侯 銳，楊 霞，許廣杰，馬媛媛，惠小勇，王肖楠，張林林，胡 曼

（1軍事口腔醫(yī)學國家重點實驗室，口腔疾病國家臨床醫(yī)學研究中心，陜西省口腔疾病臨床醫(yī)學研究中心，第四軍醫(yī)大學口腔醫(yī)院口腔外科，陜西西安710032；2第三軍醫(yī)大學大坪醫(yī)院野戰(zhàn)外科研究所口腔科，重慶400042）

海奧口腔修復膜復合骨填充材料在低位阻生第三磨牙自體牙移植術(shù)中的應用

侯 銳1，楊 霞1，許廣杰1，馬媛媛2，惠小勇1，王肖楠1，張林林1，胡 曼1

（1軍事口腔醫(yī)學國家重點實驗室，口腔疾病國家臨床醫(yī)學研究中心，陜西省口腔疾病臨床醫(yī)學研究中心，第四軍醫(yī)大學口腔醫(yī)院口腔外科，陜西西安710032；2第三軍醫(yī)大學大坪醫(yī)院野戰(zhàn)外科研究所口腔科，重慶400042）

【摘 要】目的：采用海奧口腔修復膜復合骨填充材料修復低位阻生第三磨牙自體移植至第二磨牙后的骨缺損.方法：對各種原因造成的下頜第二磨牙病變無法保留且遠中牙槽骨吸收，鄰牙為低位近中或水平阻生第三磨牙的常規(guī)治療為拔除兩顆牙齒，后期種植義齒或活動義齒修復.若實施自體牙移植術(shù)，即拔除第二和第三磨牙，然后將第三磨牙移植入第二磨牙牙槽窩，但因為頰側(cè)及遠中骨缺損多，植入后牙齒不易固定且活動性大，以往并不是自體牙移植術(shù)的適應證.本研究針對上述問題在拔牙同期將適量人工骨粉（Bio?oss或天然煅燒骨修復材料，陜西瑞盛生物科技有限公司，骼瑞）填入移植牙頰側(cè)和遠中骨缺損區(qū)，并采用海奧口腔修復膜（煙臺正海生物技術(shù)有限公司），經(jīng)形態(tài)修剪后覆蓋于骨粉表面.縫合黏膜組織后用金屬麻花絲彈性固定移植牙.覆蓋牙周敷料保護創(chuàng)面.結(jié)果：移植牙術(shù)后固定良好，即刻動度在I°范圍內(nèi).影像學檢查顯示：移植牙遠中骨缺損得到填充修復，近中與鄰牙鄰接良好.結(jié)論：低位阻生第三磨牙自體移植至第二磨牙可以成為自體牙移植術(shù)的適應證，采用海奧口腔修復膜復合骨填充材料能夠提高伴有骨缺損的移植牙的術(shù)后即刻穩(wěn)定性.

【關(guān)鍵詞】自體牙移植；骨填充材料；阻生第三磨牙；生物膜

附：視頻——自體牙移植術(shù)

【參考文獻】

［1］Mitsuhiro Tsukiboshi，主編，autotransp1antationof teeth.侯銳周宏志主譯，自體牙移植，人民軍醫(yī)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，F(xiàn)enske 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.

【中圖分類號】R782.12

【文獻標識碼】A

收稿日期：2016-04-07；接受日期：2016-04-23

作者簡介：侯 銳.副教授，碩士研究生導師.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