Ma Zhigui, Zheng Jisi, Yang Chi, Xie Qianyang, Liu Xiaohan, Abdelrehem Ahmed
Department of Oral Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, PR China Department of Craniomaxillofacial and Plastic Surgery, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
Medicine (Baltimore). 2018 Sep;97(37):e12047. doi: 10.1097/MD.0000000000012047.
The aim of this study was to introduce an improved surgical technique using a pouch design and tension-free wound closure for periodontally accelerated osteogenic orthodontics (PAOO) in the anterior alveolar region of the mandible.Patients with bone dehiscence and fenestrations on the buccal surfaces of the anterior mandible region underwent the modified PAOO technique (using a pouch design and tension-free closure). Postoperative symptoms were evaluated at 1 and 2 weeks intervals following the procedure. Probing depth (PD), gingival recession depth (GRD), and clinical attachment level (CAL) were assessed at the gingival recession sites at baseline, postoperative 6 and 12 months. Cone-beam computerized tomography (CBCT) was used for quantitative radiographic analyses at baseline, 1 week and 12 months after bone-augmentation procedure.The sample was composed of a total of 12 patients (2 males and 10 females; mean age, 21.9 years) with 72 teeth showing dehiscence/fenestrations and 17 sites presenting with gingival recessions. Clinical evaluations revealed a statistically significant reduction in swelling, pain, and clinical appearance from postoperative week 1 to week 2 (P < .05). Moreover, gingival recession sites exhibited a significant reduction in the GRD and an increase in CAL after surgery with mean root coverage of 69.8% at the end of observation period (P < .01). Both alveolar bone height and width increased after surgery (P < .01) and decreased during the 12-month follow-up (P < .01). However, compared with the baseline records, there was still a significant increase in alveolar bone volume (P < .01).This modified PAOO technique may have advantages in terms of soft and hard tissue augmentation, facilitating extensive bone augmentation and allowing the simultaneous correction of vertical and horizontal defects in the labial aspect of the mandibular anterior area.
本研究的目的是介绍一种改良的手术技术，该技术采用袋状设计和无张力伤口闭合，用于下颌前牙区的牙周加速成骨正畸术（PAOO）。下颌前牙区颊侧骨缺损和开窗的患者接受改良的PAOO技术（采用袋状设计和无张力闭合）。术后每隔1周和2周评估术后症状。在基线、术后6个月和12个月时，在牙龈退缩部位评估探诊深度（PD）、牙龈退缩深度（GRD）和临床附着水平（CAL）。锥形束计算机断层扫描（CBCT）用于在骨增量手术后基线、1周和12个月时进行定量放射学分析。样本共包括12例患者（2例男性和10例女性；平均年龄21.9岁），72颗牙齿有骨缺损/开窗，17个部位有牙龈退缩。临床评估显示，从术后第1周到第2周，肿胀、疼痛和临床表现有统计学意义的减轻（P<0.05）。此外，牙龈退缩部位术后GRD显著降低，CAL增加，观察期末平均牙根覆盖率为69.8%（P<0.01）。牙槽骨高度和宽度术后均增加（P<0.01），并在12个月随访期间降低（P<0.01）。然而，与基线记录相比，牙槽骨体积仍有显著增加（P<0.01）。这种改良的PAOO技术在软硬组织增量方面可能具有优势，有助于广泛的骨增量，并允许同时矫正下颌前部唇侧的垂直和水平缺损。
