Department of Orthodontics, School of Dentistry, Iwate Medical University
Abstract
通常臨床歯科医学における骨移植は,その病理学的形態より3壁性骨欠損を有する歯周病患者に対して広く行われている。今回,下顎前歯部(下顎結合部)唇側面歯槽骨の開窓や限局性穿孔は存在するが,歯肉退縮を生じていない骨格型III級不正咬合患者へ顎矯正手術と同時に自家骨移植を付加的に行った。初診時のセファログラム所見より高く幅の狭い下顎結合部とこの薄い骨に直立している下顎前歯が確認された。また,術前矯正歯科治療中,下顎前歯はその捻転の解消と頬舌的な移動が行われた。手術時には下顎前歯部の開窓や限局性穿孔が確認された。下顎前歯部(下顎結合部)唇側面に自己海面骨を移植することによって歯槽骨の開窓や限局性穿孔は覆われた。結果的にセファログラム上での経過所見より,その後4年10か月間移植骨の残留が認められ,さらに臨床的に咬合が安定し通常後戻りしやすいとされる下顎前歯捻転の後戻りも認められず良好な結果を得たので報告した。Bone graft in clinical dentistry prevails in periodontal patients who have three wall infrabony defect around the tooth because of its pathological morphology. In this case report, bone graft on the labial bone surface of the lower incisors (mandibular symphysis) was applied as an auxiliary procedure at the same time of orthognathic surgery to a patient who had fenestrations and circumscribed holes without gingival recession and skeletal Class III malocclusion. The initial lateral cephalometric radiograph revealed a narrow and high symphysis, with an incisor position straight above the thin bone. During the pre-surgical orthodontic treatment, the incisors had been derotated and moved in the minimal labiolingual direction. Some fenestrations and circumscribed holes were found during orthognathic surgery. Through the bone allograft, the labial bone surface of the lower incisors (mandibular symphysis) with fenestrations and circumscribed holes were covered with the patient\u27s cancellous bone. Consequently, a series of the lateral cephalometric radiographs revealed that the grafted bone was kept for four years and ten months after surgery with stable occlusion and no rotational relapse on the lower incisors where it is usually easy to relapse clinically
