Preprosthetic vertical distraction osteogenesis of the mandible using an L-shaped osteotomy and titanium membranes for guided bone regeneration
Preprosthetic vertical distraction osteogenesis of the mandible using an L-shaped osteotomy and titanium membranes for guided bone regeneration
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DOI：
10.1053/joms.2001.27520
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发表时间：
2001-11-01
影响因子：
1.9
通讯作者：
Ewers, R
中科院分区：
文献类型：
--
作者：
Klug, CN;Millesi-Schobel, GA;Ewers, R
目的：垂直骨牵引是下颌骨牙槽嵴增高的一种新的替代方法。本文的目的是描述一种使用 L 形截骨术和钛膜在牵引间隙中进行引导骨再生 (GBR) 的技术。 患者和方法：10 名下颌无牙磨牙区域严重萎缩的患者使用口内微板牵引器在 13 个部位进行了垂直愈伤组织牵引。进行L形截骨，其中垂直部分较短，水平部分较长，终止于磨牙后区域，截骨段通过微板将其远端边缘固定在下颌升支上，该部分成为牵引开始时的旋转中心。通过这种方式，可以在近中产生比远中磨牙区域更多的愈伤组织。在第一例病例中，沿下颌骨轴线轴向重建的后续计算机断层扫描 (CT) 扫描显示，在牵引间隙中产生的颊面骨有半月形凹陷。移除牵引器的临床检查显示间隙中有纤维结缔组织。因此，为了防止这种情况发生，在后续病例中应用钛膜覆盖撑开间隙。结果：10例患者（13个部位）接受了垂直骨痂撑开治疗。在 4 个案例中，GBR 是使用钛膜实现的。在所有情况下，牙槽高度的增加足以使牙种植成为可能。 1例患者出现牵引器骨折，2例出现裂开。这些并发症并没有改变治疗计划，也没有影响结果。 CT扫描显示GBR应用的再生下颌骨表面均匀。结论：L形截骨术和在牵张间隙应用GBR钛膜对于下颌增高、产生生理形状的牙槽嵴具有重要价值。 (C) 2001 年美国口腔颌面外科医师协会。
Purpose: Vertical osteo distraction is a new alternative method for alveolar ridge augmentation of the mandible. The purpose of this article is describe a technique using an L-shaped osteotomy and titanium membranes for guided bone regeneration (GBR) in the distraction gap.Patients and Methods: Ten patients with severe atrophy of the edentulous molar region of the mandible underwent vertical callus distraction in 13 sites using intraoral microplate distractors. An L-shaped osteotomy with a short vertical part mesially and a longer horizontal part ending in the retromolar region was made, and the osteotomized segment was fixed to the mandibular ramus at its distal edge by a microplate, which became the center of rotation when distraction began. In this way, more callus generation could be achieved mesially than in the distal molar region. Follow-up computed tomography (CT) scans reconstructed axially to the axis of the mandible revealed semilunar excavations of the generated bone buccally in the distraction gap in the first cases. Clinical inspection on removal of the distractors showed fibrous connective tissue in the gap. Therefore, to prevent this from happening, titanium membranes covering the distraction gap were applied in subsequent cases.Results: Ten patients (13 sites) were treated by vertical callus distraction. In 4 cases, GBR was achieved using titanium membranes. In all cases, the increase in alveolar height was sufficient to make dental implantation possible. In 1 patient, a fracture of the distractor occurred, and dehiscence was observed in 2 cases. These complications did not change the plan of therapy nor did they influence the results. The CT scans showed a homogenous surface on the regenerated mandible in the cases of GBR application.Conclusion: Both an L-shaped osteotomy and the application of titanium membranes for GBR in the distraction gap are of great value for mandibular augmentation, producing a physiologically shaped alveolar ridge. (C) 2001 American Association of Oral and Maxillofacial Surgeons.