海奥口腔修复膜复合骨填充材料在低位阻生第三磨牙自体牙移植术中的应用

侯 锐，杨 霞，许广杰，马媛媛，惠小勇，王肖楠，张林林，胡 曼

（1军事口腔医学国家重点实验室，口腔疾病国家临床医学研究中心，陕西省口腔疾病临床医学研究中心，第四军医大学口腔医院口腔外科，陕西西安710032；2第三军医大学大坪医院野战外科研究所口腔科，重庆400042）

海奥口腔修复膜复合骨填充材料在低位阻生第三磨牙自体牙移植术中的应用

侯 锐1，杨 霞1，许广杰1，马媛媛2，惠小勇1，王肖楠1，张林林1，胡 曼1

（1军事口腔医学国家重点实验室，口腔疾病国家临床医学研究中心，陕西省口腔疾病临床医学研究中心，第四军医大学口腔医院口腔外科，陕西西安710032；2第三军医大学大坪医院野战外科研究所口腔科，重庆400042）

【摘 要】目的：采用海奥口腔修复膜复合骨填充材料修复低位阻生第三磨牙自体移植至第二磨牙后的骨缺损.方法：对各种原因造成的下颌第二磨牙病变无法保留且远中牙槽骨吸收，邻牙为低位近中或水平阻生第三磨牙的常规治疗为拔除两颗牙齿，后期种植义齿或活动义齿修复.若实施自体牙移植术，即拔除第二和第三磨牙，然后将第三磨牙移植入第二磨牙牙槽窝，但因为颊侧及远中骨缺损多，植入后牙齿不易固定且活动性大，以往并不是自体牙移植术的适应证.本研究针对上述问题在拔牙同期将适量人工骨粉（Bio⁃oss或天然煅烧骨修复材料，陕西瑞盛生物科技有限公司，骼瑞）填入移植牙颊侧和远中骨缺损区，并采用海奥口腔修复膜（烟台正海生物技术有限公司），经形态修剪后覆盖于骨粉表面.缝合黏膜组织后用金属麻花丝弹性固定移植牙.覆盖牙周敷料保护创面.结果：移植牙术后固定良好，即刻动度在I°范围内.影像学检查显示：移植牙远中骨缺损得到填充修复，近中与邻牙邻接良好.结论：低位阻生第三磨牙自体移植至第二磨牙可以成为自体牙移植术的适应证，采用海奥口腔修复膜复合骨填充材料能够提高伴有骨缺损的移植牙的术后即刻稳定性.

【关键词】自体牙移植；骨填充材料；阻生第三磨牙；生物膜

附：视频——自体牙移植术

【参考文献】

［1］Mitsuhiro Tsukiboshi，主编，autotransp1antationof teeth.侯锐周宏志主译，自体牙移植，人民军医出版社 2013 ISBN 978-7-5091-6654-3.

［2］C1okie CM，Yau DM，Chano L.Autogenous tooth transp1antation：an a1ternative to denta1 imp1ant p1acement？［J］.J Can Dent Assoc，2001，67（2）：92-96.

［3］Bauss O，Schi1ke R，Fenske C，et a1.Autotransp1antation of immature third mo1ars：inf1uence of different sp1inting methods and fixation peri⁃ods［J］.Dent Traumato1，2002，18（6）：322-328.

［4］Kim E，Jung JY，Cha IH，et a1.Eva1uation of the prognosis and causes of fai1ure in 182 cases of autogenous tooth transp1antation［J］. Ora1 Surg Ora1 Med Ora1 Patho1 Ora1 Radio1 Endod，2005，100（1）：112-119.

［5］Wa1don K，Barber SK，Spencer RJ，et a1.Indications for the use of auto⁃transp1antation of teeth in the chi1d and ado1escent［J］.Eur Arch Paediatr Dent，2012，13（4）：210-216.

【中图分类号】R782.12

【文献标识码】A

收稿日期：2016-04-07；接受日期：2016-04-23

作者简介：侯 锐.副教授，硕士研究生导师.Te1：029⁃84776483 E⁃mai1：hourui@fmmu.edu.cn

The application of Heal-all biological membrance combined bone filling material on repair of bone defect When autotransplanting loW site impacted mandiblular third molar to the second molar

HOU Rui1，YANG Xia1，XU Guang⁃Jie1，MA Yuan⁃Yuan2，HUI Xiao⁃Yong1，WANG Xiao⁃Nan1，ZHANG Lin⁃Lin1，HU Man11State Key Laboratory of Mi1itary Stomato1ogy，Nationa1 C1inica1 Research Center for Ora1 Diseases，Shaanxi C1inica1 Research Center for Ora1 Diseases，Department of Ora1 Surgery，Schoo1 of Stomato1ogy，theFourthMi1itaryMedica1University，Xi'an 710032，China；2Department of Stomato1ogy，Research Institute of Surgery&Daping Hospita1，the Third Mi1itary Medica1 Univer⁃sity，Chungking 400042，China

【Abstract】AIM：To fi11 the bone defects with hea1⁃a11 bio1ogica1 membrane combined bone fi11ing materia1 when autotransp1anting the 1ow site impacted third mo1ar to the second mo1ar.METHODS：A1veo1ar bone resorption caused by various reasons of the mandibu1ar second mo1ar 1esions cannot be preserved，and the conventiona1 treatment was 1ow in adjacent teeth or horizonta11y impacted third mo1ars for two teeth extraction，or 1ater imp1ant denture.The autotransp1antation was a1so not the indication since the fixation was difficu1t and the mobi1ity is not enough because of the bone defect.In this study，the innovative method was to use the artificia1 bone fi11ing materia1（Spongious Bone substitute，Bio⁃oss，Geist1ich，Switzer1and or Ca1cined Bovine Bone，RuiSh⁃eng，China）to fi11 the bucca1 and dista1 bone defect area.Then the hea1⁃a11 bio1ogica1 membrane（ZhengHai，China）was cut out and suppressed as a fi1m to cover the surface of the materia1.Twis⁃ted meta1 wire was used for the e1astic fixation after the suture and cover periodonta1 dressings in wound for protection.RESULTS：The autotransp1anted tooth was we11⁃fixed，and the instant mobi1ity was within the I°range.Imaging examination showed the dista1 bone defect of the transp1anted tooth was fi11ed and repaired. CONCLUSION：Transp1anting the 1ow site impacted third mo1ar to the second mo1ar cou1d be the indication of autotransp1antation. Hea1⁃a11 bio1ogica1 membrane combined bone fi11ing materia1 cou1d improve the instant stabi1ity of the transp1anted teeth with bucca1 and dista1 bone defects.

【KeyWords】autotransp1antation；bone fi11ing materia1；impacted third mo1ar；membrane