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

doi:10.19438/j.cjoms.2021.06.008

摘要/Abstract

摘要： 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。

关键词: 牙槽骨增量, 骨皮质切开术, 成骨, 错畸形, 正畸治疗

Abstract: PURPOSE: To evaluate the osteogenesis for patients with malocclusion after augmented corticotomy-assisted surgical orthodontics. METHODS: Forty-two patients with malocclusion augmented corticotomy-assisted surgical orthodontics were selected in this study. The patients were divided into 2 groups, twenty-two were treated with Rebone (group 1), twenty were treated with Bio-oss (group 2). Cone-beam CT was used to measure the alveolar bone indexes of the two groups at different time(T0: preoperative, T1: after 2 week, T2: after 3 month, T3: after 6 month). SPSS 21.0 software package was used for statistical analysis. RESULTS: Among the 42 patients, the labial bone height (HL) in group 2 increased from T0 to T2 (P<0.001); the apical labial bone thickness (TL1) and middle root labial bone thickness (TL2) increased from T0 to T1 and decreased from T1 to T2 (P<0.001). CT value of the area without bone graft(CTn) decreased from T0 to T1 and increased from T1 to T3(P<0.001). CT value of the bone graft area(CTg) decreased from T1 to T3(P<0.001). The differences of TL1, TL2, CTn, and CTg between the two groups were significant(P<0.001). CONCLUSIONS: Patients with malocclusion can achieve sufficient bone increment in the operation area through augmented corticotomy-assisted surgical orthodontics, without periodontal injury and root resorption. The osteogenic effect of the two materials was ideal, and the osteogenesis was stable after half a year follow-up.

Key words: Alveolar bone augmentation, Corticotomy, Osteogenesis, Malocclusion, Orthodontic treatment

中图分类号:

R782.1

朱磊, 刘庆成, 于洪波. 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[J]. 中国口腔颌面外科杂志, 2021, 19(6): 525-530.

ZHU Lei, LIU Qing-cheng, YU Hong-bo. Radiographic analysis of osteogenesis of two bone implant materials after augmented corticotomy-assisted surgical orthodontics[J]. China J Oral Maxillofac Surg, 2021, 19(6): 525-530.

参考文献

[1] Kole H.Surgical operations on the alveolar ridge to correct occlusal abnormalities[J]. Oral Surg Oral Med Oral Pathol,1959, 12(5): 515-529.
[2] Frost HM.The regional acceleratory phenomenon: a review[J]. Henry Ford Hosp Med J, 1983, 31(1): 3-9.
[3] Vercellotti T, Podesta A.Orthodontic microsurgery: a new surgically guided technique for dental movement[J]. Int J Periodontics Restorative Dent, 2007, 27(4): 325-331.
[4] Dibart S, Sebaoun JD, Surmenian J. Piezocision: a minimally invasive, periodontally accelerated orthodontic tooth movement procedure[J]. Compend Contin Educ Dent, 2009, 30(6): 342-344,346,348-350.
[5] Dukka H, Gossweiler M, Kishimoto T, et al.Periodontally accelerated osteogenic orthodontics (PAOO) using platelet-rich fibrin alone: a modified approach with a 3-year follow-up[J]. Clin Adv Periodontics, 2018, 8(4): 177-181.
[6] Bahammam MA.Effectiveness of bovine-derived xenograft versus bioactive glass with periodontally accelerated osteogenic orthodontics in adults: a randomized, controlled clinical trial[J]. BMC Oral Health, 2016, 16(1): 126-135.
[7] Wilcko WM, Wilcko T, Bouquot JE, et al.Rapid orthodontics with alveolar reshaping: two case reports of decrowding[J]. Int J Periodontics Restorative Dent, 2001, 21(1): 9-19.
[8] Murphy KG, Wilcko MT, Wilcko WM, et al.Periodontal accelerated osteogenic orthodontics: a description of the surgical technique[J]. J Oral Maxillofac Surg, 2009, 67(10): 2160-2166.
[9] Charavet C, Lecloux G, Bruwier A, et al.Localized piezoelectric alveolar decortication for orthodontic treatment in adults: a randomized controlled trial[J]. J Dent Res, 2016, 95(9): 1003-1009.
[10] Sehdev B, Singh R, Anshul. Periodontally accelerated osteogenic orthodontics in class Ⅰ bi-maxillary protrusion: a case report[J]. J Orofac Health Sci, 2018, 9(2): 84-89.
[11] Wang B, Shen G, Guo Q, et al.Long-term effects of augmented corticotomy-assisted orthodontics in patients with mandibular anterior alveolar defect[J]. J Craniofac Surg, 2019, 30(8): e737-e740.
[12] Horton JE, Tarpley TM Jr, Jacoway JR.Clinical applications of ultrasonic instrumentation in the surgical removal of bone[J]. Oral Surg Oral Med Oral Pathol, 1981, 51(3): 236-242.
[13] Sendyk DI, de Oliveira NK, Pannuti CM, et al. Conventional drilling versus piezosurgery for implant site preparation: a meta-analysis[J]. J Oral Implantol, 2018, 44(5): 400-405.
[14] Yu H, Jiao F, Wang B, et al.Piezoelectric decortication applied in periodontally accelerated osteogenic orthodontics[J]. J Craniofac Surg, 2013, 24(5): 1750-1752.
[15] Leung CC, Palomo L, Griffith R, et al.Accuracy and reliability of cone-beam computed tomography for measuring alveolar bone height and detecting bony dehiscences and fenestrations[J]. Am J Orthod Dentofacial Orthop, 2010, 137(4 Suppl): S109-S119.
[16] Lechuga L, Weidlich GA.Cone beam CT vs. fan beam CT: a comparison of image quality and dose delivered between two differing CT imaging modalities[J]. Cureus, 2016, 8(9): e778-e791.
[17] Mehdizadeh M, Faghihian E.Comparison of linear measurement accuracy on cone-beam computed tomography images and digital lateral cephalometric radiographs[J]. J Isfahan Dent Sch, 2013, 8(6): 567-576.
[18] Lagravère MO, Carey J, Toogood RW, et al.Three-dimensional accuracy of measurements made with software on cone-beam computed tomography images[J]. Am J Orthod Dentofacial Orthop, 2008, 134(1): 112-116.
[19] Dalili KZ, Neshandar AH, Taramsari M, et al.Comparison of height and width measurements of mandibular bone in various head orientations using cone beam computed tomography: an experimental in vitro study[J]. Oral Radiol, 2015, 31(1): 28-35.
[20] 潘成琼, 李明, 秦燕军, 等. 上颌前牙牙槽骨骨皮质切开辅助治疗轻度骨性Ⅱ类错畸形的临床观察[J].实用口腔医学杂志, 2016, 32(4): 495-500.
[21] Wang B, Shen G, Fang B, et al.Augmented corticotomy-assisted presurgical orthodontics of Class Ⅲ malocclusions: a cephalometric and cone-beam computed tomography study[J]. J Craniofac Surg, 2013, 24(6): 1886-1890.
[22] Wang B, Shen G, Fang B, et al.Augmented corticotomy-assisted surgical orthodontics decompensates lower incisors in Class Ⅲ malocclusion patients[J]. J Oral Maxillofac Surg, 2014, 72(3): 596-602.
[23] Gantes B, Rathbun E, Anholm M.Effect on the periodontium following corticotomy-facilitated orthodontics. Case reports[J]. J Periodontol, 1990, 61(4): 234-238.
[24] Aristizába JF, Bellaiza W, Ortiz MA, et al.Clinical and systemic effects of periodontally accelerated osteogenic orthodontics: a pilot study[J]. Int J Odontostomat, 2016, 10(1): 119-127.
[25] 赵岩, 屈振宇, 刘琳, 等. 锥形束CT用于骨性安氏Ⅱ类1分类错畸形切牙区唇侧牙槽骨开窗及骨开裂的研究[J].中华口腔正畸学杂志, 2016, 22(1): 2-7.
[26] Bhattacharya P, Bhattacharya H, Anjum A, et al. Assessment of corticotomy facilitated tooth movement and changes in alveolar bone thickness- a CT scan study[J]. J Clin Diagn Res, 2014, 8(10): ZC26-ZC30.
[27] Ma Z, Zheng J, Yang C, et al.A new modified bone grafting technique for periodontally accelerated osteogenic orthodontics[J]. Medicine (Baltimore), 2018, 97(37): e12047.
[28] Sebaoun JD, Kantarci A, Turner JW, et al.Modeling of trabecular bone and lamina dura following selective alveolar decortication in rats[J]. J Periodontol, 2008, 79(9): 1679-1688.
[29] Shoreibah EA, Ibrahim SA, Attia MS, et al.Clinical and radiographic evaluation of bone grafting in corticotomy-facilitated orthodontics in adults[J]. J Int Acad Periodontol, 2012, 14(4): 105-113.
[30] 庄丽, 屈克勤, 周玉玲, 等. 大鼠颌骨骨皮质切开术后骨小梁三维结构的改变[J]. 中华口腔正畸学杂志, 2016, 2(1): 77-81.
[31] 刘永静, 廖建兴, 刘昌胜, 等. 3种骨替代材料修复犬下颌种植体周围骨缺损的实验研究[J]. 口腔颌面外科杂志, 2009, 19(4): 248-252.
[32] 罗有福, 高金鉴, 高浩然, 等. 负载重组人骨形态发生蛋白2的α型半水硫酸钙/纳米羟基磷灰石复合植骨材料的成骨性能研究[J]. 中国脊柱脊髓杂志, 2016, 26(4): 348-353.