PAOO在成人骨性Ⅲ类错术前正畸治疗中的应用

成人骨性Ⅲ类错牙合畸形患者接受正颌手术治疗前,通常需要进行术前正畸去代偿治疗,但常因患者牙槽骨薄,代谢慢等特点,在彻底去除代偿过程中会对牙周组织造成不可逆的创伤。牙周加速成骨辅助正畸治疗(periodontally accelerated osteogenic orthodontic,PAOO)的出现,为骨性Ⅲ类患者带来了巨大的便利,其可以显著缩短术前正畸治疗时间,增加牙槽骨厚度,降低牙根吸收、骨开裂及骨开窗的风险。通过阅读大量国内外相关文献,对其进行综述。     

骨移植材料用于PAOO的应用研究进展

当牙槽骨皮质切开术与骨移植技术联合应用于辅助正畸治疗时,被称为牙周辅助加速成骨正畸治疗(periodontally accelerated osteogenic orthodontics, PAOO)。目前,PAOO已被证明可以加速正畸牙齿移动并实现牙周硬组织增量,对于正畸治疗过程中降低牙周并发症及提高正畸长期稳定性有重要的意义。骨移植材料是骨增量的基础。本文就应用于PAOO的骨移植材料和辅助骨移植物固定技术的应用及研究现状作一综述。     

辅助正畸扩弓治疗的上颌后牙区牙周软硬组织增量1例

目的 本病例报道1例牙周软硬组织增量在正畸治疗过程中出现骨开裂及根面暴露的临床应用。诊治经过：一位26岁男性患者在正畸扩弓治疗过程中出现右上后牙牙龈退缩,遂停止正畸加力,要求牙周治疗。临床检查显示7-5牙Miller Ⅲ类牙龈退缩,CBCT检查显示$\underline{7-5}\rvert$牙颊侧根中1/3-根颈1/3牙槽骨吸收。一期通过膜龈手术完成根面覆盖及角化龈增量后,二期采用骨皮质切开+骨增量手术治疗$\underline{7-5}\rvert$牙颊侧骨开裂。结果 术后1年随访,正畸治疗顺利结束,$\underline{7-5}\rvert$牙根面覆盖效果稳定,颊侧骨充盈良好。结论 治疗正畸过程中出现骨开裂及根面暴露时,基于上皮下结缔组织移植的根面覆盖术联合骨皮质切开+骨增量技术能够取得满意效果,然而其长期稳定性仍有待进一步探究。     

牙周辅助加速成骨正畸用于骨性Ⅲ类正畸正颌联合治疗牙周安全性的系统评价与Meta分析

目的:通过Meta分析与系统综述评价牙周辅助加速成骨正畸用于骨性Ⅲ类患者正畸-正颌联合治疗中牙槽骨形态和牙周软组织的变化。方法:对六个中英文数据库进行文献检索,筛选骨性Ⅲ类患者正颌术前正畸采用牙周辅助加速的成骨正畸(periodontal accelerated osteogenic orthodontics, PAO...     

牙周辅助加速成骨正畸治疗技术

加速牙齿移动是近年来正畸医生关注的焦点之一。其中牙周辅助加速成骨正畸治疗（periodontally accelerated osteogenic orthodontics,PAOO）技术被证实可有效加速牙齿移动。该技术以局部加速现象为理论基础发展而来,术式在其发展的几年间也几经改良。目前认为PAOO技术可以加速牙齿移动,缩短疗程,减少牙根吸收,增加牙槽骨量,可获得差异性牙齿移动,同时增强术后稳定性。本文阐述PAOO技术的发展历史及加速牙齿移动机制,介绍其目前临床研究和临床应用的现况,可让读者对PAOO技术有较全面的了解和认识。     

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。     

引导组织再生术联合植骨术治疗角形骨吸收1例

目的 分析引导组织再生术联合植骨术治疗1例角形骨吸收的临床效果。诊治经过：本文报道1例Ⅲ期C级牙周炎患者,通过引导组织再生术联合植骨术治疗,恢复了牙周组织正常的生理结构和功能,两次手术分别使用Guidor基质膜与海奥胶原膜覆盖两个术区。结果 在术后4年的牙周支持治疗期间,患者牙周状况保持稳定,取得了良好的临床效果。结论 窄而深的骨下袋因其牙周膜细胞来源丰富,能提供稳定的再生空间,较适合引导组织再生术。     

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...     

下颌第一磨牙缺失间隙关闭前后的骨量变化

目的 研究下颌第一磨牙缺失区骨量与正畸关闭间隙后移入间隙的第二磨牙骨丧失量之间的关系,为风险预判及预后提供参考。方法 选取下颌第一磨牙缺失的正畸患者50例,行全口固定矫治,微种植体支抗辅助近中移动磨牙关闭间隙。治疗前后分别拍摄锥形束CT,并测量骨量。运用SPSS22.0统计软件分析数据。结果 测量的下颌第二磨牙8个位点中7个位点的平均骨高度丧失量均小于1 mm。骨高度增加的位点占34.5%,90%的磨牙存在骨高度增加的位点。下颌第一磨牙缺失区牙槽骨的高度吸收量、宽度吸收量与移入缺牙嵴的第二磨牙骨高度丧失量均不存在显著相关性。结论 通过正畸近中移动相邻磨牙关闭下颌第一磨牙缺失间隙不会造成严重的磨牙骨高度丧失,还可能形成骨高度的增加。缺牙区的骨吸收量不提示治疗风险,该项治疗前也无需行植骨术。     

目标引导的骨性III类错多学科联合治疗一例

目标引导的正畸治疗（Objective oriented orthodontics）囊括主诉、牙面美学、动态咬合、稳定、关节健康、气道健康、牙周牙体健康、心理等八个方面。本文报道一例以正畸治疗目标为导向的严重骨性III类错患者的多学科联合治疗病例。在明确诊断的前提下,制定计划如下：牙周辅助加速成骨（Periodontally accelerated osteogenic orthodontics,PAOO）手术后进行上下颌牙列去代偿;经外科会诊后拟行Lefort I型截骨术前徙上颌骨,矢状劈开并后退及逆旋下颌骨伴颏成型术。术后颌位检查显示咬合高点与正中关系-正中颌位不调,CBCT显示左侧髁突-关节窝关系不良并发现上颌骨骨性宽度不足,稳定性板治疗后行种植钉辅助上颌快速扩弓（Maxillary skeletal expander, MSE）;下颌采用关闭曲法实现下前牙控根,继而通过短颌间牵引精调尖、磨牙关系。经由多学科联合治疗,同时依赖患者的配合与信赖,基本实现初定的治疗目标,患者及家属对治疗结果满意。     

改良骨皮质切开术对下前牙牙周组织和基骨宽度影响的临床研究

目的:研究改良骨皮质切开术前术后下前牙牙周组织和基骨宽度的变化,评估其手术的安全性,为临床提供参考。方法:选取轻中度安氏Ⅲ类错牙合的健康成人,进行下前牙改良骨皮质切开术辅助正畸治疗,并对下前牙正畸矫治前后的各项牙周指数和基骨宽度进行比较。结果:下前牙正畸矫治前后探诊深度、出血指数、牙龈萎缩各项指标均无统计学差异;正畸治疗后角化龈宽度(5.8±2.4) mm大于术前(5.2±1.9) mm(P=0.041);下前牙根尖区基骨厚度治疗后(6.04±4.57) mm比治疗前(5.32±3.87) mm增厚(P=0.024),但其中下前牙根尖区唇侧基骨厚度治疗后(2.27±1.72) mm,比治疗前(2.88±2.35) mm减小(P=0.014),舌侧基骨厚度治疗后(3.97±3.49) mm则比治疗前(2.54±2.06) mm增大(P=0.040);下颌B点基骨厚度治疗后(7.17±5.21) mm比治疗前(6.47±3.99) mm增厚(P=0.042)。结论:改良骨皮质切开术辅助正畸治疗矫治中度安氏Ⅲ类错牙合,对其下前牙牙周组织是安全的,甚至能刺激下前牙基骨的增生。     

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。     

正畸治疗策略中牙周支持组织改建的风险考量

随着成年正畸患者比例的增加,牙周状况对正畸治疗效果的影响以及正畸治疗与牙周支持组织改建的关系逐渐成为焦点。越来越多的正畸医师意识到,正畸治疗前牙周炎症应得到有效控制。牙周炎可增加正畸治疗的难度,导致额外的牙槽骨吸收;因此,降低牙周炎患者在正畸治疗过程中牙周组织健康状况恶化的风险成为临床医师关注的重点。除牙周炎外,正畸治疗也有可能导致牙龈退缩。另外,正畸治疗中应考虑特定类型的牙槽骨缺损情况:如骨开窗、骨开裂与正畸牙移动的关系。本文主要从牙周炎与正畸、牙龈退缩与正畸以及骨开窗和(或)骨开裂与正畸三方面阐述正畸治疗中牙周支持组织的风险考量。     

Wilckodontics--an alternative adult orthodontic treatment method: rational and application

Adult orthodontics poses a challenge for practitioners as it involves unique biomechanical considerations due to biologic age related changes and lack of skeletal growth potential. Dental risks in adult orthodontics include, amongst others, root resorption and periodontal complications. As modern life calls for quick and efficient orthodontic treatments, a novel orthodontic modality was developed utilizing adjunctive periodontal surgery that includes bone corticotomy combined with bone augmentation. This multidisciplinary team approach: Periodontally Accelerated Osteogenic Orthodontics (PAOO) or Wilckodontics seems to be promising not only for reducing orthodontic treatment duration, but also for biological aspects during and after orthodontic treatment. PAOO enhances bone remodeling and augmentation, accelerates tooth movement and significantly reduces the duration of treatment. The presented cases manifest the biologic benefit of profound enlargement in the envelope of motion reducing the need for extraction and eliminating the need for aggressive intervention of surgically-assisted rapid maxillary expansion. PAOO serves as a reasonable and safe option for the growing demand of shortened treatment duration of adult teeth movement in three dimensions. Further research is recommended for an in depth evaluation of the long-term stability claimed to be advantageous in this modality.     

Periodontal consequences of mandibular incisor proclination during presurgical orthodontic treatment in Class III malocclusion patients

Objective:To test the hypothesis that periodontal changes are similar between proclined and minimal-changed mandibular incisor position groups during presurgical orthodontic treatment for Class III orthognathic surgery.Materials and Methods:The following measurements were performed before and after presurgical orthodontic treatment of 75 patients (proclination group, 39 subjects; minimal-change group, 36 subjects): clinical crown length, sulcus and bone probing depths, and width of attached gingiva from clinical examination; infradentale-to-MP (perpendicular distance of infradentale to mandibular plane) from examination of lateral cephalograms; and the distance between the cementoenamel junction and alveolar crest from examination of periapical radiographs. Data were compared between the two groups, and a regression analysis was performed to investigate factors affecting the periodontal changes.Results:In both groups, clinical crown length and bone probing depth increased during presurgical orthodontics (P < .05). Infradentale-to-MP and the width of attached gingiva decreased more in the proclination group than in the minimal-change group (P < .05). Proclination and protrusion of the mandibular incisors, and treatment duration affected the periodontal changes.Conclusions:The null hypothesis was rejected. Proclination of the mandibular incisors for decompensation in Class III surgery patients seems to result in labial alveolar bone recession and a decrease in width of attached gingiva. However, the amount of the periodontal recession appeared to be clinically insignificant.     

Orthodontic treatment of gingival recession: indications

Gingival recession is a complex phenomenon. Root coverage results can be predictable regarding to the anatomy of the area. This includes the width of keratinized and attached gingiva, the buccolingual dimension of both soft tissue and alveolar bone, and the position and angulation of the teeth. If the tooth is out of the envelope of the alveolar process, with alveolar bone dehiscence and low thickness of the marginal soft tissue, the recession risk is important. Many techniques have been introduced to treat gingival recession. But lots of failures are linked to tooth position. An adequate orthodontic therapy, with controlled tooth movement, can improve periodontal tissues and thus improves the esthetical outcome. In some cases, orthodontic treatment is suggested to lead to an improved periodontal condition without pre-orthodontic gingival augmentation.     

Guided bone regeneration of a pronounced gingivo-alveolar cleft due to orthodontic space closure

BACKGROUND: Gingival invagination is a relatively common occurrence following orthodontic closure of extraction sites. The present paper reports a combined periodontal and orthodontic treatment in a patient with a severe gingivo-alveolar cleft due to orthodontic closure of maxillary central incisor extraction space. METHODS: A definite interdental gingival cleft, extending 8 mm into the alveolar bone, required the correction of the gingival deformity as a first step, followed by guided bone regeneration (GBR). The GBR approach included the emptying of the incisive foramen to approximately 5 mm in depth followed by the insertion of bioabsorbable hydroxyapatite and covering with a bioabsorbable barrier membrane. Six months afterward, the orthodontic therapy was resumed. RESULTS: Radiographs and clinical examination 4 years after the completion of therapy indicates functionally and aesthetically satisfactory and stable results. CONCLUSION: The present paper illustrates an additional application for the guided bone regeneration technique.     

中药大黄对正畸固定矫治中龈炎的治疗研究

目的:评价中药大黄对正畸固定矫治中龈炎治疗的临床疗效。方法:选择牙周健康者20例(尚未矫治)和矫治6个月临床诊断为牙龈炎的患者60例为研究对象,牙周健康患者20例设为牙周健康组,60例牙龈炎患者随机分为3组:大黄组、明胶海绵组和对照组。分别于治疗前采集4组研究对象的牙周临床指数和龈沟液标本,使用ELISA法测量龈沟液中白介素-1β的含量,比较组间各项指标间的差异。对牙龈炎3组患者,其中大黄组用大黄明胶海绵药条,明胶海绵组用灭菌蒸馏水明胶海绵条,分别置于龈袋内,每周上药1次,共4次,对照组患者龈袋内不放任何药物。于4周后重新采样比较牙周治疗前后上述指标间的差异。结果:牙龈炎组治疗前牙周临床指数、龈沟液IL -1β浓度均显著高于牙周健康组(P＜0.05),大黄组、明胶海绵组与对照组比较无显著性差异。治疗后明胶海绵组上述指标与对照组比较无显著性差异,且明显高于牙周健康组(P＜0.05)。治疗后明胶海绵组和对照组分别与治疗前比较均无显著性差异。治疗后大黄组上述指标相比治疗前及对照组均明显降低(P＜0.05),与牙周健康组比较,龈沟出血指数(SBI)接近正常。结论:中药大黄对正畸固定矫治中龈炎具有明显的治疗效果。