唇腭裂新生儿的腭裂数字化模型方法

目的:利用硅橡胶印模和结构光三维扫描技术制取唇腭裂新生儿出生后第2天的腭裂表面形态数字化模型.方法:采用特殊重体硅橡胶印模材料制取患儿腭裂印模,通过3DSS扫描仪对石膏模型进行三维数据采集,经逆向工程软件处理数据,建立腭裂的数字化模型.结果:结构光扫描系统采得的腭裂数字化模型形态清晰,在软件平台上可以自由编辑和测量.结论:利用结构光三维扫描技术可以获取理想的新生儿腭裂数字化模型,该模型具有快捷、能长期存储等特点.     

口内扫描数字化模型与硅橡胶制取石膏模型测量的对比研究

目的 研究应用口内扫描仪采集数字化牙颌模型与硅橡胶石膏模型测量之间的差异性.方法 选择口腔正畸科门诊初诊患者共30例,分别制取上下颌硅橡胶印模并灌制成超硬石膏模型;并用口内扫描仪（Trios,3Shape,丹麦）获取数字化模型并记录上下颌口内扫描时间.对口内数字化模型和石膏模型的牙齿宽度,牙弓长度、宽度,Spee＇s曲度进行测量,应用配对t检验分析各测量项目在两种模型测量的差异,独立样本t检验分析上下颌扫描时间、上下颌拥挤度的差异;重复测量计算组内相关系数（ICC）进行一致性检验.结果 两种模型上测量包含第一磨牙以前所有牙齿宽度,牙弓长度、宽度,Spee＇s曲度无统计学差异（P＞0.05）;所有重复测量ICC大于0.90.口内扫描时间上颌（411.9±162.2）s明显大于下颌（290.8±94.9）s,（P＜0.001）.结论 口内扫描获取的数字化模型与传统石膏模型测量之间无明显差异,有望在今后替代石膏模型.     

硅橡胶印模与口内扫描印模在口腔临床教学中的比较

目的：通过本科实习医师制取硅橡胶印模及数字化口内扫描印模的教学实践,对比2种取模方式的操作时间、学习的难易程度和患者的接受程度等。方法：6名本科实习医师分别作为医师和患者进行取模练习,由专人记录操作时间,并用视觉模拟量表（VAS）记录患者满意度。采用SPSS 23.0软件包对数据进行统计学分析。结果：在取模时间、学习总时间、总体舒适度方面,硅橡胶印模优于口内扫描印模,两者之间有显著差异(P<0.05)。结论：采用硅橡胶取模,患者的就诊体验更好。采用口内扫描印模技术,需要医师具有更熟练的操作技能。应用角色扮演的方式,实习医师可以更好地学习到不同取模方式的操作要点及注意事项。     

唇腭裂新生儿的模型制取方法初探

目的 探讨一种精确、简便、安全的唇腭裂新生儿上颌模型制取方法。方法 采用普通的藻酸盐印模材料,通过适当的方法制取唇腭裂新生儿的上颌模型。结果 通过采用本文的模型制取方法,可以在临床上获得满意的唇腭裂新生儿上颌模型。结论 利用该技术可以获取理想的新生儿腭裂模型,具有精确、简便、安全等特点,为临床广泛地开展唇腭裂术前正畸提供便利。     

高温高压消毒对超硬石膏模型三维精度的影响

目的：评价高温高压消毒对超硬石膏模型三维精度有无影响。方法：对30例患者制取藻酸盐印模,再用超硬石膏灌模,1h后脱模,静置24h定标志点。石膏模型扫描成数字模型后用测量软件进行标志点三维测量。测量后进行高温高压消毒。消毒后用同种方法测量标志点距离。最后用SPSS软件分析消毒前后数据。结果：高温高压消毒后对超硬石膏模型三维精度无统计学差异。结论：高温高压消毒对超硬石膏模型三维精度无明显影响。     

成人上颌骨性扩弓疗效评价及对面中部相邻骨块的影响

目的: 利用锥形束CT（CBCT）测量、分析上颌骨性扩弓（maxillary skeletal expander, MSE）治疗前、后在腭中缝扩开、牙与牙槽骨在横向上的变化及面中部上颌相邻骨块的移动,评估成人上颌骨性扩弓的疗效及对相邻骨块的影响。方法: 选择12例成人骨性上颌牙弓狭窄病例（男4例,女8例）,平均年龄（21.33±3.14）岁,采用MSE扩弓器治疗,治疗后解除后牙反,上颌牙弓宽度达到理想牙弓宽度,分别于扩弓前和扩弓完成后拍摄CBCT,测量相关骨性和牙性项目。采用SPSS 26.0软件包对数据进行统计学分析。结果: 扩弓后前部腭中缝宽度增加（2.38±1.01） mm、后部腭中缝宽度增加（2.25±1.08） mm（P<0.01）;上颌第一磨牙牙冠处平均扩开（5.56±1.38） mm、上颌第一磨牙牙根处平均扩开（4.14±1.29） mm（P<0.01）;双侧上颌第一磨牙倾斜度治疗前后变化无显著差异（P>0.05）;蝶骨翼突外侧板角度,蝶骨翼突外侧板宽度,上颌骨前部间距与上、下颧骨间距扩弓后有显著差异（P<0.01）;颞骨后部间距、双侧颧颌角扩弓后变化无显著差异（P>0.05）。结论: MSE对于成年患者具有良好的骨性扩弓效应,实现腭中缝的平行扩开。扩弓后牙出现一定程度的颊向倾斜,但牙相对于牙槽骨无明显移动。面中部相邻骨块受到矫治力影响,在三维方向上也将发生一定移动。     

191例福建居民上颌前牙解剖长度及宽度分析

目的: 通过锥形束CT（cone-beam CT, CBCT）测量分析,了解福建居民上前牙解剖学特征,为进行上颌前牙区修复提供参考。方法: 利用CBCT测量191例就诊于福建医科大学附属口腔医院门诊患者的1 146颗上前牙（中切牙、侧切牙、尖牙）各牙位的长度及宽度,根据性别进行分组,量化分析牙体解剖特征的参数比例（宽长比及宽度比）。采用SPSS 19.0软件包对数据进行统计学分析。结果: 男性中切牙、尖牙的宽度和长度大于女性,差异有统计学意义（P<0.05）,男性、女性侧切牙的宽度和长度无显著差异（P>0.05）;男性、女性上颌前牙的宽长比值无显著差异（P>0.05）,宽度比值差异有统计学意义（P<0.05）。结论: 临床上应充分考虑患者地区、种族及性别差异,以更好地进行上颌前牙修复。     

替牙期单侧完全性唇腭裂患者鼻上颌复合体对称性的锥形束CT研究

目的 探讨替牙期单侧完全性唇腭裂（unilateral complete cleft lip and palate, UCLP）患者鼻上颌复合体在三维方向上的对称性。方法 选择20例替牙期UCLP患者颅面部锥形束CT（CBCT）图像,运用Mimics 图像分析软件对骨组织进行三维重建,描记鼻根点及鼻上颌复合体健、患侧32个同名标记点,建立三维参考平面、分别测量32个点到三维平面的距离。采用SPSS 22.0 软件包对数据进行统计学分析。结果 在水平方向上,与非裂隙侧相比,裂隙侧点INM 、SPC处上颌骨的宽度小,点LPA、SPr处上颌骨宽度大,差异具有统计学意义（P<0.05)。在矢状方向上,与非裂隙侧相比,裂隙侧点LPA、Maz、SPr处深度大,点SPM、SPC处深度小,差异具有统计学意义（P<0.05)。在垂直方向上,裂隙侧点LPA、INM、Maz低于非裂隙侧,点SPC、SPr高于非裂隙侧,差异具有统计学意义（P<0.05)。其余各点均无统计学差异（P>0.05)。结论 替牙期UCLP患者鼻上颌复合体在三维方向上均不对称,不对称部位集中在鼻腔和牙槽骨处。眶部及远离裂隙的上颌骨区域未发现明显不对称。     

不同数字印模方式影响全瓷冠边缘适合性的研究

目的 研究硅橡胶印模扫描、直接光学印模和传统的物理印模对计算机义齿辅助设计与制作全瓷冠边缘适合性的影响。方法 用数控车床制备聚甲基丙烯酸甲酯材质下颌第一磨牙标准全冠预备体16个,采用硅橡胶制取精细印模,超硬石膏灌注翻制成石膏模型。分别采用扫描全冠预备体、硅橡胶印模和石膏模型获取数字化模型,制作48个氧化锆全瓷冠。采用间隙印模测量法评价3组冠的边缘间隙,应用SPSS 17.0软件对实验数据进行统计分析。结果 直接扫描组、硅橡胶印模组、超硬石膏组的全瓷冠边缘间隙测量结果分别为（69.18±9.47）、（81.04±10.88）、（84.42±9.96） μm。直接扫描组与硅橡胶印模组、超硬石膏组差异有统计学意义（P<0.05）,硅橡胶印模组与超硬石膏组之间差异无统计学意义（P>0.05）。结论 直接扫描、硅橡胶印模扫描、石膏模型扫描法全瓷冠的边缘适合性均在临床可接受范围之内,硅橡胶印模扫描可作为临床上获取数字模型的方式之一。     

睾酮水平对牙周炎小鼠模型炎症性骨吸收的影响及机制探讨

目的：探讨睾酮水平对牙周炎小鼠模型炎症性骨吸收的影响及机制。方法：48只SD小鼠随机分为未结扎组、假手术组、去势组、去势+睾酮组4组,每组各12只,分别进行空白处理、去势模型和牙周炎模型构建。于结扎术后6周采集小鼠内眦静脉血,测定血清睾酮水平。处死小鼠后,取左侧上颌骨组织,进行苏木精-伊红染色和亚甲蓝染色,比较各组小鼠牙槽骨丧失量（alveolar bone loss,ABL）和牙槽骨吸收面积。利用实时荧光定量PCR测定牙龈组织中炎性细胞因子mRNA的表达,同时对血清睾酮水平与ABL、牙槽骨吸收面积及细胞因子进行相关性分析。采用SPSS 20.0软件包对数据进行统计学分析。结果：假手术组、去势组和去势+睾酮组小鼠血清睾酮水平显著低于未结扎组（P<0.05）;去势+睾酮组小鼠血清睾酮水平显著高于假手术组和去势组（P<0.05）;去势组小鼠血清睾酮水平显著低于假手术组（P<0.05）;去势+睾酮组小鼠ABL显著大于未结扎组、假手术组和去势组（P<0.05）,去势组小鼠ABL显著小于假手术组（P<0.05）;去势+睾酮组小鼠牙槽骨吸收面积显著大于未结扎组、假手术组和去势组（P<0.05）,去势组小鼠牙槽骨吸收面积显著小于假手术组（P<0.05）;假手术组、去势组和去势+睾酮组小鼠牙龈组织中白介素1β（IL-1β）mRNA、白介素6（IL-6）mRNA及肿瘤坏死因子α（TNF-α）mRNA水平显著高于未结扎组,白介素10（IL-10）mRNA水平显著低于未结扎组（P<0.05）;假手术组和去势组小鼠牙龈组织中IL-1β mRNA水平显著低于去势+睾酮组,去势组显著低于假手术组（P<0.05）;血清睾酮水平与ABL、牙槽骨吸收面积、IL-1β呈正相关（P<0.05）。结论：牙周炎小鼠睾酮水平降低,睾酮长期耗竭状态可减少牙槽骨炎症性骨吸收,可能通过降低IL-1β水平而实现。合理降低睾酮水平,有可能成为减少牙周炎患者牙槽骨吸收的治疗新思路。     

Reliability of linear measurements on a virtual bilateral cleft lip and palate model.

OBJECTIVE: To assess the reliability and validity of measurements performed on three-dimensional virtual models of neonatal bilateral cleft lip and palate patients, compared with measurements performed on plaster cast models. MATERIALS AND METHODS: Ten high-quality plaster cast models of bilateral cleft lip and palate patients were scanned with an LDI-scanner to obtain a three-dimensional virtual model. Linear measurements were performed on the plaster cast models using a digital caliper and also on the three-dimensional virtual model using Viscam RP version 2.1 software. The measurements were performed by two observers on two occasions. RESULTS: Intraclass correlations ranging from .81 to .96 were found for all measurements except the measurement between the constructed reference point pr and reference point i (intraclass correlation = .40). A post hoc procedure in which top-view screen prints of the three-dimensional virtual model were used to perform the measurement between reference points pr and i demonstrated an intraclass coefficient of .90. CONCLUSIONS: Three-dimensional virtual models obtained by laser scanning neonatal cast models of bilateral cleft lip and palate patients can be used reliably and validly to perform linear measurements between existing reference points on the surface of the model using Viscam RP version 2.1 software. Measurements between reference points constructed outside the surface of the model cannot be validly performed on the three-dimensional virtual model with the software used in this study. For these measurements, top-view screen prints of the three-dimensional virtual model can be used.     

Palate morphology after unilateral and bilateral cleft lip and palate closure

The aim of the present study was to compare the morphology of the hard palate of patients with uni- and bilateral cleft lip and palate after palatoplasty using vomer and palatal pedicled flaps with the palatal morphology of non-cleft individuals. Eighty patients were enrolled into this retrospective study: 40 patients with cleft lip and palate (30 unilateral, 10 bilateral) and 40 non-cleft patients with class I occlusion, who served as controls. Analysis of the development of the maxillary arch and evaluation of palatal morphology were accomplished from reformatted CT scans from plaster casts of the maxilla at the age of 4, 10 and 15 years (cleft patients) and 10 years (controls). Width and symmetry of the maxillary arch and morphology of the hard palate were assessed in the canine and molar region and compared both among the cleft groups and the controls. Maxillary arch width as assessed from plaster casts did not differ significantly between uni- and bilateral cleft patients and was not significantly different from controls at the age of 10. Deviation from symmetry was present in both types of cleft and significant in unilateral clefts when compared to bilateral clefts and non-cleft patients. Palatal morphology did not differ significantly between uni- and bilateral clefts until the age of 15, but was significantly different from control patients in the molar area at the age of 10 presumably due to the medial shift of soft tissue flaps used for palatoplasty. It is concluded that palatoplasty significantly alters hard palate morphology particularly in the posterior area. The relevance of this alteration for speech and articulation remains to be explored.     

Presurgical nasoalveolar molding therapy for the treatment of bilateral cleft lip and palate: A preliminary study.

OBJECTIVE: To evaluate the outcome of presurgical nasoalveolar molding therapy in the treatment of patients with bilateral cleft lip and palate. DESIGN: A prospective study with blinded measurements. SETTING: The Cleft and Craniofacial Clinic at the University of Texas at Houston Medical School, Houston, Texas. PATIENTS: Eight patients with bilateral cleft lip and palate, treated between 2002 and 2004. INTERVENTIONS: The starting age for presurgical nasoalveolar molding therapy was 34.9 days and the average length of the therapy was 212.5 days. MAIN OUTCOME MEASURES: Measurements of intraoral and extraoral casts were performed, and statistical analyses were used to compare the differences between measurements before and after therapy. RESULTS: Intraoral measurements demonstrated that there was a statistically significant reduction of the premaxillary protrusion and deviation. There was also a significant reduction in the width of the larger cleft. Extraoral measurements revealed that there was a significant increase in the bi-alar width and in the columellar length and width. Moreover, there was a significant improvement in columellar deviation. Finally, the nostril heights of both sides were increased. CONCLUSION: The authors have quantitatively shown that presurgical nasoalveolar molding therapy has significant advantages in the treatment of bilateral cleft lip and palate patients. It improves the nasal asymmetry and deficient nasal tip projection associated with bilateral cleft lip and palate. It also forces the protruded premaxillary segment into alignment with the dental alveolar segments, improving the shape of the maxillary arch. As a result, the changes associated with presurgical nasoalveolar molding therapy help decrease the complexity of subsequent surgeries.     

Photographs of dental casts or digital models: rating dental arch relationships in bilateral cleft lip and palate

Yardsticks have been developed to measure dental arch relations in cleft lip and palate (CLP) patients as diagnostic proxies for the underlying skeletal relationship. Travelling with plaster casts to compare results between CLP centres is inefficient so the aim of this study was to investigate the reliability of using digital models or photographs of dental casts instead of plaster casts for rating dental arch relationships in children with complete bilateral cleft lip and palate (CBCLP). Dental casts of children with CBCLP (n=20) were included. Plaster casts, digital models and photographs of the plaster casts were available for all the children at 6, 9, and 12 years of age. All three record formats were scored using the bilateral cleft lip and palate (BCLP) yardstick by four observers in random order. No significant differences were found for the BCLP yardstick scores among the three formats. The interobserver weighted kappa scores were between 0.672 and 0.934. Comparison between the formats per observer resulted in weighted kappa scores between 0.692 and 0.885. It is concluded that digital models and photographs of dental casts can be used for rating dental arch relationships in patients with CBCLP. These formats are a reliable alternative for BCLP yardstick assessments on conventional plaster casts.     

Factors influencing changes in maxillary arch dimensions in unilateral cleft lip and palate patients until six months of age.

OBJECTIVE: The objectives of the present study were (1) to investigate whether growth increments until 6 months of age are influenced by particular factors, (2) to analyze whether anterior cleft reduction is dependent on the extent of the cleft width at birth, and (3) to examine the correlation between maxillary measurements at birth and the anterior cleft width at 6 months of age. DESIGN: The study design was prospective and longitudinal. SETTING: Heidelberg University Hospital Interdisciplinary Cleft/Craniofacial Center. PATIENTS AND METHOD: The longitudinal records of 34 patients (24 male and 10 female) with complete unilateral cleft lip, alveolar ridge, and hard and soft palate were included in this study. All patients were treated with the same protocol. All participants were assessed at 0 and 6 months of age. Maxillary plaster casts of the patients were analyzed using a computer-controlled three-dimensional digitizing system. MAIN OUTCOME MEASURE: Maxillary models were measured and compared to putative factors influencing growth. RESULTS: No statistically significant differences were found between maxillary growth changes and increases in weight and length. Similarly, there was no significant interaction between the extent of the alveolar cleft width at birth and its reduction prior to lip closure. In contrast, significant differences of maxillary growth increments could be found between male and female patients. Stepwise regression analysis demonstrated a correlation between maxillary measurements at birth and growth increments. CONCLUSION: The results of the study indicate that gender plays a certain role in growth changes within the first 6 months of age.     

Digital surface photogrammetry for anthropometric analysis of the cleft infant face.

OBJECTIVE: To analyze the three-dimensional morphology of the cleft infant face with digital surface photogrammetry. DESIGN: Fifty plaster casts of unoperated infants with cleft lip and palate were imaged three-dimensionally with digital surface photogrammetry. Twenty-one standard craniofacial measurements were taken. The plaster casts were divided into 4 groups with unilateral, bilateral, complete, and incomplete clefts of the lip and palate. The measurements were compared with standard values for healthy infants. RESULTS: Significant differences (p < .0025) were found for the alar base width (33% to 55%), the alar base root width (59% to 103%), the width of the nose (7% to 25%), the length of the alar wing (18% to 25%), and the intercanthal (6% to 17%) and biocular (4% to 12%) width, depending on the cleft type. The vertical dimensions of the nose and the upper lip did not differ significantly from the controls. CONCLUSION: This study describes preliminary data on the cleft infant facial deformity. The obtained results were mainly in agreement with data in the limited literature. Three-dimensional photogrammetry has proven to be reliable and can be applied more readily to potentially uncooperative patients.     

Evaluation of the intercanine distance in newborns with cleft lip and palate using 3D digital casts

Objective

The purpose of this present study was to compare, by means of 3D digital casts, the anterior transverse dimension of the dental arch of newborns with and without cleft lip and palate.

Material and Methods

The sample was composed of ninety-four children aged from 3 to 9 months divided into three study groups: Group I - children without craniofacial deformities (control group); Group II - children with unilateral cleft lip and palate; Group III - children with bilateral cleft lip and palate. Impressions were executed before lip and palate repair in patients with clefts. Dental casts were digitized using a 3D scanner linked to a computer. Measurements of the intercanine distance were measured on the digital casts. Intergroup comparisons were performed using ANOVA (p<0.05).

Results

The results showed a mean of 36.5 mm for unilateral cleft lip and palate group, 34.8 mm for bilateral cleft lip and palate group and 27.52 mm for the control group. There was a statistically significant difference between the control group and both groups of patients with cleft lip and palate. There was no statistically significant difference between complete unilateral and bilateral cleft lip and palate groups.

Conclusions

Patients with complete cleft lip and palate were born with an increased anterior dimension of the maxillary dental arch compared to non cleft patients.     

Relapse tendency in maxillary arch width in unilateral cleft lip and palate patients with different maxillary arch forms.

OBJECTIVE: The aim of this study was to investigate the relapse tendency in the maxillary dental arch widths in unilateral cleft lip and palate patients with different types of maxillary arch form. SUBJECTS: Thirty-two unilateral cleft lip and palate patients treated by one-stage surgical palatal closure were included. The subjects were divided into three groups according to the types of the maxillary arch forms: group A, symmetrical arch form; group B, collapse of minor segment; group C, collapse of both segments. METHODS: Using dental casts obtained at three different times, relapse in the intercanine, interpremolar, and intermolar widths in each group was assessed and differences between groups were investigated. Results: Patients in group A showed stable results in all measurements. Patients in group B showed posttreatment relapse in the intercanine width only, whereas patients in group C demonstrated significant posttreatment relapses in the interpremolar and intermolar widths. Comparison between groups showed more significant relapse in the interpremolar and intermolar widths of group C than in those of group B. CONCLUSION: The types of the maxillary arch forms in unilateral cleft lip and palate patients might play a stronger role in the stability of the maxillary dental arch widths after orthodontic treatment in patients with collapse of both segments and a severe degree of maxillary narrowness.     

Palatal surface area of maxillary plaster casts--a comparison between two-dimensional and three-dimensional measurements.

OBJECTIVE: To investigate the relationship between corresponding two-dimensional and three-dimensional measurements on maxillary plaster casts taken from photographs and three-dimensional surface scans, respectively. MATERIALS AND METHODS: Corresponding two-dimensional and three-dimensional measurements of selected linear distances, curve lengths, and (surface) areas were carried out on maxillary plaster casts from individuals with unilateral or bilateral cleft lip and palate. The relationship between two-dimensional and three-dimensional measurements was investigated using linear regression. RESULTS AND CONCLUSIONS: Error sources in the measurement of three-dimensional palatal segment surface area from a two-dimensional photograph were identified as photographic distortion (2.7%), interobserver error (3.3%), variability in the orientation of the plaster cast (3.2%), and natural shape variation (4.6%). The total error of determining the cleft area/palate surface area ratio was 15%. In population studies, the effect of using two-dimensional measurements is a decrease of discriminating power. In well-calibrated setups, a two-dimensional measurement of the cleft area/palate surface area ratio may be converted to a three-dimensional measurement by use of a multiplication factor of 0.75.     

Craniofacial growth in clefting from one month to ten years as studied by P-A headfilms

Craniofacial growth of 64 children with a unilateral cleft of lip and palate, 32 children with a bilateral cleft of lip and palate, and 78 children with a cleft of palate only were studied at the ages of one month, three months, six months, one year, 18 months, two years, and annually till the age of 10 years. Nine width and 12 height measurements are obtained from the tracings of p-a X-ray headfilms and analysed. It was found that the cleft type differences were mainly restricted to the base line width, interorbital width, optic foramen width, basal maxillary width, interorbital height, optic foramen height, and gonial height. For all these measurements except basal maxillary width, the means are in the order BCLP greater than UCLP greater than CPO. For basal maxillary breadth it was UCLP greater than BCLP greater than CPO. Sex differences are restricted to base line width, basal maxillary width, bizygomatic width, interorbital height, and optic foramen height. For these width measurements, males have larger means than females. For the height measurements, females have larger means than males.