COMBINED ORTHODONTIC-SURGICAL MANAGEMENT OF RESIDUAL PALATO-ALVEOLAR CLEFT DEFECTS
COMBINED ORTHODONTIC-SURGICAL MANAGEMENT OF RESIDUAL PALATO-ALVEOLAR CLEFT DEFECTS
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DOI：
10.1016/0002-9416(76)90258-x
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发表时间：
1976-01-01
影响因子：
3
通讯作者：
SANDS, NR
中科院分区：
文献类型：
--
作者：
BOYNE, PJ;SANDS, NR
这些病例是从一系列以上述方式治疗的15例病例中详细介绍的，并在PMCB移植后2至5年内随访正畸记录。所有病例的远期疗效均为优良。晚期或继发性骨性牙槽突裂和前腭裂的骨重建可以使用基本上不能存活的自体移植物或自体颗粒骨髓和松质骨移植物来完成。主要区别如下：1.在非成活的植牙中，在植牙前的一段时间内，裂隙附近牙齿的正畸移动是进行的。这与自体PMCB移植物的使用是相反的，在自体PMCB移植物中，在骨移植手术后2个月内可以进行积极的正畸治疗。2.在使用不能存活的自体骨时，由于移植后通常不可能进行广泛的牙弓扩张，因此术前矫形治疗以扩大牙弓通常是必要的。对于PMCB移植物，术后可能常规进行牙弓扩张。3.认为只有在前颌区发生大的生长发育后，才允许使用肋骨、来自髂骨的坚固的整体式移植物和其他类型的不成活的移植物。这是因为这样的移植区域没有能力跟上邻近骨段的生长。这将意味着使用这种移植物的二次移植将仅限于15岁以上的患者。这与PMCB技术是相反的，在PMCB技术中，下一次手术可以在从混合牙列年龄到成年年龄的任何时间进行，但最好在7岁之前进行，之后侧切牙已经萌出，并因裂区的剥落而丢失。因此，对于这两种技术，嫁接的理念有明显的不同，总体结果也有明显的差异。此外，对整个颌面腭裂团队的哲学影响也发生了变化，在患者的社会康复方面可以提供的治疗类型和预后方面存在显著差异。虽然治疗腭裂患者的团队在社会和心理问题领域、语音矫正以及软腭和整形唇部修复方面已经在促进康复方面做了很多工作，但从牙科的角度来看，要完全恢复患者的健康，还需要做很多工作。我们认为，如果没有合适的牙槽突骨移植手术，牙科修复的预后是不好的。PMCB手术结合正畸治疗的使用为上颌前裂患者的全面康复开辟了新的途径。
These cases are presented in detail from a series of fifteen cases treated in the described manner, with follow-up orthodontic documentation 2 to 5 years after PMCB grafts. The long-term results in all of the cases were excellent. Late or secondary bony reconstruction of the osseous alveolar and anterior palatal clefts may be accomplished with either an essentially nonviable autogenous graft or an autogenous particulate marrow and cancellous bone graft. The differences essentially are as follows: 1. In the nonviable graft, orthodontic movement of teeth adjacent to the cleft is undertaken at some time prior to the grafting procedure. This is opposed to the use of the autogenous PMCB graft in which active orthodontic treatment may be undertaken within 2 months after the osseous grafting procedure. 2. In the use of nonviable autogenous bone, presurgical orthopedic treatment to expand the arch is usually essential since extensive arch expansion is not usually possible after grafting. With PMCB grafts, postsurgical arch expansion may be routinely undertaken. 3. It is thought that the use of rib, solid one-piece grafts from the ilium, and other types of nonviable graft is warrented only after major growth and development of the premaxillary region has occurred. This is due to lack of ability of such a grafted area to keep pace with the growth of adjacent bone segments. This would mean that secondary grafting with such grafts would be restricted to patients over 15 years of age. This is opposed to the PMCB technique, in which the next procedure may be undertaken at any time from the age of mixed dentition to adulthood but preferably earlier than the age of 7, before the lateral incisor has erupted and been lost through exfoliation into the cleft area. Thus with these two techniques, there is a marked difference in the philosophy of grafting and a marked difference in the overall results. There is, in addition, an altered philosophical effect upon the total maxillofacial cleft palate team, with a marked difference in the type of treatment and prognosis which can be offered in terms of social rehabilitation of the patient. While the team approcah to the treatment of the cleft palate patient has done much to advance rehabilitation in terms of social and psychological problem areas, speech correction, and soft-palate and cosmetic lip restoration, much needs to be done to rehabilitate the patient completely from a dental standpoint. We believe that the prognosis of dental rehabilitation without appropraite bone-grafting procedures of the alvolar and prepalatal cleft is unfavorable. The use of the PMCB procedure in conjunction with orthondotic therapy opens new avenues to the total rehabilitation of the patient with an anterior maxillary cleft.