Bone cement 및 자가골이식이 치조골 결손의 재생에 미치는 영향에 관한 연구

Abstract

[한글]

치조골의 흡수는 치주질환 중 가장 문제가 되는 것의 하나로서 이에 대한 일반적인 치료방법은 치주낭을 소파한 다음 골의 자연재생을 기대하는 것(Ochsenbein and Bohannan,1963)이었으나, 골손실의 부위와 정도에 따라 한계성을 갖고 있기 때문에 근래에 추천되고 있는 효과적인 방법은 자가골이식이다. 한때 이종골이식이 제안되기도 하였으나(Beube, 1947) 그 치유효과는 매우 회의적이며(Skinner et at., 1976), 동종골이식에 관한 연구보고도 활발하지만(Hiatt, 1970; Hiatt and Schallhorn, 1971; Register et al., 1972)제공자의 선택과 저장방법에 따른 문제가 적지 않다(Poulson et al., 1976). 자가골이식에 관하여는 많은 연구자의 호응을 얻고 있으며 또 실제로 임상적용을 하여 그 치유효과를 어느정도 인정받고 있으나(Yuktanandana, 1959; Nabers and 0'Leary, 1965; Patterson

, 1966; Schallhorn, 1967, 1968, 1972; Seibert, 1970: Haggerty and Maeda, 1971; Ellegaard and Loe, 1971; Boyne, 1973; Ellegaard et al., 1973), 간혹 치근이 흡수되는 부작용이 있을 뿐 아니라(Dragoo and Sullivan, 1973b; Morris, 1973)그것에 의한 골재생기전도 아직 확실한 결론에 이르지 못하고 있으며, 또한 본시술이외에 이식을 위한 골편 및 골수를 채취하기 위하여 또 다른 시술이 필요하다는 문제점이 있다. 이러한 견지에서 볼 때 골이식에 대치될 수 있는 방법에 대한 연구가 필요할 것으로 생각된다. 따라서 acrylic bone cement가 치과 및 정형외과 영역에서 이용되고 있는 점에 착안하여(Ray et al.,1974; Harrington et at., 1976; Persson and Wouters, 1976)개에 인공적 치조골결손을만들고 자가골이식 및 acrylic bone cement 충전을 할 때 치조골재생에 어떠한 영향을 미치는가를 비교 연구하기 위하여 본 실험을 시행하였다.

<실험재료 및 방법>

실험재료로는 체중 7∼8kg의 개 16마리를 사용하였으며 마리당 4개소씩(상악의 좌우측견치와 제 3문치의 사이, 하악의 좌우측 견치와 제 1전구치 사이의 치조골에서 견치에 연한 부위) 도할 64개소의 실험부위를 정하여 다음과 같이 대조군과 실험군으로 대별하고,

대조군은 다시 무처치대조군 및 모의수술군으로, 실험군은 자가골이식군 및 acrylic bone cement 충전군으로 구분하였다.

제Ⅰ군 : 대조군…………………………………………………………………………14개소

Ⅰ-1 : 무처치대조군………………………………………………………………… 4개소

Ⅱ-2 : 모의수술군……………………………………………………………………10개소

제Ⅱ군 : 실험군…………………………………………………………………………50개소

Ⅱ-1 : 자가골이식군…………………………………………………………………25개소

Ⅱ-2 : Acrylic bone cement 충전군………………………………………………25개소

모의수술군 및 실험군에 있어서는 치은점막과 점막하 연부조직을 제치고 정해질 실험부위에 깊이 4mm 넓이 2∼3mm되는 V모양의 치조골결손을 만든 다음 증류수로 씻어내고 자가골 또는 acrylic bone cement를 충전하였다. 도살시기에 따라 실험군동물 15마리를 3마리씩 5개의 소군으로 나누어서 각 소군의 실험부위 12개소 중 임의의 5개소에는 자기골이식, 다른 5개소에는 bone cement 충전 나머지 2개소는 모의수술만 시행하였다.

이식용 골편은 치조골결손형성 24시간전에 골수천자로 장골에서 채취하여 MEM(minimumessential medium)에 넣어 4℃에 보관한 다음 사용하였고 acrylic hone cement 는 CMW회사제품을 사용하였다. 수술 후 5일, 10일, 15일, 4주 및 8주에 3마리씩 도살(무처치대조군은 15일에 도살)하여, 고정, 탈회(cement 충전군은 cement제거), Paraffin 포매를 거쳐서 H-E 염색을 하여 광학현미경으로 검색하였다.

<연구성적 및 결론>

1. 모의수술군과 실험군 공히 결손후의 잔존치조골 내외측에 막내화골에 의한 가골조직이 신생되었으며 8주에는 완전히 치밀골화하였다.

2. 모의수술만 시행한 군에서는 치조골 내외측으로 골조직의 재생을 볼 수 있었으나,결손부위의 맑은 부분이 치밀결체조직으로 복구되었으며 8주까지도 치조골은 함몰되어 있었다.

3. 자가골이식군에서는 이식골편이 완전히 흡수되고 그 주위에 육아조직 및 소성결합조직의 증식이 지속되면서 가골조직이 신생되고 8주에는 완전히 치밀골로 복구되었다.

4. Bone cement는 흡수되지 않으나 이물반응을 초래하지 않았으며 8주후의 cement는 치밀결체조직으로 피복되고 그 주위에는 신생된 치밀골이 견고하게 둘러싸고 있었다.

이상의 결과를 종합하면 자가골이식이 가장 좋은 방법으로 생각되나 acrylic bone cement충전도 자가골이식대신 사용할 수 있는 좋은 방법으로 사료되며, 자가골이식군에 있어서 이식부위의 조골기전은 이식골편의 흡수과정에서 유리되는 어떤 물질이 미분화간엽세포를 자극하여 골아세포로 분화하도록 유도하는 것으로 추측된다.

[영문]

The restoration and reconstruction of periodontal osseous defects that have been destroyed by various periodontal diseases has always been a challenge in the practice of periodontics. Although there are a number of studies reported in the literature, which have attempted to regenerate alveolar support, there are solute limitations in each of these procedures.

Clinicians have used to curette the infrabony pockets and expected spontaneous regrowth of bone(Ochsenbein and Bohannan. 1963), but the results were variable according to the size and location of the defects.

Many workers have depicted then the potential therapeutic value of bone transplant for the alveolar bone defect. Skinner et al.(1976) denied the effect of heterogenous bone graft, which had been proposed by Beube(1947). Allogeneic transplantation of bone has been successfully studied in experimental animals and repeatedly studied on human application(Hiatt, 1970; Hiatt and Schallhorn, 1971; Resister et al., 1972), but there are also many problems on the selection of donor and bank system from which the bone could be obtained.

The autogenous bone graft, which was reported first by Haegedus in 1923, has been of significant interest, and manr investigators have found this to be the best grafting procedure availab1e today(Yuktanandana, 1959; Nabers and 0'Leary, 1965; Patterson, 1966: Schallhorn, 1967, 1968, 1972; Seibert, 1977; Haggerty and Maeda, 1971; Ellegaard and Loe, 1971; Boyne, 1973; Ellegaard et al., 1973). The utilization of autogenous transplant, however, needs another procedure to obtain the graft material, and there are reports that fresh iliac graft has been associated with rout resorption (Dragoo and Sullivan, 1973b; Morris, 1973).

Furthermore the exact mechanism of enhanced osteogenesis following autogenous bone transplantation is still not clarified.

The present study, therefore, is designed to investigate whether the autograft of bone could be substituted by acrylic bone cement, which has been frequently used by dentists to treat the caries and used also in orthopaedic field(Ray et al., 1974;

Harrington et at., 1976; Persson and Woutera, 1976), and to understand the mechanism by which the former enhances the activity of osteogenesis.

Materials and Methods

From 16 adult mongrel dogs weighing 7∼8kg regardless of the sex, a total of 64 experimental sites were obtained, 4 in each animal(bilateral mesial borders of maxillary canines and distal borders of mandibular canines), and were divided into control and experimental groups as follows. The former was further divided into nontreated control and sham operation groups and the latter into groups of autogenic bone graft and acrylic bone cement implant.

Group Ⅰ : control group………………………………………………………… 14 sites

Ⅰ-1 : Non-treated control………………………………………………………4 sites

Ⅰ-2 : Sham operation……………………………………………………………10 sites

Group Ⅱ : Experimental group……………………………………………………50 sites

Ⅱ-1 : Autogenic bone graft……………………………………………………25 sites

Ⅱ-2 : Acrylic bone cement implant………………………………………… 25 sites

A full thickness of mucoperiosteal flap was made and with the use of a No. 6 round bur, V shaped bone defects 4mm in depth and 2 to 3mm in width were created at the experimental sites. Following irrigation with sterile distilled water, the defects were filled with autogenic bone fragment or acrylic bone cement.

The cores of cancelleus bone obtained from the right iliac crest 24 hours prior to the formation of bony defect were stored in 10cc MEM at 4℃ before they were transplanted, and the acrylic bone cement used in this study was the Type 1 bone cement of CMW Laboratories Ltd.

At the time of sacrifice, 5, 10, 15 days, 4 weeks and 8 weeks after alveolar bone defect, 3 animals were killed providing 12 experimental sites(5 bone autograft, 5 acrylic bone cement implant and 2 sham operation), which were removed for histological processing. The animal of non-treated control group was sacrificed at the 15th day. Following fixation and decalcification, light microscopic findings of the paraffin embedded sections were described.

Results and Summary

1) In sham operation and all experimental groups, from the inner and outer surface of the viable alveolar bone newly formed osteoid tissue was demonstrated, which was followed by transformation into compact bone at the 8th week.

2) In group of sham operation, bony repair was wholely depended upon regeneration from the remaining viable alveolar bone, which seemed not sufficient to fill the defect as seen in animals of the 8th week. The upper portion of the defect was therefore largely substituted by dense connective tissue.

3) In group of autogenic bone graft, the graft material was slowly but progressively destroyed and resorbed with formation of granulation tissue and proliferation of loose connective tissue. At the areas, where the graft fragments had been completely resorbed, osteoblasts were found with formation of osteoid

tissue, which was transformed into compact bone as seen in the 8th week.

4) The acrylic bone cement was neuter absorbed, and there was no foreign body reaction against the implant. At the 8th week the cement was completely covered by dense connective tissue, which in turn surrounded by newly formed compact bone.

In summary, it is suggested that acrylic bone cement may be used as a substituent for autogenic bone transplantation, althougn the latter seems to be the best procedure. Osteoid tissue and osteoblasts developed at the site of autogenic bone

graft are thought to be differentiated from primitive mesenchyme following contact with some inductive substance, which might be released from the grafted bone fragment during absorption.