单侧完全性唇腭裂术后牙弓间横向关系的不调及正畸矫治后变化的探讨

目的 :探讨单侧完全性唇腭裂术后患者上下颌牙弓间横向关系以及正畸治疗对上颌牙弓的影响。方法 :对 84名单侧完全性唇腭裂术后患者的错畸形和上下颌颌间关系进行研究 ;并对 36名唇腭裂术后患者进行正畸治疗前后的牙模型进行测量分析上颌牙弓宽度的变化。结果 :(1)单侧完全性唇腭裂术后 6 0 .7%的患者出现牙弓间横向关系的不协调 ,双尖牙区较易受累。 (2 )在出现牙弓间横向关系不调的患者中 ,双侧后牙反者为 6 0 %。 (3)正畸治疗后上颌牙弓的尖牙、第一、第二双尖牙间各自的宽度均有显著增加 ,第一磨牙间宽度变化不显著。上颌第一、第二双尖牙间各自宽度较尖牙间、第一磨牙间宽度增加显著。结论 :单侧完全性唇腭裂术后患者上颌宽度的发育受到明显的限制 ,牙弓间横向关系不协调的比率较高 ,以双尖牙区为主 ;正畸矫治扩弓的重点应在双尖牙区。     

双侧完全性唇腭裂术后牙弓宽度的研究

目的探讨双侧完全性唇腭裂术后患者上下颌牙弓宽度关系及牙弓形态特征.方法唇腭裂组为23名第二恒磨牙已萌出的已经完成唇腭裂修复的双侧完全性唇腭裂患者,均为男性;选择23名年龄与唇腭裂组患者相匹配的第二恒磨牙均已萌出的正常(牙合)人作为对照组;制作牙(牙合)模型、记录颌间关系、游标卡尺测量牙弓各部位宽度并计算牙弓各段宽度与第二磨牙间宽度比,统计分析为两样本T检验.结果 (1)52.1%(12人)的患者存在后牙段的反(牙合),另外13.2%(3人)的患者宽度的不调累及双尖牙段及以前的牙弓.(2)双侧完全性唇腭裂患者上颌除第二磨牙外各段间牙弓宽度,均小于正常(牙合)人,差异有显著性;(3)上颌牙弓除第一磨牙远中尖外,其余各段宽度与第二磨牙的宽度比均显著减小,差异显著.(4)双侧完全性唇腭裂术后患者下颌牙弓各段宽度正常.结论双侧完全性唇腭裂手术修复后上颌牙弓发育受到明显影响,牙弓缩窄明显并以尖牙双尖牙区显著,后牙反(牙合)发生率较高;上颌牙弓从后向前渐进缩窄,牙弓呈尖型.     

单侧完全性唇腭裂患者牙弓宽度正畸扩弓治疗后的稳定性研究

目的探讨单侧完全性唇腭裂后牙反[牙合]患者正畸扩弓矫治后牙弓宽度的稳定性。方法已经完成保持的经过四角舌弓及固定矫治器正畸治疗的手术后单侧完全性唇腭裂患者20名（男性14名，女性6名），三维测量仪对治疗前、治疗后及保持后的研究模型进行尖牙间、第一、二双尖牙、第一磨牙间宽度以及基骨和牙槽弓宽度的测量。统计方法为配对资料的方差分析，两两比较用Fishe rLSD法。结果经过四角舌弓及固定矫治器治疗后单侧完全性唇腭裂患者上颌各段宽度均增加，差异有统计学意义；下颌除第一双尖牙外各段宽度变化不具统计学意义。正畸治疗后上颌牙弓宽度的增加在尖牙和双尖牙区大于磨牙区。保持结束后牙弓各段宽度较治疗后均有减小，其中上颌尖牙间宽度减小1．34±0．82mm（P〈0．05）、第一双尖牙间宽度减小1．52±0．78mm（P〈0．05）达到显著水平。但是保持结束后上颌各段的牙弓宽度仍大于治疗前，差异有统计学意义。结论经过四角舌弓及固定矫治器系统治疗后，单侧完全性唇腭裂患者上颌牙弓各段的宽度均显著增加；保持结束后上颌牙弓各段宽度虽有复发，但是大部分矫治结果能够保持。     

单侧完全性唇腭裂术后患者牙弓间宽度不调的矫治

目的　通过对单侧完全性唇腭裂术后患者上下颌间牙弓宽度不调的研究及对患者正畸治疗的临床观察 ,总结该类患者正畸治疗的特点。方法　对 4 8例单侧完全性唇腭裂术后患者进行临床检查 ,记录其上下牙弓间的宽度关系 ;根据患者错情况制定不同的治疗方案进行临床治疗。结果　 (1)单侧完全性唇腭裂术后患者中出现上下颌牙弓宽度不调的比率为 6 0 .4 % ,双侧后牙反为 33.3% ,单侧后牙反为 16 .7%。男女之间差异无显著性。 (2 )宽度不调以双尖牙区为重 ,上尖牙区是扩弓治疗的重点。 (3)磨牙区牙弓宽度的不协调常较轻微 ,一些患者甚至上颌最后磨牙区略宽 ,对 5例患者 (占 10 4 % )进行了上颌磨牙的腭向移动。结论　单侧完全性唇腭裂患者正畸治疗中上颌多需扩弓 ,且扩弓潜力较大。对于严重拥挤的患者 ,拔牙决定应在扩弓后作出。扩弓治疗应在牙槽突植骨前进行 ,扩弓后需延长保持时间     

安氏Ⅰ类边缘型牙列拥挤非拔牙快速扩弓矫治的临床疗效研究

目的研究安氏Ⅰ类边缘型牙列拥挤病例非拔牙快速扩弓矫治的牙弓参数变化,探讨其临床疗效.方法对9例安氏Ⅰ类边缘型牙列拥挤病例采用上颌快速扩弓配合上下固定矫治技术进行非拔牙正畸治疗,分别在T1(正畸治疗前)、T2(快速扩弓三个月后)和T3(正畸治疗结束进入固定保持期)三个时间点结合模型分析对牙弓参数进行分析.结果上颌第一磨牙、第一双尖牙和尖牙间宽度在T1、T2和T3相互之间均有显著性差异.下颌第一磨牙间宽度(T1-T2,T1-T3)和下颌尖牙间宽度(T1-T2)有显著性增加.上颌牙弓周径、上颌第一磨牙及第一双尖牙颊倾度有显著性增加(T1-T2),但有少量复发(T2-T3).下颌牙弓周径、下颌第一磨牙和第一双尖牙颊倾度随治疗均有显著性增加.结论快速扩弓能够通过改变上颌牙弓宽度增加其牙弓周径,下颌舌弓配合固定矫治也能显著增加下颌牙弓周径.因此可以较好地解决边缘型牙列拥挤中牙量/骨量不调问题,并有利于建立良好的咬合关系和疗效的稳定.     

自锁托槽对唇腭裂腭扩展短期效果的研究

目的：探讨自锁托槽对单侧完全性唇腭裂患者上颌腭扩展的短期治疗效果。方法选取5例恒牙期单侧完全性唇腭裂（UCLP）患者,未行牙槽突裂骨移植手术,上颌牙齿粘贴自锁托槽（AO, Time2）,放置高弹性镍钛弓丝,采集患者治疗前和腭扩展6~17个月后的牙颌模型、头颅定位后前位片进行测量,分析上颌腭扩展前后患者的牙弓、牙槽骨、腭穹窿以及颌骨的形态变化。结果牙颌模型测量结果提示：第一前磨牙区牙弓宽度明显增大,其次为尖牙区牙弓宽度,第一磨牙区牙弓宽度增加最少,第二磨牙区宽度减小。牙弓长度变化不明显。第一磨牙近中颊向扭转。腭部宽度增加,深度减小。头影测量结果提示：鼻腔宽度、上颌基骨宽度和上颌磨牙宽度稍有增加。结论唇腭裂自锁托槽腭扩展后上颌牙颌形态在横向宽度的变化较矢状向的变化明显。短期腭扩展治疗效果以牙齿移动和牙槽改建为主。     

快速上颌扩大后下颌牙弓、基骨弓宽度变化的研究

本文的目的是通过研究上颌快速扩弓后，下颌尖牙、第一双尖牙、第一恒磨牙牙弓、基骨弓宽度变化的影响。结果仅第一双尖牙、第一恒磨牙牙弓间宽度增加，平均增加分别为１．０５ｍｍ、１．９４ｍｍ，差异具有显著性（Ｐ＜０．０５）。提示出快速上颌扩大术是双牙弓狭窄错患者的适应症。其它下颌尖牙弓与基骨间以及下第一双尖牙、第一恒磨牙基骨弓间宽度无变化。     

MBT矫治前后牙弓宽度变化的模型分析研究

目的 分析牙列拥挤患者不拔牙与拔牙的MBT矫治对牙弓宽度变化的影响。方法 选择我院正畸科2008—2011年MBT矫治器治疗的牙列拥挤患者40例。其中轻中度牙列拥挤患者20例,使用MBT矫治器进行不拔牙正畸;中重度牙列拥挤患者20例,使用MBT矫治器进行拔除4颗第一前磨牙的拔牙正畸。测量术前术后石膏模型的牙弓宽度,对矫治前后不拔牙组和拔牙组的测量数据分别进行组内、组间统计学分析。结果 矫治前后不拔牙组:上颌尖牙间宽度增大,上下颌第一前磨牙、第一磨牙间宽度增大,有统计学意义;拔牙组:上颌尖牙间宽度增大,上下颌第二前磨牙、第一磨牙间宽度变小,有统计学意义。矫治前2组上下颌尖牙、第一磨牙间牙弓宽度相近,无统计学差异;矫治后不拔牙组上下颌第一磨牙间牙弓宽度大于拔牙组,有统计学意义,2组上下颌尖牙间牙弓宽度相近,差异无统计学意义。结论 不拔牙矫治牙弓宽度变化与拥挤部位、拥挤程度有关,拔牙矫治牙弓宽度变化主要与牙齿移动方向有关。拔牙矫治后尖牙间宽度不会减小。     

拔牙与不拔牙矫正治疗对牙弓宽度的影响

目的比较拔牙与不拔牙矫正治疗对牙弓宽度的影响。方法选择25例拔除第一或第二前磨牙的正畸患者,25例未拔牙的正畸患者,测量治疗前后的牙颌模型,记录上、下颌牙弓宽度,其中包括尖牙间、前磨牙间及磨牙间宽度,比较拔牙与不拔牙矫正治疗对牙弓宽度的影响。结果上、下颌尖牙牙弓宽度的比较中,拔牙组比不拔牙组大,上颌大1.79mm,下颌大1.95mm,(P<0.01)。磨牙区牙弓宽度差异无显著性。结论拔牙治疗不会导致尖牙区宽度的减小。     

摆式矫治器治疗安氏Ⅱ类错(牙合)的牙弓形态变化

目的 研究摆式矫治器治疗安氏Ⅱ类错(牙合)的牙弓形态变化.方法 应用摆式矫治器治疗安氏Ⅱ类错(牙合)患者32例,定量测量矫治前后上下颌石膏模型的尖牙间宽度、第一磨牙间宽度,测量结果行t检验.结果 上颌尖牙间宽度、上颌第一磨牙间宽度分别增加3.49 mm和3.04 mm.上颌第一磨牙的轴倾度减少3.77°.下牙弓的拥挤改善,前牙覆(牙合)减少3.37 mm、覆盖减少4.42 mm.磨牙关系由安氏Ⅱ类转为安氏Ⅰ类.结论 摆式矫治器可用于治疗轻、中度安氏Ⅱ类错(牙合),且避免拔牙.     

Dental arch width stability after quadhelix and edgewise treatment in complete unilateral cleft lip and palate

OBJECTIVE: To evaluate the transverse stability of the dental arch in unilateral cleft lip and palate (UCLP) patients after orthodontic treatment with quadhelix and edgewise appliances. MATERIALS AND METHODS: Twenty repaired complete UCLP patients with posterior crossbites were chosen as the study subjects. All had ceased retention at least 15 months previously. Measurements were carried out directly on the pretreatment, posttreatment, and postretention study models using a three-dimensional dental cast analyzer. The interdental widths were measured for the canines, first premolars, second premolars, first molars, basal bone, and the alveolar arch. Two-way analysis of variance and Fisher's LSD was performed in comparing the difference between intervals. RESULTS: Lower inter-first-premolar width and upper arch widths of each region increased significantly (P < .05) after orthodontic treatment. The expansion was greater in the anterior than the posterior region in the upper arch, and the greatest increase was in the upper first premolar region. The upper arch width decreased after retention, with the decrease of the arch width in the upper canine (1.3 +/- 0.8 mm) and first premolar (1.5 +/- 0.8 mm) regions being statistically significant. The increased upper arch width in each region and the lower inter-first-premolar width maintained significant expansion after retention. CONCLUSIONS: The widths of the dental arch increased significantly after expansion with a quadhelix followed by preadjusted edgewise treatment. Relapse occurred, especially in the upper canine and first premolar region, but most of the treatment effect on the upper arch remained after retention.     

恒牙晚期单侧完全性唇腭裂患者正畸治疗临床疗效研究

目的　通过测量恒牙晚期单侧完全性唇腭裂（UCLP）患者术后牙牙合、软硬组织的相关数据,观察正畸治疗对患者面型、牙弓及咬合关系的临床疗效。方法　选择10例UCLP恒牙晚期（15～17岁）术后患者,采用上颌慢速扩弓联合固定矫治,对治疗前、扩弓保持半年后X线头颅侧位片及扩弓治疗前、扩弓结束后、保持半年后牙牙合模型相关数据进行测量。采用配对t检验和配伍组设计资料的方差分析的统计方法,2组之间的两两比较用最小显著差(LSD)检验。结果　UCLP患者在正畸治疗后,X线头颅侧位片在软硬组织部分测量数据上有显著性变化(P<0.01),牙弓宽度在尖牙和前磨牙区有明显增加（P<0.01）,前磨牙区宽度的增加能稳定保持（P<0.05）。结论　 恒牙晚期UCLP术后患者经正畸治疗,骨骼、面部软硬组织及咬合关系均有较理想的治疗效果。     

The influence of early orthodontic treatment on the growth of craniofacial complex in deciduous occlusion of unilateral cleft lip and palate patients

This study evaluates dental occlusion and dental arch parameters of 5-6 year old children with unilateral cleft lip and palate (UCLP) treated and untreated orthodonticly before lip plastic with noncleft children. The aim of the study was to verify whether early orthodontic treatment improves deciduous dental arch relationship of children with unilateral cleft lip and palate.135 casts of 5-6 year old children from Riga and Vilnius were evaluated. 90 casts from children with UCLP (45 - got early orthodontic treatment, 45 - without early orthodontic treatment) and 45 casts from noncleft children. All patients with UCLP had surgically closed lip and palate; five-Year-Olds, Index was used to assess dental arch relationship of UCLP patients. Measurements of dental arch length, canine and molar arch width was taken similar to Bland and Altman method. Statistical analysis: the difference of the mean values was tested using t-test between and within groups: UCLP-1 (without early orthodontics), UCLP-2 (treated orthodonticaly before lip plastic) and control group - noncleft children). Measurements were performed by two calibrated orthodontists, mean error was calculated according to the Dalberg method. Measurement error was less than 1 mm. Measurements showed that the occlusion parameters and transverse distance between deciduous molars of UCLP-1 group differed from the occlusion of UCLP-2. Children who had got early orthodontics showed better growth of the maxillae. More cases with positive overjet and meziodistal or distal deciduous molar relationship had treated with early orthodontics. Maxillary width between deciduous molars was statistically significant wider in children with UCLP who had early orthodontic treatment comparing with untreated children. Growth of mandible was not inhibited and did not differ treated and untreated children with UCLP and control group.     

Transverse changes after surgical closure of complete cleft lip, alveolus and palate

Surgery for patients with unilateral (UCLP) and bilateral (BCLP) complete cleft lip, alveolus and palate has a considerable influence upon craniofacial growth. With respect to this, the cleft team at Hannover Medical School has attempted to reduce necessary surgical interventions to labioplasty, palatoplasty and veloplasty. Still, the effects of these operations influence maxillary growth to an extent which requires orthodontic treatment in all patients. This study focuses upon the transverse alterations of the alveolar arch and the deciduous dentition after lip and palate surgery. Dental casts prior to any surgical intervention and after labioplasty and complete palaotoplasty of the hard and soft palate were measured for transverse changes by using anatomical landmarks. The results indicate a significant occurrence of anterior relative to posterior arch width loss for both UCLP and BCLP patients. Orthodontic treatment should be planned and performed with respect to these findings in order to support craniofacial growth and prevent maxillary dental arch deficiency. Received: 2 November 1998 / Accepted: 15 February 1999     

唇腭裂患者牙槽突裂植骨术前使用半固定式四眼圈簧扩大上牙弓的正畸治疗

目的探讨半固定式四眼圈簧矫治器对伴有上牙弓狭窄的唇腭裂患者的扩弓效果。方法选择15例需行牙槽突裂植骨术的唇腭裂患者,术前正畸治疗先采用半固定式四眼圈簧矫治器扩大上牙弓,测量扩弓前、中、后的上颌左右尖牙、第一前磨牙、第一磨牙间宽度的变化。结果经过半固定式四眼圈簧矫治器扩弓治疗的患者,均在5个月左右的时间内有效地扩大了上牙弓。正畸治疗后上牙弓扩大,牙齿排列基本整齐,为牙槽突裂植骨术提供了良好的条件。结论半固定式四眼圈簧矫治器可有效扩大唇腭裂患者的上牙弓,同时配合固定正畸治疗,疗效确切,使用方便。     

单侧完全性唇腭裂患者的正畸治疗

目的总结单侧完全性唇腭裂患者正畸治疗过程与疗效。方法临床矫治15例单侧完全性唇腭裂患者,初诊年龄8～17岁,采用HX直丝弓矫治技术,部分配合活动矫治器进行矫治。结果矫治后牙列整齐,咬合良好,在患者有限的口腔解剖生理条件下达到最大程度的美观、稳定、健康和功能。结论正畸治疗是单侧唇腭裂患者序列治疗中的重要部分。     

A long-term study of transverse stability of maxillary teeth in patients with unilateral complete cleft lip and palate

summary The aim of this study was to investigate the long term post-treatment transverse stability of the maxillary dental arch in subjects with unilateral complete cleft lip and palate (UCLP) treated by the Harvold/Bøhn method of orthodontic expansion and prosthodontic retention. The treatment of 22 consecutive patients, primarily operated on during the period 1957–60, was completed at a mean age of 18.1 years by the provision of a fixed partial retention prosthesis across the cleft using the cleft side central incisor and canine only as abutment teeth. The cleft side lateral incisor was missing in each case. Dental casts were made at the time of abutment preparation and at six subsequent times with the final observation 13·5 years after treatment completion. Measurements of any shift in the transverse position of cleft side and non-cleft side canines, premolars and first molars were made on standardized photographs of the casts. A constructed antero-posterior palatal line served as 'midline' reference. A mean reduction of width at the final observation, as recorded from the palatal surface to the reference line, was for the cleft side canine: −0·4 mm, the premolar immediately distal to the prosthesis and the first molar: both −1·2 mm. The corresponding mean width reductions on the noncleft side were: canine −0·9 mm, premolar −1·2 mm, first molar −1·6 mm. The rate of movement towards the midline decreased linearly with in(time) for all variables (P < 0·02) but for the cleft side canine.