摘要：

目的: 探究牵张成骨重建下颌节段性缺损术后进行数字化种植修复的疗效。方法: 本研究采用回顾性病例系列分析，共纳入2016年10月—2021年8月间由四川大学华西口腔医院种植科收治的4例（共8个种植位点）应用输送盘牵张成骨术（transport disc distraction osteogenesis，TDDO）进行颌骨重建术的患者，记录颌骨重建长度、种植位点牙槽嵴高度与宽度。种植前采用虚拟排牙进行以修复为引导的种植方案设计，对于对颌牙伸长的病例采用正畸压低的治疗方案。运用数字化种植外科技术于缺牙位点植入种植体。修复前对种植位点进行角化黏膜增量。每年复查，测量边缘骨吸收、探诊深度及角化黏膜宽度。结果: 患者随访时间为36~50个月。种植前，进行TDDO后颌骨重建长度为（23.65±61.11） mm；在理想种植位点，骨高度为（22.37±4.30） mm，可用骨高度为（21.25±3.78） mm，牙槽嵴顶宽度在牙槽嵴顶下1、2和3 mm处分别为（7.14±1.78） mm、（9.00±1.77） mm和（10.47±2.34） mm；随访3年，种植存活率为100%，种植成功率为87.5%。修复后3年，种植体周边缘骨吸收、探诊深度与角化黏膜宽度分别为（1.38±0.74） mm、（2.50±1.08） mm与（2.50±1.08） mm。结论: TDDO是重建下颌骨外形与功能的可行方案。以修复为导向的数字化种植外科与多学科治疗可实现种植修复的成功，种植体周围软硬组织可维持健康。

关键词: 下颌骨缺损, 牵张成骨, 牙种植, 数字化种植修复, 多学科治疗

Abstract:

Objective: This paper describes the clinical efficacy of digital implant restoration after distraction osteogenesis for reconstruction of mandibular segemental defect. Method: A retrospective case series study was conducted. A total of 4 cases （8 implant sites） that patients who had received transport distraction osteogenesis （TDDO） for reconstruction of segmental mandibular defect from October 2016 to August 2021 in Department of Oral Implantology, Sichuan West China Hospital, were included. The length of reconstructed mandible, as well as the height and width of crest at the implant sites were recorded. Before implantation, virtual tooth arrangement was performed to design the implantation plan guided by restoration. Orthodontic depression treatment was applied for the cases with over-erupted teeth. Digital-guided implant surgery technology was adopted to place implants in edentulous sites. Before final restoration, keratinized mucosa augmentation was performed for the cases with inadequate keratinized mucosa width. In annual follow-ups, all patients were assessed with marginal bone loss around implant, probing depth and keratinized mucosa width. Results: The total of following-up time was 36-50 months. Before implants placement, the length of reconstructed mandible by TDDO was （23.65±61.11） mm. At the sites where ideal implants were simulated, the bone height and the available bone height for implantation were （22.37±4.30） mm and（21.25±3.78） mm respectively. The bone width of crest were （7.14±1.78） mm, （9.00±1.77） mm and （10.47±2.34） mm at 1, 2, 3 mm below the alveolar crest, respectively. After 3-year follow-up, the survival rate and successful rate of implants was 100% and 87.5% respectively. Marginal bone loss around implant, probing depth and keratinized mucosa width were （1.38±0.74） mm, （2.50±1.08） mm and （2.50±1.08） mm respectively at 3-year follow-up. Conclusion: The above findings suggested that TDDO could be a reliable approach for reconstruction of mandibular segmental defect. Digital-guided implant surgery for restoration and multidisciplinary treatment could achieve successful implant restoration and maintained peri-implant soft and hard tissues healthy.

Key words: mandible defect, distraction osteogenesis, dental implant, digital implant restoration, multidisciplinary treatment