Keller E E, Tolman D, Eckert S
Mayo Medical School, Rochester, Minnesota, USA.
Int J Oral Maxillofac Implants. 1998 Nov-Dec;13(6):767-80.
Surgical, medical, and prosthodontic records of 61 consecutively treated patients with mandibular discontinuity were reviewed retrospectively. All 61 patients had undergone discontinuity reconstruction with autogenous bone grafts; 31 of 61 had also received endosseous dental implants and a dental osseoprosthesis. Of these 31 implant-reconstructed patients, 23 had free autogenous nonvascularized and 8 had vascularized bone grafts. The surgical-prosthetic protocol consisted primarily of secondary, free autogenous nonvascularized bone graft reconstruction and secondary root-form endosseous implant and fixed prosthesis dental reconstruction. Vascularized bone (8 patients) or soft tissue (4 patients) grafts were utilized selectively for severely compromised patients after extensive oncologic resection, avulsive trauma, or after previous radiation treatment. Endosseous implant survival (95.5% in 31 patients), autogenous bone graft success (98.4% in 61 patients), and dental osseoprosthesis success (100% in 31 patients) were favorable. A high incidence (9.1%) of nonfunctioning (sleeping) implants was recorded for this patient population. The need to remove the titanium mesh tray for various reasons (17.6%) and the need to reconstruct soft tissue in the irradiated patient (12%) were noteworthy.
对61例连续接受治疗的下颌骨连续性中断患者的外科手术、医学及口腔修复记录进行了回顾性研究。所有61例患者均接受了自体骨移植的连续性重建；61例中有31例还接受了骨内牙种植体及牙骨修复体。在这31例接受种植体重建的患者中，23例采用了游离自体非血管化骨移植，8例采用了血管化骨移植。手术修复方案主要包括二期游离自体非血管化骨移植重建以及二期根形骨内种植体和固定义齿修复。对于广泛肿瘤切除、撕脱伤或既往接受过放疗后严重受损的患者，选择性地采用了血管化骨移植（8例）或软组织移植（4例）。骨内种植体存留率（31例患者中为95.5%）、自体骨移植成功率（61例患者中为98.4%）以及牙骨修复体成功率（31例患者中为100%）均良好。该患者群体中无功能（休眠）种植体的发生率较高（9.1%）。因各种原因需要取出钛网托盘的情况（17.6%）以及在接受放疗的患者中重建软组织的需求（12%）值得关注。
