Dentofacial rehabilitation by osteodistraction, augmentation and implantation despite osteogenesis imperfecta
Dentofacial rehabilitation by osteodistraction, augmentation and implantation despite osteogenesis imperfecta
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DOI：
10.1016/j.ijom.2006.01.014
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发表时间：
2006-06-01
影响因子：
2.4
通讯作者：
Spitzer, W. J.
中科院分区：
文献类型：
--
作者：
Binger, T.;Ruecker, M.;Spitzer, W. J.
成骨不全是一种以骨骼脆性增强为特征的遗传性全身性疾病，通常与III类错牙合和明显的牙病有关。这位患者患有晚期的成骨不全，表现为早期牙齿缺失和严重的上颌骨发育不良。在种植牙之前，牙槽骨的植骨被认为不能保证中性的基牙关系。由于非典型骨折的风险，传统的正颌手术被排除在萎缩的上颌骨中。与传统的Le Fort I截骨术不同，上颌骨可以进行骨牵引，而不需要危险的向下骨折程序。尽管在成骨不完善的患者中缺乏这项技术的报道，但上颌骨牵引矫正了颌骨发育障碍。牙齿缺失的治疗方法是用来自髂骨的自体骨充填牙槽骨，然后植入种植体。种植覆盖义齿在4年内无复发，达到稳定的正常闭合。首次证明，即使在患有成骨不全的患者中，也可以成功地将骨牵引、牙槽骨隆起和牙种植体等先进的外科技术结合起来用于口腔颌面修复。
Osteogenesis imperfecta - a heritable systemic disorder characterized by enhanced bone fragility - is frequently associated with a Class III malocclusion and distinct dental disorders. This patient, suffering from a late form of osteogenesis imperfecta, displayed early loss of teeth and severe maxillary hypoplasia. Bone grafting of the alveolar ridge was assumed not to guarantee a neutral basal relation before dental implantation. Due to the risk of atypical fractures conventional orthognathic surgery was excluded in the atrophic maxilla. In contrast to a conventional Le Fort I osteotomy, osteodistraction of the maxilla can be performed omitting the precarious down-fracture procedure. Despite a lack of reports on this technique in patients with osteogenesis imperfecta, dysgnathia was corrected by osteodistraction of the upper jaw. The loss of teeth was treated by augmentation of the alveolar crest using autogenous bone from the iliac crest followed by placement of dental implants. Stable normocclusion of the implant-supported overdentures was achieved without any detectable relapse over 4 years. For the first time it has been demonstrated that advanced surgical techniques like osteodistraction, alveolar crest augmentation and dental implantation can successfully be combined for dentofacial rehabilitation even in patients suffering from osteogenesis imperfecta.