Schliephake H, Schmelzeisen R, Husstedt H, Schmidt-Wondera L U
Department of Oral and Maxillofacial Surgery, Medizinische Hochschule Hannover, Germany.
J Oral Maxillofac Surg. 1999 Aug;57(8):944-50; discussion 950-1. doi: 10.1016/s0278-2391(99)90015-0.
This study evaluates contour restoration in segmental defects of the mandible and the survival rate of endosseous implants placed into these reconstructions.
Forty-four patients with 23 nonvascularized grafts and 21 patients with vascularized bone flaps were included in the study. The lateral and the sagittal extension of the contour of both the mandibular bone and the overlying soft tissues was determined from serial computed tomography (CT) scans in defined planes through the reconstructed mandible. The success rate of dental implants was determined by a life-table analysis.
Average lateral deviation of the reconstructed side from the nonreconstructed side was 4.3 mm (nonvascularized grafts) and 5.6 mm (vascularized grafts). The soft tissue contour followed the skeletal contour quite closely, with slightly smaller degrees of deviation. Asymmetry was greatest in the area of the horizontal ramus. In some cases, skeletal deviation was intentionally produced to compensate for a soft tissue deficit on the reconstructed side. However, in some cases, a major deviation of bone contour was associated with considerable deviation of the soft tissue contour (maximum, 10.5 mm). The cumulative implant success rate was 100% after 5 years and 60.3% after 10 years. None of the seven implant failures accounted for prosthetic failure.
Although there are minor differences, both nonvascularized and revascularized grafts allow for satisfactory contour restoration in segmental reconstructions of the mandible. Implants placed into these grafts provide a reliable basis for dental rehabilitation.
本研究评估下颌骨节段性缺损的轮廓修复情况以及植入这些重建物中的骨内种植体的存活率。
本研究纳入了44例患者，其中23例采用非血管化移植，21例采用血管化骨瓣。通过对重建下颌骨的特定平面进行系列计算机断层扫描（CT），确定下颌骨及其上方软组织轮廓的横向和矢状延伸。通过寿命表分析确定牙种植体的成功率。
重建侧与未重建侧的平均横向偏差在非血管化移植组为4.3毫米，在血管化移植组为5.6毫米。软组织轮廓与骨骼轮廓相当紧密地跟随，偏差程度略小。水平支区域的不对称最为明显。在某些情况下，故意制造骨骼偏差以补偿重建侧的软组织缺损。然而，在某些情况下，骨轮廓的较大偏差与软组织轮廓的相当大偏差相关（最大为10.5毫米）。种植体的累积成功率在5年后为100%，在10年后为60.3%。7例种植体失败均未导致修复失败。
尽管存在细微差异，但非血管化和血管化移植在颌骨节段性重建中均能实现令人满意的轮廓修复。植入这些移植体中的种植体为牙齿修复提供了可靠的基础。
