以牙嵴劈開術合併自體腸骨崤嵌入術重建上顎缺牙區－病例報告

Reconstruction of Maxillary Edentulous Ridge by Using Ridge Splitting Technique and Inlay Block Iliac Graft-A Case Report

楊榮武(Rong-Wu Yang) ； 張敏德(Min-Te Chang) ； 周菀吟(Wan-Yin Chou) ； 官文雄(Wen-Hsiung Guan) ； 邱昶達(Chang-Ta Chiu) ； 蔣維凡(Wei-Fan Chiang)

《臺灣口腔顎面外科學會雜誌》 21卷4期 (2010/12) Pp. 280-295

https://doi.org/10.7104/TJOMS.201012.0280

摘要

齒槽骨在牙齒拔除後會呈現多面向的萎縮，此類骨萎縮對於牙齒贋復是極大的挑戰，特別是在當代植體美學的要求下，更增添手術的困難性。對於這些骨萎縮的重建方式有側向增加水平寬度和垂直向增加高度。側向增加水平寬度包括塊狀骨覆蓋生成術、牙脊劈開術有或無合併骨嵌入術；垂直向增加高度包括引導骨生成術、截骨術併骨嵌入術、以及牽引骨生成術等。以上的術式各有優缺點，加上配合不同的移植骨來源如腸骨嵴、肋骨、鎖骨、頭蓋骨、上顎隆凸、下顎正中聯合區、下顎外斜嵴、異體骨、異種骨和合成物等，就有許多重建的方法可供選擇。其中很重要的是骨重建之後的骨吸收比率，骨吸收的程度端賴移植骨來源的差異、接受區的差異、重建術式的差異等而有不同考量。本文介紹一例上顎前牙區常見的Cawood和Howell Class IV上顎骨萎縮合併骨性埋伏齒病例，經牙嵴劈開術將埋伏齒移除，同時輔以自體腸骨崎嵌入街進行牙崎寬度重建，術後四個月以人工植體輔以引導骨生成術進行高度重建，十個月後進行牙齒贗復物的製作。本文將針對此一病例三階段重建的過程加以介紹與討論。

關鍵字

牙嵴劈開術 ； 自體骨嵌入術 ； 引導骨生成術 ； 骨性阻生齒 ； 牙根植體

並列摘要

Atrophy and resorption of the alveolar processes progress in multiple dimensions after teeth extraction. To reconstruct the severe bone loss region with sufficient bone width for implantation is a challenge, especially in current esthetic implantology. Atrophied ridges can be reconstructed with lateral augmentation and vertical augmentation. Lateral augmentation includes onlay block, ridge-splitting technique with or without interpositional grafting. Vertical augmentation includes guided bone regeneration, segmental osteotomy with inlay bone block grafting and distraction osteogenesis. Different methods have various advantages and disadvantages. There are several reconstructive methods using bone grafts from iliac crest, ribs, clavicle, calvaria, maxillary tuberosity, mandibular symphysis, external oblique ridge, and some other allogenic, xenogenic or alloplastic materials. The most important thing is the bone loss after reconstruction. The resorption rate is dependent on the donor sites, reconstructive methods and recipient sites. This report presents a case with Cawood & Howell Class IV resorption at maxillary anterior region with two impacted teeth. The impacted teeth were removed by means of ridge splitting technique. Simultaneous reconstruction of the ridge width with inlay iliac bone block autograft was performed. Delayed implant placement was done four months later with guided bone regeneration for secondary reconstruction. After ten months, the prostheses were loaded. This report will introduce the reconstructive processes with three stages.

並列關鍵字

ridge splitting technique ； inlay bone block autograft ； guided bone regeneration ； bony impacted teeth ； dental implant