Niigata Dent. J. 40（1）：19 － 28,

2010

19－ Original Article －The effects of timing of secondary alveolar bone graft on craniofacial morphology
in patients with unilateral cleft lip and alveolus.
Yassin Hemoudi 1）, Kazuhiro Yamada 5）, Toshikazu Asahito 1）,
Kazuhiro Ono 2）, Chikara Saito3）, Ritsuo Takagi 4）, Isao Saito 1）
1）

Division of Orthodontics Niigata University Graduate School of Medical and Dental Sciences (Chief: Prof.Isao Saito)

2）

Department of Oral health and Welfare Niigata University Graduate School of Medical and Dental Sciences (Chief: Prof.Kazuhiro Ono)

3）

Division of Reconstructive Surgery for Oral and Maxillofacial Region Niigata University Graduate School of Medical and Dental Sciences (Chief: Prof.Chikara Saito)

4）

Division of Oral and Maxillofacial Surgery Niigata University Graduate School of Medical and Dental Sciences (Chief: Prof.Ritsuo Takagi)

5）

Department of Orthodontics, Matsumoto Dental College. (Chief: Prof.Kazuhiro Yamada)

片側性唇顎裂患者における二次的顎裂部骨移植の時期の違いが顎顔面形態に及ぼす影響について1）

5）

へモーディ ヤシン ，山田一尋 ，朝日藤寿一
2）

小野和宏 ，齊藤3）

4）

力 ，高木律男 ，齋藤

1）

新潟大学大学院医歯学総合研究科歯科矯正学分野（主任：齋藤

2）

新潟大学大学院医歯学総合研究科口腔衛生支援学科（主任：小野1）

和宏教授）

新潟大学大学院医歯学総合研究科組織再建口腔外科学分野（主任：齊藤

4）

新潟大学大学院医歯学総合研究科顎顔面口腔外科学分野（主任：高木松本歯科大学歯科矯正学講座（主任：山田功功教授）

3）

5）

1）

力教授）
律男教授）

一尋教授）

平成 22 年４月 13 日受付

４月 27 日受理

Key word：u nilateral cleft lip and alveolus, early secondary bone grafting, late secondary bone grafting,
cephalometrics

Abstract
Objective: The purpose of this study was to compare the effect of early and late bone grafts in patients with Cleft
lip and alveolus only, consequently excluding the influence of palatal closure on craniofacial growth.
Subjects and Methods: The subjects were chosen from the records of the Orthodontic Clinic, Niigata University
Medical and Dental Hospital. 30 patients with unilateral cleft lip and alveolus only (without cleft palate) werechosen and divided into 2 groups based on the following selection criteria: Early bone grafting (EBG) at a mean
age of 8 years and 3 months. Late bone grafting (LBG) at a mean age of 13 years and 7 months. The majority had
orthodontic treatment during the mixed dentition. Lateral cephalograms were traced, and then 22 angular and 27
linear measurements were analyzed.
Results: Mann-Whitney test showed that all angular measurements were not significantly different between the 8and the 14 years old subjects in the EBG and LBG groups. The difference in the value of A'-PNS between 14 and8 years showed a significant difference when the groups were compared.
Conclusion: The present study showed decrease in anteroposterior maxillary growth in the EBG group. A
possible reason for our finding might be the inhibition of maxillary growth that caused bone grafting operationand the short evaluation period (around 1 year) in the LBG group, while it was longer for the EBG group. Graftedbone is possibly allowed to undergo resorption during remodeling or displacement of the new bone with longertime. As a result, the decrease in the maxillary anteroposterior length exhibited by the distance from A'- PNS was－ 19 －新潟歯学会誌

2040（1）：2010

recognized in the EBG group.
抄録
目的：本研究の目的は片側性唇顎裂患者において二次的顎裂部骨移植の時期の違いが顎顔面形態に及ぼす影響を明らかにすることである。
対象：新潟大学医歯学病院矯正歯科診療室において管理されている片側性唇顎裂患者のうち，早期二次的顎裂部骨移植を施行した 17 名（骨移植施行平均年齢８歳３か月，以下早期群と略す），晩期二次的骨移植群骨移植を施行した13 名（平均年齢 13 歳７か月，以下晩期群と略す）の計 30 名を対象とした。これらの８歳時ならびに 14 歳時の側面
頭部 X 線規格写真をトレースし，22 項目の角度計測ならびに 27 項目の距離計測を行ない，両群の８歳時ならびに14 歳時の値，および８歳時から 14 歳時の変化について両群間で比較した。
結果：８歳時ならびに 14 歳時両時期において，角度計測項目ならびに距離計測項目のすべての計測項目について両群間で有意差は認められなかった。しかしながら，８歳から 14 歳の変化量に関し距離計測項目のうち A'-PNS において，両群間で有意差を認めた。
結論：本研究では上顎骨の前後的な長さに関してその変化量に差を認めた。その理由として１．骨移植術施行時の外科的侵襲による成長抑制，２．晩期群では骨移植後移植骨の置換が完了せず，移植骨の吸収も少ない反面，早期群では骨移植後５年前後経過しており移植骨の置換がおこなわれ，A 点付近の骨吸収が生じること，から，上顎骨の前後的な長さに差が生じたと考えられた。

permanent maxillary canines9,11,12,13）. Specifically, bone

Introduction

grafting should be undergone before the eruption of
the canine in the cleft region, when the root of the

Orofacial clefts are very complicated conditions, withcanine is one-fourth to two-thirds formed14）. Bonehuge psychosocial difficulties to the patients and theirgrafting shouldn't be considered in isolation, but as afamilies. Interdisciplinary management by oral

part of a more comprehensive orthodontic treatment,

surgeons, orthodontists, peadodontists, general dentists

as it will allow a smooth eruption of the lateral incisorand speech pathologists is required for these patients.

and/or canine and will guarantee a well aligned

Because the treatment protocol differs among

maxillary arch without restoring to bridgework. In

different centers, many researchers have been trying

addition, oronasal fistulae are closed, and the maxillary

to assess the effects of the various steps of thesesegment is stabilized11,12）. At this point, the procedure

different protocols. The subjects' craniofacial

is able to create an osseous environment that permits

morphology is often characterized by a concave facial

the spontaneous eruption or orthodontic adjustment of

profile, which is believed to be caused by a lack of thethe canine tooth. The chances of obtaining a normal

intrinsic growth potential of the nasomaxillary complex

interdental septum in the former site of a cleft are

and/or the influence of surgical intervention 1,2） .

considerably higher when the grafting is done prior toMoreover, the difference in craniofacial growth in cleftcanine eruption 12）. On the other hand, bone graft

patients seems to depend on the extent of theplaced after the eruption of permanent dentition hasclefting

3,4）. Closure of the cleft in infancy by primary

more chances of resorption15）.

b o n e g r a f t i n g or periosteoplasty is gen e r a l l y

As sagittal and transverse growth of the maxilla has

considered to cause inhibition of subsequent maxillarylargely finished by 8 to 9 years of age12）, the chances

growth5,6,7,8）of interfering with maxillary growth are minimal after.

Since Boyne and Sands 9,10） introduced a techniquethis age; however, vertical growth of the alveolus

for bone grafting prior to the eruption of the canine,continues after that age. The beneficial effects of bone

many hospitals have adopted this method. Ideally,

grafting before eruption of the canine is that, as thesecondary bone grafting should be performed at thecanine erupts, it induces deposition of bone on theearly transitional dentition stage, after the eruption ofalveolar crest and adds to the vertical height of thethe permanent incisors, but before the eruption of themaxilla14）.

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