Rachmiel Adi, Emodi Omri, Aizenbud Dror
Cleft Palate Craniofac J. 2014 Jan;51(1):36-42. doi: 10.1597/11-286. Epub 2012 Aug 20.
Our aim is to demonstrate a method for reconstruction of a wide alveolar cleft before implant placement.
An adult patient with a unilateral cleft palate and a wide alveolar and maxillary bone defect underwent transport distraction osteogenesis to medialize the left segment and reduce the alveolar cleft to a minimum. Removal of the transport distraction device was accompanied by autogenous bone grafting to the remaining alveolar defect in the medial cleft, attaining an osseous closure with adequate soft-tissue coverage. Three months later, vertical alveolar distraction of the newly reconstructed bone was performed. Implants were placed after the removal of the distraction device.
Alveolar bone was transported forward 20 mm followed by 15 mm vertical distraction. The large cleft palate defect was reconstructed in three dimensions by the two-stage distraction osteogenesis, and the soft tissues were expanded to achieve functional correction. After removal of the distraction device, dental implants were osteointegrated in the newly reconstructed bone for fixed dental rehabilitation.
The two-stage distraction allowed gradual closure of a large defect three dimensionally. This method can be safely performed not only in patients undergoing initial treatment for large alveolar clefts but also after failed bone grafting.
我们的目的是展示一种在种植体植入前重建宽牙槽嵴裂的方法。
一名患有单侧腭裂以及宽牙槽嵴和上颌骨缺损的成年患者接受了骨运输牵张成骨术，以使左侧骨段向内侧移位，并将牙槽嵴裂减小到最小程度。在去除骨运输牵张装置的同时，对内侧裂隙处剩余的牙槽嵴缺损进行自体骨移植，实现骨愈合并伴有足够的软组织覆盖。三个月后，对新重建的骨进行垂直牙槽嵴牵张。在去除牵张装置后植入种植体。
牙槽骨向前移位20毫米，随后进行15毫米的垂直牵张。通过两阶段牵张成骨术对大的腭裂缺损进行了三维重建，并且软组织得到扩展以实现功能矫正。在去除牵张装置后，牙种植体在新重建的骨中实现骨整合，用于固定义齿修复。
两阶段牵张能够使大的缺损逐步实现三维闭合。这种方法不仅可以安全地应用于初次治疗大牙槽嵴裂的患者，也可应用于骨移植失败后的患者。
