Influences on Stability Following Orthognathic Surgery

对正颌手术后稳定性的影响

• 批准号: 7802844
• 负责人: CEIB PHILLIPS
• 金额: $ 59.04万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 1979
• 资助国家: 美国
• 起止时间: 1979-01-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7802844
• 关键词: Address; Adolescent; Adult; Aftercare; Anterior; Area; Characteristics; Clinical; Clinical Data; Complex; Deformity; Demographic Factors; Dental; Detection; Development; Devices; Diagnostic; Effectiveness; Esthetics; Evidence based treatment; Exhibits; Face; Funding; Goals; Grant; Hospitalization; Impairment; Inferior; Informed Consent; Injury; Intervention; Jaw; Knowledge; Location; Longitudinal Studies; Mandible; Mandibular Advancement; Maxilla; Measures; Methodology; Methods; Modeling; Morphology; Nerve; Nerve Fibers; Observational Study; Open Bite; Operative Surgical Procedures; Oral; Oral health; Orthodontic; Osteotomy; Outcome; Outcome Measure; Patients; Pattern; Perception; Positioning Attribute; Postoperative Period; Procedures; Protocols documentation; Quality of life; Randomized Clinical Trials; Recovery; Reliance; Reporting; Research; Research Design; Sample Size; Sampling; Sensory; Severities; Site; Surface; Techniques; Testing; Three-Dimensional Imaging; Time; Trauma; Treatment outcome; United States National Institutes of Health; Variant; X-Ray Computed Tomography; base; bilateral sagittal split osteotomy; bone healing; clinical decision-making; clinically relevant; clinically significant; cost; daily functioning; dentofacial; evidence base; expectation; experience; improved; inferior alveolar nerve; interest; nerve injury; orthognathic; primary outcome; prospective; public health relevance; response; sample fixation; skeletal; skeletal surgery; soft tissue; standard of care; treatment planning

DESCRIPTION (provided by applicant): Patients seek treatment for dentofacial deformity with the expectation that their oral function, esthetics, and oral health will be improved and that their quality of life will be enhanced as a result of treatment. Findings from this project have led to significant progress in the treatment of dentofacial disharmony by quantitatively documenting the stability and clinical acceptability of various orthognathic surgery procedures and fixation methods used to treat dentofacial disharmonies. However, even with these advances, 1) clinically significant unacceptable post-surgery and post-treatment morphological changes occur in 5 to 20 percent of patients. The localization of the condylar and regional skeletal adaptations that occur after surgery and the effect of these adaptations and presenting clinical characteristics, procedural and/or demographic factors on the skeletal results at the end of treatment and after treatment is complete have not yet been characterized; 2) virtually 100% of patients who have a mandibular osteotomy experience a neurosensory alteration in the short-term after surgery and, on average, quantitative measures of neurosensory assessment will not have returned to baseline values by two years. Although "surgical trauma" is generally cited as the cause, mandibular morphology and/or fixation screw placement may also be significant contributing factors; and 3) patients still experience a lengthy and uncomfortable recovery period following orthognathic surgery and the cost puts treatment out of reach for many patients. During this project period we will continue our use of the systematic, protocol-based, prospective observational study design using longitudinal quantitative three dimensional analyses of ConeBeamCTs. Specific Aim 1 is intended to assess the potential predictors (demographic, presenting clinical characteristics, type of surgery, pre and post-surgery condylar morphology and position, and regional areas of skeletal modeling) that underlie the clinically observed variation in positional skeletal adaptation over time. Specific Aim 2 is intended to assess the effect of mandibular morphology and fixation screw placement on post-surgical sensory alteration. Specific Aim 3 is intended to assess an emerging treatment intervention, Temporary Skeletal Anchorage, that is less costly and requires less recovery time than single jaw osteotomy as an alternative approach to treatment for specific dentofacial disharmonies. The clinical data from these three specific aims will advance our ultimate goal of improving the quality of treatment for patients with dentofacial deformities by improving clinical decision making and treatment planning for orthognathic surgery and by enhancing the ability of patients to make informed treatment choices. PUBLIC HEALTH RELEVANCE: The results from this proposal will greatly enhance the understanding of the skeletal adaptations following facial skeletal surgery and identify specific morphology and/or specific regions that contribute to the variability in the skeletal response (Specific Aim 1) and nerve recovery (Specific Aim 2). Specific Aim 3 represents, to the best of our knowledge, the first prospective longitudinal comparison of the effectiveness and recovery pattern of temporary skeletal anchorage during orthodontic treatment versus orthognathic surgery. The successful completion of this project will provide additional knowledge to facilitate improvement of procedural techniques and treatment outcomes. This project represents the next step in achieving our overall goal of improving the outcomes and treatment options of patients seeking treatment for dentofacial disharmony by developing evidence-based treatments, incorporating diagnostic, procedural, and skeletal response information.

描述（由申请人提供）：患者寻求治疗牙本质畸形的治疗，并期望他们的口腔功能，美学和口腔健康将得到改善，并且由于治疗而提高其生活质量。该项目的发现通过定量记录各种正牙性手术程序的稳定性和临床可接受性和用于治疗牙纹质不和谐的固定方法的稳定性和临床可接受性，从而导致了牙面不和谐治疗的重大进展。但是，即使有了这些进展，1）5％至20％的患者发生了临床上明显的手术后和治疗后形态学变化。手术后发生的孔和区域骨骼适应的定位以及这些适应的作用，并尚未表征临床特征，程序和/或人口统计学因素对治疗结束时骨骼结果的临床特征和/或人口统计学因素尚未表征； 2）在手术后短期内经历了下颌骨术的患者中，实际上100％的神经感觉改变，并且平均而言，神经感觉评估的定量测量方法不会在两年内恢复到基线值。尽管通常认为“手术创伤”是原因，但下颌形态和/或固定螺钉放置也可能是重要的因素。 3）患者在正牙手术后仍然经历了漫长而不舒服的恢复期，并且成本使许多患者无法接受治疗。在这个项目期间，我们将继续使用纵向定量的三维分析，以基于系统的，基于协议的前瞻性观察性研究设计。具体目标1旨在评估潜在的预测因子（人口统计学，呈现临床特征，手术类型，手术前和手术后的do孔形态和位置，以及骨骼建模的区域区域），这是临床观察到的位置骨骼适应性变化的基础。特定的目标2旨在评估下颌形态和固定螺钉放置对手术后感觉改变的影响。特定的目标3旨在评估新兴的治疗干预措施，临时骨骼锚定，其成本较低，比单颌骨截骨术的恢复时间较小，作为特定牙纹质不和谐治疗的替代方法。来自这三个特定目标的临床数据将通过改善牙纹质畸形患者的治疗质量来提高我们的最终目标，通过改善牙齿矫正手术的临床决策和治疗计划，并增强患者做出知情治疗选择的能力。 公共卫生相关性：该提案的结果将大大增强对面部骨骼手术后骨骼适应的理解，并确定有助于骨骼反应变异性（特定目标1）和神经恢复的特定形态和/或特定区域（特定目标2）。据我们所知，具体目标3代表了正畸治疗与正牙性手术期间临时骨骼锚定的有效性和恢复模式的第一个前瞻性纵向比较。该项目的成功完成将提供更多的知识，以促进程序技术和治疗结果的改善。该项目代表了实现我们通过开发基于证据的治疗，结合诊断，程序性和骨骼反应信息来改善寻求牙面不和谐治疗的患者的结果和治疗选择的总体目标的下一步。