兽研评估犬齿萌出及正畸移动对自体半厚髂骨移植修复牙槽突裂的影响：基于数字化方法的回顾性研究 甘先怡 广西医科大学 白可 广西医科大学 韦方月 广西医科大学 匡海 广西医科大学 黄涛 广西医科大学 陈国生 广西医科大学 赵冬兰 广西医科大学 李宏毅 广西医科大学 研究论文 关键词： 发布日期：2026年10月27日 DOI：https://doi.org/10.21203/rs.3.rs-11255602/v1 许可：本作品采用知识共享署名4.0国际许可协议授权。阅读完整许可协议 附加声明：未报告存在利益冲突。第1页/共28页
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摘要 目的 探讨犬齿萌出状态及术后正畸干预对自体半厚髂骨移植（STIB）修复牙槽突裂疗效的影响，并采用数字化方法分析与犬齿穿入移植骨块相关的调控效应，从而为STIB移植的临床时机选择及术后正畸治疗提供循证依据。方法 本回顾性研究纳入2023年7月至2024年8月在广西医科大学附属口腔医院接受STIB牙槽突裂移植的71例患者（76侧裂隙；年龄7～22岁，平均10.79岁）。按犬齿萌出情况及术后正畸分为：（1）犬齿未萌出且未行正畸组，（2）犬齿已萌出且行正畸组，（3）犬齿已萌出且未行正畸组。根据CBCT确认的犬齿相对于移植骨的位置，每组再分为“犬齿位于移植骨内”和“犬齿位于移植骨外”两个亚组。于术后即刻及术后6个月、12个月行CBCT扫描。使用Mimics软件进行三维重建，量化移植骨高度、厚度、体积及剩余骨体积比，评估各组移植骨的长期稳定性。结果 在未行正畸的情况下，犬齿未萌出组术后12个月的移植骨体积及剩余骨体积比显著大于犬齿已萌出/未行正畸组（P < 0.05，P < 0.0002）。犬齿未萌出/未行正畸组与犬齿已萌出/行正畸组在各时间点的所有移植骨参数上均无显著差异（P > 0.05）。在犬齿已萌出的患者中，正畸组术后12个月的移植骨体积及剩余骨体积比显著高于未行正畸组（P < 0.05，P < 0.0001）。亚组分析显示，无论萌出状态如何，“犬齿位于移植骨内”亚组在术后6个月和12个月的移植骨体积均显著大于“犬齿位于移植骨外”亚组（P < 0.05）。结论 生理性犬齿萌出及术后正畸均可减少STIB移植后的长期骨吸收。对于犬齿已萌出并接受晚期移植的患者，正畸可补偿失去的生理性生长潜力。STIB不会阻碍犬齿萌出，且正畸可 第3页/共28页
成功将已萌出的尖牙定位入移植骨内。将尖牙置于STIB移植骨内有助于维持移植骨体积。引言 唇腭裂是一种由遗传和环境因素共同调控的多因素先天性颅面畸形，其中牙槽突裂在新生儿颅面缺陷中占相当大的比例。流行病学数据显示，全球唇腭裂患病率约为0.992‰，约75%的唇腭裂患者同时伴有相关的牙槽突裂畸形[1–2]。牙槽突裂修复是唇腭裂综合治疗序列中的重要组成部分，其主要目标是恢复牙弓连续性、重建牙槽骨解剖结构以及恢复咬合功能[3]。目前，手术植骨仍是牙槽突裂修复的主要治疗方式，使用的移植材料包括自体骨、同种异体骨、异种骨、合成骨及组织工程骨等。其中，髂骨松质骨移植因其可靠的成骨效果，仍是临床实践中的“金标准”[4–5]。髂嵴松质骨具有较大的表面积和接触面积，有利于术后血管化重建，且富含成骨细胞因子，可促进术后骨再生与重塑[6]。然而，该技术存在一个显著缺点——术后骨吸收明显，据报道长期吸收率高达80%[7]。与松质骨相比，皮质骨更能抵抗周围软组织的收缩，减少局部不良应力刺激，从而最大限度地减少骨吸收并保持移植骨形态。然而，皮质骨缺乏成骨因子，成骨潜能有限，这不仅增加了移植效果不佳的风险，还可能阻碍邻近尖牙的正常萌出[8–9]。近年来，本中心采用自体半厚髂嵴骨块（STIB）修复先天性牙槽突裂，取得了良好的临床效果。STIB结合了松质骨和皮质骨的优点，在确保成功骨整合的同时，有效减少了局部不良应力所致的术后骨吸收。既往研究表明，尖牙的萌出状态是影响传统松质骨移植预后的关键因素[10–11]，大多数研究者证实，在尖牙萌出前进行移植的临床成功率显著高于萌出后[12–13]。同时，一些研究肯定了术后正畸治疗的临床价值，认为术后正畸干预可提高移植骨存活率并减少长期骨吸收[13–14]。然而，目前国内外尚无相关研究探讨尖牙自然萌出及术后正畸移动对STIB植骨结局的长期影响，也不清楚STIB移植是否会干扰尖牙的正常萌出。因此，本研究旨在 第4/28页
通过数字化方法进行回顾性分析，探讨犬齿萌出状态和术后正畸治疗对STIB修复牙槽突裂长期疗效的影响，为STIB植骨时机选择和术后管理提供临床依据。材料与方法 1.1 研究人群 本研究纳入2023年7月1日至2024年8月31日期间在广西医科大学附属口腔医院接受自体半厚髂骨移植（STIB）修复牙槽突裂的患者。患者纳入标准如下：（1）术前、术后即刻、术后6个月及12个月均有可用的CBCT影像；（2）正畸组患者需接受术后正畸治疗；（3）所有患者均由同一位外科医生治疗；（4）依从性良好、能够配合随访的患者。排除标准如下：（1）唇腭裂综合征患者；（2）既往接受过植骨的患者；（3）裂隙侧无犬齿或犬齿严重阻生的患者；（4）术前或术后影像资料不完整或不清晰、无法进行准确测量的患者。符合条件的受试者根据犬齿萌出状态分为两组：未萌出犬齿组和已萌出犬齿组。已萌出犬齿组进一步分为术后正畸亚组和非正畸亚组。在此基础上，各组再根据犬齿是否已进入移植骨块进一步分类——形成犬齿进入骨块亚组和犬齿未进入骨块亚组。比较并分析各组间术后移植效果的差异。具体纳入和排除标准见图1。本研究严格遵循世界医学协会《赫尔辛基宣言》的伦理准则。研究经广西医科大学附属口腔医院伦理委员会批准（批准号：2025098）。所有患者及其家属均充分了解研究内容和治疗方案，并已签署知情同意书。1.2 手术方法 骨采集：在髂前上棘稍内侧做手术切口。逐层仔细分离组织，暴露髂软骨。根据术前锥形束计算机断层扫描（CBCT）测量结果，使用骨凿采集与牙槽突裂大小相匹配的自体半厚髂骨移植骨块。移植骨块由比例相等的皮质骨和松质骨组成。供区彻底止血后，放置引流条，逐层关闭伤口。植骨床准备：沿牙槽突裂边缘做牙龈切口，充分松解并游离鼻侧和腭侧的黏膜瓣，然后缝合关闭鼻裂和腭裂，从而完成植骨床准备（图1A）。第5/28页
骨块植入与固定：将获取的半厚髂骨块仔细修整塑形，使其尺寸与受骨床精确匹配。随后将骨块植入骨缺损区，确保皮质骨面朝向唇侧、松质骨面朝向腭侧（图2B）。采用栅栏式固定技术，将钛钉置入移植骨邻近的周围牙槽骨内，而不穿透或损伤移植的髂骨块，从而通过应力分担原理维持术后稳定性（图2C）。最后采用水平褥式缝合技术关闭手术创口（图2D）。(A) 骨移植床的制备；(B) 骨块的放置；(C) 钛板固定；(D) 创口关闭 1.3 术后正畸治疗 所有接受术后正畸干预的患者于骨移植术后三个月在门诊局部麻醉下拆除固定钛钉，并同时开始术后正畸治疗（图3）。采用直丝弓矫治技术，将邻近尖牙逐渐向移植区牵引，引导其牙根进入移植骨块内，最终重建完整的牙弓形态并建立稳定、协调的咬合关系。1.4 影像学分析 收集所有患者术后即刻、术后6个月及术后12个月的CBCT图像，统一导出并以DICOM格式保存。将影像数据导入Mimics软件进行三维重建及相关参数测量。所有影像学测量均由同一名研究者使用相同设备和一致参数完成，以尽量减少与设备或操作者变异相关的偏倚。为确保测量可靠性，每组图像间隔一周测量三次，取平均值作为最终结果。采用组内相关系数（ICC）评估测量一致性；本研究中ICC值大于0.9，表明测量重复性优异、可靠性高。1.5 移植骨块参数的测量 将患者CBCT的DICOM数据导入Mimics软件，以轴平面作为主要测量工作区。移植的STIB骨块形态规则、边界清晰，其骨密度与周围自体牙槽骨及骨碎片存在显著差异，可进行精确区分。使用“Edit Mask”工具逐层勾画移植骨块的轮廓，并利用“Region Growing”功能重建骨块的三维模型（图4A-B）。基于重建模型，分别测量骨块的长度（图4C、E）和宽度（图4D、F），同时通过“Mask Volume”功能自动获取移植骨块的三维体积，完成定量分析。第6/28页
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Assessment of the Impact of Canine Eruption and Orthodontic Movement on the Repair of Alveolar Cleft with Autogenous Semi-Thick Iliac Bone Graft Using Digital Methods: A Retrospective Study Xianyi Gan Guangxi Medical University Ke Bai Guangxi Medical University Fangyue Wei Guangxi Medical University Hai Kuang Guangxi Medical University Tao Huang Guangxi Medical University Guosheng Chen Guangxi Medical University Donglan Zhao Guangxi Medical University Hongyi Li Guangxi Medical University Research Article Keywords: Posted Date: October 27th, 2026 DOI: https://doi.org/10.21203/rs.3.rs-11255602/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Additional Declarations: No competing interests reported. Page 1/28
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Abstract Objective To investigate the impact of canine eruption status and postoperative orthodontic intervention on the efficacy of autogenous semi-thick iliac bone grafts (STIB) in repairing alveolar clefts, and to analyze using digital methods the regulatory effects associated with canine penetration into the transplanted bone block, thereby providing evidence-based guidance for clinical timing of STIB grafting and postoperative orthodontic treatment. Method This retrospective study included 71 patients (76 cleft sides; age 7–22 years, mean 10.79 years) who underwent STIB alveolar cleft grafting at the Hospital of Stomatology, Guangxi Medical University, from July 2023 to August 2024. Patients were grouped by canine eruption and postoperative orthodontics: (1) unerupted canines without orthodontics, (2) erupted canines with orthodontics, and (3) erupted canines without orthodontics. Each group was subdivided into “canine-in-graft” and “canine-outside-graft” subgroups based on CBCT-confirmed canine position relative to the graft. CBCT scans were acquired immediately postoperatively and at 6 and 12 months. Mimics software was used for 3D reconstruction to quantify graft height, thickness, volume, and residual bone volume ratio—assessing long-term graft stability across groups. Result Without orthodontics, the unerupted-canine group had significantly greater graft volume and residual bone volume ratio at 12 months than the erupted-canine/non-orthodontic group (P < 0.05, P < 0.0002). The unerupted-canine/non-orthodontic and erupted-canine/orthodontic groups showed no significant differences in any graft parameter across all time points (P > 0.05). Among patients with erupted canines, the orthodontic group had significantly higher graft volume and residual bone volume ratio at 12 months than the non-orthodontic group (P < 0.05, P < 0.0001). Subgroup analysis showed that, regardless of eruption status, the “canine-in-graft” subgroup had significantly greater graft volume at both 6 and 12 months than the “canine-outside-graft” subgroup (P < 0.05). Conclusion Physiological canine eruption and postoperative orthodontics both reduce long-term bone resorption after STIB grafting. In patients with erupted canines undergoing late grafting, orthodontics compensates for lost physiological growth potential. STIB does not hinder canine eruption, and orthodontics can Page 3/28
successfully position erupted canines into the graft. Canine placement within the STIB graft helps maintain graft volume. Introduction Cleft lip and palate is a multifactorial congenital craniofacial malformation regulated by both genetic and environmental factors, with alveolar cleft accounting for a significant proportion of newborn craniofacial defects. Epidemiological data indicate that the global prevalence of cleft lip and palate is approximately 0.992‰, and about 75% of patients with cleft lip and palate also have associated alveolar cleft deformities [1–2]. Alveolar cleft repair is a crucial component of the comprehensive treatment sequence for cleft lip and palate, with the primary goals being restoration of dental arch continuity, reconstruction of the alveolar bone anatomy, and recovery of occlusal function [3]. Currently, surgical bone grafting remains the main treatment approach for alveolar cleft repair, using various graft materials such as autologous bone, allogeneic bone, xenogeneic bone, synthetic bone, and tissue-engineered bone. Among these, iliac cancellous bone grafts remain the "gold standard" in clinical practice due to their reliable osteogenic outcomes [4–5]. Cancellous bone of the iliac crest offers a large surface area and contact area, facilitating vascularized reconstruction after surgery and being rich in osteogenic cytokines, which promotes postoperative bone regeneration and remodeling [6]. However, this technique has a significant drawback—marked postoperative bone resorption, with reported long-term resorption rates as high as 80% [7]. In contrast to cancellous bone, cortical bone better resists contraction of surrounding soft tissues and reduces local adverse stress stimulation, thereby minimizing bone resorption and preserving graft shape. Nevertheless, cortical bone is deficient in osteogenic factors and has limited osteogenic potential, which not only increases the risk of poor graft outcomes but may also impede the normal eruption of adjacent canines [8–9]. In recent years, our center has used autologous semi-thick iliac crest bone blocks (STIB) to repair congenital alveolar clefts, achieving favorable clinical outcomes. STIB combines the advantages of both cancellous and cortical bone, ensuring successful osseous integration while effectively reducing postoperative bone resorption caused by local adverse stress. Previous studies have shown that the eruption status of canines is a critical factor affecting the prognosis of conventional cancellous bone grafting [10–11], with most researchers confirming that clinical success rates are significantly higher when grafting is performed before canine eruption compared to after eruption [12–13]. At the same time, some studies have affirmed the clinical value of postoperative orthodontic treatment, suggesting that orthodontic intervention following surgery can improve graft survival and reduce long-term bone resorption [13–14]. However, at present, there is still no relevant research either domestically or internationally investigating the long-term effects of natural canine eruption and postoperative orthodontic movement on the outcomes of STIB bone grafting, nor is it clear whether STIB grafting interferes with normal canine eruption. Therefore, this study aims to Page 4/28
explore the impact of canine eruption status and postoperative orthodontic treatment on the long-term efficacy of STIB in repairing alveolar clefts through retrospective analysis using digital methods, providing clinical evidence for timing selection and postoperative management in STIB bone grafting. Materials and Methods 1.1 Study Population This study included patients who received autologous semi-thick iliac bone graft (STIB) for alveolar cleft repair at the Stomatological Hospital Affiliated to Guangxi Medical University between July 1, 2023 and August 31, 2024. Inclusion criteria for patients were as follows: (1) Patients with available CBCT images taken preoperatively and immediately postoperatively, at 6 months, and 12 months;(2) Orthodontic group patients required postoperative orthodontic treatment; (3) All patients were treated by the same surgeon; (4) Patients with good compliance who could cooperate with follow-up. Exclusion criteria were as follows: (1) Patients with cleft lip and palate syndrome; (2) Patients who had previously undergone bone grafting; (3) Patients without canines on the cleft side or with severely impacted canines; (4) Patients with incomplete or unclear pre- or postoperative imaging data that prevented accurate measurement.Eligible participants were divided into two groups based on canine eruption status: the non-erupted canine group and the erupted canine group. The erupted canine group was further subdivided into a postoperative orthodontic subgroup and a non-orthodontic subgroup. Based on this classification, each group was further categorized according to whether the canine had been incorporated into the grafted bone block—resulting in subgroups of canines entering the bone block and those not entering the bone block. Differences in postoperative graft outcomes among these groups were compared and analyzed. Specific inclusion and exclusion criteria are shown in Fig. 1. This study strictly adhered to the ethical guidelines of the World Medical Association's Declaration of Helsinki. The research was approved by the Ethics Committee of the Stomatological Hospital Affiliated to Guangxi Medical University (Approval No. 2025098). All patients and their families were fully informed about the study content and treatment plan and had signed informed consent forms. 1.2 Surgical Procedure Bone Harvesting: A surgical incision was made slightly medial to the anterior superior iliac spine. The iliac cartilage was exposed by careful dissection through the layers of tissue. Based on preoperative cone beam computed tomography (CBCT) measurements, an autogenous semi-thick iliac bone graft matching the size of the alveolar cleft was harvested using a bone chisel. The graft consisted of equal proportions of cortical and cancellous bone. After thorough hemostasis in the donor site, a drainage strip was placed, and the wound was closed layer by layer. Bone graft bed preparation: Make a gingival incision along the edge of the alveolar cleft, thoroughly release and free the mucosal flaps on both the nasal and palatal sides, then suture to close the nasal and palatal clefts, thereby completing the bone graft bed preparation (Fig. 1A). Page 5/28
Bone block implantation and fixation: The harvested semi-thick iliac bone block is carefully shaped and sized to precisely match the recipient bed. The block is then implanted into the bony defect, ensuring that the cortical surface faces the labial side and the cancellous surface faces the palatal side (Fig. 2B). A fence-like fixation technique is employed, with titanium screws placed into the surrounding alveolar bone adjacent to the graft without penetrating or damaging the transplanted iliac block, thereby maintaining postoperative stability through stress-sharing principles (Fig. 2C). Finally, the surgical site is closed using a horizontal mattress suture technique (Fig. 2D). (A) Preparation of the bone graft bed; (B) Placement of the bone block; (C) Fixation with titanium plate; (D) Wound closure 1.3 Postoperative Orthodontics All patients who underwent postoperative orthodontic intervention had their fixed titanium screws removed under local anesthesia in the outpatient clinic three months after bone grafting, and postoperative orthodontic treatment was initiated simultaneously (Fig. 3). Using straight-wire appliance technique, the adjacent canines were gradually retracted toward the grafted area to guide their roots into the transplanted bone block, ultimately reconstructing a complete dental arch form and establishing a stable, harmonious occlusal relationship. 1.4 Imaging Analysis CBCT images of all patients were collected immediately after surgery, at 6 months postoperatively, and at 12 months postoperatively, and were uniformly exported and stored in DICOM format. The imaging data were imported into Mimics software for three-dimensional reconstruction and measurement of relevant parameters. All radiographic measurements were performed by the same researcher using the same equipment and consistent parameters to minimize bias related to equipment or operator variability. To ensure measurement reliability, each set of images was measured three times with oneweek intervals, and the average value was taken as the final result. Intra-class correlation coefficient (ICC) was used to assess measurement consistency; ICC values greater than 0.9 in this study indicated excellent repeatability and high reliability of the measurements. 1.5 Measurement of Graft Bone Block Parameters The DICOM data from the patient's CBCT were imported into Mimics software, with the axial plane used as the primary measurement workspace. The transplanted STIB bone block exhibited a regular shape and clear boundaries, and its bone density differed significantly from that of the surrounding autogenous alveolar bone and bone fragments, allowing for precise differentiation. Using the "Edit Mask" tool, the outline of the graft bone block was traced layer by layer, and the three-dimensional model of the bone block was reconstructed using the "Region Growing" function (Fig. 4A-B). Based on the reconstructed model, the length (Fig. 4C, E) and width (Fig. 4D, F) of the bone block were measured separately, while the three-dimensional volume of the graft bone block was automatically obtained via the "Mask Volume" function, completing the quantitative analysis. Page 6/28
(A