Abstract
Purpose:This study evaluated the methods and clinical effects of multidisciplinary collaborative treat-ment for occlusal reconstruction in patients with old jaw fractures and dentition defects.Methods:Patients with old jaw fractures and dentition defects who underwent occlusal reconstruction at the Third Affiliated Hospital of Air Force Military Medical University from January 2018 to December 2022 were enrolled.Clinical treatment was classified into 3 phases.In phase I,techniques such as orthognathic surgery,microsurgery,and distraction osteogenesis were employed to reconstruct the correct 3-dimensional(3D)jaw position relationship.In phase Ⅱ,bone augmentation and soft tissue management techniques were utilized to address insufficient alveolar bone mass and poor gingival soft tissue conditions.In phase Ⅲ,implant-supported overdentures or fixed dentures were used for occlusal reconstruction.A summary of treatment methods,clinical efficacy evaluation,comparative analysis of imageological examinations,and satisfaction questionnaire survey were utilized to evaluate the thera-peutic efficacy in patients with traumatic old jaw fractures and dentition defects.All data are summa-rized using the arithmetic mean±standard deviation and compared using independent sample t-tests.Results:In 15 patients with old jaw fractures and dentition defects(an average age of 32 years,ranging from 18 to 53 years),there were 7 cases of malocclusion of single maxillary fracture,6 of malocclusion of single mandible fracture,and 2 of malocclusion of both maxillary and mandible fractures.There were 5 patients with single maxillary dentition defects,2 with single mandibular dentition defects,and 8 with both maxillary and mandibular dentition defects.To reconstruct the correct 3D jaw positional rela-tionship,5 patients underwent Le Fort I osteotomy of the maxilla,3 underwent bilateral sagittal split ramus osteotomy of the mandible,4 underwent open reduction and internal fixation for old jaw frac-tures,3 underwent temporomandibular joint surgery,and 4 underwent distraction osteogenesis.All patients underwent jawbone augmentation,of whom 4 patients underwent a free composite vascular-ized bone flap(26.66％)and the remaining patients underwent local alveolar bone augmentation.Free gingival graft and connective tissue graft were the main methods for soft tissue augmentation(73.33％).The 15 patients received 81 implants,of whom 11 patients received implant-supported fixed dentures and 4 received implant-supported removable dentures.The survival rate of all implants was 93.82％.The final imageological examination of 15 patients confirmed that the malocclusion was corrected,and the clinical treatment ultimately achieved occlusal function reconstruction.The patient satisfaction ques-tionnaire survey showed that they were satisfied with the efficacy,phonetics,aesthetics,and comfort after treatment.Conclusion:Occlusal reconstruction of old jaw fractures and dentition defects requires a phased sequential comprehensive treatment,consisting of 3D spatial jaw correction,alveolar bone augmentation and soft tissue augmentation,and implant-supported occlusal reconstruction,achieving satisfactory clinical therapeutic efficacy.
基金项目
Project of State Key Laboratory of Military Stomatology(2021ZA07)
Shaanxi Provincial Key Research and Development Program(2023-YBSF-291)
Science and Technology Project of Xi'an City(22YXYJ0116)
NETL
NSTL
万方数据