双层皮质骨片夹层植骨技术对上前牙重度骨缺损患者成骨效果的长期临床观察

Clinical study on bilamina cortical grafting technique for reconstruction of severely atrophic alveolar ridges in anterior maxillae

目的评价双层皮质骨片夹层植骨技术对恢复美学区三维骨缺损患者的安全性及长期效果。方法回顾性研究2007年1月至2015年12月就诊于北京大学口腔医学院·口腔医院第四门诊部,并使用双层皮质骨片夹层植骨技术完成上前牙区三维骨重建患者24例,男性13例,女性11例,年龄(37.8±13.4)岁(20~54岁)。将取自患者下颌外斜线的自体骨块片切成2块皮质骨片,分别固定于唇、腭侧恢复缺损骨壁,两骨片间充填自体碎骨,整个植骨区域覆盖异体胶原骨或骨粉和胶原膜。测量骨增量前骨缺损大小及骨增量后的重建尺寸,种植体植入时植骨区域的体积变化,统计骨块成活率、种植体存留率及相应并发症的发生情况。结果共纳入24例患者(35个位点),随访(7.1±1.9)年。自体骨的成活率100%(24/24),种植体存留率100%(35/35)。水平向和垂直向的骨增量分别为(6.47±2.46)和(5.01±1.12) mm,吸收率分别为9.0%和10.9%。其中1例在随访9年时发生植体周黏膜炎,其余种植修复体唇侧龈缘稳定。共12牙位修复后5年后锥形束CT显示,种植体唇侧骨板厚度>1.5 mm。结论应用双层皮质骨片夹层植骨技术重建三维骨缺损安全有效,联合使用异体骨胶原或骨粉和胶原膜可进一步减少骨吸收。

Objective To evaluate the efficacy and long-term outcome of the bilaminar cortical wall building grafting technique for reconstruction of vertical and horizontal alveolar ridge defects in the esthetic zone.Methods The retrospective study was conducted between January,2007 and December,2015.The sample was composed of 24 patients who received bilaminar cortical wall building augmentation in the esthetic zone in Department of Fourth Clinical Division,Peking University School of Stomatology.The 24 patients(11 female and 13 male)had age of(37.8±13.4)years(20-54 years).A bone block harvested from the lateral aspect of the mandibular ramus was bisected into two cortical laminae,which were then used to reconstruct the buccal and palatal walls of an alveolar ridge defect.The inter-laminar space was filled with particulate autogenous bone and the whole graft was covered with anorganic bone graft and collagen membrane.Bone width and vertical measurements were measured at the time of surgery and reentry surgery.Integration of the graft,implant survival rates and complications were recorded.Results Overall,24 patients with 35 sites who were included were followed for(7.1±1.9)years.Graft integration(24/24)and implant survival rates(35/35)were determined as 100%.The average horizontal and vertical bone gain was(6.47±2.46)and(5.01±1.12)mm with resorption rates of 9.0%and 10.9%,respectively.One patient showed soft-tissue dehiscence with peri-implant mucositis were observed 9 years after surgery.More than 1.5 mm of buccal bone plate were observed using cone beam computed tomography.Conclusions This technique was effective and reliable for three-dimensional reconstruction of severely atrophic alveolar ridges in anterior maxillae.Autogenous graft combined with coverage by allogeneic bone graft and collagen membrane provided successful augmentation with low bone resorption.