齿槽裂修复方法的研究进展

目的 探讨齿槽裂修复治疗的目的、方法以及治疗时机的选择。方法 查阅1950年至2006年有关齿槽裂修复的文献，归纳文献中报道的不同方法，并评价其各自的优缺点。结果 齿槽裂修复的主要目的：关闭口鼻瘘；建立稳定、连续的上颌骨牙弓；为牙齿萌出提供基础；为上唇和鼻底提供稳定支架。主要治疗方法：植骨术；牵引成骨技术；组织工程骨和生长因子应用；引导骨再生技术。患者最佳的手术治疗时机是9～11岁时混合牙列期。结论 在9～11岁混合牙列期手术，以髂骨松质骨为移植材料被认为是修复齿槽裂的主要手段。牵引成骨技术、组织工程技术和引导骨再生技术，将是齿槽裂修复的新方向。     

牵引成骨在齿槽嵴裂修复中的应用

自体髂骨移植是齿槽嵴裂二期植骨修复中最常用的方法 ,但是对于牙槽突裂隙较大,瘢痕牵拉严重,骨段塌陷,以及缺乏健康黏骨膜以覆盖植骨组织的患者,该方法成功率较低。采用牵引成骨的方法可有效关闭牙槽裂隙,我们就牵引成骨在齿槽嵴裂修复中的应用进行综述。     

唇腭裂患者齿槽嵴裂植骨修复术后的临床观察

目的 :分析影响齿槽嵴裂修复术后效果的因素。方法 :对同一术者所行髂骨松质骨移植齿槽嵴裂修复术的唇腭裂患者 3 6例进行回顾性研究 ,所有患者均有术前及术后 3个月以上的完整资料。分析植骨区的X线组织影像的临床分级与手术年龄、裂隙类型等的关系。结果 :①齿槽嵴裂的植入骨成活率为 95 % ,临床成功率为 90 % ;②齿槽嵴裂的植骨效果与患者的年龄有关 ,18岁以上患者植骨的临床成功率明显低于其它年龄患者 ;③单纯伴发唇裂或不完全性腭裂的齿槽嵴裂植骨效果优于完全性唇腭裂的齿槽嵴裂植骨效果。结论 :良好植骨床的形成和植骨区严密的缝合是保证齿槽嵴裂植骨成功的关键。     

BMP-2复合颗粒状β-磷酸三钙在齿槽裂骨缺损修复中的应用研究

目的:评价骨形态蛋白-2(BMP-2)复合β-磷酸三钙(β-TCP)在齿槽裂修复中的应用价值.方法:本组包括12例齿槽裂患者,齿槽裂的修复首先运用局部黏骨膜瓣形成袋状受植囊,同时关闭鼻、唇、腭间的软组织裂隙,恢复解剖形态;去除裂隙两侧上颌突的部分骨皮质;根据裂隙大小、形状及与健侧的对称性,植入BMP-2/β-TCP.结果:手术切口一期愈合,无植入物排出,外形恢复理想,局部饱满.术后3个月x线片可见局部骨性愈合,术后1年x线片可见植入人工骨部分被自体骨取代.结论:BMP-2复合β-磷酸三钙修复齿槽裂,具有恢复形态准确;修复创伤小的优点;植入物组织相容性好,具有骨引导性,可降解,能被自体骨完全取代,且无不良反应.是一种良好的齿槽裂修复方法.     

齿槽裂植骨整复畸形鼻

目的:探讨齿槽裂及鼻底进行天然多孔骨(Bio-OssCollagen材料)移植整复畸形鼻的可行性和临床疗效。方法:对12例齿槽裂及鼻底行Bio-OssCollagen材料植入整复手术。结果:随访9￣12月外形恢复良好,唇部和鼻底丰满,鼻翼提升,X线片示齿槽裂及鼻底植入Bio-OssCollagen材料基本被自体骨取代。结论:用Bio-OssCollagen材料代替自体骨植入齿槽裂及鼻底整复畸形鼻,均效果良好。     

膜引导骨再生技术在上前牙美学区牙种植手术中的临床应用研究

目的：评价膜引导骨再生技术在上前牙美学区牙种植中的临床应用效果。方法：选择16例上颌前牙缺失伴骨缺损患者,植入Ankylos种植体22颗（其中即刻种植5颗）,在骨缺损区植入珊瑚羟基磷灰石骨粉,应用可吸收胶原膜18块、钛膜4块,进行引导骨再生,重建牙槽骨的形态,术后4～6个月暴露种植体,最终完成烤瓷冠修复,二期手术时根据成骨情况评估成骨效果。结果：所有病例术后均随访6个月以上,除2颗失败外,其余20颗种植体均获得良好的骨修复效果,种植修复完成后取得较好的美学效果。结论：膜引导骨再生技术可以保存和重建上前牙牙槽嵴区软硬组织的外形,获得良好的美学效果。     

牵引成骨修复人工腭裂的远期效果和对颌面部的影响

目的观察持续弹力牵引成骨技术修复人工腭裂的远期效果和对颌面部结构的影响.方法采用6个月龄杂种犬制备腭裂模型,以腭裂牵引器牵引两侧切骨后的腭骨板修复腭裂,达到预期效果后,继续饲养至12个月龄.观察治疗效果,采用头颅测量方法进行测量和统计学分析.结果牵引治疗期间实验组裂隙逐渐缩小,2～3周裂隙后部关闭.观察期间无复裂、呼吸道狭窄等并发症.实验组腭骨水平板长度明显大于对照组,平均延长4.75 mm,差异有非常显著性意义(P＜0.01);两组动物面长度、高度、宽度、腭骨水平板宽度和垂直板间距差异均无显著性意义.结论应用持续弹力牵引成骨修复腭裂疗效稳定,对颌面部结构无明显影响.腭裂牵引器设计合理,在牵引腭骨板成骨的同时,具有稳定上颌骨的功能.     

自体骨髓基质干细胞在齿槽裂骨缺损修复中的应用

目的探讨人自体骨髓基质干细胞（human bone marrow stromal cells，hBMSCs）在治疗齿槽裂骨缺损中的可行性。方法2002至2005年，选择齿槽裂骨缺损患者7例（单侧6例，双侧1例），以患者自体骨髓基质干细胞为种子细胞，部分脱钙骨（partly demineralized bone matrix，pDBM）为支架材料构建组织工程骨，治疗齿槽裂骨缺损。从患者髂前上棘穿刺取骨髓，密度梯度离心法分离hBMSCs，经体外成骨诱导和扩增至第3代。将诱导的hBMSCs，复合部分脱钙骨体外培养1周后，手术回植骨缺损区。分别于术后1、3、6、12、24、36个月进行临床外形和三维CT检查随访。结果6例患者头部三维CT检查，结果示术后3个月能形成组织工程化骨，并修复骨组织缺损。术后1～3年的随访表明组织工程骨稳定存在，无明显骨吸收现象，临床治疗效果稳定。1例患者（双侧齿槽裂）植入物外露感染。结论以自体hBMSCs为种子细胞，部分脱钙骨为支架材料，利用组织工程技术可在人体内形成稳定的组织工程化骨组织，并临床修复齿槽裂骨缺损。     

定向两次牵引成骨术在下颌骨肿瘤术后缺损修复中的应用

目的 探讨定向两次牵引成骨术在下颌骨肿瘤术后缺损修复中的应用.方法 2002年1月至2006年12月,对6例因肿瘤术后致下颌骨缺损患者,先牵引下颌骨体部,再牵引下颌骨升支部.结果 手术过程顺利,外形恢复良好,局部成骨满意,无感染等并发症.下颌骨最大体部单侧牵引幅度为5.5 cm,平均5.2 cm,升支部最大4.2 cm,平均3.4 cm.咬合及张口度恢复良好.结论 定向两次牵引成骨术用于修复肿瘤术后下颌骨缺损,创伤小、手术时间短、操作简单,并可避免植骨及由此带来的供、受区并发症,效果稳定可靠;缺点是整个治疗时间长,需3次手术.     

髂骨移植在齿槽裂的修复中的应用

目的探讨应用髂骨移植在齿槽裂修复中的价值。方法自2005年7月至2006年11月对17例齿槽裂患者于全身麻醉下应用髂骨松质骨移植修复齿槽裂裂隙。结果本组17例患者术后随访3～6个月,齿槽裂均关闭,上唇及鼻外形改善明显,无口鼻漏复发等并发症。结论髂骨松质骨移植能有效关闭齿槽裂;髂骨松质骨骨量丰富,切取方便;该手术具有手术时间短,出血少,并发症少等优点。     

Spontaneous tooth eruption after alveolar cleft osteoplasty using tissue-engineered bone: a case report.

To bridge the cleft in the alveolar bone and to allow for physiologic eruption of the canine teeth, alveolar bone grafting is often necessary in patients with cleft lips and palates. Instead of autogenous bone, biomaterial seeded with autogenous osteogenic cells has found some clinical application. However, so far no real functional proof has been available to demonstrate that this technique also allows further physiologic features such as tooth eruption to occur. This report describes the results of grafting tissue-engineered bone into the alveolar cleft of a 10-year-old boy. Immediate postoperative healing was uneventful. Eight months after grafting, erupting teeth had moved into the newly formed bone. Eighteen months postoperatively at the site where the tissue-engineered graft had been inserted, the canine had erupted spontaneously in its proper place. The data suggest that tissue-engineered bone can lead to the ossification of the alveolar cleft and allow for physiologic spontaneous tooth eruption.     

自体髂骨复合PRF修复牙槽嵴裂的实验研究

目的:将富血小板纤维蛋白(Pl at el et-ri ch fi bri n,PRF)应用于牙槽嵴裂植骨手术,验证其是否能够减少植骨术后的骨吸收。方法:8～12月龄犬8只,以外科手术的方法制备双侧牙槽嵴裂模型,随机于两侧同期植入自体髂骨(对照组)及自体髂骨混合PRF(实验组)。于术后当日、2个月、4个月时拍摄上颌骨CT,利用三维重建软件测量植骨区体积,计算骨吸收率。结果:术后2个月、4个月时实验组的骨吸收率明显小于对照组,行配对样本的t检验,P<0.01。结论:将PRF加入自体髂骨进行骨移植修复犬的牙槽嵴裂,在术后4个月的时间范围内,可以减少术后的骨吸收。     

Long-term outcome of secondary alveolar bone grafting in cleft lip and palate patients: A 10-year follow-up cohort study

Abstract

The objective was to assess the long-term outcome of secondary alveolar bone grafting (SABG) in cleft lip and palate patients and to examine relationships between preoperative and postoperative factors and overall long-term bone graft success. The records of 97 patients with cleft lip and palate, who had secondary alveolar bone grafting of 123 alveolar clefts, were examined. Interalveolar bone height was assessed radiographically a minimum of 10 years after grafting using a 4-point scale (I–IV), where types I and II were considered a success. After an average follow-up of 16 years after SABG (range = 10.2–22.7 years), 101 of the 123 grafts (82%) were categorised as successes. Mean age in the success group was 12.1 years and 13.6 years in the failure group (p = 0.03). It was found that the success rate was significantly lower (p = 0.02) if SABG was performed after eruption of the tooth distal to the cleft. No significant differences were found with regard to the other parameters investigated. The timing of secondary alveolar bone grafting is critical with regard to the age of the patient and the stage of eruption of the tooth distal to the cleft.     

An analysis of complications in secondary bone grafting in patients with unilateral complete cleft lip and palate

Aim: The aim of this investigation was to assess the outcome of secondary alveolar bone grafts 6 months after the procedure and examine the possible influence of patient sex, age at surgery, cleft width, and dehiscence of mucosa and sequestered bone at 2 weeks.

Methods: Thirty-nine consecutive patients with unilateral complete cleft lip and palate were reconstructed with secondary alveolar bone grafting. Age at surgery ranged from 7.3–12.5 years (mean?=?8.6). Cleft width varied between 2.2–14?mm (mean?=?7.3). Bone was harvested either from the iliac crest or from the chin. Two-dimensional dental radiographs of the cleft area were taken before and 6 months after surgery.

Results: Two weeks after surgery, 10 patients had minor dehiscence of the sutured gingival tissues and five had bone sequesters. However, only one of the treatments turned out to be unsuccessful with a Bergland index of IV. Twenty-nine patients had an initial uneventful course; but, at a follow-up 6 months later, two patients had a Bergland index of III and four a Bergland index of IV. In three of these cases, there were circumstances that could have contributed to the lack of success; but, in the remaining three, no such circumstances could be identified.

Conclusion: The success rate of secondary bone grafting is high, and initial wound healing problems do not necessarily lead to a failed reconstruction. Failure may be related to factors such as exposed tooth enamel during an operation, postoperative infection, and poor compliance. Still, failed operations occur without any obvious causes.     

New orthodontic and orthopaedic managements on the premaxillary deformities in patients with bilateral cleft before alveolar bone grafting

At the age of mixed dentition, a downward or laterally displaced premaxilla with a wide alveolar cleft in patients with bilateral cleft lip and palate remains a dilemma both for orthodontists and surgeons. These premaxillary deformities not only make the alveolar bone grafting difficult but also aesthetically and functionally unacceptable. The purpose of the present article is to introduce three new orthodontic and orthopaedic techniques for solving these premaxillary deformities and facilitating alveolar bone graft through a non‐surgical approach. These techniques are the premaxillary orthopaedic intrusion for correcting a downward displaced premaxilla, the premaxillary orthopaedic repositioning for correcting a laterally displaced premaxilla, and maxillary orthopaedic protraction by alternate rapid maxillary expansions and constrictions for minimizing a wide alveolar cleft. They were evaluated clinically and cephalometrically for their treatment effects. The results revealed that the premaxillary and cleft deformities were corrected in a short period of time and therefore the alveolar bone grafting could be carried out without difficulty in all of the patients who received the treatment. The treatment effects were mostly orthopaedic and partly orthodontic. No growth disturbance on the maxilla was observed throughout the treatment. These new orthodontic and orthopaedic techniques are very effective for solving the difficult‐to‐treat premaxillary deformities and facilitating the alveolar bone grafting in the patients with bilateral cleft.      

Bone grafting at the stage of mixed dentition in cleft lip and palate patients

Our results of bone grafting to the alveolar process during the mixed dentition were investigated in 55 consecutively treated patients (66 clefts). The amount of remaining bone and gingival retraction at the tooth mesial to the cleft after 3 and 12 months was measured and correlated with the following anatomical conditions present during surgery: width of the cleft, rotation of the adjacent incisor, stage of eruption of the tooth distal to the cleft. It was also considered if any deciduous lateral incisor or canine was extracted during surgery and if any flap dehiscence took place postoperatively. It was found that flap dehiscence resulted in significantly less bone at 3 months and at 1 year after surgery. Furthermore, extraction of a deciduous tooth was found to be significantly correlated to less bone 1 year after surgery, in which cases there were also persisting gingival retractions. The other factors had no significant influence on the outcome of surgery.     

扩弓后单侧完全性牙槽突裂的骨移植修复

目的:研究单侧完全性牙槽突裂畸形患者扩弓后骨移植修复的效果,为唇腭裂序列治疗后期正畸和正颌外科治疗提供临床基础。方法:对23例恒牙期单侧完全性唇腭裂术后伴发牙弓狭窄的牙槽突裂畸形患者进行快速扩弓并保持半年后,采用自体髂骨松质骨颗粒移植修复进行研究,对术后随访的X线片进行效果评价。结果:临床应用该方法治疗23例牙槽突裂患者,术后随诊3个月以上,临床观察牙槽突裂已修复,X线片显示骨密度接近正常骨质,移植骨块清晰可见,有较好的术后愈合效果。结论:正畸扩弓技术牙槽突裂骨移植修复术是唇腭裂序列治疗的重要组成部分,对于矫治伴有牙槽突裂的上牙弓缩窄畸形的唇腭裂患者,应在植骨手术前行扩弓治疗。     

Alternatives to Autogenous Bone Graft: Efficacy and Indications

Bone grafting is frequently used to augment bone healing with the numerous approaches to reconstructing or replacing skeletal defects. Autologous cancellous bone graft remains the most effective grafting material because it provides the three elements required for bone regeneration: osteoconduction, osteoinduction, and osteogenic cells. Autologous cortical bone graft provides these three components to a limited extent as well and also provides the structural integrity important in reconstruction of larger defects. However, because autogenous grafting is associated with several shortcomings and complications, including limited quantities of bone for harvest and donor-site morbidity, alternatives have been used in a wide range of orthopaedic pathologic conditions. Grafting substitutes currently available include cancellous and cortical allograft bone, ceramics, demineralized bone matrix, bone marrow, and composite grafts. No single alternative graft material provides all three components for bone regeneration. The clinical applications for each type of material are dictated by its particular structural and biochemical properties. Composite grafts consisting of several materials are often used to maximize bone healing, especially where the grafting site is compromised.     

牵张成骨关闭牙槽突裂的实验研究及组织学观察

目的:应用牵张成骨技术进行牙槽突裂关闭术,观测牙槽突裂硬软组织修复效果和牵张间隙新骨生成的过程、机制,探索一种牙槽突裂整复治疗的新途径。方法:以10只成年杂种犬为实验对象,建立人工上颌牙槽突裂的动物模型,其中2只为对照组。另8只为实验组,以牙骨复合体作为转运盘,以每次0.4mm,2次/天的速度沿牙弓方向行牵张成骨术,直到关闭硬组织裂隙。于原位固定0,14,28,63天分别处死动物各2只,对标本进行X线摄片、大体和组织学观察。结果:利用牵张成骨术成功地进行牙槽突裂整复术,硬组织裂隙关闭, 同时软组织得到扩张;骨牵张间隙完全被新生骨组织取代并沿牵张方向生长,随固定时间的延长改建、成熟。结论:牵张成骨术提供了牙槽突裂治疗的新途径,新骨的生成是膜内成骨方式。