Metzler Philipp, Obwegeser Joachim Anton, Jacobsen Christine, Zemann Wolfgang
Department of Craniomaxillofacial and Oral Surgery, University of Zurich, Zurich, Switzerland.
J Oral Maxillofac Surg. 2012 Nov;70(11):2549-58. doi: 10.1016/j.joms.2012.07.023.
Anterior alveolar osteodistraction is a common method for enlargement of the dentoalveolar process, and bone-borne distraction devices are hypothesized to avoid the risk of dental tipping and periodontal impairment during distraction. The aim of this study was to objectify this thesis and to determine the reliability of bone-borne osteodistraction of the anterior alveolar process.
The study group consisted of 18 consecutive patients who underwent anterior alveolar segmental distraction with a bone-borne distraction device for the treatment of dental crowding or alveolar retrusion from 2008 through 2011. Clinical and radiologic changes within the apical base and dentoalveolar process were analyzed after bone-borne distraction osteogenesis. All measurements were carried out using cone-beam computed tomography.
Surgery and the postoperative period were uneventful in all patients. Mean alveolar movement was 8.2° ± 2.4°. Skeletal movement was 97.6% and absolute dental tipping was 2.4%. A mean change in the occlusal plane of 1.9° ± 1.1° was verified. The apical base enlargement showed a mean of 7.9 ± 1.4 mm, and the dentoalveolar arch a mean increase of 12.7 ± 2.1 mm. Within the distraction zone, a mean vertical bone loss of 3.5 ± 0.7 mm and a mean horizontal bone loss of 3.9 ± 0.8 mm were seen. After orthodontic gap closure, both were clinically irrelevant, with no need for additional bone grafts. Periodontal impairment (gingival recessions of 1 mm) was observed in 7 patients but affected only the teeth bordering the vertical osteotomy line.
Bone-borne anterior alveolar osteodistraction is sufficient for enlargement of the apical base and the dentoalveolar arch of the mandible. Skeletal movement of the alveolar segment was predictable and dental tipping was clinically irrelevant. This technique presents further indications and approaches in orthognathic surgery.
前牙区牙槽骨牵张成骨术是扩大牙牙槽突的常用方法，骨支持式牵张装置被认为可避免牵张过程中牙齿倾斜和牙周损伤的风险。本研究旨在验证这一论点，并确定前牙区牙槽骨骨支持式牵张成骨术的可靠性。
研究组由2008年至2011年间连续18例接受骨支持式牵张装置进行前牙区节段性牵张以治疗牙列拥挤或牙槽骨后缩的患者组成。在骨支持式牵张成骨术后，分析根尖基底部和牙牙槽突的临床及影像学变化。所有测量均使用锥形束计算机断层扫描进行。
所有患者手术及术后过程均顺利。平均牙槽骨移动为8.2°±2.4°。骨移动占97.6%，绝对牙齿倾斜占2.4%。咬合平面平均变化为1.9°±1.1°。根尖基底部平均增大7.9±1.4mm，牙牙槽弓平均增加12.7±2.1mm。在牵张区域内，平均垂直骨吸收为3.5±0.7mm，平均水平骨吸收为3.9±0.8mm。正畸关闭间隙后，两者在临床上均无显著影响，无需额外植骨。7例患者出现牙周损伤（牙龈退缩1mm），但仅影响垂直截骨线附近的牙齿。
骨支持式前牙区牙槽骨牵张成骨术足以扩大下颌骨的根尖基底部和牙牙槽弓。牙槽骨节段的骨移动是可预测的，牙齿倾斜在临床上无显著影响。该技术为正颌外科提供了更多的适应证和手术方法。
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