Isparta, Turkey; and New York, N.Y.
From the Department of Orthodontics, Suleyman Demirel University; New York University School of Medicine; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center.
Plast Reconstr Surg. 2018 Apr;141(4):971-982. doi: 10.1097/PRS.0000000000004231.
Gingivoperiosteoplasty can avoid secondary alveolar bone grafting in up to 60 percent of patients with a cleft. However, preoperative predictors of success have not been characterized. This study reports on the preoperative alveolar segment position most favorable for successful gingivoperiosteoplasty.
The authors performed a single-institution, retrospective review of patients with a unilateral cleft who underwent nasoalveolar molding. Alveolar segment morphology was directly measured from maxillary dental models created before and after nasoalveolar molding. Statistical analysis was performed to identify parameters associated with the decision to perform gingivoperiosteoplasty and its success, defined as the absence of an eventual need for alveolar bone grafting.
Fifty patients with a unilateral cleft who received nasoalveolar molding therapy were included in this study (40 underwent gingivoperiosteoplasty and 10 did not). Eighteen alveolar morphology and position characteristics were tested, including cleft gap width, horizontal and vertical positions of the alveolar segments, alveolar stepoff, and degree of alveolar segment apposition. Post-nasoalveolar molding vertical rotation of the greater segment and the percentage of segment alignment in the correct anatomical zone were statistically significant predictors of the decision to perform gingivoperiosteoplasty (86 percent predictive power). Cleft gap, greater/lesser segment overlap, alveolar segment alignment, greater segment horizontal rotation, and alveolar segment width following nasoalveolar molding were significant predictors of gingivoperiosteoplasty success (86.5 percent predictive power).
Greater segment vertical rotation and proper alveolar segment anatomical alignment are positive predictors of the decision to perform gingivoperiosteoplasty. Post-nasoalveolar molding evidence of proper alignment and direct contact between the alveolar segments were significant predictors of successful gingivoperiosteoplasty.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.
牙龈骨膜成形术可避免 60%的单侧裂隙患者进行二次牙槽骨移植。然而，术前成功的预测因素尚未明确。本研究报告了最有利于牙龈骨膜成形术成功的术前牙槽段位置。
作者对接受过鼻牙槽塑形术的单侧裂隙患者进行了单机构回顾性研究。在鼻牙槽塑形术前后制作的上颌牙模型上直接测量牙槽段形态。进行统计学分析以确定与进行牙龈骨膜成形术及其成功相关的参数，成功定义为最终无需进行牙槽骨移植。
本研究共纳入 50 例接受过鼻牙槽塑形术治疗的单侧裂隙患者（40 例行牙龈骨膜成形术，10 例未行）。测试了 18 种牙槽形态和位置特征，包括裂隙间隙宽度、牙槽段的水平和垂直位置、牙槽台阶和牙槽段贴合程度。术后垂直旋转的较大段和段在正确解剖区域的百分比是进行牙龈骨膜成形术决策的统计学显著预测因子（86%的预测能力）。裂隙间隙、较大/较小段重叠、牙槽段对齐、较大段水平旋转和鼻牙槽塑形术后牙槽段宽度是牙龈骨膜成形术成功的显著预测因子（86.5%的预测能力）。
较大段的垂直旋转和适当的牙槽段解剖排列是进行牙龈骨膜成形术的积极预测因子。鼻牙槽塑形术后牙槽段适当对齐和直接接触是牙龈骨膜成形术成功的显著预测因子。
临床问题/证据水平：风险，III 级。
Zotero 插件