Marianetti Tito M, Leuzzi Fabrizio, Foresta Enrico, Gasparini Giulio, Cervelli Daniele, Amoroso Pier Fracesco, Pelo Sandro
Department of Maxillofacial Surgery, Catholic University Medical School, Rome, Italy.
J Craniofac Surg. 2013 Jul;24(4):1175-8. doi: 10.1097/SCS.0b013e31829538e8.
The aim of the current study was to appraise the effectiveness of distraction osteogenesis combined with bilateral 2-step osteotomy for the vertical augmentation of atrophic edentulous mandibles. To verify the predictability of this technique, we evaluated bone density and vertical bone gain of a cohort of 27 patients. The intraoral alveolar distractor was placed in the symphyseal area; then, it was left in situ for 2 months after surgery to consolidate the newly formed bone. A total of 189 implants were inserted. The main complications' issue was tied up to the neurosensory disturbances of the inferior alveolar nerve, which disappeared few months after the surgery.At the end of the distraction osteogenesis, a mean vertical bone gain of 10.5 mm evaluated by comparing preoperative and postoperative computed tomography was reached. Three months after the surgery, the radiologic data indicated that the difference in the mean bone density, recorded in Hounsfield units (HU), between the distracted bone and the preexisting mandibular bone was not statistically significant (P > 0.05). The last measurements done showed that the osseous density in the distraction chamber was higher than the original medullary bone density: the regenerated bones were more dense (876.8 [205.9] HU) than the preexisting medullary bone (312.1 [142.3] HU) and less dense than the preexisting cortical bone (1721.1 [170.4] HU) at the ninth month.In conclusion, this approach appeared to be a viable solution for the improvement of vertical volume in atrophic mandibles.
本研究的目的是评估牵张成骨联合双侧两步截骨术用于萎缩性无牙下颌骨垂直增高的有效性。为验证该技术的可预测性，我们评估了27例患者的骨密度和垂直骨增量。将口内牙槽牵张器置于下颌骨联合处；然后，术后将其留在原位2个月以巩固新形成的骨。共植入189颗种植体。主要并发症问题与下牙槽神经的神经感觉障碍有关，该障碍在术后数月消失。在牵张成骨结束时，通过比较术前和术后的计算机断层扫描评估，平均垂直骨增量达到10.5mm。术后3个月，放射学数据表明，以亨氏单位（HU）记录的牵张骨与下颌骨原有骨之间的平均骨密度差异无统计学意义（P>0.05）。最后一次测量显示，牵张腔内的骨密度高于原始髓质骨密度：在第9个月时，再生骨（876.8[205.9]HU）比原有髓质骨（312.1[142.3]HU）更致密，但比原有皮质骨（1721.1[170.4]HU）密度更低。总之，这种方法似乎是改善萎缩性下颌骨垂直体积的可行解决方案。
