医学院附属第九人民医院口腔颅颌面科
PAOO手术操作
植骨与骨膜
植骨主要覆盖牙根 植骨量约在0.5g 参考牙移动方向和移动量 颊侧骨支持所需厚度
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
PAOO禁忌症
活动期牙周炎 牙龈退缩者 后牙严重反颌需扩弓者 双颌前突伴有露龈笑 长期服用皮质类固醇及双磷酸盐类药物 非类固醇类抗炎药（阿司匹林）
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
正颌外科手术分类、术前检查、手术过程及术后护 理措施以及相关理论
南通市口腔医院颌面外科
2018-06-21
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
加速正畸牙齿移动的方式
外科手术
骨皮质切开 牵张成骨 牙龈纤维切断术
局部或全身用药
前列腺素、白细胞介素I
机械或物理刺激
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
的愈合”
Suya 1991 “用一个根尖下的水平
骨皮质切口代替了根尖 的水平截骨切口”：骨 皮质切开术的雏形
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
PAOO发展史
William M.Wilcko Thomas M.Wilcko 2001 “骨皮质切开术+牙槽骨移植：PAOO”
RAP使周围骨质密度降低，正畸牙 快速移动
RAP加强周围组织愈合，同期植骨 可增加牙槽骨量，重塑牙槽骨，改 善牙周状况
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
牙周加速成骨的正畸方法 PAOO
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
PAOO手术操作
术前检查
• 口腔卫生 • 牙龈类型 • 影响学检
查 • 全身情况
术前准备
• 术前洁治 • 术前漱口 • 术前抗生
素1-2天
麻醉
• 全麻/局 麻
• 碘伏
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
PAOO手术操作
缝合
无张力缝合：悬吊，骨膜松解，术 后加压
尽量减少植骨区污染 首先定位中线，防止牙龈乳头移位
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
PAOO手术操作
切开与翻瓣
牙龈沟切口 龈缘下2mm切口 保留龈乳头切口 梯形辅助切口 减少龈乳头和粘膜损伤
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
口腔颌面外 科
口腔颌面-头 颈肿瘤外科
颅颌面外科
口腔外科
牙/颅颌面畸 形
唇腭裂
颅颌面外伤
睡眠呼吸障 碍疾病
Байду номын сангаас
颅颌面修复 重建
数字化口腔
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
PAOO发展史
Kole H 1959 “截骨，形成带牙的骨
段，容易移动”：带牙 骨段的整体移动
Frost HM 1989 “骨组织的手术创伤会
引起创伤区周围组织的 加速重组与改建，暂时 性骨质减少，骨密度降 低”：局部骨加速现象
Yaffe 1994 “RAP机制可加强组织
医学院附属第九人民医院口腔颅颌面科
PAOO术后护理
局部优力舒加压2-3天 局部生长因子 术后抗生素5-7天 术后漱口7-14天 流食、半流食 3-14天后开始正畸
医学院附属第九人民医院口腔颅颌面科
PAOO手术操作
骨皮质切开
牙根间垂直切开 牙根下5mm切开 保留牙槽嵴顶至少2mm 切开骨皮质有渗血即可 防止损伤牙根
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
医学院附属第九人民医院口腔颅颌面科
PAOO术后护理
局部优力舒加压2-3天 局部生长因子 术后抗生素5-7天 术后漱口7-14天 流食、半流食 3-14天后开始正畸
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine
Department of Oral & Craniomaxillofacial Surgery, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine