방사선 조사 백서 경골에 티타늄 임플랜트 매식후 골 치유에 관한 연구

THE EXPERIMENTAL STUDY ON BONE HEALING AROUND TITANIUM IMPLANTS PLACED IN IRRADIATED RAT'S TIBIAE

  • 곽병학 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 김종렬 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 박봉수 (부산대학교 치과대학 구강해부학교실) ;
  • 신상훈 (부산대학교 치과대학 구강악안면외과학교실) ;
  • 성일용 (울산대학교 의과대학 구강악안면외과학교실)
  • Kwak, Byung-Hak (Oral & Maxillofacial Surgery, Oral Anatomy, Pusan National University) ;
  • Kim, Jong-Ryoul (Oral & Maxillofacial Surgery, Oral Anatomy, Pusan National University) ;
  • Park, Bong-Soo (College of Dentistry, Pusan National University) ;
  • Shin, Sang-Hoon (Oral & Maxillofacial Surgery, Oral Anatomy, Pusan National University) ;
  • Sung, Iel-Yong (Oral & Maxillofacial Surgery, College of Medicine, Ulsan University)
  • 발행 : 2003.12.31

초록

The present study was undertaken to evaluate bone regenerative capacity around titanium screw implants placed in irradiated rat's tibiae. At one week after single 15-Gy dose irradiation, miniaturized titanium screw implants were inserted into anterior aspect of the upper tibia of rats weighing 200-250g. Seventy rats were involved: 35 rats were control and 35 rats radiation group. The rats were killed at different intervals as 1, 2, 3, 4, 6, 8, 12 weeks after implantation for histologic observation, histomorphometric analysis and immunohistochemical study with fibronectin and CD34 antibody. 1. Histologically, various stages of bone maturation and ossification can be seen at 4 weeks and regenerated bone close to edges demonstrates more advanced calcification, and network of new bone are well formed at 12 weeks in non-irradiated group. In contrast, active bone formation with increased contact of newly formed bone to implant surface was noted at 4 weeks and a significant amount of new bone formation and bone-implant contact is oberved at 12 weeks in irradiated group. 2. Histomorphometrical analysis confirmed these histologic findings. A significant difference in implant-bone contact and bone density was measured between the control and radiation group. Mean MBD was 62.2% in control group and 27.5% in radiation group, mean MBIC was 86.6% in control group and 47.7% in radiation group, and mean TBIC was 87.3% in control group and 45.6% in radiation group at 12 weeks after implantation. 3. In immunohistochemical study with fibronectin and CD34, radiation reduced hematopoietic progenitor cells severely and disturbed differentiation of osteoblast in bone marrow. The results of this study revealed bone healing capacity around implant after radiation therapy was severely impaired and irradiation reduces the capacity for osseointegration of titanium implants. Many factors including radiation dose, period between radiation and implantation, bone quality, time elapse between first and second surgery, type of prosthetics and hyperbaric oxygen therapy must be considered carefully in postradiation implantation.

키워드

참고문헌

  1. Marx RE: Osteoradionecrosis : A new concept of its pathophysiology. J Oral Maxillofac Surg 41;283-288, 1983.
  2. Marx RE: A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg 41:351-357, 1983. https://doi.org/10.1016/S0278-2391(83)80005-6
  3. Marx RE, Johnson RP, Kline SN: Prevention of osteoradionecrosis: A randomized prospective clinical trial of hyperbaric oxygen vs penicillin. J Am Dent Assoc 111:49-54, 1985. https://doi.org/10.14219/jada.archive.1985.0074
  4. Marx RE, Johnson RP: Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oal Surg Oral Med Oral Pathol 64:379-390, 1987. https://doi.org/10.1016/0030-4220(87)90136-8
  5. Basker H, Power MP: The transmandibular reconstruction system. In Fonseca RJ, Davis WH (eds): Reconstructive preprosthetic oral and maxillofacial surgery, 2nd ed. Philadelphia, WB Saunders Co., 1995, pp 649-653.
  6. Franzen L, Rosenquist JB, Orsenquist KI, Gustafsson I: Oral implants rehabillitation of patient with oral malignancies treated with radiotherapy and surgery without adjunctive hyperbaric oxygen. Int J Oral Maxillofac Implants 10:183-187, 1995.
  7. Walzinger F, Ewers R, Sudasch G, Babka A: Endosteal implants in the irradiated lower jaw. J Craniomaxillofac Surg 24:237-244, 1996. https://doi.org/10.1016/S1010-5182(96)80007-2
  8. Werkmeister R, Szulczewski D, Walteros-Benz P, Joos U: Rehabilitation with dental implants of oral cancer patients. J Craniomaxillofac Surg 27:38-41, 1999. https://doi.org/10.1016/S1010-5182(99)80008-0
  9. Keller EE, Tolman DE, Zuck SL, Echert SE: Mandibular endosseous implants and autogenous bone grafting in irradiated tissue: a 10-year retrospective study. Int J Oral Maxillofac Implants 12:800-813, 1997.
  10. Eckert SE, Desjardine RP, Keller EE, Tolman DE: Endosseous implants in an irradiated tissue bed. J Prosthet Dent 76:45-49, 1996. https://doi.org/10.1016/S0022-3913(96)90345-5
  11. Weischer T, Mohr C: Ten-year experience in oral implant rehabilitation of cancer patients: treatment concept and proposed criteria for success. Int J Oral Maxillofac Implants 14:521-528, 1999.
  12. Ali A, Patton DW, Sharkawi AM, Davies J: Implant rehabilitation of irradiated jaws: a preliminary report. Int J Oral Maxillofac Implants 12:523-526, 1997.
  13. Brogniez V, Lejuste P, Pecheur A, Reychler H: Dental prosthetic reconstruction of osseointegrated implants placed in irradiated bone. Int J Oral Maxillofac Implants 13:506-512, 1998.
  14. Nakai H, Niimi A, Ueda M: Histologic evaluation of clinically successful osseointegrated implants retrieved from irradiated bone : a report of 2 patients. Int J Oral Maxillofac Implants 14:442-446, 1999.
  15. Beumer J, Roumanas E, Nishimura R: Advances in osseointegrated implants for dental and facial rehabilitation following major head and neck surgery. Semin Surg Oncol 11:200-207, 1995. https://doi.org/10.1002/ssu.2980110305
  16. Esser E, Wagner W: Detnal implants following radical oral cancer surgery and adjuvant radiotherapy. Int J Oral Maxillofac Implants 12:552-557, 1997.
  17. Roumamas E, Nishimura R, Beumer J, Moy P, Weinlander M, Lorant J: Craniofacial defects and osseointegrated implants: Six-year followup report on the success rates of craniofacial implants at UCLA. Int J Oral Maxillofac Implants 64:579-585, 1994.
  18. Granstrom G, Tjellstrom A, Branemark P, Fornander J: Boneanchored recons- truction of the irradiated head and neck cancer patient Otolaryngol Head Neck Surg 108:334-343, 1993.
  19. Wolfaardt JF, Wilkes GH, Parel S, Tjellstrom A: Craniofacial osseointegration: The Canadian experience. Int J Oral Maxillofac Implants 8:197-204, 1993.
  20. Elkind MM, Sutton H: Radiation response of mammalian cells growth in culture: 1. Repair of X-ray damage surviving Chinese hamster cells. Radiat Res 13:556-593, 1960. https://doi.org/10.2307/3570945
  21. Jacobsson M, Tjellstrom A, Albrektsson T, Thomsen P, Tursson I: Integration of titanium implants in irradiated bone. Histological and clinical study. Ann Otol Rhinol Laryngol 97:337-340, 1988. https://doi.org/10.1177/000348948809700402
  22. Mackova N, Praslicka M: Recovery of hematopoiesis in bone marrow of mice after continuous irradiation with dose rate 4.8Gy/day. Neoplasma 28:79-89, 1981.
  23. Jisander S, Grenthe B, Alberius P: Dental implant survival in the irradiated jaw: a preliminary report. Int J Oral Maxillofac Implants 12:643-648, 1997.
  24. Niimi A, Ueda M, Keller EE, Worthington P: Experience with osseointegrated implants in irradiated tissues in Japan and the United States. Int J Oral Maxillofac Implants 13:407-411, 1998.
  25. Brogniez V, D’hoore W, Gregoire V, Munting E, Reychler H: Implants placed in an irradiated dog mandible: a morphometric analysis. Int J Oral Maxillofac Implants 15:511-518, 2000.
  26. Waechter R, Stoll P: Moegichkeiten und Grezen enossaler Implantate bei der oraien Rehabilitation von Tumorpatienten nach Bestrahlung. Implantol 10:171- 176, 1994.
  27. Parel S, Tjellstrom A: The United States and Swedish experience with osseointegration and facial prosthesis. Int J Oral Maxillofac Implants 6:75-79, 1991.
  28. Silvestri F, Banavali S, Baccarani M, Preisler H: The CD34 hemopoietic progenitor cell associated antigen: biology and clinical applications. Haematologica 77:265- 273,1992.
  29. Holyoake T, Alcorn M: CD34+ positive haemopoietic cells: biology and clinical applications. Blood Rev 8:113-124, 1994. https://doi.org/10.1016/S0268-960X(05)80016-5
  30. Sutherland D, Keating A: The CD34 antigen: structure, biology, and potential clinical applications. J Hematother 1:115-129, 1992. https://doi.org/10.1089/scd.1.1992.1.115
  31. Sutherland D, Stewart A, Keating A: CD34 antigen; molecular features and potential clinical applications. Stem Cells 3:50-57, 1993.
  32. Moursi A, Damsky C, Lull J, Zimmerman D, Doty S, Aota S, Globus R: Fibronectin regulates calvarial osteoblast differentiation. J Cell Sci 109:1369-380, 1996.
  33. Globus R, Doty S, Lull J, Holmuhamedov E, Humphries M, Damsky C: Fibronectin is a survival factor for differentiated osteoblast. J Cell Sci 111:1385- 1393, 1998.
  34. Ruoslahti E: Fibronectin. J Oral Pathol 10:3-13, 1981. https://doi.org/10.1111/j.1600-0714.1981.tb01242.x