牙﹑微型种植体支抗联合支抗牵张成骨治疗齿槽突裂的动物实验研究

目的:建立牙、微型种植体支抗联合支抗牵张成骨治疗齿槽突裂的动物模型,评估其治疗效果。方法:成年杂种犬实验组6只,对照组2只。首先形成齿槽突裂外科模型,2周后手术截骨形成一含牙的骨运送盘,在骨运送盘上植入微型种植体支抗,一周后开始牵引。牵张完成后1,2,3月各处死动物2只,对照组术后1月处死。取标本作大体,放射学,及组织学检查。结果:齿槽突裂隙完全关闭,牵张区为丰富的新骨。结论:牙、微型种植体支抗联合支抗牵张成骨能够很好的关闭犬的齿槽突裂隙。     

牙、微型种植体支抗联合支抗牵张成骨治疗齿槽突裂的动物实验研究

目的：建立牙、微型种植体支抗联合支抗牵张成骨治疗齿槽突裂的动物模型，评估其治疗效果。方法：成年杂种犬实验组6只，对照组2只。首先形成齿槽突裂外科模型，2周后手术截骨形成一含牙的骨运送盘，在骨运送盘上植入微型种植体支抗，一周后开始牵引。牵张完成后1，2，3月各处死动物2只，对照组术后1月处死。取标本作大体，放射学，及组织学检查。结果：齿槽突裂隙完全关闭，牵张区为丰富的新骨。结论：牙、微型种植体支抗联合支抗牵张成骨能够很好的关闭犬的齿槽突裂隙。     

正畸牙移入牙槽突裂患者植骨区的牙CT评价

目的应用牙CT评价正畸牙移入牙槽突裂患者植骨区后牙槽骨的形态变化。方法对3位牙槽突裂患者在植骨前后和正畸治疗后行牙槽突裂裂隙区的三维牙CT检查,分析正畸牙移入植骨区域后,正畸牙位置及牙槽骨的形态变化。结果牙槽突裂植骨术后,正畸牙可以顺利移入植入骨区域,正畸牙的牙根尖位置发生明显的位移,牙槽骨会随正畸牙的移动发生塑形改变,而不仅仅是牙齿在牙槽骨内的移动。结论牙槽突裂植骨及正畸治疗有益于重建牙弓的完整性。     

牙槽骨牵引成骨治疗先天性双侧重度牙槽突裂1例报告

牙槽突裂的常规治疗方法为髂骨骨松质植骨术.普遍认为,牙槽突裂隙较宽者,黏膜瓣转移、缝合及血运重建困难,植骨术成功率较低.牙槽骨牵引成骨能够有效关闭或缩窄较宽的牙槽突裂,提高植骨效果.本文报告1例牙槽骨牵引成骨治疗先天性双侧重度牙槽突裂病例,截骨线设置在裂隙近中,以种植钉和后牙作为支抗,皮链牵引骨块向后,在缩窄牙槽突裂的...     

牙附着式牵张成骨对牙周组织的影响

目的：研究使用牙附着式牵张器行上颌牙槽骨牵张成骨术后牙髓和牙周的组织学改变。方法：8只成年杂种犬建立上颌单侧牙槽突裂模型，固定口内牙附着式牵张器，牵张成骨关闭裂隙，监测附着牙及支抗牙是否有松动移位，连续X线摄片并取支抗牙及附着牙的牙髓及牙周作组织学检查。结果：附着牙有大约0．8mm的近中移位，牙髓受牵张力作用发生了轻度血管扩张、充血，牙周受力后有成骨／破骨改变，早期有炎性细胞浸润，随着固定时间的延长得以恢复；支抗牙未发现松动和远中移位，牙髓及牙周组织无变化。结论：牙附着式牵张成骨术对牙髓牙周的损伤是轻微的，对牙周组织有类似正畸牙受力后的生理改变，这些改变在适宜的牵张速度和频率下可逆的。     

微型种植体支抗辅助牵引成骨重建上颌骨部分缺损的效果评估

目的：评价正畸技术自制牵引成骨装置及微型种植体支抗辅助弹力牵引重建上颌骨部分缺损的疗效。方法：选择5例上颌骨部分缺损病例,均为男性,年龄19～43岁,平均33.2岁。制作特殊的牵引装置,采用微型种植体支抗辅助支持的弹力牵引方式,进行三焦点式牵引成骨。3个月后,在两侧牵引区植入种植体,进行牙列修复。结果：骨缺损区牵引成骨后成骨良好,形成完整的牙槽嵴,可应用种植和托牙技术进行牙列修复,恢复良好的咬合关系。结论：对上颌骨部分骨缺损病例,可应用正畸技术和牵引成骨技术联合治疗,以恢复颌骨复杂的解剖结构,尤其是牙槽嵴,为牙列修复提供必备的条件。     

微型种植体支抗应用于牵张成骨中的实验研究

目的研究微型种植体支抗在牵张成骨中的作用。方法成年杂种犬12只,随机分为A、B两组,每组6只。首先形成齿槽突裂外科模型,2周后手术截骨形成含牙的骨运送盘,A组采用单纯牙支抗的方法,B组采用牙?微型种植体联合支抗的方法。牵张完成后固定1月处死全部动物,取牵张新骨及支抗牙骨标本做组织学检查并行统计学分析。结果两组牵张后新骨均能封闭齿槽突裂隙,A组支抗牙牙根吸收和牙髓病变的程度比B组明显。结论在牙支抗牵张成骨中应用微型种植体可以减少牵引力对支抗牙的影响。     

微型种植体-牙联合支抗牵张成骨在牙槽突裂治疗中的应用

目的：探讨微型种植体-牙联合支抗牵张成骨治疗牙槽突裂的可行性,以及微型种植体对支抗牙的影响。方法：成年杂种犬14只,随机分为A、B、C3组,A、B每组6只,C组2只为对照组。首先形成牙槽突裂外科模型,2周后手术截骨,形成一含牙的骨输送盘。A组采用单纯牙支抗的方法,B组采用微型种植体-牙联合支抗的方法,C组骨切开后原位固定。1周后开始牵引,牵张完成后固定1个月,处死全部动物,取标本作大体观察、组织学检查,应用SPSS10.0软件包对2组数据分别作Fisher准确性检验和t检验。结果：2种方法均能关闭牙槽突裂隙。2组犬的阳性数比较有显著性差异（P〈0.05）。A、B2组支抗牙在骨输送盘中的移动量具有显著性差异（P〈0.01）。结论：微型种植体-牙联合支抗牵张成骨治疗牙槽突裂是可行性的,使用微型种植体,可以减轻支抗牙牙周-牙髓组织的损伤,减少支抗牙的倾斜移位。     

牙槽突裂区周围牙槽骨形态的研究进展

我国是唇腭裂的高发国家,大多数唇腭裂患者同时患有牙槽突裂。有研究显示裂隙区邻近牙的牙槽骨水平较低;同时,植骨术前正畸治疗有可能导致已经降低的牙槽骨水平继续吸收。所以明确近牙槽突裂区牙牙槽骨形态,对于把握术前正畸治疗牙齿移动的限度有重要意义。锥形束电子计算机X射线断层扫描技术(cone-beam computed tomography, CBCT)在牙槽骨的定量研究中表现出很好的准确性和可重复性,相比传统二维的根尖片有着巨大的优势。本文就牙槽突裂区周围的牙槽骨形态作一综述。     

正畸应力刺激修复比格犬牙槽突裂动物模型的建立

目的采用外科手术及正畸的方法,建立正畸应力刺激修复比格犬牙槽突裂动物模型,为牙槽突裂的相关研究提供实验基础。方法比格犬6只,唇侧及腭侧分别翻瓣,拔除左侧上颌第一、二切牙并去除牙槽骨直达鼻底,断端两侧唇侧及腭侧黏膜瓣严密缝合。待牙槽突裂模型建立完成后,于断端两侧牙施加150 g正畸力向裂隙移动。结果加力16周后观察,可见牙槽突裂两侧牙体相接触,裂隙变小乃至合拢,X线显示牙槽突裂处有新骨生成。结论利用比格犬建立正畸应力刺激修复牙槽突裂模型方法可靠,切实可行。     

Oral and dental restoration of wide alveolar cleft using distraction osteogenesis and temporary anchorage devices

Closure of large alveolar clefts and restoration by a fixed bridge supported by implants is a challenge in cleft alveolus treatment. A major aesthetic concern with distraction osteogenesis is obtaining a predictable position of the implant in relation to the newly generated bony alveolar ridge. We describe the treatment of a large cleft alveolus and palate reconstruction by distraction osteogenesis utilizing temporary anchorage devices (TADs) followed by a fixed implant-supported bridge. The method consists of segmental bone transport by distraction osteogenesis using a bone-borne distractor to minimize the alveolar cleft, followed by closure of the residual small defect by bone grafting three months later. During the active transport distraction, TADs were used exerting multidirectional forces to control the distraction vector forward and laterally for better interarch relation. A vertical alveolar distraction of the newly reconstructed bone of 15 mm facilitated optimal implant placement. The endosseous implants were osteointegrated and supported a fixed dental prosthesis.In conclusion, the large cleft alveolus defect was repaired in three dimensions by distraction osteogenesis assisted by TADs, and the soft tissues expanded simultaneously. Endosseous implants were introduced in the newly reconstructed bone for a fixed dental prosthesis enabling, rehabilitation of aesthetics, eating and speaking.     

Rigid external distraction using skeletal anchorage to cleft maxilla united with alveolar bone grafting.

OBJECTIVE: Documentation of the application of maxillary distraction osteogenesis using rigid external distraction (RED) with skeletal anchorage combined with predistraction alveolar bone grafting (ABG) in cleft maxilla. DESIGN: Case report. PATIENT: A patient with numerous congenital missing teeth and severe maxillary deficiency related to complete bilateral cleft lip and palate with large alveolar bone defect. INTERVENTION: The patient received preoperative orthodontic treatment, predistraction ABG, and maxillary distraction osteogenesis using RED with skeletal anchorage. RESULTS: Predistraction ABG completely united the cleft maxilla. The united maxilla was successfully advanced by the RED system with skeletal anchorage, despite unsound dentition with numerous congenital missing teeth. CONCLUSION: The present study demonstrates that the combination of predistraction ABG and RED system with skeletal anchorage is effective for the treatment of severe maxillary deficiency related to complete bilateral cleft lip and palate with large bone defect and numerous congenital missing teeth.     

Treatment of alveolar cleft with distraction osteogenesis using anchorage with a tooth-microimplant joint in a dog model

Our aim was to investigate the efficacy of correction of an alveolar cleft with distraction osteogenesis using anchorage with a tooth-microimplant joint in a canine model, which was established in 12 adult mongrel dogs that were subsequently randomised into two groups (n=6 in each). The first group comprised dogs that had osteogenesis using anchorage with a tooth (tooth group), while in the second, anchorage with tooth-microimplant joint (microimplant group) was used. All animals were killed one month after completion of distraction. Samples were collected for gross observation and histological examination. There was a significant difference in the degree of movement of the anchorage teeth in the transport discs between the 2 groups (p<0.01). There was less prominent inclination and shift of the natural teeth in the transport disc and less bony resorption around the root in the microimplant group than in the tooth group. These changes were less remarkable in the microimplant group. Treatment of alveolar cleft by distraction osteogenesis using anchorage with a tooth-microimplant joint is practical, and yields better results.     

3D vector control during alveolar ridge augmentation using distraction osteogenesis and temporary anchorage devices: a new technique

This report describes a combined orthodontic surgical technique involving vertical alveolar distraction using temporary anchorage devices (TADs) in cases of massive alveolar ridge bone and teeth loss. A combined surgical orthodontic protocol included presurgical orthodontic preparation and a preimplantation surgical augmentation stage for insertion of a vertical distractor. During the active vertical alveolar distraction process TADs were inserted. Intraoral orthodontic elastics were attached to the main orthodontic archwire exerting multidirectional forces to control the vertical distraction vector. After 3 months of vector controlling and active bone moulding, the TADs were removed. Anterior alveolar ridge augmentation using distraction osteogenesis was achieved. The application of TADs for better anterior segment curvature enabled dental implant insertion, better positioning and restoration. A combined surgical orthodontic management protocol involving vertical alveolar distraction osteogenesis for augmentation purposes is an efficient treatment method to improve alveolar ridge volume for the preimplantation stage.     

Correction of postsurgical alveolar ridge defect with vertical alveolar distraction of the onlay block graft

ABSTRACT: Alveolar bone augmentation for dental implant rehabilitation is one of the greatest challenges for oral and maxillofacial surgeons. Bringing out an inadequate quantity of vertical bone during augmentation compromises correct implant positioning and the resulting prosthetic restoration. Alveolar distraction osteogenesis is now generally used in correcting alveolar ridge atrophy due to trauma, congenital defects, or periodontal defects. Onlay block grafting is a suitable method for restoring the alveolar bony defects. However, it sometimes can become a complicated procedure to repair the horizontal defect accompanying a vertical defect using only bone blocks. This clinical report presents a successful reconstruction of a severe anterior mandibular alveolar bony defect as a result of impacted teeth extraction and periodontal problem in a 50-year-old healthy female patient. The defect was reconstructed with symphysis graft and platelet-rich fibrin in the first step. Vertical alveolar distraction was performed on the grafted site to maintain the suitable bony height 3 months later. Grafted bony segment distraction and the treatment options in similar cases were also discussed in this clinical report among with the literature.     

Alveolar ridge augmentation by distraction osteogenesis

Distraction osteogenesis is an alternative method for reconstructing atrophic alveolar bone. Fourteen patients underwent vertical alveolar distraction by the LEAD SYSTEM-Endosseous Alveolar Distraction System (Stryker Leibinger, Kalamazoo, MI). An alveolar segmental osteotomy was carried out and the vertical distraction device was mounted. In patients with an extensive alveolar defect, two distraction devices were placed in order to better control the vector of elongation in both bone edges. The distraction was started on the fourth postoperative day at a rate of 0.8 mm/day for 10-16 days, followed by a consolidation period of 60 days. Vertical distraction osteogenesis (VDO) was completed successfully in all patients with segment lengths in the range of 8 to 13 mm and with an average of 10.3 mm. Subsequently, the devices were removed and 23 threaded titanium dental implants were placed for osteointegration. Earlier mineralization in the vertically distracted area was seen radiographically during the consolidation period. In a follow up of 6-20 months after the distraction, 22 implants were successfully osteointegrated while one implant failed due to improper distracted segment stability. As a result of alveolar distraction, a segment of mature bone was transported vertically in order to lengthen the crest for better implant anchorage, either for aesthetic purposes or for functional prosthetic requirements. The main advantages of VDO are: (1) augmentation of alveolar bone height with new bone formation and simultaneous expansion of the soft tissues; (2) no bone harvesting is necessary; (3) the technique has a lower morbidity rate compared with conventional techniques; (4) it makes the insertion of longer dental implants feasible.