- 期刊
文獻回顧：牙周輔助加速成骨矯正治療
Literature Review: Periodontal Accelerated Osteogenic Orthodontics
摘要
Periodontal accelerated osteogenic orthodontics簡稱PAOO，牙周輔助加速成骨矯正治療，是結合選擇性齒槽骨皮質骨切術(selective alveolar corticotomy)以及植骨(bone grafting)為輔助的新興矯正治療，其主要的理論概念是來自於局部骨加速現象（regional acceleratory phenomenon，簡稱RAP）。近年，有部份證據顯示其PAOO具有幾個優點：1.可以顯著縮短矯正治療時間；2.可以增加齒槽骨的寬度與體積；3.可以減少矯正期間牙齒牙根的吸收；4.可以增加矯正治療後的穩定度，減少復發的機會。雖然近年有不少的病例報告支持牙周輔助加速成骨矯正治療，但仍需要更多證據來支持這個較具侵入性的治療方法。本篇回顧主要整理了近年關於PAOO的病例報告，臨床研究，以及動物實驗研究，並介紹關於PAOO應用於快速矯正的發展、概念以及方法。總結臨床上使用PAOO，平均治療時間可以縮短到傳統矯正的三分之一到四分之一，也可以減少矯正治療期間引起的牙根吸收。因為有合併使用植骨，所以可以增加矯正治療後齒槽骨頭的體積，使得骨支持增加，由治療前後電腦斷層影像可以支持此一結論。另外根據Dr.Wilcko的病例報告，最早開始使用PAOO的病人，十年後回診結果仍具有很好的穩定性，顯示合併牙周輔助加速成骨矯正治療治療結束之後有較少復發的機會。牙周輔助加速成骨矯正治療(PAOO)目前也有一些缺點，包括額外的手術費用，且翻瓣手術是侵略性的治療，術後可能會有腫痛，甚至有感染的風險，甚至也可能會有發生齒槽骨脊喪失或者牙齦萎縮的問題。此外並不是所有的病例都是適合使用PAOO，臨床上應該要謹慎評估挑選適合的病例，具上下齒列不整或者牙弓較為狹窄但有正常或者差異不大的上下顎間骨關係的病人是較為合適的病例。
並列摘要
Periodontal accelerated osteogenic orthodontics (PAOO) is a clinical procedure that combines selective alveolar corticotomy, particulate bone grafting, and the application of orthodontic forces. This procedure is theoretically based on the bone healing pattern known as the regional acceleratory phenomenon (RAP). Recently, partial evidences supported that PAOO had some advantages: 1. Shorter treatment time; 2. An increment in alveolar bone width; 3. Decreased amount of apical root resorption; 4. Increased post-treatment stability.This article reviewed the recent case reports, clinical studies, and animal studies, and tried to introduce the development, idea, and the method of PAOO for the application of rapid orthodontics. We also tried to discuss the basis of the theory of the PAOO according to the current results of animal studies.Concluded the advantages of the PAOO, the treatment time could be shorten about one-third to one-forth, and it had less risk of root resorption. The PAOO also could increase the volume of bone, and bony support of the teeth because of using of bone grafts in combination. In addition, the stability of the outcome of the PAOO treatment would be better than the conventional treatment. These benefits could be supported by the comparing of images of CT before and after PAOO treatment and some reported animal study models.The disadvantages of PAOO included the more charge and the risk of the surgery. The flap operation may increase the risk of swelling, infection, bony ridge resorption, and gingival recession. The PAOO is not applicable for all patients, so we should carefully evaluate and select the appropriate cases, such as the candidates with the narrow arch, and not obvious abnormally anterior-posterior and transverse discrepancy of the upper and lower jaws.