Bone reconstruction of the maxillary alveolus for subsequent insertion of a dental implant in patients with cleft lip and palate
Bone reconstruction of the maxillary alveolus for subsequent insertion of a dental implant in patients with cleft lip and palate
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DOI：
10.1097/scs.0b013e31803052eb
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发表时间：
2007-05-01
影响因子：
0.9
通讯作者：
Horak, Jiri
中科院分区：
文献类型：
--
作者：
Duskova, Marketa;Kotova, Magdalena;Horak, Jiri
上颌骨牙槽裂缺损植骨后植入牙种植体可能是传统修复治疗的一个很好的替代方案。其原理是形成具有足够三维体积的稳定牙槽嵴。目前存在的问题是黏骨膜的缺乏和质量的重建壳和骨间隙的特点，骨移植的摄入。2001年8月29日至2006年6月30日期间，由一名外科医生（MD）对45例患者进行了手术，成功率为86.7%。成功定义为完成牙种植体插入过程，并通过修复体上部结构加载，从最后一步开始至少15个月没有失败。成功率主要取决于1）上颌骨段在水平和垂直平面上良好的牙槽弓流动; 2）骨柱高度至少为112 mm，组合段的贴附增强不起作用; 3）足够的松质骨移植物体积，平均3.7 cm。根据组织学验证和临床发现，骨移植物足够成熟，以确保重建后12.5周内固定装置的初期稳定性。早期负荷可防止骨吸收。并发症的预测如下：1）根据间隙大小和血运重建的可能性较低，移植物吸收增加; 2）更多的并发症与口鼻瘘和软组织瘢痕形成有关; 3）由于骨骼更纤细和女性代谢，女性的风险更高。
Bone grafting of maxillary alveolus cleft defect followed by insertion of dental implant may be a good alternative to conventional prosthetic treatment. The principle is the formation of stable alveolar crest with a sufficient three-dimensional volume. The problems are lack and quality of mucoperiosteum for the reconstruction of shell and bone gap characteristics for bone graft intake. The procedure was carried out by a single surgeon (MD) in 45 patients between 29 August 2001 and 30 June 2006, with an 86.7% success rate. The success was defined as completed process with dental implant insertion and its loading by a prosthetic suprastructure without a failure for at least 15 months from that last step. The success rate mainly depends on 1) good alveolar arch flow of maxilla segments in both horizontal and vertical planes; 2) the height of osseous poles of at least 112 mm and onlay augmentation of built-up section does not work; 3) adequate volume of cancellous bone graft, 3.7 cm on average. On the basis of histologic verification and clinical findings, the bone graft is matured enough to ensure a primary stability of a fixture in 12.5 weeks after reconstruction. Early load may prevent bone resorption. Prediction of complications are as follows: 1) graft resorption increases according to gap size and low possibility of revascularization; 2) a higher number of complications are linked to presence of oronasal fistula and to scarring of soft tissues; 3) because of more gracile skeleton and female metabolism, the risk is higher in women.