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

中国口腔颌面外科杂志 ›› 2015, Vol. 13 ›› Issue (6): 515-520.

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

马志贵¹*，杨驰¹，谢千阳¹*，叶周熹¹，潘璐璐²，沈佩¹，陈琢之¹

1.上海交通大学医学院附属第九人民医院?口腔医学院口腔外科,上海市口腔医学重点实验室，上海 200011；
2.温州医科大学附属第一医院口腔科，浙江温州 325000

收稿日期:2014-12-17 出版日期:2015-11-20 发布日期:2015-12-03
通讯作者: 杨驰，Tel:021- 23271699-5218,E-mail：yangchi63@hotmail.com
作者简介:马志贵 (1984 -)，女，硕士，主治医师，E-mail：mazhigui2007@126.com；谢千阳（1986-），男，硕士，住院医师，E-mail：xieqianyang86@126.com。*并列第一作者

A novel surgical technique for augmented corticotomy-assisted orthodontics: dumpling grafting with periosteum

MA Zhi-gui¹, YANG Chi¹, XIE Qian-yang¹, YE Zhou-xi¹, PAN Lu-lu², SHEN Pei¹, CHEN Zhuo-zhi¹.

1.Department of Oral Surgery, Shanghai Ninth People’s Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology. Shanghai 200011;
2.Department of Stomatology, the First Affiliated Hospital of Wenzhou Medical University. Wenzhou 325000, Zhejiang Province, China

Received:2014-12-17 Online:2015-11-20 Published:2015-12-03
Contact: 上海高校青年教师培养资助计划(jdy11027)；上海市卫生局青年科研项目 (20134y061)；上海交通大学医学院附属第九人民医院院级基金(2012-12)

摘要/Abstract

摘要： 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。

关键词: 骨开裂, 骨开窗, 牙槽骨再生正畸, 锥形束CT

Abstract: PURPOSE : To introduce the dumpling grafting with periosteum (dumpling technique) as an alternative surgical approach for augmented corticotomy-assisted orthodontics in the lower anterior region and evaluate the preliminary outcomes. METHODS : From March to August in 2014, eight patients (2 men, 6 women) with dehiscence/fenestration in the lower anterior region underwent an innovated augmented corticotomy using the dumpling technique. In this new technique, an initial split-thickness dissection was performed and then the periosteal layer was carefully elevated from the alveolar bone，facilitating subperiosteal placement of bone graft material. Then the periosteum was fixed by sutures to the alveolar bone surface in a dumpling-like fashion so as to protect the grafting materials from displacement and leakage. Cone-beam computerized tomography (CBCT) was used to evaluate morphologic changes of the lower anterior ridge before treatment (T0), and 1 week after bone-augmentation procedure (T1). Quantitative measurements of the vertical alveolar bone changes and horizontal bone thickness at the middle levels of the coronal, middle and apical thirds of the lower anterior teeth were evaluated at T0 and T1. Paired t test was performed using SPSS 16.0 software package for data analysis. RESULTS : No serious complications occurred after surgery. Augmented bone morphology was well maintained after surgery on CBCT. Alveolar bone thickness from T0 to T1 increased by (0.65±0.89) mm at the coronal third, (3.30±1.09) mm at the middle third, and (3.96±1.35) mm at the apical third on labial side. Significant horizontal bone augmentation was found in the lower anterior teeth (P < 0.01). Furthermore, vertical alveolar bone increased by (5.35 mm±1.90 mm), which also showed significant change (P<0.01). CONCLUSIONS : Augmented corticotomy-assisted surgical orthodontics using the dumpling technique could prevent bone graft material from shifting, well maintain primary augmented bone morphology, and facilitate bone regeneration at the desired position. However, long-term follow-up is necessary. Supported by Research Fund for Young College and University Teachers of Shanghai Municipal Education Commission (jdy11027), Research Fund of Shanghai Municipal Health Bureau (20134Y061) and Scientific Research Fund of Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine (2012-12).

Key words: Dehiscence, Fenestration, Periodontal accelerated osteogenic orthodontics, Cone-beam CT

中图分类号:

R782.1

马志贵*，杨驰，谢千阳*，叶周熹，潘璐璐，沈佩，陈琢之. 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[J]. 中国口腔颌面外科杂志, 2015, 13(6): 515-520.

MA Zhi-gui, YANG Chi, XIE Qian-yang, YE Zhou-xi, PAN Lu-lu, SHEN Pei, CHEN Zhuo-zhi.. A novel surgical technique for augmented corticotomy-assisted orthodontics: dumpling grafting with periosteum[J]. China J Oral Maxillofac Surg, 2015, 13(6): 515-520.

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