单侧唇裂结合单纯牙槽突裂二期牙槽植骨与正畸治疗

目的评价单侧唇裂合并单纯牙槽突裂二期牙槽突植骨的长期疗效.方法40例单侧唇裂合并单纯牙槽突裂患者(19男,21女),手术进行时患者的平均年龄为13.8岁,年龄范围8至33岁.根据牙槽植骨手术时裂隙尖牙萌出与否将患者分为尖牙萌出组和尖牙未萌出组尖牙萌出组24例;尖牙未萌出组16例.骨瓣材料采用髂骨松质骨.术前及术后拍摄上颌前部咬合片,术后观察期为1至8年,平均2.4年.以Bergland标准评价裂隙部位的牙槽骨高度.结果尖牙萌出组牙槽突植骨的临床成功率为96%;尖牙未萌出组牙槽突植骨的临床成功率为94%.两组成功率没有显著性差异.结论单侧唇裂合并单纯牙槽突裂患者二期牙槽植骨的疗效很好,尖牙萌出与否不是影响单侧唇裂合并单纯牙槽突裂患者牙槽突植骨临床成功率的主要因素.     

Long-term results after secondary bone grafting of alveolar clefts

The aim of this study was longitudinally to evaluate the treatment results after secondary bone grafting in 224 cleft patients with an observation period of more than four years. The patients were divided into three groups according to age and eruption stage of the canine at the time of surgery. Group A included 94 patients with a mean age of 10 years, operated before eruption of the canine; group B included 72 patients with a mean age of 13.1 years operated after eruption of the canine; and group C included 58 patients operated after the age of 16 years (mean age, 20.4 years). The evaluation of the treatment results included longitudinal comparison of marginal bone level, periodontal status on cleft-related teeth, dental status in the bone grafted region, esthetical and functional properties of the reconstructed alveolar process, as well as the influence on growth of the maxilla. The marginal bone level was found to be significantly higher among unilateral cleft lip and palate (UCLP) and bilateral cleft lip and palate (BCLP) patients in the youngest groups as compared to the other groups. The number of UCLP and BCLP patients who could be treated without bridgework was significantly higher in the youngest age group than in the other groups, as were the esthetic and functional properties of the reconstructed alveolar process. External root resorption occurred in 17 patients in groups B and C. No influence of the procedure on sagittal growth of the maxilla could be demonstrated, whereas the anterior facial height was reduced.(ABSTRACT TRUNCATED AT 250 WORDS)     

Longitudinal evaluation of secondary bone grafting into the alveolar cleft.

OBJECTIVE: To longitudinally evaluate the outcome of secondary bone grafting (SBG) using computed tomograms (CTs) and conventional dental radiographs. SUBJECTS: Nineteen alveolar clefts from 17 patients were used in this study. METHOD: A two-dimensional evaluation of SBG was performed using dental radiographs at 1 year after SBG by assigning scores of 1 to 4 (from very good to poor) based on postoperative marginal bone level on the alveolar side. On the basis of postoperative marginal bone levels on the nasal side, clefts were also assigned to groups with the bony bridge on or above (group I) or below (group II) a horizontal reference line. Three-dimensional evaluation of the SBG was performed on horizontal CT slices with the residual cortical bone (RCB) ratio before SBG (T0) as well as 1.5 (T1), 3 (T2), 6 (T3), and 12 months (T4) after SBG. RESULTS: The RCB ratio at T4 in the group with scores 1 and 2 was significantly smaller than that of score 3. Furthermore, the mean RCB ratio at T4 in group I was significantly smaller than that in group II. Nineteen alveolar clefts were divided into two groups, A and B, based on a cluster analysis of the RCB ratios. Group A showed a continuous decrease in the RCB ratio from T0 to T2, but group B showed a significant decrease only in the period from T0 to T1. CONCLUSION: These results suggested that the RCB ratio might be a useful parameter for evaluation of the bony bridge after SBG.     

唇腭裂二期牙槽突植骨临床常用评价方法的分析

目的随机选择52例单侧完全性唇腭裂患者,其中男性31人,女性21人,牙槽突植骨手术进行时,病人的年龄范围9至26岁,平均年龄15.2岁。方法在牙槽突植骨手术后对病人定期随访并拍摄上颌前部咬合片和上颌体腔片。分析上述两种X线片在评价牙槽裂隙部位牙槽骨高度的作用时,使用同一天拍摄的上颌体腔片和上颌前部咬合片。拍摄所分析的X线片时,裂隙侧尖牙已经萌出。评价标准采用1986年Bergland等所提出的临床分级方法进行。每种X线片分别进行两次评价,两次评价间间隔一周。结果上颌前部咬合片和上颌体腔片在评价牙槽突植骨部位的牙槽骨高度上没有本质的区别。结论正畸治疗前判断牙槽突高度时,既可以选择上颌体腔片也可以选择上颌前部咬合片。     

Secondary alveolar bone grafting in cleft lip and palate patients

The case records of 72 patients in Northern Ireland who had secondary bone grafting of 94 alveolar clefts between 1987 and 1997 were examined. Details were recorded of age, sex, laterality of cleft, preoperative orthodontic treatment, whether grafting was combined with soft tissue revision, method of harvesting the graft, complications, eruption of canines, and the success of grafting as established by bone levels around the erupted canine.Bone levels were assessed on a four-point scale. Of 64 canines fully erupted in 94 clefts, 91% achieved bone levels of Type I or II and only two grafts failed. The outcome was more favourable when the canine was unerupted preoperatively.     

Preliminary report of two-stage secondary alveolar bone grafting for patients with bilateral cleft lip and palate.

OBJECTIVE: To overcome the difficulties of one-stage secondary alveolar bone grafting for patients with bilateral cleft lip and palate (BCLP) who have a broad alveolar cleft, the value of two-stage alveolar bone grafting was examined. PATIENTS: Three patients (2 girls and 1 boy) with BCLP were treated by two-stage alveolar bone grafting. The procedure consisted of a first-stage surgery (mean age 8 year 6 months +/- 7.8 months), which consisted of alveolar bone grafting for one side of the BCLP, and second-stage surgery for the contralateral side several months later. For the postoperative assessment, radiographs of the operated site were examined. RESULTS: The average amount of implanted bone per operation and per patient was 6.8 +/- 1.1 g and 13.7 +/- 1.0 g, respectively. Postoperative clinical and radiographic examinations revealed that an appreciable alveolar bone ridge had formed, and there were no major complications. CONCLUSIONS: Two-stage alveolar bone grafting, which makes it possible to reduce the amount of implanted bone, could be an optional surgical procedure for patients with BCLP and a broad alveolar cleft.     

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牙槽突裂植骨术已成为唇腭裂序列治疗中必不可少的一个环节,但其术后的评价目前还没有一个统一的标准。自从1986年Bergland提出牙槽突植骨分级标准以来,得到了全世界唇腭裂序列治疗专家们的广泛认可。但随着现代医疗技术的发展,尤其是三维CT技术的发展,为牙槽突植骨分级提供了更好、更新标准的可能。牙槽突植骨的评价不应只在二维X线片的基础上,应该建立在三维CT的基础上。因为牙槽突植骨是在一个有一定立体的空间内进行的。所以,牙槽突植骨的评价应该是三维空间的一个完整的评价。目前中国学者在这一方面已经做了一些良好的尝试。     

牙槽突裂骨移植治疗进展

牙槽突裂骨移植是口腔颌面部裂隙畸形重建的重要步骤。初期肋骨移植能使上颌骨连续,消除口鼻腔瘘,不影响面中部发育,有助于防止双侧唇裂上颌骨节段性塌陷。二期髂骨移植成功率高,能稳定地产生小梁骨,恢复上颌骨连续性,提供正畸支持。牙槽突植骨能否产生足够的牙槽骨支持后期的正畸治疗,尚需进一步研究。本文就牙槽突裂骨移植治疗的进展作一综述。     

术前正畸对完全性唇腭裂牙槽突植骨疗效的影响

目的　探讨牙槽突植骨术前正畸治疗对于完全性唇腭裂牙槽突植骨长期疗效的影响。方法　选择牙弓狭窄、上颌前牙舌倾或扭转 ,可以伴有前牙反 \ ,牙槽突植骨手术不易进行的完全性唇腭裂患者 16例 ,男 9例 ,女 7例。其中单侧完全性唇腭裂 10例 ,双侧完全性唇腭裂 6例 ,共有裂隙 2 2侧 ,患者年龄 8～ 2 2岁。在牙槽突植骨前进行正畸治疗 ,植骨术后定期拍摄上颌体腔片或上颌前部咬合片 ,观察植骨疗效 ,手术后观察期为 0 5～ 4年。牙槽骨高度的评价采用Bergland标准进行。结果　术前正畸 ,特别是通过开展狭窄的上牙弓 ,能够使因存在错畸形而不易进行牙槽突植骨的唇腭裂患者顺利完成手术 ,牙槽突植骨的临床成功率达 86 %。结论　对于上牙弓狭窄 ,错畸形严重的完全性唇腭裂患者 ,应该在植骨手术前进行正畸治疗。     

牙槽突裂植骨术研究进展

本文阐述了牙槽突裂植入骨的来源,认为自体骨如髂骨仍是最佳材料。有研究应用重组人骨形成蛋白、小牛骨粉及生物胶原膜、组织工程成骨材料修复牙槽突裂取得一定效果。术前适当的正畸治疗对于部分牙槽突裂患者相当重要,术后正畸也必不可少。影响牙槽突裂移植骨成活率的原因较多,包括适应证的选择、手术时机及手术技巧等。应用三维CT评价牙槽突裂植骨较以往的牙片可以获得更全面的信息。     

Timing of alveolar bone grafting determines different outcomes in patients with unilateral cleft palate

ABSTRACT: The objective of the current study was to assess the outcome of the alveolar bone grafting (ABG) in patients with cleft palate. Thirty-one patients with complete unilateral cleft lip and palate were prospectively divided into 2 groups according to the timing of surgery: (1) secondary ABG (SABG), undertaken during mixed dentition (n = 16); and (2) tertiary ABG (TABG), undertaken during permanent dentition (n = 15). Septum height was assessed using cone beam computed tomography in 3 views (buccal, intermediate, palatal) and classified according to the modified Bergland Index, which scores the results into 5 types according to the height of the neoformed bone septum (excellent: septum with a normal height; good: septum with minor deficiency; regular: marginal defect of >25% of the root length; bad: bone deficiency on the nasal aspect; and failure). In the SABG group, 6 to 12 months postoperatively, 75% of the patients were classified as having excellent/good conditions and 25% as having regular/bad conditions. No patients were observed as having failure conditions. In the TABG group, 53% of the patients were classified as having excellent/good, 21% were classified as having regular/bad conditions, and 26% were classified as having failure conditions. Significantly better outcomes were observed for the SABG group when compared with the TABG group. In conclusion, the age at which ABG is performed is a factor that impacts on the surgical outcome. Specifically, increasing age is associated with worse outcomes.     

Maxillary growth in patients with clefts following secondary alveolar bone grafting.

OBJECTIVE: This investigation evaluated the effects of secondary alveolar bone grafting on subsequent maxillary growth in cleft patients. DESIGN: This was a retrospective longitudinal cephalometric study. Nineteen patients who had received secondary alveolar bone grafts were matched to a control sample by sex, cleft, availability of longitudinal records, and presurgical cranial base dimensions and growth direction. All patients had at least two lateral cephalometric radiographs before surgery and two radiographs after surgery. SETTING: The records were obtained from the Longitudinal Growth Study of the Lancaster (Pennsylvania) Cleft Palate Clinic. INTERVENTIONS: All patients had received similar primary surgical procedures by the same surgeon, no orthopedics, and similar mixed-dentition orthodontics. Secondary alveolar bone grafting was the only surgical intervention different between the two groups. MAIN OUTCOME MEASURES: Six measures of maxillary sagittal and vertical growth were taken from 235 radiographs. Slopes of the regression lines for each growth dimension were compared between groups both pre- and postsurgically. RESULTS: There were no significant between-group differences in maxillary sagittal or vertical growth following the grafting procedure. Anterior maxillary vertical growth rates decreased in the grafted group when their pre- and postsurgical rates were compared. Several growth trends in the postsurgical period were found to be continuations of the rates documented presurgically and unrelated to the grafting procedure. CONCLUSIONS: When evaluated longitudinally, maxillary growth in patients having received secondary alveolar bone grafting did not differ from a group of matched controls.     

不同年龄组牙槽嵴裂植骨术后牙槽嵴高度的临床观察

目的：评价在不同年龄阶段髂骨松质骨移植修复牙槽嵴裂术后植入骨的变化情况。方法：根据牙槽嵴裂患者裂隙侧尖牙萌出情况，将其分为A、B两组，通过牙槽嵴裂植骨术后临床随访和拍摄X线，追踪观察植骨区牙槽嵴高度的变化。结果：尖牙萌出前植骨优于尖牙萌出后植骨，术后正畸可增高牙槽嵴的高度。结论：牙萌出可增高牙槽嵴裂患者植骨术后牙槽嵴的高度。     

牙槽嵴裂手术修复技术改进的临床探讨

目的:探讨改良牙槽突裂修复术的临床疗效.方法:对2008-2016年收治的41例牙槽突裂患者,从手术切口、植骨床制备、取骨、植骨方法等多方面进行改进,总结临床效果.结果:手术成功率为92.8％;术后随访6～12个月,无明显供骨区并发症.结论:微创制取的条块状髂骨松质骨块成骨效果好,手术创伤小.植骨床应用“Z”瓣,可提高成骨效果,降低术后植骨区并发症.     

Treatment satisfaction and oral health-related quality of life in patients with cleft lip and palate after secondary alveolar bone grafting

Secondary alveolar bone grafting (SABG) using autologous iliac crest cancellous bone is a standard procedure for patients with cleft lip and palate (CLP). The aim of this study was to evaluate patient satisfaction after bone grafting of the alveolar cleft. Patients who underwent SABG between 2000 and 2010 in one surgical centre were included in this cross-sectional study. Three questionnaires were used, one addressing functional and aesthetic outcomes (nine items), the second being the 14-item Oral Health Impact Profile (OHIP-G14), and the third addressing donor site morbidity. A total of 103 patients fulfilled the inclusion criteria, of whom 71 could be contacted, and 52 completed the questionnaires. The majority of the patients (98%) were satisfied with the aesthetic and functional results and reported low donor site morbidity. A significant correlation was found between scores from the patient satisfaction questionnaire and the OHIP-G14. Regarding overall patient satisfaction, the manifestation of the cleft had no significant influence. The questionnaires used allowed the assessment of subjective outcome parameters, but might not be absolutely specific and exclusive for the SABG procedure in the framework of comprehensive CLP therapy. Nevertheless, SABG using autologous iliac crest cancellous bone can be considered a highly satisfactory procedure.     

Single-dose versus prolonged antibiotic prophylaxis for alveolar bone grafting in cleft patients

The increase in antimicrobial resistance requires a critical discussion of antibiotic applications. Postoperative antibiotic prophylaxis is still common for intraoral bone transplantation. However, no guidelines exist for alveolar bone grafting (ABG) in cleft patients. This study compared the infection rate between prolonged and single-dose prophylaxis for this procedure, with the null hypothesis of no difference between the two groups. In total, 109 ABG procedures in 94 cleft patients performed by two surgeons were included. Patients received either prolonged or single-dose antibiotic prophylaxis. The complication rate was compared between the groups. Fifty-nine patients (34 male, 25 female) received prolonged prophylaxis (group 1), while 35 (23 male, 12 female) had just a single dose (group 2). Median age at surgery differed between the two groups, but not significantly (P = 0.72). One relevant surgical site infection was observed among patients with postoperative antibiotic application, while no infections occurred in the single-dose prophylaxis group (1.7% vs. 0%); this difference was not statistically significant (P = 0.84). The duration of hospitalization was longer in group 1. The reduction of antibiotic prophylaxis to a single dose did not increase the infection rate. The results strongly encourage reducing antibiotic prophylaxis for ABG procedures in cleft patients.