Castro-Núñez Jaime
Institución Universitaria Colegios de Colombia, Bogota, Colombia.
Oral and Maxillofacial Surgery Department, University of Kentucky Lexington, KY.
J Craniofac Surg. 2018 Nov;29(8):2088-2095. doi: 10.1097/SCS.0000000000004892.
Recently, the terms sugosteogenesis and distraction sugosteogenesis have been introduced to the scientific literature. While the former describes a biologic phenomenon, the latter refers to the clinical technique which relies on the accelerated normal bone healing process that takes place at the osseous walls surrounding a cystic cavity when active negative pressure is applied. The purpose of this study is to provide the biologic bases and the therapeutic principles of this emerging technique. Employing well-stablished biologic principles, clinical evidence from analogous techniques, emerging experimental data, and circumstantial evidence, this study presents the possible mechanism of action of the evacuator for odontogenic cysts (Evocyst), a closed, vacuum-like drain system intended to treat cystic conditions using negative pressure.
A review of the literature was done. Keywords for the Medline search were: marsupialization, decompression, odontogenic cysts, effects of negative pressure on bone, and negative pressure wound therapy. In addition, relevant publications from the reference list of the retrieved studies were considered. The matches were evaluated for relevance and analyzed accordingly. Clinical reports used to illustrate the concept of distraction sugosteogenesis were performed following the Declaration of Helsinki on medical protocol and ethics.
Currently, the standard of care to manage odontogenic cystic lesions includes marsupialization, enucleation and curettage, decompression, and surgical resection. However, there is a need for an alternative option in which the entity could be treated while promoting bone formation. With large odontogenic cystic conditions treated in a short period of time, distraction sugosteogenesis appears to be a choice.
The application of negative pressure to osseous cells produces a stretching that creates mechanical cues that trigger signaling pathways, promotes fluid flow, and enhances angiogenesis. All of them, combined, may explain sugosteogenesis. The clinical application of such parameters may explain the good clinical results obtained with the Evocyst.
最近，“囊内成骨”和“牵张囊内成骨”这两个术语已被引入科学文献。前者描述一种生物学现象，后者指的是一种临床技术，该技术依赖于当施加主动负压时，在囊性腔隙周围骨壁发生的加速正常骨愈合过程。本研究的目的是提供这种新兴技术的生物学基础和治疗原则。本研究运用成熟的生物学原理、类似技术的临床证据、新出现的实验数据以及间接证据，阐述了用于治疗牙源性囊肿的抽吸引流器（Evocyst）——一种旨在利用负压治疗囊性病症的封闭式、类似真空的引流系统——可能的作用机制。
进行了文献综述。Medline检索的关键词为：袋形缝合术、减压、牙源性囊肿、负压对骨的影响以及负压伤口治疗。此外，还考虑了检索到的研究的参考文献列表中的相关出版物。对匹配结果进行相关性评估并相应分析。用于说明牵张囊内成骨概念的临床报告是按照关于医学方案和伦理的《赫尔辛基宣言》进行的。
目前，治疗牙源性囊性病变的标准护理方法包括袋形缝合术、摘除术和刮除术、减压以及手术切除。然而，需要一种替代方案，在治疗病变实体的同时促进骨形成。对于在短时间内治疗的大型牙源性囊性病症，牵张囊内成骨似乎是一种选择。
对骨细胞施加负压会产生拉伸，从而产生机械信号，触发信号通路、促进液体流动并增强血管生成。所有这些因素共同作用，可能解释了囊内成骨现象。这些参数的临床应用可能解释了使用Evocyst获得的良好临床效果。
