Giudice Giuseppe, Gozzo Giuseppe, Sportelli Pasquale, Gargiuoli Florinda, Siate Apollonia De
Bari, Italy From the Departments of Plastic and Reconstructive Surgery and Odontostomatology, Faculty of Medicine, University of Bari.
Plast Reconstr Surg. 2007 Jun;119(7):2206-2217. doi: 10.1097/01.prs.0000260709.90237.ae.
The most widely accepted protocol for alveolar cleft reconstruction is repair during the mixed dentition stage (age, 9 to 11 years), before eruption of the canine teeth. Alveolar bone grafting should not be considered as an isolated therapy but always as an integrated part of comprehensive orthodontic treatment.
The authors evaluate the results of transitional secondary osteoplasty, comparing the use of autogenous cancellous bone versus heterogenetic implants, in patients with unilateral complete clefts who did or did not undergo orthodontic treatment. From 1990 to 1994, 48 patients aged between 9 and 11 years with unilateral alveolar cleft underwent alveolar grafting by transitional secondary osteoplasty. In 30 patients (group A), autogenous cancellous bone was used, and in 18 patients (group B), a heterogenetic implant consisting of demineralized bone powder containing bone morphogenetic protein and hydroxylapatite was used.
Twenty-two patients in group A and 12 patients in group B underwent orthodontic treatment. After 10 to 12 years of follow-up, the clinical and radiographic examinations revealed that the best alveolar bone repair results were obtained using autologous bone graft in association with orthodontic treatment. Also, in the patients who underwent heterogenetic implantation, the orthodontic treatment clearly improved the quality of the osteoplasty.
The essential conditions for a successful osteoplasty include meticulous operative technique and orthodontic treatment. The latter plays an essential role at several stages of development in children with clefts. The "functional stress" on the autologous or heterogenetic implant exerts a decisive influence on the quality and volume of the osteoplasty, preventing progressive resorption.
牙槽嵴裂修复最广泛接受的方案是在混合牙列期（9至11岁）、尖牙萌出前进行修复。牙槽骨植骨不应被视为一种孤立的治疗方法，而应始终作为综合正畸治疗的一个组成部分。
作者评估了在接受或未接受正畸治疗的单侧完全性腭裂患者中，采用自体松质骨与异种植入物进行过渡性二期骨成形术（transitional secondary osteoplasty）的结果。1990年至1994年，48例年龄在9至11岁的单侧牙槽嵴裂患者接受了过渡性二期骨成形术牙槽植骨。30例患者（A组）使用自体松质骨，18例患者（B组）使用由含骨形态发生蛋白的脱矿骨粉和羟基磷灰石组成的异种植入物。
A组22例患者和B组12例患者接受了正畸治疗。经过10至12年的随访，临床和影像学检查显示，自体骨移植联合正畸治疗获得了最佳的牙槽骨修复效果。此外，在接受异种植入的患者中，正畸治疗明显改善了骨成形术的质量。
成功进行骨成形术的基本条件包括细致的手术技术和正畸治疗。后者在腭裂患儿发育的几个阶段起着至关重要的作用。自体或异种植入物上的“功能应力”对骨成形术的质量和体积产生决定性影响，防止进行性吸收。
