Bare-Welchel Britney, Campbell Phillip M, Gonzalez Marianela, Buschang Peter H
Private Practice, Charlotte, NC.
Baylor College of Dentistry, Texas A&M Health Science Center, Dallas, Tex.
Am J Orthod Dentofacial Orthop. 2017 Jun;151(6):1034-1047. doi: 10.1016/j.ajodo.2016.10.033.
A randomized split-mouth experiment was performed in dogs to determine the effects of bone grafting, together with corticotomies and buccal tooth movements, on dehiscence formation.
Bilateral full-thickness mucoperiosteal buccal flaps were raised, and corticotomies were performed with a piezosurgery unit adjacent to the maxillary second premolars in 7 dogs. The experimental (graft+) side received a demineralized freeze-dried allograph and a resorbable collagen membrane. The second premolars were expanded with archwires for 9 weeks, followed by 3 weeks of consolidation. Soft tissue measurements included probing depths, attachment loss, and recession. Tooth movements were monitored using intraoral, radiographic, and model measurements. Bone surrounding the second premolars was evaluated with microcomputed tomography. New bone formation was analyzed histologically using calcein and alizarin fluorescent labels, and hematoxylin and eosin stains.
Postsurgical healing progressed normally with no signs of infection. The graft+ and control (graft-) second premolars underwent similar amounts of expansion (about 2.5 mm intraorally; about 1.7 mm radiographically) and tipping, with no statistically significant side differences. The soft tissue periodontium was not affected on either side. There were bony dehiscences on both the graft+ and graft- sides, with slightly but significantly (P = 0.038) more bone loss over the mesial root on the graft- side. Bone material density was significantly (P = 0.028) greater on the graft+ side. Buccal bone apposition was evident surrounding graft particles, and mineralized particulate graft material was present at the apical aspect of the roots on the graft+ side.
Bone grafting does not prevent dehiscence formation because only a limited amount of new bone is formed, primarily at the more apical aspects of the tooth's roots.
在犬类中进行了一项随机双盲实验,以确定骨移植联合皮质切开术和颊向牙齿移动对骨缺损形成的影响。
在7只犬中掀起双侧全厚黏膜骨膜颊侧瓣,使用压电手术装置在上颌第二前磨牙附近进行皮质切开术。实验侧(移植+侧)接受脱矿冻干异体骨和可吸收胶原膜。使用弓丝将第二前磨牙扩弓9周,随后进行3周的巩固期。软组织测量包括探诊深度、附着丧失和牙龈退缩。使用口内、影像学和模型测量来监测牙齿移动。使用微型计算机断层扫描评估第二前磨牙周围的骨组织。使用钙黄绿素和茜素荧光标记以及苏木精和伊红染色进行组织学分析新骨形成情况。
术后愈合正常,无感染迹象。移植+侧和对照(移植-)侧的第二前磨牙扩弓量(口内约2.5mm;影像学约1.7mm)和倾斜度相似,两侧无统计学显著差异。两侧的软组织牙周组织均未受影响。移植+侧和移植-侧均有骨缺损,移植-侧近中根处的骨丧失略多但有显著差异(P = 0.038)。移植+侧的骨材料密度显著更高(P = 0.028)。移植颗粒周围可见颊侧骨附着,移植+侧牙根根尖处存在矿化的颗粒状移植材料。
骨移植不能防止骨缺损形成,因为仅形成了有限量的新骨,主要在牙根的更根尖部位。