一种牙周加速成骨正畸的改良术式和改良悬吊缝合法的设计、应用及初步评价

doi:10.13701/j.cnki.kqyxyj.2019.09.006

口腔医学研究 ›› 2019, Vol. 35 ›› Issue (9): 841-845.DOI: 10.13701/j.cnki.kqyxyj.2019.09.006

一种牙周加速成骨正畸的改良术式和改良悬吊缝合法的设计、应用及初步评价

杨栋^1,2, 华先明^2,3, 李寒月^2,3, 董维理^1,2, 张晨^2,3, 曹正国^1,2*

1. 武汉大学口腔医院牙周科湖北武汉 430079;
2. 口腔基础医学省部共建国家重点实验室培育基地和口腔生物医学教育部重点实验室,武汉大学口腔医学院湖北武汉 430079;
3. 武汉大学口腔医院正畸科湖北武汉 430079

收稿日期:2018-12-13 出版日期:2019-09-28 发布日期:2019-09-25
通讯作者: 曹正国,E-mail:czg94@163.com
作者简介:杨栋 (1986~ ),男,博士,讲师、副主任医师,主要从事口腔牙周病学临床与科研工作。
基金资助:
国家自然科学基金(编号:81503624、81570946);中央高校基本科研业务费专项资金(编号:2042014kf0179);武汉大学口腔医院新技术新业务项目,武汉大学教学研究项目(编号:2015034)

A Modified Surgical Technique with Novel Suspensory Suture for Periodontal Accelerated Osteogenic Orthodontics: Design, Application, and Preliminary Evaluation

YANG Dong^1,2, HUA Xianming^2,3, LI Hanyue^2,3, DONG Weili^1,2, ZHANG Chen^2,3, CAO Zhengguo^1,2*

1. Department of Periodontology, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China;
2. The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-Most & Key Laboratory of Oral Biomedicine Ministry of Education, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China;
3. Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan 430079, China.

Received:2018-12-13 Online:2019-09-28 Published:2019-09-25

摘要/Abstract

摘要： 目的:对牙周加速成骨正畸(periodontal accelerated osteogenic orthodontics,PAOO)术式及悬吊缝合方法分别进行改良,并对其手术效果进行初步评价。方法:针对传统PAOO术式及缝合方法,分别进行改良。对6例前牙牙槽骨颊侧局部缺损的患者采用新的术式和缝合方法进行治疗。自下前牙龈缘顶之下3 mm或4 mm处向下分离2 mm的半厚瓣,在此半厚瓣之下切开骨膜达骨面并向下分离全厚瓣。全厚瓣达根尖之下2~3 mm处。在术区植骨粉,复位龈瓣,将缝合针线穿过龈瓣、半厚瓣,自牙龈乳头底部从舌侧龈沟穿出,越过舌侧牙体至另一侧,使用同样的方法,再次返回最初缝线处,打结,形成改良悬吊缝合法。患者于术前、术后3个月拍摄锥形束断层扫描片(cone-beam computed tomography,CBCT)评价下前牙根面牙槽骨的骨增量,采用Graphpad软件包对所获得的数据进行配对t检验。结果:CBCT显示根中1/3颊侧牙槽骨厚度由(0.98±0.33) mm增加至(3.64±0.89) mm,根尖1/3由(1.28±0.57) mm增加至(3.97±1.04) mm,根中和根尖颊侧的骨厚度明显增加。结论:采用PAOO改良术式及改良悬吊缝合法,能够有效保持骨植入物形态,有效增加了根中1/3和根尖1/3处颊侧牙槽骨厚度。该改良术及改良悬吊缝合法克服了传统PAOO术式的一些缺点,临床效果较好,远期疗效有待进一步观察。

关键词: 牙周加速成骨正畸, 骨开窗, 骨开裂, 改良悬吊缝合, 骨增量

Abstract: Objective: To improve periodontal accelerated osteogenic orthodontics (PAOO) technique and suspensory suture method, and to preliminarily evaluate the effects of them. Methods: The PAOO technique and suspensory suture method were modified respectively. Six patients were treated with new operative and suture methods. 2 mm partial thickness flap was dissected from 3 or 4 mm below gingival margin. Full-thickness flap was preformed downwards. In the operation area, bone dust and gingival flap were restored. The needle and thread were passed through flap, and then were passed from the bottom of gingival papilla to the lingual gingival sulcus. The needle was placed around the lingual surface of the tooth, and was passed from the bottom of gingival papilla on the other side of the tooth, and then passed through the flap. The procedure was repeated and the suture was brought back to the starting point. Cone-beam computed tomography (CBCT) were used to evaluate the alveolar bone before and 3 months after surgery. Graphpad was used to carry out statistic analyze. Results: CBCT showed the thickness of buccal alveolar in root-middle 1/3 of the anterior tooth root increased from (0.98±0.33) mm to (3.64±0.89) mm, and the thickness of root-apical 1/3 increased from (1.28±0.57) mm to (3.97±1.04) mm. The bone thickness of root-middle and -apical significantly increased. Conclusion: The novel PAOO method with modified suspensory suture can effectively increase the bone thickness of buccal alveolar. The modified methods showed effective clinical results. However, long term follow-up is still needed in further study.

Key words: periodontally accelerated osteogenic orthodontics, alveolar fenestration, alveolar dehiscence, modified suspensory suture, bone increment

杨栋, 华先明, 李寒月, 董维理, 张晨, 曹正国. 一种牙周加速成骨正畸的改良术式和改良悬吊缝合法的设计、应用及初步评价[J]. 口腔医学研究, 2019, 35(9): 841-845.

YANG Dong, HUA Xianming, LI Hanyue, DONG Weili, ZHANG Chen, CAO Zhengguo. A Modified Surgical Technique with Novel Suspensory Suture for Periodontal Accelerated Osteogenic Orthodontics: Design, Application, and Preliminary Evaluation[J]. Journal of Oral Science Research, 2019, 35(9): 841-845.

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一种牙周加速成骨正畸的改良术式和改良悬吊缝合法的设计、应用及初步评价

A Modified Surgical Technique with Novel Suspensory Suture for Periodontal Accelerated Osteogenic Orthodontics: Design, Application, and Preliminary Evaluation

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