颧骨骨壳技术:在颧骨植入失败后在人体尸体上进行骨重建的概念验证手术方案

IF 1.7 Q3 DENTISTRY, ORAL SURGERY & MEDICINE
Agliardi Enrico Luigi, Pozzi Alessandro, Gherlone Enrico
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引用次数: 0

摘要

本文旨在介绍一种概念验证的手术技术,用于在植入物失败和并发症后立即重建颧骨解剖,并举例说明尸体标本的相关临床步骤。颧骨种植体代表了一种范式转变,解决了严重上颌骨萎缩和部分或完全上颌切除术所带来的挑战,不适合传统的牙科种植体安置。尽管有文献记载的生存率很高,但可能发生内、术后并发症并导致植入物失败,导致严重的缺损延伸至颧骨金字塔的整个高度。这些缺陷可能会立即或延迟植入新的植入物,需要复杂的外科手术来恢复颧骨解剖的完整性。材料与方法采用特殊形式的骨再生或骨壳技术,利用下颌骨外斜线取薄皮质板对颧骨缺损进行三维重建。在对移除种植体导致的骨缺损进行细致的机械清创后,从下颌骨分支获取薄皮质骨块。清除后的骨缺损用自体骨片填充,并用骨固定螺钉固定上面的薄骨壳。结果颧骨骨壳技术能恢复颧骨金字塔脊的轮廓。下颌骨和颧骨的相似组成,特别是在皮质区域,允许解剖相似性,促进最佳结构相容性,促进骨移植物无缝整合到颧骨区域。结论:在这个概念验证的局限性内,颧骨骨壳技术可能为颧骨植入失败后立即骨重建提供一种可行的外科手术方法。根据先前报道的骨壳技术的临床结果,可以在植入物取出失败的当天使用骨壳技术来重建颧骨解剖,术后并发症的风险有限。需要进一步的临床研究来证实其可预测性、可靠性和预期的益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Zygoma Bone Shell Technique: A Proof-of-Concept Surgical Protocol in Human Cadaver for Bone Reconstruction After Zygomatic Implant Failure

Zygoma Bone Shell Technique: A Proof-of-Concept Surgical Protocol in Human Cadaver for Bone Reconstruction After Zygomatic Implant Failure

Objectives

This article aims to present a proof-of-concept surgical technique for immediate reconstruction of zygoma anatomy following implant failure and complications, illustrating the related clinical steps in a cadaver specimen. Zygomatic implants represent a paradigm shift, addressing challenges posed by severe maxillary bone atrophy and partial or complete maxillectomy, not suitable for conventional dental implant placement. Despite documented high survival rates, intra- and postoperative complications can occur and lead to implant failure, resulting in severe defects extended up to entire height of zygomatic bone pyramid. Such defects may infringe immediate or delayed new implant placement, requiring complex surgical procedures to restore integrity of zygomatic bone anatomy.

Material and Methods

The three-dimensional reconstruction of zygomatic bone defect was achieved by specific form of guided bone regeneration or shell technique, using a thin cortical plate harvested from external oblique line of the mandible. After a meticulous mechanical debridement of bone defect resulting from implant removal, a thin cortical bone block was harvested from the mandibular ramus. The cleared bone defect was filled with autogenous bone chips and thin bone shell was secured above with a bone fixation screw.

Results

Zygoma Bone Shell technique was able to restore contours of zygomatic pyramid ridge. The comparable composition between mandibular and zygomatic bone, particularly in the cortical region allowed an anatomical resemblance that facilitates optimal structural compatibility, fostering seamless integration of bone graft into zygomatic area.

Conclusions

Within limitations of this proof-of-concept, zygoma bone shell technique may offer a viable surgical procedure for immediate bone reconstruction after zygomatic implant failure. Translating the previously reported clinical outcomes of bone shell technique, it may be used same day of failing implant removal to achieve reconstruction of zygomatic anatomy with limited risk of postoperative complications. Further clinical studies are needed to confirm its predictability, reliability and anticipated benefits.

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来源期刊
Clinical and Experimental Dental Research
Clinical and Experimental Dental Research DENTISTRY, ORAL SURGERY & MEDICINE-
CiteScore
3.30
自引率
5.60%
发文量
165
审稿时长
26 weeks
期刊介绍: Clinical and Experimental Dental Research aims to provide open access peer-reviewed publications of high scientific quality representing original clinical, diagnostic or experimental work within all disciplines and fields of oral medicine and dentistry. The scope of Clinical and Experimental Dental Research comprises original research material on the anatomy, physiology and pathology of oro-facial, oro-pharyngeal and maxillofacial tissues, and functions and dysfunctions within the stomatognathic system, and the epidemiology, aetiology, prevention, diagnosis, prognosis and therapy of diseases and conditions that have an effect on the homeostasis of the mouth, jaws, and closely associated structures, as well as the healing and regeneration and the clinical aspects of replacement of hard and soft tissues with biomaterials, and the rehabilitation of stomatognathic functions. Studies that bring new knowledge on how to advance health on the individual or public health levels, including interactions between oral and general health and ill-health are welcome.
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