PAOO手术的临床实践考量与决策

doi:10.13591/j.cnki.kqyx.2026.09.001

摘要/Abstract

摘要：

成人正畸治疗需求日益增加,但患者常面临治疗周期长及牙周并发症风险高等问题。牙周辅助加速成骨正畸(periodontal accelerated osteogenic orthodontics,PAOO)通过骨皮质切开与骨移植材料的联合应用,借助区域加速现象(regional acceleratory phenomenon,RAP)缩短疗程、改善牙周表型、降低骨开窗与骨开裂风险并提高正畸后稳定性。本文系统回顾PAOO的发展历程及不同术式的特点,总结手术流程;结合文献证据与临床实践,围绕适应证、骨移植材料选择、屏障膜使用、软组织增量时机等临床决策难点及手术并发症处理提出建议,以期为PAOO的规范化临床应用提供参考。

关键词: 牙周辅助加速成骨正畸, 牙周表型, 临床决策, 并发症处理, 正畸治疗

Abstract:

The demand for adult orthodontic treatment is increasing, yet patients often face challenges such as prolonged treatment duration and elevated risks of periodontal complications. Periodontal accelerated osteogenic orthodontics(PAOO), which combines corticotomy with bone grafting, leverages the regional acceleratory phenomenon(RAP) to shorten treatment time, improve the periodontal phenotype, reduce the risk of fenestration and dehiscence, and enhance post-orthodontic stability. This article systematically reviews the developmental history of PAOO and the characteristics of various surgical techniques, and summarizes the procedural workflow. Integrating evidence from the literature with clinical practice, we provide recommendations on key clinical decision-making issues, including indications, selection of bone graft materials, use of barrier membranes, timing of soft tissue augmentation and management of surgical complications, with the aim of informing the standardized clinical application of PAOO.

Key words: periodontal accelerated osteogenic orthodontics, periodontal phenotype, clinical decision-making, management of complications, orthodontic treatment

中图分类号:

R781.4

吴靖, 赵珂, 王晓璇, 曹正国. PAOO手术的临床实践考量与决策[J]. 口腔医学, 2026, 46(9): 641-651.

WU Jing, ZHAO Ke, WANG Xiaoxuan, CAO Zhengguo. Clinical considerations and decision-making in PAOO[J]. Stomatology, 2026, 46(9): 641-651.

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提出人(年份)	技术名称	关键操作/改良	优势	不足
Kim等(2009)^[24]	骨皮质切开术(corticision)	不翻瓣;使用加强型手术刀及骨槌进行骨皮质切开。	创伤小,操作快捷,成本较低。	RAP效应有限;器械易断裂;患者震动感强,不能进行硬组织增量。
Dibart等(2009)^[25]	超声骨皮质切开术(piezocision)	不翻瓣;使用超声骨刀进行骨皮质切开。可辅助内窥镜^[26]或CAD/CAM手术导板^[27]。	创伤小,术后不适感较低,切割只作用于矿化组织,更安全。	软硬组织增量操作复杂,多切口术后易留瘢痕。
Seifi等(2012)^[28]	激光辅助骨皮质切开术(laser-assisted flapless corticotomy,LAFC)	不翻瓣;使用激光行骨皮质切开。	无机械震动,舒适度高,耗时短;术后疼痛轻、愈合快。	加速效果的维持时间有限;设备贵;美学区瘢痕风险;软硬组织增量操作难度大。
Buyuk等(2018)^[29]	盘状切开术(discision)	不翻瓣;使用圆盘锯连接牙科手机进行骨皮质切开。	创伤小,设备成本低。	仅限垂直切割;对术者操作精细度要求高。
Alikhani等(2013)^[30]	微骨穿孔术(micro-osteoperforations,MOPs)	不翻瓣;使用微型螺钉直接穿透牙龈及骨皮质。	创伤最小;无需切开,术后瘢痕风险低;操作简便。	RAP程度较轻、持续短;需反复穿刺,增加治疗时间和费用;不能进行硬组织增量。
Wu等(2015)^[31]	改良加速成骨正畸(improved accelerated osteogenic orthodontics,IAOO)	仅翻开单侧全厚瓣,省略根尖下骨皮质切开。	术野清晰,便于进行软硬组织增量;相对PAOO,创伤较小,手术效率高。	需翻瓣,存在术后肿胀、不适风险。