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研究生：	詹穎仁 Chan, Ying-Jen
論文名稱：	利用兔子實驗比較不同表面處理的植體，經細菌污染並清潔後，其骨整合的可能性 Comparison of the osseointegration on different implant surfaces after bacterial contamination and cleaning: a rabbit study
指導教授：	袁國 Yuan, Kuo
共同指導教授:	李澤民 Lee, Tzer-Min
學位類別：	碩士 Master
系所名稱：	醫學院 - 口腔醫學研究所 Institute of Oral Medicine
論文出版年：	2010
畢業學年度：	98
語文別：	英文
論文頁數：	51
中文關鍵詞：	植體表面、植體周圍炎、骨整合
外文關鍵詞：	implant surfaces, peri-implantitis, osseointegration
相關次數：	點閱：114 下載：1
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使用可骨整合的植體來取代缺失的牙齒，已成為牙醫臨床一般的治療。而植體周圍炎則是植體因發炎而喪失骨整合，並伴隨膿血產生。有文獻指出病患植牙後9-14年發生植體周圍炎的比率大約是16%。再生骨整合則是預期在植體發炎後，可以重建因發炎而喪失的骨頭與骨整合。因此我們想探討不同表面處理的植體對於被細菌污染並清潔後，其骨整合是否有影響。
首先製作四種不同表面處理的植體：machined (M), hydroxyapatite plasma spray (HAPS), sand-blasted, large grit, acid-etched (SA), and Titanium anodic oxide (TAO)。每一種表面處理的植體再分成對照組與實驗組。在實驗組中，消毒過後的植體先用Prevotella intermedia污染2個星期，再模擬臨床治療植體周圍炎的方法，使用含生理食鹽水的棉球清潔與沖洗。在同一兔子的股骨上分實驗組與對照組，並各自植入不同表面處理的植體，總共使用10隻兔子。6星期癒合後，五隻兔子作股骨切片觀察各組骨頭與植體的接觸，與新骨生成範圍的差異。另五隻兔子作功能性的扭力測試。
藉由這個實驗，可以知道不同的植體表面處理，會造成不同的表面型態，組成成分和表面粗糙度。而在對照組中，不論是在扭力測試，骨頭與植體的接觸與新骨生成範圍，較粗糙的HAPS和SA表面都比較平滑的TAO和M明顯得好。而就TAO與M表面來說，可能TAO表面有較多的鈣磷沉積，與較多的孔洞，所以在扭力測試，骨頭與植體的接觸與新骨生成範圍都比M來的佳。另一方面，從實驗組看來，較粗糙的HAPS和SA表面，在被細菌污染後，即使是經過清潔，他們在骨頭與植體的接觸與新骨生成範圍都明顯的降低。甚至比較光滑的TAO 和M這兩組還差。
就臨床上來，粗糙表面的植體仍是較佳的植牙選擇，但須注意的是，發生植體周圍炎的粗糙表面植體，既使經過表面清潔其骨整合的結果仍較光滑表面的差。除此之外，不同的骨缺損大小或型態，手術方式，再生材料和手術者的技術。都會影響治療植體周圍炎的結果，更需進一步的實驗釐清。

The use of osseointegrated implants has become a common treatment procedure in the replacement of missing teeth. The loss of osseointegration of the implant combined with bleeding and/or pus on probing is defined as peri-implantitis. Peri-implantitis has been reported to occur in 16% of patients treated with implants after 9–14 years of function. Re-osseointegration can be defined as the establishment of de novo bone formation and de novo osseo¬integration to a portion of an implant that suffered loss of bone-to-implant contact (BIC) and became exposed to microbial colonization. This in vivo study is aimed to realize that what kinds of implant surfaces could have better osseointegration after bacteria contamination and cleaning.
Four different implant surfaces were manufactured: machined (M), hydroxyapatite plasma spray (HAPS), sand-blasted, large grit, acid-etched (SA), and Titanium anodic oxide (TAO). Each surface was subdivided into control group and test group. In the test group, after the disinfection of implants, we colonized these implants with Prevotella intermedia for 2 weeks. These test implants were cleaned with cotton pellets soaked in saline and irrigate. The procedures mimicked the clinical decontamination for peri-implantitis. After that, we implanted control group (including four different surfaces) into one femur of the New Zealand rabbit and test group into the other femur of the same rabbit. Ten rabbits were used totally. After 6 weeks of healing, five rabbits were sacrificed for comparing the bone to implant contact and bone area, and others for functional remove torque value (RTV) measurement.
With the limitation of this animal study, it was concluded that different surface treatment produced different surface topography, composition and roughness. In the control group, the rougher HAPS and SA surfaces were significantly superior to the smoother M surface in the RTV, BIC and bone area analysis. The TAO surface was better than the M surface in the RTV, BIC and bone area; perhaps they had chemically more O, Ca and P elements and physically more roughness and porous texture. The rougher surfaces, such as HAPS and SA, showed statistically significant reduction in the BIC and bone area after bacterial challenge and decontamination, and they also exhibited lower BIC and bone area than the smoother TAO and M surfaces.
According to this study, the rougher surface implant may be a better choice for clinical practice. It should be noted that the peri-implantitis would enhance the destruction around the rougher implant, even after decontamination. There are also other possible factors for the treatment outcome, such as different defect size and shape, surgical methods, regenerative materials and surgeon technique. Further study is needed to distinguish the variables for treating peri-implantitis.

Table of contents
Chapter 1. Introduction ................................1
1.1	Background.......................................1
1.1.1	Biomaterials.....................................1
1.1.2	Titanium for Dental Implant......................4
1.1.3	Implant Surface..................................6
1.1.4	Peri-implant Disease.............................8
1.1.5	Implant Surface and Bacterial....................9
1.1.6	Treatment Modalities for Peri-implantitis........10
1.2	Motivation.......................................11
1.3	Objective........................................12
Chapter 2. Materials and Methods........................13
2.1	Titanium Alloy and Surface Treatment.............14
2.1.1	Titanium Alloy...................................14
2.1.2	Surface Treatment................................14
2.1.2.1	Machined.........................................14
2.1.2.2	Titanium Anodic Oxide............................15
2.1.2.3	Hydroxyapatite Plasma Spray......................15
2.1.2.4	Sand Blasting and Acid Etching...................15
2.2	Surface Characteristic Analysis..................15
2.2.1	Topographic Observation by SEM...................15
2.2.2	Roughness Analysis...............................16
2.3	Bacteria Culture.................................16
2.4	Animal Study.....................................16
2.4.1	Animals and Anesthesia...........................16
2.4.2	Microimplant Surgery Procedure...................17
2.4.3	Removal Torque Value (RTV) Measurement...........18
2.4.4	Histomorphometric Analysis.......................18
2.5	Statistical Analysis.............................19
Chapter 3. Results......................................20
3.1	Surface Characteristic Analysis..................20
3.1.1	Topographic Observation and Roughness Analysis...............20
3.1.2	Energy Dispersive Spectrometer (EDS).............20
3.1.3	Bacteria Contaminate on Microimplant Surface.....20
3.2	Removal Torque Value Measurement.................21
3.3	Histomorphometric Analysis.......................21
3.3.1	Bone to Implant Contact..........................21
3.3.2	Bone Area........................................21
3.3.3	Correlation between Bone to Implant Contact and Remove Torque Value................22
Chapter 4. Discussion...................................23
4.1	Study Design.....................................23
4.2	Surface Characteristic Analysis..................24
4.3	Removal Torque Value Measurement.................26
4.4	Histomorphometric Analysis.......................27
Chapter 5. Conclusions ..................................30
References............................................31-37

List of Tables
Table 1: Mechanical properties of common biomaterials in metal......................... 38
Table 2: Components of Ti6Al4V...........................38
Table 3: Parameters of Hydroxyapatite Plasma Spray.......38
Table 4: Remove torque value.............................39
Table 5: Bone to implant contact (%).....................39
Table 6: Bone area (%)...................................39

List of Figures
Figure 1: Study Flow Chart...............................40
Figure 2: Surgical process...............................40
Figure 3: Microimplants .................................41
Figure 4: Surface treatment in SEM ......................42
Figure 5: EDS for different surface treatment............43
Figure 6: Contaminated and decontaminated surface in SEM......................44
Figure 7: Remove torque value result.....................45
Figure 8: The curve of RTV in one animal sample..........46
Figure 9: Histomorphometric result...................47, 48
Figure10: Bone to implant contact result.................49
Figure11: Bone area result...............................50
Figure12: Correlation between Bone to Implant Contact and Remove Torque Value....................51
                                    

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