Dolanmaz Dogan, Karaman Ali Ihya, Durmus Ercan, Malkoc Siddik
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Selcuk, Konya, Turkey.
Angle Orthod. 2003 Dec;73(6):723-9. doi: 10.1043/0003-3219(2003)073<0723:MOACUD>2.0.CO;2.
This article evaluates the usage of distraction osteogenesis (DO) in the treatment of cleft alveoli. The procedure was carried out on eight alveolar clefts of five patients between the ages of 17 and 25 years. Three patients had bilateral alveolar clefts (BAC) and two patients had unilateral alveolar clefts (UAC). DO was carried out bilateral to the palatal segments for the BAC patients and unilateral to the lesser segment for the UAC patients. A custom-made tooth-borne distractor was used. The average amount of distraction was eight mm (range, 5-11.5 mm). The average amount of distal movement of the anchorage teeth was 0.8 mm (range, 0-2 mm). The average amount of inclination changes of the transport segments and anchorage teeth was 7.6 degrees (range, 2-17.5 degrees) and 3.3 degrees (range, 0-9 degrees), respectively. Two important problems were observed attributable to the method. First, the transport segment was docked in a more superior position at the end of distraction process. This undesirable movement also changed the inclination of the teeth in the transport segment and increased tooth tipping. Removing the device in the second week of the consolidation period and retracting the segment to its ideal position orthodontically solved these problems. Second, the bony defect on the nasal side of the alveolar cleft could not be completely closed. This method for repairing small or large alveolar clefts is a simple, cost-effective, and useful treatment option. However, repairing the alveolar cleft without grafts seems to be impossible when using a tooth-borne device.
本文评估了牵张成骨术（DO）在牙槽嵴裂治疗中的应用。该手术在5例年龄在17至25岁之间患者的8个牙槽嵴裂上进行。3例患者为双侧牙槽嵴裂（BAC），2例患者为单侧牙槽嵴裂（UAC）。对于BAC患者，在腭部节段双侧进行DO；对于UAC患者，在较小节段单侧进行DO。使用了定制的牙支持式牵张器。平均牵张量为8毫米（范围为5 - 11.5毫米）。支抗牙的平均远中移动量为0.8毫米（范围为0 - 2毫米）。运输节段和支抗牙的平均倾斜度变化分别为7.6度（范围为2 - 17.5度）和3.3度（范围为0 - 9度）。观察到该方法存在两个重要问题。首先，在牵张过程结束时，运输节段对接在更高的位置。这种不良移动还改变了运输节段中牙齿的倾斜度并增加了牙齿倾斜。在巩固期的第二周移除装置并通过正畸将节段缩回至理想位置解决了这些问题。其次，牙槽嵴裂鼻侧的骨缺损无法完全闭合。这种修复大小牙槽嵴裂的方法是一种简单、经济有效且有用的治疗选择。然而，使用牙支持式装置时，不进行植骨似乎不可能修复牙槽嵴裂。
