Sato Yuki, Grayson Barry H, Garfinkle Judah S, Barillas Ingrid, Maki Koutaro, Cutting Court B
Tokyo, Japan; and New York, N.Y. From the Division of Orthodontics, Showa University Dental Hospital, and the Institute of Reconstructive Plastic Surgery, New York University Medical Center.
Plast Reconstr Surg. 2008 Apr;121(4):1356-1367. doi: 10.1097/01.prs.0000302461.56820.c9.
Gingivoperiosteoplasty has been shown to eliminate the need for secondary alveolar bone grafting in 60 percent of patients. The purpose of this study was to compare radiographic alveolar anatomy following infant gingivoperiosteoplasty, secondary alveolar bone grafting, and secondary alveolar bone grafting in patients who had prior infant gingivoperiosteoplasty with inadequate bone formation.
Seventy-four consecutive nonsyndromic patients (complete bilateral cleft lip-cleft palate, n = 12; complete unilateral cleft lip-cleft palate, n = 46; complete unilateral cleft lip and alveolus, n = 14) treated at New York University Medical Center were available for evaluation. Eighty-two complete alveolar cleft sites were assigned to three groups: gingivoperiosteoplasty (n = 30), secondary alveolar bone grafting (n = 41), and secondary alveolar bone grafting following gingivoperiosteoplasty (n = 11). All gingivoperiosteoplasties were performed at the time of primary lip surgery, and secondary alveolar bone grafting (cancellous iliac crest at 7 to 12.5 years of age) was performed before eruption of the permanent canine. Radiographs were measured according to the modified method of Long.
Seventy-three percent of gingivoperiosteoplasty cases did not require secondary alveolar bone grafting and none had fistulas. The rate of missing teeth in the total sample, adjacent to the cleft, was within normal limits for the population. Group 1 alone and groups 1 and 3 combined had superior alveolar anatomy compared with group 2 (p < 0.01). No significant differences existed between groups 1 and 3 (p > 0.05). Crest height was best in group 1 (p < 0.01), followed by group 3 and then group 2, with no difference between the latter two groups.
Gingivoperiosteoplasty alone or combined with secondary alveolar bone grafting results in superior bone levels when compared with conventional secondary alveolar bone grafting alone.
牙龈骨膜成形术已被证明可使60%的患者无需进行二期牙槽骨移植。本研究的目的是比较婴儿牙龈骨膜成形术、二期牙槽骨移植以及先前婴儿牙龈骨膜成形术但骨形成不足的患者接受二期牙槽骨移植后的影像学牙槽解剖结构。
纽约大学医学中心连续治疗的74例非综合征患者（双侧完全性唇腭裂，n = 12；单侧完全性唇腭裂，n = 46；单侧完全性唇裂合并牙槽突裂，n = 14）可供评估。82个完整的牙槽裂部位被分为三组：牙龈骨膜成形术组（n = 30）、二期牙槽骨移植组（n = 41）以及牙龈骨膜成形术后二期牙槽骨移植组（n = 11）。所有牙龈骨膜成形术均在一期唇裂修复术时进行，二期牙槽骨移植（7至12.5岁时取髂骨松质骨）在恒牙尖牙萌出前进行。根据Long的改良方法对X线片进行测量。
73%的牙龈骨膜成形术病例无需进行二期牙槽骨移植，且无一例出现瘘管。整个样本中，与裂隙相邻区域的牙齿缺失率在人群正常范围内。与第2组相比，单独的第1组以及第1组和第3组联合的牙槽解剖结构更优（p < 0.01）。第1组和第3组之间无显著差异（p > 0.05）。嵴高度在第1组最佳（p < 0.01），其次是第3组，然后是第2组，后两组之间无差异。
与单纯传统二期牙槽骨移植相比，单独的牙龈骨膜成形术或与二期牙槽骨移植联合使用可产生更优的骨水平。
