顎裂部自家腸骨海綿骨細片移植術術後の骨吸収について―梨状孔下縁形態における評価―

Abstract

Grafting of autogenous particulate cancellous bone and marrow to residual alveolar clefts in patients with cleft lip and palate is a well-established procedure for non-prosthetic rehabilitation with canine eruption into the grafted bone or for maintenance treatment after achieving arch alignment. Various analyses of the effect of grafting have been reported, but nearly all previous studies focused on non-prosthetic rehabilitation. The reconstruction of alveolar bone has been evaluated on only intraoral radiographs.We consider the purposes of bone grafting to the alveolar cleft to be not only non-prosthetic rehabilitation, but also correction of anomalies around the nasal cavity. We evaluated the status of bone bridge formation and bone resorption in 146 unilateral clefts of the prepalate and palate, which underwent bone grafting between 1996 and 2000. We also examined factors related to bone anomalies around both the alveolar ridge and the piriform aperture.Our results showed that age at bone grafting had a signifcant influence on resorption. Thus, we consider the time of bone grafting to be very important. Grafting should be done before 11 years of age and eruption of the canines. In addition, orthodontic space closure, which includes tooth root guidance to the grafted bone after alveolar bone grafting, is necessary for bone bridge formation on the piriform aperture side.