Department of Morphological and Biomedical Sciences, Section of Dentistry and Maxillofacial Surgery, University of Verona, Verona, Italy.
Clin Oral Implants Res. 2012 Jan;23(1):60-9. doi: 10.1111/j.1600-0501.2011.02181.x. Epub 2011 Apr 19.
Edentulism causes progressive bone resorption of the maxillae, which can lead to altered maxillo-mandibular relationships. The aim of the study was to evaluate the applicability of guided bone regeneration (GBR) to Le Fort I osteotomies with interpositional bone grafts for treatment of patients with severe maxillary atrophy.
Twenty consecutive patients characterized by severely atrophic maxillae were treated from January 2003 to January 2006 in order to resolve maxillary edentulism. All patients underwent pre-prosthetic surgery, including a Le Fort I osteotomy associated with autologous interpositional bone grafts to move the alveolar arch forward and to resolve the maxillary atrophy. Barrier membranes were also used to cover the bone grafts and the osteotomy line, favoring the healing process according to GBR principles. Maxilla advancement and alveolar crest augmentation were measured to assess the degree of reconstruction. A total of 154 implants were inserted in reconstructed maxillae 4 months after surgery and were restored with fixed full-arch dentures after another 4 months. Surgical and prosthetic complications were recorded and previously established implant success criteria were used to assess the success of this treatment protocol.
The outcome of pre-prosthetic surgery and implant-supported rehabilitation was prospectively evaluated every year. All Le Fort I osteotomies were successfully carried out, with a mean maxilla advancement of 4.2 cm (range: 3.1-5 cm), which appeared to be stable during the follow-up. After a mean follow-up of 66.4 ± 18.4 months, only four implants failed according to the success criteria, yielding a cumulative success rate of 95.8%.
Le Fort I osteotomies with the use of barrier membranes to cover the interpositional bone grafts can be a predictable treatment for edentulous patients with severely resorbed maxillae. The study data suggest that this approach makes it possible to compensate for both sagittal and vertical discrepancies due to maxilla atrophy, with a minimum resorption of advanced maxillae and grafted bone. A GBR-based protocol seems to lead to high implant success rates, although further randomized controlled studies are needed to demonstrate the usefulness and advantageousness of GBR.
无牙颌导致上颌骨进行性骨吸收，从而导致上下颌骨关系改变。本研究旨在评估引导骨再生（GBR）在使用自体骨移植进行 Le Fort I 截骨术中的应用，以治疗严重上颌骨萎缩的患者。
2013 年 1 月至 2016 年 1 月，连续 20 例上颌骨严重萎缩的患者接受了治疗，以解决上颌骨无牙颌问题。所有患者均接受了术前手术，包括 Le Fort I 截骨术，同时进行自体骨移植，以向前移动牙槽弓，解决上颌骨萎缩问题。还使用屏障膜覆盖骨移植物和截骨线，根据 GBR 原则促进愈合过程。上颌骨前突和牙槽嵴增宽用于评估重建程度。术后 4 个月，在重建的上颌骨中植入了 154 个种植体，4 个月后，用固定全口义齿修复。记录手术和修复体并发症，并使用先前建立的种植体成功标准评估该治疗方案的成功情况。
每年对术前手术和种植体支持的修复效果进行前瞻性评估。所有 Le Fort I 截骨术均成功完成，平均上颌骨前突 4.2 厘米（范围：3.1-5 厘米），随访期间似乎稳定。平均随访 66.4±18.4 个月后，根据成功标准，仅 4 个种植体失败，累积成功率为 95.8%。
使用屏障膜覆盖自体骨移植的 Le Fort I 截骨术可以成为治疗严重上颌骨萎缩的无牙颌患者的一种有预测性的治疗方法。研究数据表明，这种方法可以补偿由于上颌骨萎缩引起的矢状和垂直差异，最大限度地减少上颌骨和移植骨的吸收。基于 GBR 的方案似乎可以获得较高的种植体成功率，但需要进一步的随机对照研究来证明 GBR 的有用性和优势。
