牙槽突裂植骨研究进展

<正>先天性唇腭裂的治疗已由早期单纯关闭唇腭裂隙发展到序列治疗。它包括正畸治疗、矫形修复、牙槽骨缺损修复、正颌外科治疗。以及耳鼻喉科治疗及语音训练和心理治疗等综合治疗方法。牙槽突裂植骨术是其序列治疗的一个重要环节,它可以恢复上     

唇腭裂牙槽突裂同期植骨修复术

先天性牙槽突裂是唇、腭裂常见的伴发畸形,并造成口腔形态和功能异常以及面部整体发育不协调。早期修复牙槽突畸形,恢复上颌骨骨性结构的完整和连续性,有助于恢复口腔正常形态和功能,利于面中、下部骨性支架的生长发育,是唇腭裂序列治疗中极为重要的一环。为此,近3年来作者在行唇、腭裂修复术的同时进行牙槽突一期植骨修复术(简称同期手术),近期效果满意,并对此进行讨论。1材料和方法1.1 临床资料1997年5月～1999年12月在西安交通大学口腔医学院颁面外科唇腭裂治疗科进行唇、腭裂修复术的患者中选择26例行牙槽突裂同期植骨修复术,其中男20例,女6例,年龄6月～16岁,平均5.2岁。26例均合并有牙槽突裂,其     

不同时机牙移动对SD大鼠牙槽突裂植骨区骨改建的影响

目的:评价牙移动产生的功能性刺激对SD大鼠牙槽突裂植骨区骨改建的影响,探讨植骨后牙移动的合适时机。方法:选择16只56天的雄性SD大鼠,随机分为4组,按照已建立的外科诱导SD大鼠双侧牙槽突裂模型要求造裂,填塞骨蜡8周后,在双侧裂隙区同时植入大鼠自体髂骨松质骨,左侧为牙移动侧,分别在植骨后即刻、2周、4周、8周近中移动左侧第二磨牙进入植骨区,右侧为对照侧,第二磨牙不进行任何处理。加力牙移动4周后处死动物。通过Micro-CT扫描标本,运用Mimics 10.01软件计算双侧植骨区骨量,采用SAS 9.0软件包对双侧植骨区骨量进行配对t检验,对双侧植骨区骨量的差值进行组间方差分析。结果:各组的牙移动侧植骨区骨量均多于对照侧。0周组牙移动侧与对照侧植骨区骨量差值为0.87mm3,无显著差异(P>0.05);2周组和4周组牙移动侧与对照侧植骨区骨量的差值分别为1.7mm3和1.77mm3,有显著差异(P<0.05);8周组牙移动侧与对照侧植骨区骨量的差值为3.47mm3,有显著差异(P<0.01),8周组两侧植骨区骨量差值的均数与0周组、2周组和4周组均有显著差异(P<0.05)。结论:牙移动对植骨区的功能性刺激能抑制植骨区的骨吸收。植骨8周后的牙移动抑制植骨区移植骨吸收的作用最为明显。     

正畸牙移入对牙槽突裂植骨区骨改建的生物学影响

目的：通过检测正畸牙移人后牙槽突裂植骨区内Trap、Rankl、Runx2的表达,研究正畸牙移人对牙槽突裂植骨区骨改建的生物学影响。方法：选用12只8周龄SD雄性大鼠,制备正畸牙移入牙槽突裂植骨区的动物模型,加力前及加力1、3、5d后处死动物取材．进行H—E染色,检测裂隙区骨形成情况,采用实时荧光定量PCR检测Trap、Rankl、Runx2表达。应用SPSS13．0软件包对数据进行两样本均数t检验。结果：Trap在早、中期升高,Rankl在早期升高,Runx2在晚期升高。结论：正畸牙移入加强了植入骨的骨重建,诱导了破骨和以后的成骨过程。     

牙槽突裂的裂隙特点及正畸治疗对唇腭裂患者牙槽突植骨术的影响

牙槽突裂是位于唇腭裂患者上颌牙弓处的骨缺损,常发生于侧切牙与尖牙之间。由于先天性裂隙、早期手术治疗所致瘢痕挛缩及唇肌压迫等原因,患者多并发严重的上颌骨横向发育障碍。牙槽突植骨术作为唇腭裂序列治疗中的重要步骤,是修补上颌骨裂隙和矫正上颌横向发育不足的有效手段。众多临床实践及研究发现,正畸治疗的时机选择与牙槽突植骨术的成功率及预后效果密不可分,同时,牙槽突裂的裂隙特点对牙槽突植骨术产生的影响也不可忽视。本文就牙槽突裂的裂隙特点与正畸治疗时机对牙槽突植骨术成功率及预后的影响两方面进行综述,以期为唇腭裂患者临床治疗方案的选择及实验研究的设计提供一定的依据。     

髂骨块状骨植骨术修复恒牙列牙槽突裂的短期临床观察

目的探讨牙槽突裂髂骨块状骨植骨术的临床可行性和可靠性。方法回顾分析15例行"牙槽突裂髂骨块状骨植骨术"的恒牙列牙槽突裂患者,随访6个月以上,收集临床资料,并进行影像学分析。结果所有患者均能定期复诊,术后13例患者创口愈合良好,2例因创口裂开导致植骨失败。影像学资料显示术后6个月植骨区间隙消失,骨桥形成,且植骨区无明显吸收。已有2例患者完成正畸及种植治疗。术后3个月所有患者均可正常行走,无明显行动障碍。结论牙槽突裂髂骨块状骨植骨术短期临床效果满意,移植骨吸收少,长期效果还需进一步研究。     

牙槽突裂植骨术后的植骨效果评价

目的通过牙CT的扫描及Matlab7.0软件的应用,评价牙槽突裂植骨术后的骨缺损区的体积变化。方法选取11名单侧完全性牙槽突裂患者,应用牙CT扫描及Matlab7.0软件计算植骨前和植骨后3个月的牙槽突裂空隙体积和所植入骨的体积,并计算术前后体积比值。结果植骨术后骨桥的体积与植骨前牙槽突裂隙的体积比值,最大值可达114.99%,最小值仅有13.36%,平均数为71.80%,变异系数为47.987。结论植骨后存活的骨桥体积变化较大。     

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。     

唇腭裂患者牙槽突裂的修复与效果评价

本文对牙槽突裂修复的历史、修复时间、植骨材料的选择、植骨效果及与正畸治疗的关系进行了综述，对牙槽突裂植骨的评价和正畸治疗的新方法进行分析，对牙槽突裂患者的治疗有一定指导意义。     

牙槽突裂植骨与颌骨生长发育的关系

牙槽突裂植骨是唇腭裂患者序列治疗的重要组成部分。学者们在植骨时机的选择上存在分歧,主要分为一期植骨和二期植骨,原因在于不同时期植骨对颌骨生长发育的影响不同。本文分别从这两个植骨时机上阐述了其植骨来源以及植骨与颌骨生长发育的关系。     

Reliability of the Kindelan scoring system for alveolar bone grafting with and without a pre-graft occlusal radiograph in patients with cleft lip and palate

We aimed to compare the reliability of the Kindelan system using one postoperative radiograph to assess the success of alveolar bone grafts with the use of two occlusal radiographs (before and after operation). This retrospective reliability study took place at Glasgow Dental Hospital cleft unit, and two examiners scored 84 radiographs two weeks apart. The sample was taken from a database of patients having alveolar bone grafts between 2007 and 2010. They had an upper anterior occlusal radiograph taken before the graft and another at a mean of 6 months (range 3-12 months) postoperatively. Kappa scores were used to measure intraobserver and interobserver agreement. Intraexaminer agreement ranged from good to very good using one or two radiographs, and interexaminer agreement ranged from moderate to good for both systems. Reliability when scoring with either one or two radiographs was similar, and ranged from good to very good.     

牙槽突裂植骨术后鼻外形的改变

目的：通过比较单侧牙槽突裂植骨手术前后鼻外形的变化,评价牙槽突裂植骨术在鼻畸形矫治中的作用。方法：通过人体学测量25例单侧牙槽突裂患者术前、术后即刻及随访6个月的外鼻形态,主要测量指标为健、患侧鼻孔宽度和高度,鼻翼基底宽度及两侧鼻翼基底连线与内眦连线的夹角,应用SPSS18.0软件包,对测得的数据进行配对t检验。结果：25例患者行牙槽突裂植骨手术后患侧鼻孔宽度为（11.61±2.18）mm,大于术前的（10.28±1.83）mm;高度为（4.52±1.19）mm,小于术前的（5.81±1.18）mm;患侧鼻翼基底均高于术前,与术前相比有显著差异（P〈0.01）。随访6个月后,虽形态有向术前回复的倾向,与术前相比仍有显著差异（P〈0.01）。结论：牙槽突裂植骨术后鼻翼基底的变化是植骨成功与否的一个重要指标,适量的超充填可弥补术后骨质吸收,为以后的鼻畸形整复提供一个对称的基底。牙槽突裂植骨后,鼻孔宽度和高度均有变化,故不主张在牙槽突裂植骨同期或之前行鼻畸形整复术。     

唇腭裂患者牙槽突裂的正畸治疗程序探讨

目的:唇腭裂伴牙槽突裂的上颌骨牙列矫正,常存在牙槽突裂隙区牙槽骨塌陷、牙龈高位、植入骨吸收等不理想状态,本研究回顾性分析8例患者,探讨上颌骨牙列矫治的治疗程序.方法:8例单侧牙槽突裂患者,在牙槽突裂植骨术同期行尖牙骨皮质切开,术后以正畸方法快速将尖牙向颌方、唇向移动,牙根移入植骨区.术前、术后1周、尖牙正轴完成后拍摄曲面体层片、尖牙根尖片、上颌咬合片和尖牙区照片,比较治疗前后尖牙区植骨量、尖牙牙根吸收程度和松动度变化;测量裂隙侧尖牙和邻牙之间的龈缘高度差和牙根之间的夹角,采用SPSS 17.0软件包对治疗前后各测量项目进行配对t检验,比较治疗前后结果有无统计学差异,评价植骨效果以及尖牙移动的有效性和安全性.结果:治疗后牙槽突裂植入骨高度均位于相邻牙牙根长度的1/2以上;裂隙侧尖牙牙根与邻牙牙根基本平行,牙根吸收均<2mm,龈缘高度较治疗前改建良好.结论:该治疗程序具有较强优势,在一次手术的基础上,使尖牙安全、有效进入裂隙区,保证了植入骨的丰满度和高度,重建了正常龈缘.     

牙槽骨缺损修复对牙齿移动影响的动物实验

目的了解大鼠牙齿在牙槽骨缺损修复区的移动情况。方法选择40只大鼠，造成一侧牙槽骨缺损，填入45％二氧化硅、24．5％氧化钠、24．5％氧化钙和6％五氧化二磷，作为修复侧，另一侧作为对照侧。术后14周用0．39N力牵引双侧第一磨牙近中移动。配对t检验比较牵引8周后双侧磨牙的移动距离和牙周膜宽度。结果36只大鼠两侧第一磨牙的平均移动距离、牙周膜宽度的差异均无统计学意义（P〉0．05）。结论牙槽骨缺损修复侧可以进行正畸牙齿移动，修复侧的牙齿移动距离及牙周组织受正畸力后的改建情况，均与对照侧无显著差别。     

持续力和间歇力对牙移动骨改建的影响

正畸矫治力的作用时间对牙移动和牙槽骨改建的速度有直接影响,国内外许多学者对此进行了研究。该文就持续力和间歇力对牙移动速度、牙周膜牙槽骨改建和牙体应力反应的影响作一简要综述。选择合适的正畸加力方式,有助于临床医师有效控制牙移动,缩短正畸疗程。     

Comparison of tooth development stage of the maxillary anterior teeth before and after secondary alveolar bone graft: Unilateral cleft lip and alveolus vs unilateral cleft lip and palate

Objective:To compare the effect of secondary alveolar bone graft (SABG) on the tooth development stage of the maxillary central incisor (MXCI) and maxillary canine (MXC) in terms of the severity of unilateral cleft.Materials and Methods:The subjects consisted of 50 boys with unilateral cleft lip and alveolus (UCLA) or unilateral cleft lip, alveolus, and palate (UCLP). The age- and sex-matched subjects were divided into group 1 (UCLA, n = 25; 9.3 ± 0.8 years old) and group 2 (UCLP, n = 25; 9.4 ± 0.6 years old). In panoramic radiographs taken 1 month before (T0) and 1 year after SABG (T1), tooth development stage was evaluated according to the Nolla developmental (ND) stage. A panoramic radiograph taken 3 years after SABG was used as a reference for the final root length of individual tooth.Results:In groups 1 and 2, the ND stage of the MXCI did not exhibit differences between the cleft and non-cleft sides at T0 and T1, respectively. However, although the ND stage of the MXC of group 2 was delayed on the cleft side compared with the non-cleft side at T0 (P < .05), the MXC on the cleft side developed faster than that on the non-cleft side after SABG (P < .01). In terms of tooth development speed, group 2 showed a higher rate of faster developed MXCs on the cleft side compared with the non-cleft side after SABG than group 1 (36.0% vs 8.0%, P < .05).Conclusion:SABG performed at approximately 9 years of age might increase tooth development speed of MXC in patients with UCLP compared with patients with UCLA.     

Assessment of the alveolar bone support of patients with unilateral cleft lip and palate: A cone-beam computed tomography study

Objective:To assess the bone support of the teeth adjacent to a cleft using cone-beam computed tomography (CBCT).Materials and Methods:The CBCT scans of 31 patients with unilateral cleft lip and palate (UCLP) were assessed. The data for teeth neighboring the cleft were compared with those of contralateral noncleft teeth. For each tooth analyzed, the distance between the cementoenamel junction (CEJ) and the bone crest (AC) at the buccal side was measured as was the thickness of the buccal bone level at 0, 1, 2, and 4 mm.Results:The bone thicknesses of the central teeth at the cleft region at the crest and 2 mm apically were statistically significantly thinner than that of the central incisor at a noncleft region. The CEJ-AC distance for central teeth at the cleft region was higher than that for central teeth in a noncleft region.Conclusions:Subjects with UCLP showed reduced bone support at teeth neighboring the cleft compared with controls. This may cause some problems during orthodontic treatment.     

Decreased alveolar bone turnover is related to the occurrence of root resorption during experimental tooth movement in dogs

Objective:To investigate the relationship between root resorption (RR) and bone turnover in two different types of tooth movement in dogs.Materials and Methods:A total of 16 dogs in two different groups were used. Tooth movement of dog premolars resulted from approximately 200 g of force. Histomorphometric analysis of premolar roots was assessed after 4 and 12 weeks of tooth movement by comparing nonresorptive to resorptive surfaces.Results:Histomorphometric analysis indicated a significant decrease in the bone formation rate in the root resorptive areas, which resulted in decreased bone volume after 12 weeks. The threshold to detect RR in periapical radiographs was about 1.0 mm².Conclusions:A sustained mechanical load, due to the prolonged stress and strain of continuous mechanics, induces elevated bone metabolic activity, such as the bone turnover (remodeling) and change in bone volume (modeling). Therefore, our data support the hypothesis that increased RR is related to decreased bone formation (turnover) in high stress areas exposed to prolonged orthodontic tooth movement.