一种非手术组织增量方法：正畸牵引在口腔种植的应用

doi:10.3877/cma.j.issn.1674-1366.2020.06.009

通过正畸牵引无法保留的患牙来增加种植位点的牙槽骨量及软组织量的方法在一定条件下可以达到满意的效果，并为成功的种植修复做准备。对于美学区（前牙区）的种植修复而言，患者需求不仅仅局限于恢复咀嚼功能，亦更加注重美学效果。正畸牵引重建这种非手术的方法同时实现软、硬组织的增量，具备创伤小、安全、可靠的优点。尽管该项技术存在应用范围较窄及治疗周期较长等局限性，同时临床实施上尚且缺乏统一标准，但正畸牵引重建种植位点软硬组织是跨学科治疗的有益实践，具有一定的发展前景。

关键词: 牙列, 牙种植, 牙正畸牵引, 牙列缺损, 骨增量, 软组织重建

To increase the amount of alveolar bone and soft tissue at the implant site through orthodontic extrusion to increase the amount of alveolar bone and soft tissue at the implant site, and to prepare for successful implant restoration, especially for the aesthetic area (anterior tooth area) . In terms of implant restoration, the patient′s needs are not only limited to recovering chewing function, but also hoping to obtain better aesthetic results. The orthodontic extrusive remodeling can simultaneously increase the soft and hard tissues, and has the advantages of less trauma, safety and reliability. Although this technology has limitations such as narrow application range and long treatment period, and the lack of uniform standards in clinical implementation. For the reconstruction of the soft and hard tissues of the implant site, orthodontic extrusive remodeling is a beneficial practice for interdisciplinary treatment and has certain development prospect.

Key words: Dentition, Dental implantation, Orthodontic extrusion, Dental arch deficiency remodeling, Bone augmentation, Soft tissue reconstruction

图1 正畸牵引后牙龈及牙槽骨的改变示意图　A：正畸牵引后牙龈及牙槽骨；B：正畸牵引后牙龈及牙槽骨的改变

表1 正畸牵引重建种植位点软硬组织的治疗程序

阶段	分期	施力（N）	牵引速度
第一阶段	缓慢期	1.0 ~ 1.5	1 mm/月
第二阶段	快速期	0.2 ~ 0.5	1 mm/周
第三阶段	稳定期	-	-

表1 正畸牵引重建种植位点软硬组织的治疗程序

阶段	分期	施力（N）	牵引速度
第一阶段	缓慢期	1.0 ~ 1.5	1 mm/月
第二阶段	快速期	0.2 ~ 0.5	1 mm/周
第三阶段	稳定期	-	-

[1]	Tolstunov L. Surgical algorithm for alveolar bone augmentation in implant dentistry[J]. Oral Maxil Surg Clin，2019，31(2):155-161. DOI：10.1016/j.coms.2019.01.001.
[2]	Zucchelli G. Autogenous soft tissue grafting for periodontal and peri-implant plastic surgical reconstruction[J]. J Periodontol，2020，91(1):9-16. DOI：10.1002/JPER.19-0350.
[3]	Salama H, Salama M. The role of orthodontic extrusive remodeling in the enhancement of soft and hard tissue profiles prior to implant placement：a systematic approach to the management of extraction site defects[J]. Int J Periodontics Restorative Dent，1993，13(4):312-333.
[4]	Brown IS. The effect of orthodontic therapy on certain types of periodontal defects. I. Clinical findings[J]. J Periodontol，1973，44(12):742-756. DOI：10.1902/jop.1973.44.12.742.
[5]	Ingber JS. Forced eruption. I. A method of treating isolated one and two wall infrabony osseous defects-rationale and case report[J]. J Periodontol，1974，45(4):199-206. DOI：10.1902/jop.1974.45.4.199.
[6]	Ingber JS. Forced eruption：partⅡ. A method of treating nonrestorable teeth--Periodontal and restorative considerations[J]. J Periodontol，1976，47(4):203-216. DOI：10.1902/jop.1976.47.4.203.
[7]	Brindis MA, Block MS. Orthodontic tooth extrusion to enhance soft tissue implant esthetics[J]. J Oral Maxillofac Surg，2009，67(11):49-59. DOI：10.1016/j.joms.2009.07.013.
[8]	Nappen DL, Kohlan DJ. Orthodontic extrusion of premolar teeth：an improved technique[J]. J Prosthet Dent，1989，61(5):549-554. DOI：10.1016/0022-3913(89)90274-6.
[9]	Greco M, Derton N. Orthodontic extrusion for a preprosthetic approach：a bracketless mini-implant-based mechanics[J]. Orthodontics（Chic.），2012，13(1):210-215.
[10]	Alsahhaf A, Att W. Orthodontic extrusion for pre-implant site enhancement：Principles and clinical guidelines[J]. J Prosthodont Res，2016，60(3):145-155. DOI：10.1016/j.jpor.2016.02.004.
[11]	Magkavali-Trikka P, Kirmanidou Y, Michalakis K，et al. Efficacy of two site-development procedures for implants in the maxillary esthetic region：a systematic review[J]. Int J Oral Maxillofac Implants，2015，30(1):73-94. DOI：10.11607/jomi.3652.
[12]	Joo J, Son S, Lee J. Implant site development for enhancing esthetics of soft and hard tissue and simplification of implant surgery using a forced Eruption[J]. Int J Periodontics Restorative Dent，2016，36(4):583-589. DOI：10.11607/prd.2291.
[13]	Hasson JN, Hasson B. Implant site development by orthodontic forced eruption for esthetic restoration of adjacent implants[J]. Clin Adv Periodontics，2016，6(3):146-152. DOI：10.1902/cap.2016.150083.
[14]	Kwon E, Lee J, Choi J. Effect of slow forced eruption on the vertical levels of the interproximal boneand papilla and the width of the alveolar ridge[J]. Korean J Orthod，2016，46(6):379-385. DOI：10.4041/kjod.2016.46.6.379.
[15]	Paolone MG, Kaitsas R. Orthodontic-periodontal interactions：orthodontic extrusion in interdisciplinary regenerative treatments[J]. Int Orthod，2018，16(2):217-245. DOI：10.1016/j.ortho.2018.03.019.
[16]	Becciani R, Faganello D, Fradeani M. Surgical extrusion：a simplified esthetic method of treating non-restorable teeth[J]. Int J Esthet Dent，2018，13(2):240-273.
[17]	Hayashi J, Shin K. Implant site development by orthodontic extrusion and buccal root torque at asite showing severe gingival recession with periodontitis：a case report[J]. Int J Periodontics Restorative Dent，2019，39(4):589-594. DOI：10.11607/prd.4088.
[18]	Bauer C, Boileau MJ, Bazert C. Implementation of orthodontic extraction for pre-implant soft tissue management：a systematic review[J]. Int J Orthod，2019，17(1):20-37. DOI：10.1016/j.ortho.2019.01.019.
[19]	Böhl MV, Maltha J, Von den Hoff H，et al. Changes in the periodontal ligament after experimental tooth movement using high and low continuous forces in beagle dogs[J]. Angle Orthod，2004，74(1):16-25. DOI：10.1043/0003-3219(2004)074<0016:CITPLA>2.0.CO;2.
[20]	Buser D, Chappuis V, Belser UC，et al. Implant placement post extraction in esthetic single tooth sites：when immediate，when early，when late？[J]. Periodontol2000，2017,73(1):84-102. DOI：10.1111/prd.12170.
[21]	González-Martín O, Solano-Hernandez B, González-Martín A，et al. Orthodontic Extrusion：Guidelines for Contemporary Clinical Practice[J]. Int J Periodontics Restorative Dent，2020，40(5):667-676. DOI：10.11607/prd.4789.
[22]	Hochman MN, Chu SJ, Tarnow DP. Orthodontic extrusion for implant site development revisited：a new classification determined by anatomy and clinical outcomes[J]. Semin Orthod，2014，20(3):208-227. DOI：10.1053/j.sodo.2014.06.007.
[23]	Lin IP, Lai EH, Chang JZ，et al. Staged orthodontic treatment in preparation for immediate implant placement：a clinical report with a 5-year follow-up[J]. J Prosthet Dent，2019，122(6):503-509. DOI：10.1016/j.prosdent.2018.10.027.
[24]	Korayem M, Flores-Mir C, Nassar U，et al. Implant site development by orthodontic extrusion. a systematic review[J]. Angle Orthod，2008，78(4):752-760. DOI：10.2319/0003-3219(2008)078[0752:ISDBOE]2.0.CO;2.
[25]	Uribe F, Taylor T, Shafer D，et al. A novel approach for implant site development through root tipping[J]. Am J Orthod Dentofacial Orthop，2010，138(5):649-655. DOI：10.1016/j.ajodo.2009.01.027.
[26]	Feller L, Khammissa RAG, Schechter I，et al. Biological events in periodontal ligament and alveolar bone associated with application of orthodontic forces[J]. The Scientific World J，2015，2015:876509. DOI：10.1155/2015/876509.
[27]	Asiry MA. Biological aspects of orthodontic tooth movement：a review of literature[J]. Saudi J Biol Sci，2018，25(6):1027-1032. DOI：10.1016/j.sjbs.2018.03.008.
[28]	Chakraborty A, Barajas S, Lammoglia GM，et al. Vascular Endothelial Growth Factor-D （VEGF-D） overexpression and lymphatic expansion in murine adipose tissue improves metabolism in obesity[J]. Am J Pathol，2019，189(4):924-939. DOI：10.1016/j.ajpath.2018.12.008.
[29]	Mammoto A, Connor KM, Mammoto T，et al. A mechanosensitive transcriptional mechanism that controls angiogenesis[J]. Nature，2009，457(7233):1103-1108. DOI：10.1038/nature07765.
[30]	Meunier PJ. Cellular mechanisms of bone remodeling evaluated at the intermediary level of organization of bone[J]. Adv Exp Med Biol，1986，208:247-254. DOI：10.1007/978-1-4684-5206-8_31.
[31]	Mantzikos T, Shamus I. Forced eruption and implant site development：an osteophysiologic response[J]. Am J Orthod Dentofacial Orthop，1999，115(5):583-591. DOI：10.1016/s0889-5406(99)70284-2.
[32]	Da Costa Filho LC, Soria ML, De Lima EM，et al. Orthodontic extrusion anchored in osseointegrated implants：a case report[J]. Gen Dent，2004，52(5):416-418.
[33]	Kan JY, Rungcharassaeng K, Fillman M，et al. Tissue architecture modification for anterior implant esthetics：aninterdisciplinary approach[J]. Eur J Esthet Dent，2009，4(2):104-117.
[34]	Balasubramaniam AS, Raja SV, Thomas LJ. Peri-implant esthetics assessment and management[J]. Dent Res J，2013，10(1):7-14. DOI：10.4103/1735-3327.111757.
[35]	Lee EA. Tridimensional reconstruction of a complex iatrogenic defect using orthodontic forced eruption and minimally invasive bone grafting[J]. Compend Contin Educ Dent，2017，38(7):447-456.
[36]	Mantzikos T, Shamus I. Forced eruption and implant site development：soft tissue response[J]. Am J Orthod Dentofacial Orthop，1997，112(6):596-606. DOI：10.1016/s0889-5406(97)70224-5.
[37]	孟耀，刘曼，邓倩楠. 正畸应力作用下牙龈肌成纤维细胞表达的初步研究[J]. 华西口腔医学杂志，2019，37(5):537-540. DOI：10.7518/hxkq.2019.05.016.
[38]	Villa O, Brookes SJ, Thiede B，et al. Subfractions of enamel matrix derivative differentially influence cytokine secretion from human oral fibroblasts[J]. J Tissue Eng，2015，6(3):204173 1415575857. DOI：10.1177/2041731415575857.
[39]	Miron RJ, Zhang Q, Sculean A，et al. Osteoinductive potential of 4 commonly employed bone grafts[J]. Clin Oral Investig，2016，20(8):2259-2265. DOI：10.1007/s00784-016-1724-4.
[40]	Ogihara S, Wang H. Periodontal regeneration with or without limited orthodontics for the treatment of 2- or 3-wall infrabony defects[J]. J Periodontol，2010，81(12):1734-1742. DOI：10.1902/jop.2010.100127.
[41]	Zuccati G, Bocchieri A. Implant site development by orthodontic extrusion of teeth with poor prognosis[J]. J Clin Orthod，2003，37(6):307-311.
[42]	Arun KV, Shreemogana S. Implant site development using forced eruption：a mini review[J]. J Indian Chem Soc，2018，52(5):68. DOI：10.4103/jios.jios_261_17.
[43]	Roig M, Morelló S, Mercadé M，et al. Invasive cervical resorption：report on two cases[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod，2010，110(4):e64-e69. DOI：10.1016/j.tripleo.2010.03.006.
[44]	Borzabadi-Farahani A, Zadeh HH. Adjunctive Orthodontic Applications in Dental Implantology [J]. J Oral Implantol，2015，41(4):501-508. DOI：10.1563/AAID-JOI-D-13-00235.

[1]	宫镇江, 王守一, 姚超, 庞永志, 崔婧. sticky bone混合浓缩生长因子应用于水平骨增量患者的临床效果研究[J]. 中华口腔医学研究杂志(电子版), 2023, 17(06): 430-435.
[2]	李芸, 乔栒柏, 邓华颉, 游云华. 增材制造Ti-6Al-4V钛合金种植体在牙缺失种植修复中的临床应用[J]. 中华口腔医学研究杂志(电子版), 2023, 17(05): 359-364.
[3]	王勇, 彭玲燕, 赵一姣. 数字化序列导板技术用于"终末牙列"患者即刻种植即刻修复[J]. 中华口腔医学研究杂志(电子版), 2023, 17(04): 239-243.
[4]	王焱, 王烟岚. 以始为终：数字化导板在牙列重度磨耗咬合重建序列治疗中的应用[J]. 中华口腔医学研究杂志(电子版), 2023, 17(04): 233-238.
[5]	黄晓琼, 邓飞龙. 种植体颊侧软组织开裂的研究进展及分类诊疗建议[J]. 中华口腔医学研究杂志(电子版), 2023, 17(01): 10-14.
[6]	朱珠, 顾烨辰, 朱庆萍, 何峰, 张玮. 老年患者种植修复成功率与满意度的随访研究[J]. 中华口腔医学研究杂志(电子版), 2022, 16(01): 21-26.
[7]	任静, 耿宁波, 周天任, 陈松龄. 动态实时导航辅助下颌后牙区牙槽骨骨量不足种植[J]. 中华口腔医学研究杂志(电子版), 2022, 16(01): 27-33.
[8]	呙誉东, 鄢雷, 张树新, 闫明. 改良上颌窦底提升术同期种植在上颌后牙区严重萎缩牙槽嵴病例应用的效果评价[J]. 中华口腔医学研究杂志(电子版), 2021, 15(06): 348-354.
[9]	杨雨虹, 李歆, 邓永强. 种植体周围软组织临床意义及软组织不足的防治[J]. 中华口腔医学研究杂志(电子版), 2021, 15(05): 272-277.
[10]	王兵, 国丹妮, 衡墨笛, 国丽丽, 周永胜, 潘韶霞. 上下颌牙列缺失应用数字化技术制作复制义齿修复一例[J]. 中华口腔医学研究杂志(电子版), 2021, 15(04): 234-240.
[11]	安维康, 张薇, 郑亚飞, 马楚凡. 影响短种植体成功率的因素探讨[J]. 中华口腔医学研究杂志(电子版), 2021, 15(03): 129-134.
[12]	林娟, 李燕燕, 宋晓萌, 朱珠, 谢雯静, 张玮. 前牙美学区牙槽嵴保存延期种植的临床研究[J]. 中华口腔医学研究杂志(电子版), 2021, 15(02): 92-97.
[13]	武东辉, 曹少萍, 朱韵莹, 梁坚强, 苏静君. 伴上颌窦囊肿或慢性上颌窦炎的上颌窦底外提升术效果评价[J]. 中华口腔医学研究杂志(电子版), 2020, 14(02): 108-114.
[14]	呙誉东, 周炼, 张东强. 帐篷螺丝技术在单颗上前牙水平向骨增量的临床应用[J]. 中华口腔医学研究杂志(电子版), 2020, 14(01): 41-46.
[15]	王子瑞, 陈宇江, 惠泽明, 韩欣欣, 赵辛, 王小竞. 新型生物陶瓷材料在儿童牙髓治疗中的临床研究进展[J]. 中华口腔医学研究杂志(电子版), 2019, 13(04): 247-251.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

A nonsurgical tissue incremental approach: application of orthodontic extrusive in oral implantology

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

A nonsurgical tissue incremental approach: application of orthodontic extrusive in oral implantology