羟基磷灰石/胶原重建下颌牙槽嵴的临床和X线评价

Clinical and Radiographic Evaluation of Mandibular Ridges Augmented with Hydroxylaptite/Purified Fibrillar Collagen

本文报告了89例严重下颌骨萎缩病例用羟基磷灰石/胶原重建下颌牙槽嵴的临床和x线评价效果。A组27例,三块HA/PFC预成块即1块弯曲形的重建前牙区,2块直的重建磨牙区;B组62例,1块弯曲形的重建前牙区,HA颗粒重建磨牙区。重建术后再行降低口底、前庭沟加深和植皮术。临床和x线评价结果说明,两种重建方法都可为严重下颌骨萎缩患者提供理想的牙槽嵴形态,获得最佳的义齿固位。HA/PFC复合预成块的主要缺点是伤口的延期愈合和材料通过延期愈合的伤口逸出。

89 cases of severe mandibular atrophy(mean pre-op heighe=10.4mm) were augmented; Group A: 27 cases with three HA/PFC blocks, Group B: 62 cases, 1 curved HA/PFC block anteriorly and dense HA particles posteriorly. All patients underwent insertion of the material,ridge extension by total lowering of the mouth with vestibuloplasty and skin grafts. The overall increase of ridge height immediately after augmentation is 92％ and 79％ in Group A and B. The decrease of ridge heights at one year follow-up period was 16％ and 15％. The best ridge form, comma-shaped was obtained in 73％ of the cases; the second one, inverted U-shaped in 25％; inverted V-shaped only in 2％. 94％ of patients are satisfied wearing dentures without pain, 98％ pleased with excellent retention and stability of dentures, 97％ with good looking of dentures. All patients obtained great improvement of mastication. In contrast to their complains before treatment, their gastrointestinal and TMJ complains are reduced or totally cleared. The most frequent complications for both groups either at insertion or after skin grafting was wound dehiscence (27％) or ulceration (28％). In conclusion, both surgical procedures are very helpful in providing the best ridge forms for maximum denture retention in cases of severe mandibular atrophy. The major drawback of the composite HA/PFC is a propensity for occasional delayed healing and release of material.