牙周辅助成骨加速正畸研究新进展

牙周辅助成骨加速正畸技术(periodontally accelerated osteogenic orthodontics,PAOO)因能够有效加速正畸牙移动、缩短正畸疗程,增加牙槽骨骨量、扩大正畸牙移动界限,减少并发症,增强正畸治疗长期稳定性等,受到口腔医师的广泛关注.近年来,随生物医疗器械及生物材料的不断发展,P...     

牙周加速成骨正畸临床应用效果的研究进展

牙周加速成骨正畸(PAOO)是指对牙槽骨进行骨皮质切开,并在切开骨表面进行颗粒骨移植以辅助正畸治疗。骨皮质切开诱导的局部加速现象可诱导破骨活性增加,加速骨代谢,从而有效加速正畸牙移动,缩短疗程,并可以减少牙根吸收等正畸并发症的发生。颗粒骨的植入能扩大正畸牙的移动范围,拓宽正畸治疗的适应证,保证牙周健康,提高治疗稳定性。本文就PAOO对正畸治疗中牙移动速率、骨增量效果以及牙根吸收的临床效果作一综述,以便为该技术的临床应用提供参考。     

骨皮质切开术加速正畸牙移动的治疗技术

骨皮质切开术是一种有效加快正畸牙移动的技术,能使正畸治疗时间缩短至传统正畸治疗时间的1／3-1／4,同时也能增加牙槽骨宽度,提高正畸术后稳定性,减少牙根吸收等。该技术理论基础是通过局部加速现象（ RAP）来加速正畸牙移动。本文将从骨皮质切开术的发展历史和加快正畸牙移动的理论基础及其临床应用进行综述。     

骨增量技术在正畸治疗中的应用

报告1例后牙缺失且牙槽骨量不足的患者,进行上颌窦提升、下颌骨骨劈开植骨后,完成正畸治疗的临床病例.正畸治疗前采用骨增量技术可以有效增加牙齿移动路径的骨量,从而促进牙齿移动,减少并发症的发生.     

牙槽骨再生正畸治疗伴牙槽骨缺损的成人错畸形远期疗效评价

目的：评价牙槽骨再生正畸治疗伴牙槽骨缺损的成人错畸形的远期疗效。方法伴牙槽骨缺损的成人错畸形3例,平均年龄29岁。经正颌-正畸联合会诊制订治疗计划,按照牙槽骨再生正畸及正颌-正畸联合治疗模式,分别进行系统治疗并随访2~3 a。结果3例患者均顺利完成治疗,面型及咬合关系获得良好改善;牙槽骨缺损区正畸牙移动到位且未见医源性牙周并发症,牙槽骨缺损区骨量增加明显且远期效果稳定。结论针对伴牙槽骨缺损的成人患者,牙槽骨再生正畸是一种较为理想的技术。     

牵引成骨在正畸牙快速移动中成骨速度的研究

目的 观察牙周膜牵引成骨在正畸牙快速移动中牵引侧牙槽骨的成骨速度。方法 6只犬采用自身对照，对照侧用传统方法以第三前磨牙为支抗牙移动第一前磨牙向远中，实验侧用自制牙周膜牵引装置。用序列四环素荧光标记法标记被移动的牙张力侧新形成的牙槽骨，荧光显微镜下观察切片，拍照，用计算机图象分析系统测量新骨量。结果 实验侧和对照侧新骨形成的量有显著性差别，实验侧大于对照侧。结论 牙周膜牵引成骨术在正畸牙快速移动中比传统的牙齿移动方法可加快新骨的形成。     

伴错[牙合]畸形的侵袭性牙周炎患者牙周-正畸联合治疗长期疗效的影响因素分析

目的分析侵袭性牙周炎(aggressive periodontitis,AgP)患者牙周-正畸联合治疗长期疗效的相关影响因素。方法纳入2002年1月至2010年9月于北京大学口腔医学院·口腔医院牙周科就诊,并完成牙周-正畸治疗的AgP患者25例,收集初诊(T0)、正畸治疗完成后(T1)、正畸结束3年以上末次复查(T2)时的全口根尖X线片,通过根尖X线片评价患者根形态异常情况、正畸前后剩余牙槽骨高度(residual alveolar bone height,RBH)的变化。评价根形态异常对牙周-正畸治疗的影响,并进行多因素分析,评价与正畸后长期牙槽骨高度变化相关的牙和个体水平因素。结果T0、T1时统计25例患者的693颗牙,T2期随访14例患者,共观测368颗牙。牙周-正畸治疗前后,牙槽骨高度变化的主要影响因素为根形态异常(估计值为-2.392)、牙位(上颌牙vs.下颌牙估计值为3.139;前牙vs.后牙估计值为?3.469)和T0期的牙槽骨高度变化(估计值为-0.391)(P<0.05)。根形态异常、下颌牙、前牙以及T0时牙槽骨高度高,都是牙槽骨增加的不利因素。正畸后长期观察,牙槽骨高度变化的主要影响因素为牙位(上颌牙vs.下颌牙估计值为3.735;前牙vs.后牙估计值为-5.318)、T0时探诊深度(估计值为-1.594)和T0时牙槽骨高度(估计值为-0.498)(P<0.05)。下颌牙、前牙、T0时牙槽骨高度增加和T0探诊深度增加,都是正畸后长期牙槽骨增加的不利因素。结论多因素分析显示,正畸治疗结束时,牙槽骨高度变化的主要影响因素为根形态异常、牙位和T0时牙槽骨高度;正畸后3年以上复查,牙槽骨高度变化的主要影响因素为牙位、T0时的探诊深度和T0时牙槽骨高度。     

正畸牙移动困难相关因素研究进展

正畸牙移动是以牙周组织塑建为生物学基础的复杂生理过程。许多因素如口颌复合体的解剖特征、咬合干扰、机械因素及系统性因素等都可能对其造成影响,导致正畸牙移动困难。近年来,国内外学者非常关注牙移动困难相关因素的研究,但当前有关正畸牙移动困难的研究多为动物实验及回顾性研究,亟需高质量的临床试验及循证医学研究。许多正畸牙移动困难相关因素的作用机制尚存在争议,未形成一个普遍认可的完善理论体系,目前认为牙槽骨缺损、上颌窦、牙龈、牙根粘连、骨岛和摩擦力等因素都可能导致正畸牙移动困难。了解正畸牙移动困难的相关因素有助于正畸医生为患者制定更全面的个性化治疗方案,实现更高效、安全的牙移动。本文对目前正畸牙移动困难的相关因素作一综述,为正畸临床治疗提供参考。     

骨质疏松症及相关治疗药物对正畸治疗影响的研究进展

随着骨质疏松症发病率逐年增高,正畸患者中患有骨质疏松症的比例也在增加,骨质疏松症患者正常骨代谢受到破坏,这也对以牙周组织改建为基础的正畸牙移动产生了影响;由于治疗骨质疏松症的药物对骨改建的影响,同时也会对骨改建活跃的牙槽骨有着不同的作用,如何在保证正畸治疗效率的同时重建牙槽骨的骨改建平衡,应该是未来研究的重点。     

Influence of ibuprofen combined with corticotomy on tooth movement and alveolar bone remodeling in rats

ObjectivesTo investigate the effects of corticotomy-assisted orthodontic tooth movement and administration of ibuprofen on tooth movement rate and alveolar bone response.Materials and MethodsA total of 78 adult male Wistar rats were randomly assigned to five groups: one baseline group (no treatment) and four experimental groups including orthodontic tooth movement only (OTM), orthodontic tooth movement with ibuprofen (OTMI), corticotomy-assisted orthodontic tooth movement (COTM), and corticotomy-assisted orthodontic tooth movement with ibuprofen (COTMI). Corticotomy was performed on a maxillary molar unilaterally. Nickel-titanium closed-coil springs generated a 10-gram force for maxillary first molar movement. The experimental drug groups received 15 mg/kg of ibuprofen, and the other groups received reverse osmosis water. Tooth movement and bone volume fraction were evaluated by micro–computed tomography on days 0, 7, 14, and 21.ResultsThe corticotomy groups had statistically significantly higher tooth movement and lower bone volume fraction than the orthodontic groups (P < .05). The amount and rate of tooth movement were statistically significantly different between the OTM and OTMI groups, but not statistically significantly different in bone volume fraction. However, statistically significant differences were not observed in any measurements between the COTM and COTMI groups.ConclusionsIbuprofen during orthodontic tooth movement inhibited tooth movement and alveolar bone remodeling but had no effect on corticotomy-assisted orthodontic treatment.     

Periodontally accelerated osteogenic orthodontics combined with autogenous bone grafting

This case report documents the first use of particulate autogenous bone graft with the corticotomy-assisted rapid orthodontic procedure known as periodontally accelerated osteogenic orthodontics (PAOO). A 41-year-old man, with class II, division 2 crowded occlusion, was treated with the PAOO procedure. Buccal mucoperiosteal flaps were reflected, and selected vertical and horizontal corticotomy was performed around the roots in both the maxillary and mandibular arches. Particulate bone graft was harvested from the rami and exostosis for alveolar ridge augmentation. Orthodontic movement was initiated immediately after the surgical intervention and adjusted every 2 weeks. Eight months after corticotomy surgery, total active orthodontic treatment was completed. No detrimental periodontal effects or root resorption were observed. The alveolar ridges of both the maxilla and mandible maintained the original thickness and configuration despite facial tipping of the incisors. It was concluded that PAOO is an effective treatment approach in adults to decrease treatment time and reduce the risk of root resorption. Selected corticotomy limited to the buccal and labial aspects also significantly reduces treatment time. More clinical studies with additional patients and long-term follow-up are needed to determine the optimal amount of autogenous bone graft.     

Corticotomy facilitated orthodontics: Review of a technique

Corticotomy found to be effective in accelerating orthodontic treatment. The most important factors in the success of this technique is proper case selection and careful surgical and orthodontic treatment.Corticotomy facilitated orthodontics advocated for comprehensive fixed orthodontic appliances in conjunction with full thickness flaps and labial and lingual corticotomies around teeth to be moved. Bone graft should be applied directly over the bone cuts and the flap sutured in place. Tooth movement should be initiated two weeks after the surgery, and every two weeks thereafter by activation of the orthodontic appliance.Orthodontic treatment time with this technique will be reduced to one-third the time of conventional orthodontics. Alveolar augmentation of labial and lingual cortical plates were used in an effort to enhance and strengthen the periodontium, reasoning that the addition of bone to alveolar housing of the teeth, using modern bone grafting techniques, ensures root coverage as the dental arch expanded.Corticotomy facilitated orthodontics is promising procedure but only few cases were reported in the literature. Controlled clinical and histological studies are needed to understand the biology of tooth movement with this procedure, the effect on teeth and bone, post-retention stability, measuring the volume of mature bone formation, and determining the status of the periodontium and roots after treatment.     

正畸后龈乳头退缩的研究进展

正畸患者龈乳头退缩所致的前牙"黑三角"是仅次于龋齿和修复体边缘暴露的第三大美学问题,发病率高达38.0％～43.7％.龈乳头退缩的危险因素有正畸移动方式、牙列拥挤程度、牙槽骨高度和局部解剖结构等.目前的治疗方法包括修复、正畸、膜龈手术以及注射透明质酸等.文章就正畸患者龈乳头退缩的危险因素、治疗和预防做一综述,以期制定合...     

Rapid orthodontic treatment after the ridge-splitting technique--a combined surgical-orthodontic approach for implant site development: case report

This article presents a clinical case of bilateral partial edentulism in the posterior mandible with severe horizontal and moderate vertical bone atrophy. A new technique using rapid orthodontics after ridge splitting is presented. The split-crest technique was carried out using piezosurgical instruments in the first molar and second premolar areas to widen the bone crest and open a channel for tooth movement. Immediately after, orthodontic appliances were used to move the first premolars distally and the second molars mesially into the surgical site. The rationale was to facilitate and accelerate orthodontic movement of the teeth, which is otherwise difficult in a cortical knife-edged ridge. The bone defect was filled with the alveolar bone of the adjacent teeth that were moved into the surgically opened path. Adequate bone volume for implant placement was generated in the first premolar area. Implants were then inserted, and the patient was rehabilitated.     

Forced eruption and implant site development: Soft tissue response

The increased use of implants in orthodontics has stimulated interest in augmenting bone in patients who have deficient alveolar ridges that preclude ideal implant placement. A nonsurgical technique for increasing the amount of available bone for implant site development and fixture placement is orthodontic extrusion, or forced eruption. The concept of a tooth moving coronally by orthodontic means and the clinical alterations in the soft tissue architecture of the periodontium demonstrated during orthodontic extrusive movement of periodontally compromised teeth have demonstrated a direct relationship of pocket depth reduction, accompanied with an immature appearing tissue, “the red patch.” This article will describe the periodontium during eruptive tooth movement.(Am J Orthod Dentofac Orthop 1997;112:596-606.)     

Micro-CT对骨皮质切开术中区域性加速现象的分析

目的:Micro-CT观测骨皮质切开辅助正畸治疗中牙齿移动速率和牙槽骨结构的改变。方法:选用75只4~6周龄的雄性SD大鼠,随机分为3组:组1:牙槽骨皮质切开辅助正畸(CO+TM),组2:传统正畸(TM),组3:单纯牙槽骨皮质切开(CO),按照时间点(加力4、7、14、21、28 d后)处死实验动物并进行Micro-CT扫描,测量牙移动距离;三维重建后测量牙颈部、根中部、根尖部3个平面张力侧及压力侧共6个区域的牙槽骨骨密度及骨体积。结果:1)牙移动距离:初期TM组高于CO+TM组,在第14、21、28天时,CO+TM组明显高于TM组(P<0.05)。速率:4~7 d时TM组大于CO+TM组,之后小于CO+TM组,组间比较P<0.05。2)骨密度:4、7、21、28 d时远中骨密度CO+TM组与CO、TM组比较持续下降,TM组则先下降后上升,CO组稳定于0左右(P<0.05)。3)骨体积:CO+TM组近中骨体积始终呈下降趋势,TM组近中骨体积自加力4 d后持续缓慢升高。结论:牙槽骨骨皮质改良切开术辅助正畸可以在术后14~28 d内增加正畸牙移动距离;牙槽骨远中侧骨密度降低明显,压力侧骨体积下降,张力侧骨体积上升,骨改建活跃,区域性加速现象在21 d时最明显。     

牙槽骨增量骨皮质切开术后2种植骨材料成骨的影像学分析

目的 探讨错畸形患者牙槽骨增量骨皮质切开术的成骨效果。方法 收集进行牙槽骨增量骨皮质切开术的错畸形患者42例,分为2组,瑞邦骨粉植骨22例（第1组）,Bio-oss骨粉植骨20例（第2组）。应用锥形束CT（cone-beam CT,CBCT）测量2组患者术前（T0）、术后2周（T1）、术后3个月（T2）、术后6个月（T3）牙槽骨相关指标,采用SPSS 21.0软件包对数据进行单因素方差分析。结果 第2组的唇侧骨高度（HL）在T0至T2时增加（P<0.001）;2组的根尖部唇侧骨厚度（TL1）及根中部唇侧骨厚度（TL2）在T0至T1时增加,T1至T2时减少（P<0.001）;2组的根尖非植骨区域CT值（CTn）在T0至T1时减少,T1至T3时增加（P<0.001）;2组的植骨区域CT值（CTg）在T1至T3时减少（P<0.001）。TL1、TL2、CTn、CTg的组间差异有统计学意义（P<0.001）。结论 错畸形患者通过牙槽骨增量骨皮质切开术,可在术区实现充分的骨增量,无明显牙周损伤及牙根吸收。2种植骨材料成骨效果理想,术后随访半年,成骨情况稳定。     

一种牙槽骨再生正畸治疗骨开裂、骨开窗的新术式：骨膜“包饺子”植骨法

目的 ：介绍并评价一种牙槽骨再生正畸治疗(periodontal accelerated osteogenic orthodontics, PAOO) 下前牙区唇侧骨开裂、骨开窗的新术式,即采用骨膜“包饺子”植骨法对牙根表面牙槽骨 缺损行骨增量术。方法 ：自2014年3月—2014年8月,对8例 (男2例,女6例)下前牙唇侧骨开窗、骨开裂患者行骨膜“包饺子”植骨法。首先向根方分离半厚瓣,于半厚瓣最下方切开骨膜层,仔细将骨膜层剥离牙槽骨骨膜,以利于骨膜下植入骨移植材料,最后将骨膜缝合固定于骨面,形似“饺子”, 以防止植骨材料移位与外漏。所有患者术前、术后1周进行锥形束CT(cone-beam computed tomography,CBCT)检查,评价下前牙唇侧牙槽骨高度的变化及冠1/3、中1/3、根1/3的中部牙槽骨宽度改变。采用SPSS 16.0软件包对数据进行配对t检验。结果 ：术后无严重并发症出现。CBCT显示骨植入物形态维持良好。冠1/3中部唇侧牙槽骨宽度增加(0.65±0.89) mm,牙根中部牙槽骨宽度增加(3.30±1.09) mm,根1/3中部宽度增加至(3.96±1.35) mm,所有改变均具有统计学意义（P<0.01）;下前牙垂直向牙槽骨增加(5.35±1.90) mm（P<0.01）。结论 ：采用骨膜“包饺子”植骨法能防止移植材料移位,利于其塑形,促进骨再生在需要的部位发生,最终有效增加了缺损牙槽骨的高度及宽度。该方法并发症少,近期疗效好,但远期效果有待进一步评价。     

成人牙周病正畸治疗的疗效分析

目的通过对牙周病患者施行牙周和正畸联合治疗,探讨正畸治疗对牙根长度和牙槽骨高度的影响。方法选择30例牙周病患者,采取牙周治疗和直丝弓固定矫治器正畸的联合方法,拍摄正畸治疗前后的曲面断层片,借鉴Sche i提出测量牙槽骨吸收程度的方法,测量正畸治疗前后牙根长度和牙槽骨高度,用计算机进行统计分析。结果 30例牙周病患者,经过牙周和正畸联合治疗,治疗前后牙根长度和牙槽骨高度的变化差异无统计学意义（P〉0.05）。结论牙周病患者严格控制炎症、采取轻力,通过牙周和正畸联合治疗,不会对牙根长度和牙槽骨高度产生影响。