国际口腔医学杂志

国际口腔医学杂志 ›› 2026, Vol. 53 ›› Issue (6): 787-797.doi: 10.7518/gjkq.2026633

• 专家笔谈 •    

牙槽突裂植骨疗效及植骨前正畸干预

李巍然()   

  1. 北京大学口腔医学院·口腔医院正畸科 国家口腔医学中心 口腔疾病国家临床医学研究中心 口腔生物材料和数字化诊疗装备国家工程中心 口腔数字医学北京市重点实验室 北京 100081
  • 收稿日期:2026-04-14 修回日期:2026-06-23 出版日期:2026-11-01 发布日期:2026-10-29
  • 通讯作者: 李巍然
  • 作者简介:李巍然，主任医师、教授、博士生导师。现为北京大学口腔医学院正畸科主任，Tweed中国中心主任，Orthodontics Craniofacial Research副主编，《中华口腔正畸学杂志》副主编，中华口腔医学会正畸专业委员会副主任委员、唇腭裂专业委员会常务委员，北京口腔医学会正畸专业委员会副主任委员、美学专业委员会常务委员。长期从事正畸临床实践及研究工作，在核心期刊及SCI期刊发表第一/通信作者论文210余篇，获得国家自然科学基金、北京市自然科学基金等18项基金资助，主编《现代口腔正畸学规范诊疗手册》《唇腭裂与正畸治疗》等口腔正畸学专著及教材6部，编写口腔正畸相关专著及教材16部。获得省部级科技奖励10项，以及欧洲正畸协会Beni Solow奖、美国正畸协会最佳年度病例奖等奖项。|李巍然，教授，博士，Email：weiranli@bjmu.edu.cn
  • 基金资助:
    国家口腔医学中心（北京大学口腔医院）适宜技术推广项目(2024NCSHTP04);北京市自然科学基金(L242127)

Outcome of alveolar cleft bone grafting and presurgical orthodontic intervention

Weiran Li()   

  1. Dept. of Orthodontics, Peking University School and Hospital of Stomatology, National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2026-04-14 Revised:2026-06-23 Online:2026-11-01 Published:2026-10-29
  • Contact: Weiran Li
  • Supported by:
    Appropriate Technology Promotion Project of National Center of Stomatology (Peking University School of Stomatology)(2024NCSHTP04);Natural Science Foundation of Beijing(L242127)

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摘要：

唇腭裂患者的牙槽突裂植骨是序列治疗中的关键治疗，决定着后续错畸形矫治的设计、治疗难度及效果，影响整个序列治疗。然而，关于牙槽突裂植骨的疗效评价、影响植骨疗效的原因及防治措施仍存在许多困惑。本文对牙槽突裂植骨疗效和植骨前正畸治疗及其影响因素进行论述，希望给临床医生提供参考。

关键词: 唇腭裂, 正畸治疗, 牙槽突裂植骨

Abstract:

Alveolar bone grafting constitutes a pivotal procedure in the sequential treatment of patients with cleft lip and palate. It dictates orthodontic treatment planning and determines the difficulty and final outcomes of subsequent or-thodontic management. Successful bone grafting is therefore an essential prerequisite for the overall efficacy of the entire sequential treatment protocol. However, considerable uncertainties remain regarding the therapeutic effects of alveolar bone grafting and corresponding preventive and interventional strategies. This article elaborates on preoperative assessment for alveolar bone grafting, along with presurgical orthodontic interventions and their associated impacts, aiming to offer clinical references for clinicians.

Key words: cleft lip and palate, orthodontic treatment, alveolar bone grafting

中图分类号: 

  • R783.5

图 1

CBCT三维评价显示植骨效果良好A、B：单侧完全性唇腭裂植骨前牙槽突裂区骨缺损；C、D：植骨后牙槽突裂区骨质高度、宽度及厚度。"

图 2

CBCT三维评价显示植骨疗效欠佳A、B：单侧完全性唇腭裂植骨前牙槽突裂区骨缺损；C、D：植骨后牙槽突裂区骨质高度、宽度及厚度。"

图 3

植骨前正畸治疗的适应证A：牙弓严重狭窄；B：裂隙邻近牙齿斜轴；C：裂隙邻近牙齿扭转和骨段间台阶；D：上颌骨段间存在明显的台阶；E：牙槽突裂隙宽大；F：侧腭段靠拢，前颌突前突。"

图 4

活动矫治器扩弓及切牙矫治A~C：21牙舌倾、远中倾斜，反，上牙弓前部狭窄；D：曲面体层片；E：上颌分裂基托垫舌簧矫治器，扩弓，矫治前牙反；F~H：植骨前正畸完成，骨段间关系改善，反解除。"

图 5

固定矫治器扩弓治疗及牙轴调整A~C：植骨前口内像显示21牙扭转斜轴，22牙远中斜轴，21、22、23牙拥挤，上颌前部塌陷；D~F：植骨前上颌扩弓并调整21牙轴，计划22牙术前拔除；G~I：植骨后尖牙继续萌出。"

图 6

植骨前上颌扩弓矫治牙弓狭窄，调节裂隙邻近牙齿牙轴及骨段间高度差，减小裂隙A~C：治疗前前颌突前突，两侧腭段塌陷，骨段间存在明显台阶；D：治疗前曲面体层片显示前颌突与2个侧腭段存在明显台阶，12、22牙位于裂隙；E：上颌扩弓，调整2个侧腭段；F~H：上颌宽度扩宽后，固定矫治器调整裂隙邻近牙槽突骨段；I~K：固定矫治器调整前牙牙轴并改善骨段间关系。"

图 7

正畸正颌牙槽骨转运减小牙槽突裂隙A~C：植骨前牙槽突裂隙过大；D~F：正畸结合正颌外科上颌牙槽骨转运牵张成骨近中移动小段骨，减小裂隙，为植骨创造条件。"

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