Horiuchi Katsuhiro, Uchida Hiroya, Yamamoto Kazuhiko, Hatano Naoki
Department of Oral and Maxillofacial Surgery, Nara Medical University, Japan.
Int J Oral Maxillofac Implants. 2002 May-Jun;17(3):416-23.
Most reports on alveolar distraction have been related to vertical distraction in the mandible and the maxilla. There have been few reports on horizontal or oblique alveolar distraction. A case of an atrophic subtotal maxillary alveolus distracted 10 mm anteriorly and 5 mm vertically, followed by the placement of 9 implants, is presented. A healthy, 55-year-old woman presented with a chief complaint of mobility of all maxillary teeth. All remaining 11 teeth except the maxillary left second molar were diagnosed as being involved with advanced marginal periodontitis, and were considered hopeless and subsequently extracted. Three months after extraction, a horizontal osteotomy was performed with a bone saw between the bilateral second premolar regions, extending vertically distal to the second premolars, without involving the maxillary sinuses. After confirming mobility of the alveolar bone, a distraction device was seated with titanium miniscrews and adhesive resin cement over the hard palate. After a 7-day waiting period, the maxillary alveolus was distracted anteroinferiorly 0.25 mm twice a day for 25 consecutive days. The distraction process was completed uneventfully. Postdistraction computed tomography demonstrated that the maxillary alveolus was adequately distracted to place implants in an ideal position. Nine endosseous implants were placed 4 months after seating the distraction device. All implants had good primary stability and were submerged. All implants osseointegrated, although 2 anterior implants were replaced due to disintegration resulting from transmucosal overloading of the interim removable prosthesis. No significant marginal bone resorption was seen around the implants 16 months after implant placement. It was concluded that alveolar distraction can be very useful for augmenting the atrophic alveolus, not only vertically but also horizontally or obliquely.
大多数关于牙槽骨牵张成骨的报道都与下颌骨和上颌骨的垂直牵张有关。关于水平或斜向牙槽骨牵张的报道很少。本文介绍了一例萎缩性上颌骨牙槽骨向前牵张10mm、垂直牵张5mm，随后植入9枚种植体的病例。一名55岁健康女性，主要诉求为上颌所有牙齿松动。除上颌左第二磨牙外，其余11颗牙齿均被诊断为重度边缘性牙周炎，被认为预后无望，随后拔除。拔牙后3个月，用骨锯在双侧第二前磨牙区域之间进行水平截骨，垂直延伸至第二前磨牙远中，不涉及上颌窦。确认牙槽骨有松动后，在硬腭上用钛微螺钉和粘结树脂水门汀安装牵张装置。经过7天的等待期后，上颌牙槽骨每天向前下方牵张0.25mm，连续牵张25天。牵张过程顺利完成。牵张后计算机断层扫描显示，上颌牙槽骨已充分牵张，可将种植体植入理想位置。在安装牵张装置4个月后植入9枚骨内种植体。所有种植体均具有良好的初期稳定性，且为埋植式。所有种植体均实现骨结合，尽管有2枚前部种植体因临时可摘义齿经黏膜过度加载导致崩解而被更换。种植体植入16个月后，种植体周围未见明显的边缘骨吸收。结论是，牙槽骨牵张成骨不仅在垂直方向，而且在水平或斜向方向上对增大萎缩性牙槽骨非常有用。
