唇腭裂患者的双重牙列修复

目的 试图修复唇腭裂患者的牙列,以恢复他们的美观、咀嚼和发音功能。方法 用双重牙列修复的方法对２３例唇腭裂患者进行治疗。结果 ２３例患者全部得到满意的效果。结论双重牙列是唇腭裂患者比较实用的修复方法。     

树脂基托、钛基托全口义齿戴用前后语音效果的对比研究

目的对全口义齿初戴前后的临床语音适应效果做出主观评价。方法以患者自评和语音专业人员共同评价汉语语音清晰度的方法,分析30例全牙列缺失患者在义齿初戴前、初戴时、初戴后1、2、4、8周的语音变化规律。结果全口义齿初戴时,两实验组均感觉发音不适,初戴1周后,金属基托组已感觉能适应义齿,塑料基托组需2周以上时间。语音清晰度测评显示,义齿初戴后1周,两组之间有显著性差异(P<0.05),此时金属基托组已显示与初戴前有非常显著差异(P<0.01),塑料基托组需2周以上时间。结论减少全口义齿基托厚度,重建腭皱形态,有助于牙列缺失患者语音功能的恢复,其语音清晰度值较高。     

上前牙缺失兼深覆的可摘局部义齿修复

本文对上前牙缺失的深覆患者,采用将基托设计在唇侧,卡环由颊侧伸向腭侧安放的修复方法,虽司解决腭侧基托问题,但深覆(牙合)未能矫治,这是主要缺点,应予重视。     

小基托舌侧卡环可摘局部义齿63例

可摘局部义齿至今仍是牙列缺损的主要修复方法。传统的可摘局部义齿通常舌腭侧的基托较宽厚、固位卡环置于基牙唇颊侧[1]。当今人们崇尚自然美,尤其是那些单纯前牙缺失且缺牙数较少的青年患者往往不能接受上述传统可摘局部义齿。为此,笔者设计了小基托舌侧卡环可摘局部义?..     

单侧上颌骨切除术后赝复体修复患者的语音评价

目的：对单侧上颌骨缺失患者赝复体修复前后的语音及修复效果进行评价。方法：单侧上颌骨缺失患者15例,给予设计中空式基托的上颌阻塞器赝复体修复,练习被检敏感音/a／、/o/、/e/、／i／、/u/后,分别在初戴前和初戴后输入CSL4400,均测量第1、2、3共振峰（Fonnart）的平均值。使用SPSS11．0对资料行配对t检验。结果：初戴赝复体前后被检敏感音之间的差异主要集中在F2和F3上（P〈0．05）,初戴后较初戴前F3有显著性上升。结论：初戴后修复体重建软腭,有效地封闭了口鼻通道,形成近似正常的口腔环境。除F1外,初戴后几乎所有元音的F2、F3均发生改变。单侧上颌骨缺失患者赝复体修复,能显著提高语音效果。     

先天性腭隐裂发生腭瘘导致语音不清1例

本文报告1例患有先天性腭隐裂的成年女性,由于腭部炎症所致软硬腭交界处、软腭部2处穿孔(腭瘘)而导致语音不清患者,经外科手术转移黏骨瓣封闭前端硬腭部裂隙,行咽成形术后,关闭软腭部瘘孔同时缩小咽腔,得以恢复正常语音功能.     

计及牙尖斜度的上颌全口义齿基托应力及其分布状况

目的 :研究牙尖斜度对上颌全口义齿基托应力分布状况的影响 ,为预防上颌全口义齿基托折裂和全口义齿修复时人工牙牙尖斜度的选择提供理论依据。方法 :应用三维有限元应力分析法研究不同牙尖斜度时上颌全口义齿基托应力及其分布状况。结果 :随着牙尖斜度的增加 ,基托的应力集中状况明显加剧 ,牙尖斜度为 10°时 ,基托应力集中状况相对较缓 ,2 0°时次之 ;拉应力集中区由基托前腭部、前牙腭侧移动到唇系带切迹区 ;综合应力集中区由基托前腭部、前牙腭侧移动至后牙牙列的部位。结论 :牙尖斜度对上颌全口义齿基托的应力集中状况有明显的影响作用。临床行全口义齿修复时 ,宜选用牙尖斜度为 10°或 2 0°的人工牙 ,以便达到减缓基托应力集中之目的。提示如何使基托内集中的应力重新分布或减缓应力集中应是解决基托折裂的关键性问题。     

全口义齿修复后辅音第二共振峰的变化

目的研究全口义齿初戴前、后的临床语音适应效果。方法应用计算机语音分析系统(CSL)测量30例全牙列缺失患者在全口义齿初戴前、初戴时、初戴后1、2、4、8周/ji/、/qi/、/xi/的第二共振峰(F2)值。结果F2值大多在义齿初戴后下降,初戴1周后开始缓缓上升。义齿初戴前辅音条纹数目少,共振峰能量分散,冲直条和乱纹不多。适应义齿后,辅音条纹数目增多,3个共振峰清晰可见,各共振峰之间着色较浅,能量集中,冲直条和乱纹明显。结论全口义齿初戴后的语音适应过程呈规律性。CSL可对全口义齿初戴前、后患者语音变化特征进行定量分析,对临床修复有较好的指导意义。     

全口义齿初戴前后辅音第2共振峰频率与带宽的变化

目的：研究全口义齿韧戴前后的语音适应效果。方法：应用计算机语音分析系统，测量30例全牙列缺失患者在全口义齿初戴前、初戴时及初戴后1、2、4、8周，/zi/、/ci/、/si/、的第2共振峰及带宽。结果：辅音第2共振峰及其带宽值在义齿初戴时与义齿韧戴前相比，有显著性差异。结论：全口义齿初戴后的语音适应过程呈规律性。计算机语音分析系统可对全口义齿初戴前后患者语音变化特征进行定量分析．对临床修复有较好的指导意义。     

上颌全口义齿后牙排列位置对腭部基托应力影响的有限元分析

目的运用三维有限元的方法分析上颌全口义齿后牙不同排列位置时上颌全口义齿腭侧基托的应力应变,进一步探讨上颌全口义齿基托的折断机理。方法采用Ansys有限元应力分析大型结构分析软件,建立三维数学模型,改变上颌全口义齿后牙排列位置,分别向颊侧平行移动2mm、4mm、6mm,计算腭侧基托各部位应力应变值。结果上颌全口义齿后牙从牙槽嵴顶向颊侧分别外移2mm、4mm、6mm,腭侧基托的应力应变值随外移量的增加而增加(P<0.05)。结论上颌全口义齿排牙时,后牙颊侧外移量的增加,导致腭侧基托中部应力应变值逐步增加,是引起基托断裂的重要原因之一。提示上颌全口义齿后牙排列以位于牙槽嵴顶为宜,其颊侧外移量最好不超过2mm。     

Prosthetic rehabilitation of cleft palate patients with fixed partial dentures

Treatment of cleft palate patients demands a well coordinated work of medical and dental specialists. In spite of the surgical and orthodontic therapy a prosthetic rehabilitation is often necessary because of missing teeth, maxillary hypoplasia, malocclusion and palatal defects. The prosthetic phase begins immediately after the orthodontic treatment. In this way the fixed partial denture replaces the retention appliance and stabilizes the achieved status. The aim of the prosthetic treatment is to improve the function of the masticatory apparatus, speech and aesthetic appearance of the patient. An important task of the prostheses is to support and lift up the upper lip and the base of the nose. There are several factors, which make the treatment difficult, like underdeveloped and collapsed maxillary arch, retrognath position of the maxilla, missing alveolar ridge, defects of the bone and mucosa, scars and stiffness of the upper lip. The maintenance of the oral hygiene with the fixed restorations is often difficult because of the stiffness of the upper lip, therefore the design of the pontic is very important especially in the cases, when the missing processus alveolaris has to be replaced in order to improve the harmony of the face.     

上前牙双牙列可摘义齿修复唇腭裂牙列缺损疗效评价

目的观察唇腭裂患者采用上颌前牙双牙列可摘义齿修复的临床疗效。方法 12例唇腭裂患者采用上颌前牙双牙列可摘义齿修复,术后随访2年,对修复后义齿使用情况、面容改善效果和口腔软硬组织健康状况等进行评价。结果 12例患者对面部美观、发音及咀嚼功能的改善、义齿使用效果、口腔健康状况和治疗费用等均比较满意。结论上颌前牙双牙列可摘义齿修复唇腭裂可以取得较好的临床效果,是一种简单、实用的修复方法。     

黏膜下腭裂的形态分类与腭咽功能分析

目的 通过观测黏膜下腭裂患者的多项指标,以了解黏膜下腭裂的解剖形态与腭咽功能,以期提高临床诊断和治疗的准确率。方法对2008-2014年就诊的276例黏膜下腭裂患者的资料进行回顾性研究,对其术前腭咽功能、腭部形态、是否伴发唇裂、就诊原因等因素进行分析,观察各指标与腭咽功能的相关关系。结果276例患者中,术前腭咽闭合完全（VPC）者96例（34.78%）,腭咽闭合不全（VPI）者151例（54.71%）,边缘性腭咽闭合不全（MVPI）者29例（10.51%）。单纯黏膜下腭裂者196例（71.01%）,伴发唇裂者80例（28.99%）,伴发唇裂者较单纯的黏膜下腭裂者有更高的术前VPC率。黏膜下腭裂有不同的形态,完全具备Calnan三联征者仅103例（37.32%）。结论不同类型黏膜下腭裂的构成比和腭咽闭合率不同,需综合考虑各个因素与腭咽功能间的可能关系,谨慎选择治疗方案。     

改良唇挡扩弓后牙齿及牙槽骨变化的 CBCT 研究

目的：研究改良唇挡单侧扩弓后牙齿及牙槽骨的变化。方法：20例单侧完全性唇腭裂患者应用改良唇挡进行单侧扩弓,扩弓前后分别进行CBCT扫描重建,测量裂隙侧牙齿及牙槽骨的变化并进行统计学分析。结果：①未经扩弓治疗的单侧完全性唇腭裂隙患者裂侧尖牙和前磨牙相对于健侧均表现为舌倾,其中尖牙舌倾最明显;②牙及牙槽骨均发生颊倾;颊侧牙槽骨倾斜度大于腭侧,变化量与牙齿的颊倾程度呈正相关性;③根尖基骨宽度增加。结论：唇挡扩弓后牙槽骨随牙齿的颊倾发生适应性改建,同时唇挡刺激牵引牙根尖基骨的改建,在适应症范围内唇挡扩弓是安全有效的。     

Dento-alveolar development in unilateral cleft lip, alveolus and palate.

BACKGROUND AND OBJECTIVE: Palatal surgery for cleft lip, alveolus and palate is considered to have the most powerful negative impact on maxillary growth. The aim of this study was to compare dento-alveolar development of the permanent dentition and morphology of the palate after surgery in unilateral cleft lip, alveolus and palate patients following two types of palatoplasty: supraperiosteal flap vs mucoperiosteal flap technique.PATIENTS: Thirty-eight patients born between 1976 and 1983 with a complete unilateral cleft of lip, alveolus and palate were studied. Fifteen patients were treated with supraperiosteal flaps (SP group), and the other 23 patients with mucoperiosteal flaps (MP group). In this cross-sectional study, dental casts of stage IV A of Hellman's dental age in each patient were used. METHODS: The following distances were measured: (1). transverse distance C-C', (2). transverse distance M-M', (3). palatal length, (4). palatal height. RESULTS: No statistically differences were seen between the SP and MP groups regarding C-C' and M-M'. However, palatal length and palatal height were significantly greater in the SP than in the MP group. CONCLUSION: The technique that leaves no denuded palatal bone is considered to be advantageous for the development of the alveolar process.     

唇腭裂患者口腔修复治疗的临床体会

目的：讨论固定桥修复、活动义齿修复、双重牙列修复这三种保守修复方法在唇腭裂患者口腔修复中的初步临床体会。方法：结合100例唇腭裂患者保守修复的治疗经验,讨论三种保守治疗方法的临床适应症和优缺点。结果：唇腭裂患者的保守修复治疗方法可以一定程度上恢复咀嚼功能和颌面外观,修复口鼻瘘,改善发音,同时获得心理康复等。结论：对于不能手术治疗的患者,在选择好适应症后,保守性修复治疗是一种简单、经济、实用的修复方法。     

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies-USP (HRAC-USP)--part 2: pediatric dentistry and orthodontics

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.     

Vestibuloplasty in patients with cleft lip and palate

After cleft lip repair the upper lip is sometimes attached at the premaxilla. The scar bands and contractures may occur deleterious effects on: the growth, the facial expression, the speech, problems during orthodontic treatment and in prosthetic dental care, regression of the attached gingiva, resorption of the transplanted bone and the aspect of the upper lip. In nine edentulous patients with cleft lip palate, in six patients with cleft lip palate and with a mutilated dentition and in ten younger patients with cleft lip palate the buccal sulcus was successfully restored. The importance of a free upper lip and adequate sulcus has been under-emphasized in treatment of the patient with cleft lip palate.     

Investigations on the Palatal Rugae Pattern in Cleft Patients

The study investigated the relationship of the palatal rugae to points and distances of the cleft palate during the time period from birth to early mixed dentition in subjects with unilateral and bilateral cleft lip and palate by means of a three-dimensional measuring system. The changes identified in the distances from the lateral palatal rugae points of the first and third rugae to the incisal point, the canine point and the tuberosity line made it possible to assess how growth and the various forms of therapy applied affected the position of the palatal rugae during the study period (from birth to early mixed dentition). Changes in the linear distances from the palatal rugae to the maxillary measuring points were identified during preoperative therapy, after lip surgery, and after palate surgery. A comparison of the distances from the palatal rugae with distances between equivalent points (incisal point-canine point, canine point-tuberosity line, canine point-canine point) revealed differences in some instances. The results suggest that the palatal rugae in combination with measuring points of the cleft palate can serve to depict the changes occurring in the anterior palate during various stages of therapy and growth.     

Construction of the new dental arch in the prosthetic rehabilitation of cleft lip and palate. Case report

The authors describe the prosthodontic rehabilitation of an adult patient with unilateral cleft lip and palate. After the surgical and orthodontic treatment of cleft lip and palate patients the prosthodontic treatment was started to correct the palatal defect, the malocclusion and the missing teeth. The authors emphasize on preliminary steps by using diagnostic casts and try-in dentures and they also suggest other directives in the dental management of cleft lip and palate patients.