulated, autogenous bone grafts; (2) determine clinical and radiographic success and survival rates of implants placed in surgical sites after prosthetic loading; and (3) compare success and survival rates of implants placed in defects treated simultaneously with sinus augmentation and vertical GBR to other areas treated with vertical GBR only. 这项回顾性研究的目的是(1) 评估使用颗粒状自体骨移植的垂直 GBR 的效果；(2) 确定植入手术部位的种植体在修复加载后的临床和影像学成功率和存活率；(3) 比较植入同时接受上颌窦增量术和垂直 GBR 治疗的缺损部位的种植体与仅接受垂直 GBR 治疗的其他部位的种植体的成功率和存活率。
MATERIALS AND METHODS 材料和方法
This retrospective study reports on patients who were consecutively treated with vertical augmentation using GBR and particulated autografts from June 1999 to October 2004. All patients were treated at either the Center for Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, California, or in a private clinic in Budapest, Hungary. All surgical procedures were performed by the same clinician (I.U.), who had more than 15 years of experience in oral surgery and implant therapies, and the prosthetic treatments were performed by residents in the Loma Linda University Implant Dentistry program or private practitioners 这项回顾性研究报告了 1999 年 6 月至 2004 年 10 月期间连续使用 GBR 和微粒自体移植进行垂直隆牙治疗的患者。所有患者均在加利福尼亚州洛马琳达的洛马琳达大学牙科学院种植牙中心或匈牙利布达佩斯的一家私人诊所接受了治疗。所有外科手术均由同一临床医生（I.U.）实施，他在口腔外科和种植治疗方面拥有超过 15 年的经验，修复治疗则由洛马琳达大学种植牙项目的住院医师或私人医生实施。
Patients were selected who required vertical bone regeneration (1) to achieve the necessary bone volume to place dental implants and (2) to improve the crown/implant ratio and esthetics. Patients were required to have good oral hygiene prior to treatment. Participants were excluded if they were current smokers, engaged in excessive alcohol consumption, or had uncontrolled systemic conditions or uncontrolled periodontal disease. 选择的患者需要进行垂直骨再生（1）以获得必要的骨量来植入种植体，（2）以改善牙冠/种植体的比例和美观。要求患者在治疗前保持良好的口腔卫生。吸烟、酗酒、患有未控制的全身性疾病或未控制的牙周病的患者不得参加治疗。
Clinical Procedures 临床程序
All patients were treated with vertical ridge augmentation using titanium-reinforced, nonresorbable, expanded polytetrafluoroethylene (e-PTFE) membranes (GORE-TEX Regenerative Membrane, Titanium-Reinforced; W.L. Gore & Associates, Flagstaff, AZ) and particulated autografts. Defects were measured during the grafting procedures with a calibrated periodontal probe. Vertical bone defects were measured from the most apical portion of the bony defect to a line connecting the interproximal bone between neighboring teeth or to the original bone crest of the edentulous area. 所有患者都接受了使用钛增强型、不可吸收的膨体聚四氟乙烯（e-PTFE）膜（GORE-TEX Regenerative Membrane, Titanium-Reinforced; W.L. Gore & Associates, Flagstaff, AZ）和颗粒状自体移植物进行的垂直牙脊增量治疗。在移植过程中使用校准过的牙周探针测量缺损情况。垂直骨缺损的测量是从骨缺损的最顶端部分到邻牙间近端骨的连接线或缺牙区的原始骨嵴。
The surgical technique has been described previously. Briefly, a remote full-thickness flap was elevated in the edentulous area and the residual bone ridge was prepared carefully to receive an autogenous bone graft and an e-PTFE membrane. The autografts were harvested from the mandible, particulated in a bone mill (R. Quétin Bone-Mill, Roswitha Quétin Dental Products, Leimen, Germany), and applied to the defect. The bone graft was immobilized and covered with a membrane, which was stabilized with titanium bone tacks. When implants were placed simultaneously, the implants protruded from the base of the defect to the desired vertical position and were covered with the graft and membranes. 手术技术在之前已有描述。 简而言之，在缺牙区隆起一个远端全厚皮瓣，仔细准备残余骨脊，以接受自体骨移植和 e-PTFE 膜。自体骨移植物取自下颌骨，在骨研磨机（R. Quétin Bone-Mill，Roswitha Quétin Dental Products，Leimen，Germany）中粉碎，然后应用于缺损处。骨移植体用薄膜固定和覆盖，薄膜用钛骨钉固定。当同时植入种植体时，种植体从缺损的底部突出到所需的垂直位置，并被移植骨和骨膜覆盖。
In posterior maxillary cases with both severe vertical crestal bone atrophy and enlarged maxillary sinus cavities, a combined procedure of vertical GBR and maxillary sinus grafting was used. The sinus grafts used the lateral window approach, and the grafting material consisted of autogenous particulated bone with anorganic bovine spongiosa bone mineral (BioOss, Osteohealth, Shirley, NY). The classification and rationale for this procedure with posterior maxillary alveolar defects, which combines GBR and sinus bone grafts, have been described previously. Bone harvesting sites were selected based on the amount of bone required versus available bone and anatomic limitations. Clinical photographs were taken during the procedures (Fig 1). 对于既有严重垂直嵴骨萎缩又有上颌窦腔扩大的上颌后牙病例，采用了垂直 GBR 和上颌窦移植的联合手术。上颌窦移植采用侧窗方法，移植材料包括自体颗粒骨和无机牛海绵骨矿（BioOss，Osteohealth，Shirley，NY）。这种结合了 GBR 和上颌窦骨移植的上颌后牙槽缺损手术的分类和原理已在之前的文章中进行过描述。 根据所需骨量、可用骨量和解剖限制来选择取骨部位。手术过程中拍摄了临床照片（图 1）。
The surgical site was allowed to heal for 6 to 9 months. Then, the membranes were removed, and implants were placed or uncovered. At the time of membrane removal, bone regeneration was evaluated. At implant placement, a resorbable collagen membrane (Bio-Gide, Osteohealth, Shirley, NY) was placed over the newly formed crestal bone to protect the graft from early resorption. The objective was to place the implant platform at the crestal bone level, leave it submerged to heal for 6 months, then uncover and restore the implants. 手术部位的愈合期为 6 至 9 个月。然后，去除薄膜，植入或揭开植入物。去膜时，对骨再生情况进行评估。植入种植体时，在新形成的骨嵴上放置一层可吸收胶原膜（Bio-Gide，Osteohealth，Shirley，NY），以保护移植物不被早期吸收。目的是将种植体平台放置在骨嵴水平，使其浸没愈合 6 个月，然后揭开并修复种植体。
All patients were to receive a provisional prosthesis during the healing phase of the bone grafts and the implants to provide function and esthetics and avoid pressure on the operated site. Definitive restorations were placed within a few weeks after the implants were uncovered. Patients received fixed implant-supported restorations and attended a scheduled maintenance program that included a clinical examination every 6 months and annual radiographic examinations. 在骨移植和种植体愈合期间，所有患者都要接受临时修复，以保证功能和美观，并避免对手术部位造成压力。种植体揭开后的几周内，患者将接受最终修复。患者接受种植体支持的固定修复体，并参加定期维护计划，包括每 6 个月进行一次临床检查和每年进行一次放射检查。
Fig 1 Measurement of a representative defect before and after treatment. 图 1 测量治疗前后的代表性缺陷。
Fig 1a A 7-mm vertical defect involving three teeth. 图 1a 涉及三颗牙齿的 7 毫米垂直缺损。
Fig 1b Buccal view of the autogenous bone graft and membrane in place. 图 1b 自体骨移植和骨膜就位的颊侧视图。
Figs 1c and 1d Regenerated bone crest at membrane removal after 9 months of healing. 图 1c 和 1d 经过 9 个月的愈合，骨膜移除后的再生骨嵴。
Peri-implant mucosal conditions were assessed for redness, hyperplasia, suppuration, swelling, and the presence of plaque. Probing depths were recorded according to established methods. 4,12,13 Periapical radiographs were obtained at abutment connection and then every 12 months thereafter with a long-cone paralleling technique. Crestal bone levels were measured to the nearest using NIH Image software (National Institutes of Health, Bethesda, MD), with the implant-abutment junction as the baseline reference point. Complications in bone graft healing, such as membrane exposure and/or subsequent infection, were recorded. 对种植体周围的粘膜状况进行评估，包括发红、增生、化脓、肿胀和是否存在牙菌斑。根据既定方法记录探诊深度。4,12,13在基台连接时拍摄根尖周X光片，之后每12个月使用长锥体平行技术拍摄一次。使用 NIH Image 软件（National Institutes of Health, Bethesda, MD）测量牙槽骨水平，以种植体与基台交界处为基线参考点，精确到最接近的 。 记录骨移植愈合过程中的并发症，如骨膜暴露和/或随后的感染。
Implant Success Criteria 植入成功标准
Success was evaluated according to established methods. The absence of pain, foreign body sensation, dysesthesia, mobility, or peri-implant radiolucency were the clinical criteria for success throughout the follow-up period. Following the first year of function, there could be no more than crestal bone remodeling annually, and total crestal bone remodeling by the end of the fifth year was considered acceptable. 成功与否根据既定方法进行评估。在整个随访期间，无疼痛、无异物感、无痛觉障碍、无活动度、无种植体周围放射性透明是成功的临床标准。在功能发挥的第一年后，每年的骨嵴重塑不能超过 ， ，到第五年年底， ，骨嵴重塑总量被认为是可以接受的。
Statistical Analysis 统计分析
Recorded data were used for calculations of mean values and standard deviations (SDs). Cumulative success rates (CSRs) were evaluated using life table analysis. Significant differences in marginal bone level changes between the three groups were assessed by the test, employing a critical value of .0167 to account for multiple comparisons. 记录的数据用于计算平均值和标准差（SD）。累积成功率（CSR）采用生命表分析法进行评估。 三组间边缘骨水平变化的显著性差异通过 检验进行评估，采用的临界 值为 0.0167，以考虑多重比较。
Table 1 Distribution and Surgical Approach in the Three Treatment Groups 表 1 三个治疗组的分布和手术方法
Surgical approach 手术方法
(no. and %)
Treatment No. of 治疗次数
No. of
No. of
N
group
patients
defects
implants
Simultaneous
Staged
A
12
12
12
B
16
16
42
C
7
8
28
Total
35
36
82
6
31
RESULTS 结果
This retrospective study sought to encompass the scope of clinical practice where vertical bone augmentation is required for the purpose of implant placement: 82 implants were placed in 35 patients with 36 three-dimensional ridge defects ranging from 2 to 12 . Thirty-three patients ( ) were partially edentulous, and two ( ) were completely edentulous. Fourteen ( ) patients were men and 21 ( ) were women, and the mean age was 44.9 years (range, 19 to 72 years). A staged approach that allowed the graft to heal uneventfully before implant placement was used in most cases. 这项回顾性研究试图涵盖为植入种植体而需要进行垂直骨增量的临床实践范围：在 35 名患者中植入了 82 个种植体，这些患者有 36 个三维牙脊缺损，缺损范围从 2 到 12 不等。33 名患者 ( ) 部分无牙颌，2 名患者 ( ) 完全无牙颌。14名患者（ ）为男性，21名患者（ ）为女性，平均年龄为44.9岁（19至72岁）。大多数病例都采用了分期方法，使移植体在种植体植入前顺利愈合。
Table 1 provides treatment approaches of the patient sample. The patients treated with the simultaneous approach had less severe vertical defects, with a maximum defect size of . With one exception, intraoral bone grafts were used; the graft was taken from the retromolar area in 21 cases and the chin in 13 cases In one patient (2.8%), bone was harvested from the hip. 表 1 提供了患者样本的治疗方法。采用同步方法治疗的患者垂直缺损程度较轻，最大缺损大小为 。除一名患者外，其他患者均采用口内植骨；21 例患者的植骨取自后臼齿区域 ，13 例患者的植骨取自下巴 ，一名患者（2.8%）的植骨取自髋部。
Fig 2a Atrophic posterior mandibular area in a representative case from treatment group . 图 2a 治疗组一个代表性病例的下颌骨后部萎缩区域。
Fig 2c The membrane is secured over the graft with titanium pins. 图 2c 用钛针将薄膜固定在移植物上。
Fig 2b Particulated chin bone graft is placed on the ridge. The cortical bone was perforated, and the membrane was secured on the lingual side before applying bone graft. 图 2b 将颗粒状颏骨移植到颏脊上。皮质骨被打孔，薄膜被固定在舌侧，然后再进行植骨。
Fig Three implants are in place in the newly formed posterior mandibular ridge. Note the well-integrated bone graft. 图 在新形成的下颌后嵴中植入了三个种植体。请注意骨移植的良好整合。
Fig 2e Periapical radiograph at abutment connection. 图 2e 基台连接处的根尖周射线照片。
Fig Periapical radiograph at 3-year follow-up with implant in function. 图 3 年随访时的根尖周 X 光片，种植体功能正常。
Fig Clinical view demonstrates healthy peri-implant mucosa. 图 临床显示种植体周围粘膜健康。
The implants used in this study were all commercially available from the same manufacturer at the time of the respective surgery. Thirteen acid-etched Steri-Oss (Nobel Biocare, Yorba Linda, CA), 66 anodized-surface Brånemark TiUnite (Nobel Biocare), and three anodized-surface Replace TiUnite (Nobel Biocare) implants were placed in the 35 patients. All patients presented with vertical bone defects and were divided into three treatment groups: group A (12 patients) had single missing teeth, group B (16 patients) had multiple missing teeth, and group patients/8 defects) had vertical defects in the posterior maxilla only and were treated simultaneously with sinus and vertical augmentations. 本研究中使用的植入体在各自手术时均由同一制造商提供。35 位患者分别植入了 13 个酸蚀 Steri-Oss 种植体（Nobel Biocare，加利福尼亚州约巴林达）、66 个阳极氧化表面 Brånemark TiUnite 种植体（Nobel Biocare）和 3 个阳极氧化表面 Replace TiUnite 种植体（Nobel Biocare）。所有患者都有垂直骨缺损，并被分为三个治疗组：A 组（12 名患者）有单颗牙齿缺失，B 组（16 名患者）有多颗牙齿缺失，而 患者/8 例缺损）仅上颌后部有垂直缺损，并同时进行了上颌窦和垂直增量治疗。
Fig 3 Representative case requiring posterior maxillary bone regeneration (treatment group C). 图 3 需要上颌骨后方骨再生的代表性病例（治疗组 C）。
Fig 3a Vertical defect in the posterior maxilla. 图 3a 上颌骨后部的垂直缺损。
Fig 3b Panoramic radiograph shows defects after treatment with sinus augmentation and vertical GBR. 图 3b 全景照片显示了窦增量和垂直 GBR 治疗后的缺陷。
Figs 3c and 3d After 9 months of uneventful healing, complete vertical bone gain is demonstrated. 图 3c 和 3d 经过 9 个月的顺利愈合，垂直骨量完全增加。
Fig 3 R Radiograph of implants after 4 years of loading. 图 3 R 种植体植入 4 年后的 X 光片。
Fig Definitive implant-supported complete fixed prosthesis. ment connection. 图 最终种植体支持的完全固定义齿。
Bone regeneration was evaluated clinically at the time of membrane removal. In general, all treated defect sites exhibited excellent bone formation, with an overall average of (SD 2.29) of vertical augmentation (Table 2). None of the patients showed less bone regeneration than the space created by the membrane (Figs 2 and 3), with one exception. 去除骨膜时对骨再生进行临床评估。总的来说，所有治疗过的缺损部位都表现出了良好的骨形成，总体平均垂直增量为 （标度 2.29）（表 2）。除一名患者外，没有一名患者的骨再生低于骨膜形成的空间（图 2 和图 3）。
Table 2 Results of Vertical Augmentation 表 2 纵向扩展的结果
Treatment group 治疗组
Mean
SD
Range
A
4.7
1.67
B
5.1
2.13
C
7.4
2.56
Overall
5.5
2.29
Table 3 Mean Marginal Bone Loss Around Implants at Different Time Periods (in mm) 表 3 不同时间段种植体周围平均边缘骨质流失量（单位：毫米）
Time
Bone loss
Group A
Group B
Group C
Overall
Mean (SD)
Mean (SD)
n*
Mean (SD)
n*
Mean (SD)
n*
Abutment connection 基台连接
0.47 (0.61)
11
42
28
81
11
42
28
81
10
32
25
67
6
24
19
49
3
15
17
35
-0.28
1
6
9
16
3
4
7
*No. of patients who attended the respective follow-up visit as a part of this retrospective study. *作为本次回顾性研究的一部分，参加了相关随访的患者人数。
There was one complication associated with bone graft healing CI: .This group B patient developed a fistula on top of the membrane area 2 weeks after bone grafting. The surgical site was reopened and the membrane was removed carefully so that the graft was not disturbed. There was no visible infection of the graft. After gentle irrigation with saline, a resorbable collagen membrane (Bio-Gide) was placed over the graft, and the flap was closed and permitted to heal for an additional 7 months; at this point, implants were placed successfully. At the time of implant placement, of the original vertical deficiency were still present, along with minimal vertical gain . 与植骨愈合相关的并发症有 1 例 CI: 。B 组患者在植骨 2 周后，骨膜区域顶部出现瘘管。手术部位被重新打开，为了不影响植骨，我们小心翼翼地移除了骨膜。移植骨没有明显感染。用生理盐水轻轻冲洗后，在移植物上放置了一层可吸收的胶原蛋白膜（Bio-Gide），然后关闭皮瓣并允许其再愈合 7 个月；此时，种植体已成功植入。植入种植体时， ，原来的垂直缺损仍然存在，垂直增高也很小 。
Regardless of which site was used for bone harvesting, there appeared to be no difference in the results in terms of bone quality and quantity at implant placement or during the follow-up period when implants were assessed clinically and radiographically. Throughout the period of the study, no early or late resorption of the newly formed bone crest was noted. The use of collagen membranes at the time of implant placement was strictly empirical, and it was not possible to evaluate whether they were of any benefit in maintaining bone dimensions. 无论在哪个部位取骨，植入种植体时的骨质和骨量似乎都没有差别，在后续的临床和影像学评估中也是如此。在整个研究期间，新形成的骨嵴没有出现早期或晚期吸收。在植入种植体时使用胶原蛋白膜完全是经验之谈，因此无法评估胶原蛋白膜在保持骨量方面是否有任何益处。
All implants were placed according to their predetermined optimal prosthetic positions. At the time of abutment connection, all implants were stable and were fully embedded within bone. 所有种植体都按照预先确定的最佳修复位置植入。在基台连接时，所有种植体都很稳定，并完全嵌入骨内。
After the last exam for the cohort in this retrospective study, all patients had comfortable prostheses in place; all implants were still in function; and no patients reported any complaints of foreign body sensation, pain, or dysesthesia. Intraoral examinations demonstrated healthy peri-implant mucosa without suppuration, swelling, or redness at any implant sites. The mean probing depth was (SD 0.61). 在这项回顾性研究的最后一次检查后，所有患者的修复体均已就位，舒适度良好；所有种植体仍在正常使用；没有患者抱怨有异物感、疼痛或感觉异常。口腔内检查显示种植体周围粘膜健康，没有任何种植体部位出现化脓、肿胀或发红现象。平均探诊深度为 (SD 0.61)。
Two patients dropped out of the study after successful treatment. One patient in group A was lost to follow-up after the abutment connection, refused a radiographic exam, and consequently could not be evaluated at the 1 -year evaluation. The other patient was in group B and became lost to follow-up after the 1 -year evaluation. 两名患者在成功治疗后退出了研究。A 组的一名患者在基台连接后失去了随访机会，拒绝接受放射检查，因此无法在 1 年评估时进行评估。另一名患者属于 B 组，在一年评估后失去了随访机会。
In the 81 consecutively treated implants that were evaluated clinically and radiographically after abutment connection, the period of functional loading in this study ranged from 1 to 6 years (mean: 40.3 months), and the mean radiographic follow-up was 34.2 months. At the 1 -year examination, the mean crestal bone remodeling value for the 81 implants was (SD 0.57) and, in most cases, the first bone-implant contact was located near the first implant thread. The mean marginal bone remodeling for the 81 implants throughout the study is provided in Table 3. There were no statistically significant differences between the three groups in mean marginal bone remodeling, and the crestal bone remained stable throughout the follow-up period. 在基台连接后进行临床和影像学评估的 81 个连续治疗的种植体中，本研究中的功能负荷期为 1 到 6 年（平均：40.3 个月），平均影像学随访期为 34.2 个月。在 1 年的检查中，81 个种植体的平均骨嵴骨改建值为 （SD 0.57），在大多数情况下，骨与种植体的第一次接触位于第一个种植体螺纹附近。整个研究过程中 81 个种植体的平均边缘骨重塑情况见表 3。三组之间的平均边缘骨重塑没有明显的统计学差异，在整个随访期间，种植体骨质保持稳定。
All of the examined 81 implants survived (Tables 4 and 5). Only three implants in group B showed increased bone remodeling (slightly more than , and these were not considered clinically successful. 受检的 81 个种植体全部存活（表 4 和表 5）。只有 B 组的三个种植体出现了骨重塑（略高于 ），这些种植体在临床上并不成功。
DISCUSSION 讨论
Bone augmentation using GBR techniques is well documented and characterized by high predictability and survival of implants. However, few publications have reported long-term results on vertical ridge augmentation following GBR. 9,10 These studies found that vertical bone regeneration of more than could only be achieved with the use of autogenous bone chips. This is consistent with the present study, since up to of vertical bone gain was achieved. None of the sites showed less bone regeneration than the space created by the membrane; however, the one site in which early membrane removal 使用 GBR 技术进行骨质增量的文献资料丰富，其特点是植入物的可预测性和存活率高。 然而，很少有文献报道 GBR 后垂直骨脊增量的长期结果。9,10 这些研究发现，只有使用自体骨片才能实现超过 的垂直骨再生。这与本研究的结果一致，因为垂直骨增量高达 。没有一个部位的骨再生少于骨膜形成的空间；但是，有一个部位的骨再生少于骨膜形成的空间。
Table 4 Life Table Analysis of Implants: Overall Cumulative Success Rates 表 4 植入物生命表分析：总体累积成功率
Time
Implants
Cumulative success rate* 累计成功率*
Standard error 标准误差
No. surveyed
No. of failures 失败次数
No. censored
Placement to loading 从放置到装载
82
0
0
Loading to 1 y 加载至 1 y
82
0
1
to
81
13
to
67
17
to
49
13
to
35
0
19
to
16
0
9
to
7
0
7
*Based on implants that were evaluated in the respective follow-up period. * 基于在相应跟踪期内接受评估的植入物。
'Patient in group B who became lost to follow-up after the 1-year evaluation. One of the patient's two treated defects exhibited 2.5 mm of bone remodeling. 'B组患者在1年评估后失去随访机会。该患者的两个治疗缺损中，有一个出现了 2.5 毫米的骨重塑。
§One implant in group B had bone remodeling at the 1 -year evaluation, and the amount of bone remodeling had increased to 2.38 mm at the year evaluation. §B组的一个种植体在1年评估时， 骨重塑，在 年评估时，骨重塑量增加到2.38毫米。
Table 5 Life Table Analysis of Implants 表 5 植入物寿命表分析
Time
Implants
Cumulative success rate* 累计成功率*
Standard error 标准误差
No. of implants 植入数量
No. of failures 失败次数
No. censored
Placement to loading 从放置到装载
group
12
0
0
group B
42
0
0
group C
28
0
0
Loading to 1 y 加载至 1 y
group A
12
0
1
group B
42
0
0
group C
28
0
0
1 y to
group
11
0
1
group
42
1
9
group C
28
0
3
to
group A
10
0
4
group B
32
1
7
group C
25
0
6
to
group A
6
0
3
group B
24
1
8
group C
19
0
2
to
group A
3
0
2
group
15
0
9
group C
17
0
8
to
group A
1
0
1
group B
6
0
3
group C
9
0
5
to
group A
0
0
0
group B
3
0
3
group C
4
0
4
was necessary showed minimal vertical bone gain. This indicates that a dimensionally stable barrier, such as the titanium-reinforced e-PTFE membrane, may be necessary for vertical augmentation. 垂直骨增量最小。这表明，垂直增骨可能需要一个尺寸稳定的屏障，如钛增强型 e-PTFE 膜。
After abutment connection, clinical follow-up demonstrated healthy peri-implant mucosa and a mean probing depth of . These values are consistent with those reported previously in longterm studies on implants placed into native and regenerated bone. 4,9 基台连接后，临床随访显示种植体周围粘膜健康，平均探查深度为 。这些数值与之前关于在原生 和再生骨中植入种植体的长期研究报告一致。4,9
Crestal bone remodeling was measured from the implant-abutment junction. This showed an overall mean change of in the first year and remained stable throughout the follow-up period. Similarly, of remodeling was shown previously in a study reporting on 32 sites that were vertically augmented with autogenous bone chips and a titanium-reinforced e-PTFE membrane. In the current study, there was a slight difference in the first year between the three groups examined in this report. However, the differences were not statistically significant and in fact could be expected given the span size and location of the defects. 从种植体与基台交界处开始测量嵴骨重塑情况。结果显示，第一年的总体平均变化为 ，并在整个随访期间保持稳定。同样， 的重塑也出现在之前的一项研究中，该研究报告了使用自体骨片和钛增强型 e-PTFE 膜进行垂直增量的 32 个部位。 在目前的研究中，本报告所研究的三组患者在第一年的情况略有不同。然而，这些差异在统计学上并不显著，事实上，鉴于缺损的跨度大小和位置，这些差异是意料之中的。
The overall implant success rates within this study are consistent with published long-term results of implants placed in horizontally and vertically regenerated bone and with results reported for implants placed in native bone. The overall cumulative implant survival rate of and cumulative success rate of in this study compare favorably with the aforementioned studies on implants placed in regenerated bone as well as native bone. However, there was a marked difference in results reported in previous studies on vertical GBR and the current study. Implant survival and implant success rates were and , respectively, in a study that combined sinus augmentation and posterior maxillary vertical ridge augmentation, whereas implant success was achieved in a similar population in the current study (group C). However, in the previous report, only machined-surface implants were used, whereas enhanced-surface implants were used in the current study. The use of enhanced implant surfaces may have helped, especially in the posterior maxilla where the bone quality is typically poor. Also, in the previous report 7 patients were treated with a simultaneous technique, whereas in the current study the same type of patients were treated with a staged technique, which allowed more time for regenerated bone to mature prior to loading. 本研究中的总体种植体成功率与已发表的在水平和垂直再生骨 中植入种植体的长期结果以及在原生骨中植入种植体的结果一致。 本研究中植入体的总体累积存活率为 ，累积成功率为 ，与上述在再生骨和原生骨中植入植入体的研究结果相比毫不逊色。然而，以往关于垂直 GBR 的研究结果与本研究报告的结果存在明显差异。在一项结合了上颌窦增量术和上颌后垂直脊增量术的研究中，种植体存活率和种植体成功率分别为 和 ， ，而在本研究（C 组）中，类似人群的种植体成功率为 。不过，在之前的报告中，只使用了机加工表面的种植体，而在本次研究中则使用了增强表面的种植体。使用增强型种植体表面可能会有所帮助，尤其是在骨质通常较差的后上颌骨。此外，在之前的报告中，7 名患者 采用了同步技术，而在本次研究中，同类患者采用了分期技术，这样就有更多的时间让再生骨在加载前成熟。
In the present report, the complication rate was . This is significantly lower than the complication rates reported in earlier clinical studies on vertical augmentation with GBR (ranging from to ), and these earlier reports also included membrane exposures and/or subsequent infections. The technique employed in this vertical augmentation study is essentially the same technique reported previously. However, this retrospective study represents the time period when vertical ridge augmentation was considered routine clinical practice and does not represent the initial learning curve. The results of this study indicate that (1) there can be reduced complication rates with vertical bone regeneration, (2) implants can be placed successfully in vertically regenerated bone, and (3) implants can survive over time with high clinical success rates. 在本报告中，并发症发生率为 。这明显低于早先关于使用 GBR 进行垂直隆鼻的临床研究中报告的并发症发生率（从 到 不等），而且这些早先的报告还包括膜暴露和/或随后的感染。 这项垂直隆鼻研究采用的技术与之前报道的技术基本相同。 不过，这项回顾性研究代表的是垂直隆鼻被认为是常规临床实践的时期，并不代表最初的学习曲线。研究结果表明：(1) 垂直骨再生可降低并发症发生率；(2) 种植体可成功植入垂直再生骨中；(3) 种植体可长期存活，临床成功率高。
Some similarities and differences have been identified between the present study and the previously reported studies. These studies should be analyzed in a meta-analytic fashion to coalesce the data into a more meaningful finding relative to the current state of the science on vertical augmentation. Also, since most of the vertical augmentation studies reported in the literature have been retrospective in nature, future research should focus on long-term prospective studies. 本研究与之前报告的研究之间存在一些异同。应该以元分析的方式对这些研究进行分析，以便根据垂直增强的科学现状，将数据整合成更有意义的结论。此外，由于文献中报道的大多数垂直增强研究都是回顾性的，因此未来的研究应侧重于长期的前瞻性研究。
CONCLUSIONS 结 论
Within the limitations of this retrospective study, the results suggest that the following conclusions can be made: (1) vertical augmentation with e-PTFE membranes and particulated autografts is safe and predictable, with minimal complications; (2) clinical success and survival of implants placed in vertically augmented bone with the GBR technique appear similar to success and survival of implants placed in native bone under loading conditions, regardless of the harvest site, surgical area, or defect size; and (3) the success and survival rates of implants placed simultaneously with sinus and vertical augmentation techniques compare favorably to those in sites requiring vertical augmentation of single- or multiple-tooth ridge defects. The results of this retrospective study should be verified with studies of more rigorous designs. 在这项回顾性研究的限制条件下，研究结果表明可以得出以下结论：(1) 使用 e-PTFE 膜和微粒自体移植物进行垂直增量是安全和可预测的，并发症极少；(2) 使用 GBR 技术在垂直增量骨中植入种植体的临床成功率和存活率与在加载条件下在原生骨中植入种植体的成功率和存活率相似，与取骨部位、手术区域或缺损大小无关；(3) 采用窦和垂直增量技术同时植入种植体的成功率和存活率与需要垂直增量单牙或多牙牙槽骨缺损部位的成功率和存活率相比较，后者更胜一筹。这项回顾性研究的结果应通过更严格设计的研究来验证。
REFERENCES 参考文献
Buser D, Brägger U,Lang NP, Nyman S. Regeneration and enlargement of jaw bone using guided tissue regeneration. Clin Oral Implant Res 1990;1:22-32. Buser D、Brägger U、Lang NP、Nyman S. 利用引导组织再生技术再生和扩大颌骨。Clin Oral Implant Res 1990; 1:22-32.
Jovanovic SA, Spiekermann H, Richter EJ. Bone regeneration around titanium dental implants in dehisced defect sites: A clinical study.Int J Oral Maxillofac Implants 1992;7:233-245. Jovanovic SA, Spiekermann H, Richter EJ.缺损部位钛牙种植体周围的骨再生：一项临床研究.Int J Oral Maxillofac Implants 1992; 7:233-245：Int J Oral Maxillofac Implants 1992; 7:233-245.
Buser D, Dula K, Hirt HP, Schenk RK. Lateral ridge augmentation using autografts and barrier membranes: A clinical study with 40 partially edentulous patients. J Oral Maxillofac Surg 1996;54:420-432. Buser D、Dula K、Hirt HP、Schenk RK。使用自体移植物和屏障膜进行侧脊增高：40 例部分缺牙患者的临床研究。J Oral Maxillofac Surg 1996;54:420-432.
Buser D, Ingimarsson S, Dula K, Lussi A, Hirt HP, Belser UC. Long-term stability of osseointegrated implants in augmented bone: A 5-year prospective study in partially edentulous patients. Int J Periodontics Restorative Dent Buser D、Ingimarsson S、Dula K、Lussi A、Hirt HP、Belser UC。增量骨中骨结合种植体的长期稳定性：对部分无牙颌患者进行的为期 5 年的前瞻性研究。Int J Periodontics Restorative Dent
Jovanovic SA, Schenk RK, Orsini M, Kenney EB. Supracrestal bone formation around dental implants: An experimental dog study. Int J Oral Maxillofac Implants 1995;10:23-31. Jovanovic SA、Schenk RK、Orsini M、Kenney EB。牙科植入物周围的上皮层骨形成：狗实验研究。Int J Oral Maxillofac Implants 1995;10:23-31.
Simion M, Trisi P, Piattelli A.Vertical ridge augmentation using a membrane technique associated with osseointegrated implants. Int J Periodontics Restorative Dent 1994;14:496-511. Simion M, Trisi P, Piattelli A.使用与骨结合种植体相关的膜技术进行垂直脊增量术。Int J Periodontics Restorative Dent 1994;14:496-511.
Simion M, Jovanovic SA, Trisi P, Scarano A, Piattelli A.Vertical ridge augmentation around dental implants using a membrane technique and autogenous bone or allografts in humans. Int J Periodontics Restorative Dent 1998;18:18-23. Simion M, Jovanovic SA, Trisi P, Scarano A, Piattelli A.使用膜技术和自体骨或同种异体移植物在人体种植体周围进行垂直脊增量术。Int J Periodontics Restorative Dent 1998;18:18-23.
Simion M, Jovanovic SA,Tinti C, Parma-Benfenati S. Long-term evaluation of osseointegrated implants inserted at the time or after vertical ridge augmentation. A retrospective study on 123 implants with 1-5 year follow-up. Clin Oral Implants Res . Simion M、Jovanovic SA、Tinti C、Parma-Benfenati S。对垂直脊增高术时或术后植入的骨结合植入体进行长期评估。对 123 个种植体进行 1-5 年随访的回顾性研究。Clin Oral Implants Res .
Simion M, Fontana F, Rasperini G, Maiorana C. Long-term evaluation of osseointegrated implants placed in sites augmented with sinus floor elevation associated with vertical ridge augmentation: A retrospective study of 38 consecutive implants with 1- to 7-year follow-up. Int J Periodontics Restorative Dent . Simion M、Fontana F、Rasperini G、Maiorana C。骨结合种植体植入与垂直脊增高相关的窦底增高部位的长期评估：对 38 个连续种植体进行 1-7 年随访的回顾性研究。Int J Periodontics Restorative Dent .
Jovanovic SA, Altman RR. Reconstruction of the posterior maxilla following total loss of crestal bone support. Pract Periodontics Aesthet Dent 1998;10:241-244. Jovanovic SA, Altman RR.嵴骨支撑完全丧失后的上颌骨后部重建。Pract Periodontics Aesthet Dent 1998;10:241-244.
van Steenberghe D, Lekholm U, Bolender C, et al. Applicability of osseointegrated oral implants in the rehabilitation of partial edentulism: A prospective multicenter study on 558 fixtures. Int J Oral Maxillofac Implants 1990;5:272-281. van Steenberghe D, Lekholm U, Bolender C, et al：对 558 个固定装置进行的前瞻性多中心研究。Int J Oral Maxillofac Implants 1990; 5:272-281.
Buser D, Weber HP, Lang NP.Tissue integration of non-submerged implants. 1-year results of a prospective study with 100 ITI hollow-cylinder and hollow-screw implants. Clin Oral Implants Res 1990;1:33-40. Buser D、Weber HP、Lang NP.非浸没种植体的组织整合。对 100 个 ITI 空心圆柱体和空心螺丝种植体进行的前瞻性研究的 1 年结果。Clin Oral Implants Res 1990;1:33-40.
Wyatt CC, Byant SR, Avivi-Arber L, Chaytor DV, Zarb GA.A computer-assisted measurement technique to assess bone proximal to oral implants on intraoral radiographs. Clin Oral Implants Res 2001;12:225-229. Wyatt CC, Byant SR, Avivi-Arber L, Chaytor DV, Zarb GA.口内X光片上评估口腔种植体近端骨质的计算机辅助测量技术。Clin Oral Implants Res 2001; 12:225-229.
Albrektsson T, Zarb G, Worthington P, Eriksson B.The longterm efficacy of currently used dental implants: A review and proposed criteria of success. Int J Oral Maxillofac Implants . Albrektsson T、Zarb G、Worthington P、Eriksson B.目前使用的牙科种植体的长期功效：回顾与成功标准建议。Int J Oral Maxillofac Implants .
Wennstrom JL, Palmer RM. Consensus report of Session C. In: Lang NP, Karring T, Lindhe J (eds). Proceedings of the 3rd European Workshop on Periodontology: Implant Dentistry. Berlin: Quintessenz, 1999:255-259. Wennstrom JL, Palmer RM.会议 C 的共识报告。见：Lang NP、Karring T、Lindhe J（编辑）。第三届欧洲牙周病学研讨会论文集：Implant Dentistry.柏林：Quintessenz, 1999:255-259.
Colton T. Longitudinal studies and the use of the life table. In: Colton T. Statistics in Medicine. Boston: Little, Brown and Company, 1974:237-250. Colton T. Longitudinal studies and the use of the life table.In. Colton T. Statistics in Medicine：Colton T. Statistics in Medicine.波士顿：Little, Brown and Company, 1974:237-250.
Hunt DR, Jovanovic SA. Autogenous bone harvesting: A chin graft technique for particulate and monocortical bone blocks. Int J Periodontics Restorative Dent 1999;19:165-173. Hunt DR, Jovanovic SA.自体骨采集：颗粒状和单皮质骨块的下巴移植技术。Int J Periodontics Restorative Dent 1999; 19:165-173.
Nevins M, Mellonig JT, Clem DS III, Reiser GM, Buser DA. Implants in regenerated bone:Long-term survival. Int J Periodontics Restorative Dent 1998;18:34-45. Nevins M、Mellonig JT、Clem DS III、Reiser GM、Buser DA。再生骨中的种植体：长期存活。Int J Periodontics Restorative Dent 1998;18:34-45.
Zitzmann NU, Schärer P, Marinello CP.Long-term results of implants treated with guided bone regeneration: A 5-year prospective study. Int J Oral Maxillofac Implants 2001;16:355-366. Zitzmann NU、Schärer P、Marinello CP.采用引导骨再生技术治疗种植体的长期效果：为期 5 年的前瞻性研究。Int J Oral Maxillofac Implants 2001;16:355-366.
Lekholm U, van Steenberghe D, Herrmann I, et al. Osseointegrated implants in the treatment of partially edentulous jaws: A prospective 5-year multicenter study. Int J Oral Maxillofac Implants 1994;9:627-635. Lekholm U, van Steenberghe D, Herrmann I, et al. Osseointegrated implants in the treatment of partially edentulous jaws：一项为期 5 年的前瞻性多中心研究。Int J Oral Maxillofac Implants 1994; 9:627-635.
Adell R, Lekholm U, Rockler B, Brånemark PI. A 15-year study of osseointegrated implants in the treatment of edentulous jaws. Int J Oral Surg 1981;10:387-416. Adell R, Lekholm U, Rockler B, Brånemark PI.骨结合植入物治疗无牙颌的 15 年研究。Int J Oral Surg 1981;10:387-416.
Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Longterm follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Surg 1990;5:347-359. Adell R、Eriksson B、Lekholm U、Brånemark PI、Jemt T.治疗完全无牙颌的骨结合植入物的长期随访研究。Int J Oral Maxillofac Surg 1990; 5:347-359.
Jemt T, Lekholm U. Oral implant treatment in posterior partially edentulous jaws: A 5-year follow-up report. Int J Oral Maxillofac Implants 1993;8:635-640. Jemt T, Lekholm U. 后牙部分缺失颌骨的口腔种植治疗：5年随访报告。Int J Oral Maxillofac Implants 1993; 8:635-640.
Lekholm U, Gunne J, Henry P, et al. Survival of the Brånemark implant in partially edentulous jaws: A 10 -year prospective multicenter study. Int J Oral Maxillofac Implants Lekholm U、Gunne J、Henry P 等：部分无牙颌的 Brånemark 种植体的存活率：一项为期 10 年的前瞻性多中心研究。Int J Oral Maxillofac Implants
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Assistant Professor, Graduate Implant Dentistry, Loma Linda University, Loma Linda, California; Private Practice in Periodontics and Implant Dentistry, Budapest, Hungary. 加利福尼亚州洛马林达，洛马林达大学种植牙研究生院助理教授；匈牙利布达佩斯，牙周病学和种植牙私人诊所。
Lecturer, Continuing Dental Education, University of California Los Angeles (UCLA), Los Angeles, California. 加州大学洛杉矶分校牙科进修教育讲师。
Professor, Department of Restorative Dentistry, Director of Graduate Implant Dentistry, Loma Linda University, Loma Linda, California. 加州洛马琳达大学牙科修复系教授、种植牙研究生部主任。
Correspondence to: Dr Istvan Urban, Sodras utca 9, Budapest, Hungary 1026. Fax: +36-12004447. Email: istvan@implant.hu 通讯地址：Dr Istvan Urban, Sodras utca 9, Budapest, Hungest 1026：Dr Istvan Urban, Sodras utca 9, Budapest, Hungary 1026.传真：+36-12004447。电子邮件：istvan@implant.hu
Preliminary results were presented in 2004 at the annual meeting of the European Association of Osseointegration in Paris, France. 2004 年在法国巴黎举行的欧洲骨整合协会年会上公布了初步结果。
*Based on implants that had been evaluated in the respective follow-up period. not applicable. * 不适用。
