Graf Thibaut, Grogniet Florian, Contrepois Mathieu, Fricain Jean-Christophe, Catros Sylvain, Fenelon Mathilde
Department of Oral Surgery, Centre Hospitalier Universitaire Bordeaux, F-33076 Bordeaux, France.
Unité de Formation et de Recherche des Sciences Odontologiques, Université de Bordeaux, 33000 Bordeaux, France.
J Oral Implantol. 2025 Feb 1;51(1):36-41. doi: 10.1563/aaid-joi-D-24-00094.
Cemento-osseous dysplasia (COD) is a benign fibro-osseous pathology in which fibrous connective tissues, osteoid and cementum-like materials, replace bone. Concerning the hypovascularization and increased mineralization of bone that occurs in these patients, the clinician may face 2 types of problems: infectious complications, such as osteomyelitis, and increased implant failure. The present study aims to report the successful and innovative management of a COD patient complicated by mandibular osteomyelitis and the implant rehabilitation of this area. We report the management of a 54-year-old patient presenting with florid cemento-osseous dysplasia complicated by mandibular osteomyelitis, which required antibiotic administration and 2 surgeries to resolve. This area was then reconstructed with guided bone regeneration before 3 implants were placed using guided surgery, including 1 implant in a dysplastic area and 1 in the graft site. Osseointegration of the implants allowed rehabilitation with a supraimplant bridge. An optimal functional rehabilitation and complete integration of implants were observed 13 months after the surgery. Eight cases of implant placement in COD patients have been reported before in the literature (n = 35 implants). The success rate of dental implants in nondysplastic areas is comparable to the general population, but it decreases when implants are placed in dysplastic areas. Guided implant surgery is an interesting tool for placing implants outside dysplastic regions.
骨水泥性发育异常（COD）是一种良性纤维-骨病理状态，其中纤维结缔组织、类骨质和牙骨质样物质取代了骨组织。鉴于这些患者会出现骨血管减少和矿化增加的情况，临床医生可能会面临两类问题：感染性并发症，如骨髓炎，以及种植体失败率增加。本研究旨在报告一例合并下颌骨骨髓炎的COD患者的成功创新治疗方法以及该区域的种植体修复情况。我们报告了一名54岁患者的治疗情况，该患者患有严重的骨水泥性发育异常并合并下颌骨骨髓炎，需要使用抗生素并进行两次手术才能解决。然后在引导骨再生技术下对该区域进行重建，之后使用引导手术植入3颗种植体，其中1颗位于发育异常区域，1颗位于移植部位。种植体的骨结合使得可以使用种植体上方桥体进行修复。术后13个月观察到功能恢复良好且种植体完全整合。此前文献中已报道过8例在COD患者中植入种植体的病例（共35颗种植体）。在非发育异常区域，种植牙的成功率与普通人群相当，但在发育异常区域植入种植体时成功率会降低。引导种植手术是在发育异常区域以外植入种植体的一种有效方法。
