高位头帽-口外弓肌激动器治疗Ⅱ类高角儿童患者前、后的上气道变化

目的： 研究生长发育高峰期Ⅱ类高角错畸形患者矫形治疗前、后上气道的变化。方法： 收集并拍摄23例生长发育高峰期患者经高位头帽-口外弓肌激动器矫形治疗前（T1）、矫形治疗后（T2）的锥形束CT（CBCT），将T1和T2的CBCT数据导入Minics17.0软件中进行测量。采用SPSS22.0软件包中的配对t检验对安氏Ⅱ类儿童患者矫形治疗前、后上气道的变化进行分析。结果： 患者经矫形治疗后，上气道总容积、腭咽容积、喉咽容积、舌咽容积，软腭尖平面、会厌尖平面上气道的横截面积和口咽段最小横截面积，软腭尖、会厌尖平面的矢状径、横径的变化均具有统计学意义（P<0.05）；上气道形态在软腭尖平面趋于圆形（P<0.05），而在会厌顶平面无显著变化（P>0.05）。结论： 高位头帽-口外弓肌激动器矫形治疗使下颌骨发育不足的高角儿童患者上气道容积增大，通气量增加，呼吸功能改善。     

Pharyngeal airway changes following maxillary expansion or protraction: A meta‐analysis

The aim of this meta‐analysis was to investigate the changes in airway dimensions after rapid maxillary expansion (RME) and facemask (FM) protraction. Using PubMed, Medline, ScienceDirect and Web of Science, only controlled clinical trials, published up to November 2016, with RME and/or FM as keywords that had ≥6 months follow‐up period were included in this meta‐analysis. The changes in pharyngeal airway dimension in both two‐dimensional and three‐dimensional images were included in the analysis. Nine studies met the criteria. There are statically significant changes in upper airway and nasal passage airway in the intervention groups as compared to the control groups, assessed in two‐dimensional and three‐dimensional images. However , in the lower airway and the airway below the palatal plane, no statistically significant changes are seen in 2D and 3D images. RME/FM treatments might increase the upper airway space in children and young adolescents. However, more RCTs and long‐term cohort studies are needed to further clarify the effects on pharyngeal airway changes.     

无牙上颌骨组织应力分布的影响因素及三维有限元分析

目的：研究不同腭穹窿形态的无牙上颌骨组织表面压应力的分布及大小随加载方式及牙尖斜度变化而变化的规律。方法：分别对尖、平、凹三种腭穹隆形态的无牙上颌进行加载（全牙列、前牙列、双侧后牙列、单侧后牙列）,在牙尖斜度为0°、20°、30°时得出骨组织表面压应力的数值及应力分布图。结果：全牙列及前牙加载时无牙上颌骨组织前部为应力集中区,后牙加载时应力集中区向后牙牙槽嵴顶区转移。牙尖斜度的增加使后牙牙槽嵴顶区及上腭区应力值增加。凹型腭穹隆形态无牙上颌的受力较平型及尖型更显著。结论：腭穹隆形态、牙尖斜度及加载方式对无牙上颌应力值的影响有交互作用,加载方式对应力值影响最强,并且决定了无牙上颌的应力分布形式,腭穹隆形态对应力值的影响较牙尖斜度弱。     

口腔矫治器对阻塞性睡眠呼吸暂停低通气综合征患者上气道影响的磁共振研究

目的:采用磁共振(MRI)结合三维重建技术观察口腔矫治器对阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者上气道形态的影响.方法:对12例男性OSAHS患者进行静态MRI扫描,使用咬蜡块的下颌前伸定位方法,在牙尖交错位与口腔矫治器测定的下颌前伸位获得MRI图像.利用三维重建软件重现患者上气道立体形态影像,计算分析患者上...     

阻塞性睡眠呼吸暂停低通气综合征患者的牙弓与上气道形态变化及相关性分析

目的：：比较阻塞性睡眠呼吸暂停低通气综合征( OSAHS)患者与正常人牙弓及上气道形态差异,揭示OSAHS牙弓形态改变与上气道容积对应变化的关系。方法：利用上气道CBCT扫描及口腔模型测量经PSG诊断为OSAHS的男性患者( n=22)与正常男性对照(n=19)的牙弓形态与上气道容积变化,并行相关性分析。结果：OSAHS组上颌牙弓长度与腭弓高度分别大于对照组(均P<0.05);OSAHS组鼻咽段、腭咽段截面积及上气道总容积与腭弓高度、上颌牙弓长度呈负相关(均P<0.05),与上颌后段牙弓宽度呈正相关关系(P<0.05)。结论：OSAHS患者上颌牙弓形态的异常与鼻咽段和腭咽段容积的变化有关联。     

Three dimensional measurements of the palate using a semiconductor laser: The influence of anterior cross bite on the palate in deciduous dentition

The objective of the study was to make three dimensional measurements of the maxillary palate of 3- and 4-year old children who have developed anterior cross bite of deciduous dentition using a semiconductor laser. The effects of anterior cross bite were examined on the interdentition section area, the intradentition projection area, and the palate volume. Compared with normal occlusion, anterior cross bite of deciduous dentition caused smaller interdentition section areas at the deciduous canines and the primary first molars, and greater interdentition section areas at the primary second molars and between the posterior margins of the primary second molars. The intradentition projection area at the anterior dentition was smaller in anterior cross bite than in normal occlusion. The intradentition projection area at the posterior dentition in anterior cross bite was nearly the same as that in normal occlusion. The anterior palate volume was smaller and the posterior palate volume was greater in anterior cross bite than in normal occlusion. The above results suggest that anterior cross bite in deciduous dentition suppresses anterior growth and accelerates posterior growth of the maxillary palate.     

上颌快速扩弓联合前方牵引治疗骨性Ⅲ类错牙合畸形对上气道影响的锥形束 CT 分析

目的：研究上颌快速扩弓联合前方牵引治疗骨性Ⅲ类错(牙合)畸形对上气道影响的三维变化。方法：选择53例伴上颌骨横向发育不足的骨性Ⅲ类错(牙合)畸形患者。所有患者先采用 Hyrax 矫治器进行上颌快速扩弓,然后前方牵引矫治。平均扩弓16 d,前方牵引平均5个月。分别于扩弓前（T0）、扩弓结束时（T1）及前方牵引结束时（T2）拍摄锥形束 CT 并进行三维重建和测量。结果：扩弓结束时鼻咽段最小截面积、最小截面积处冠状径和鼻咽段容积显著增大（P ＜0．05）;前方牵引矫治后鼻咽段4项指标与扩弓治疗前相比明显增大（P ＜0．05）。结论：上颌骨快速扩弓联合前方牵引可显著增加鼻咽段上气道容积。     

上颌腭骨三维有限元模型的建立

目的建立腭骨三维有限元模型,为进一步研究腭部种植支抗进行上颌扩大的可行性及其与牙支抗的对比研究建立数学模型基础。方法采用螺旋CT断层扫描成年人上颌骨,计算机图像处理和转录技术,自编程序和ANSYS软件相结合,将CT扫描图像转换为可用于有限元建模的数值图像。结果建立了上颌腭骨、部分颧弓根部的三维有限元模型。结论借助螺旋CT扫描技术和ANSYS有限元分析软件,建立上颌腭骨的有限元模型是切实可行的。该模型为上颌腭部种植支抗的生物力学研究提供了一个平台。     

3-D Analysis of Palatal Morphology Associated with Palatalized Articulation in Patients with Unilateral Cleft Lip and Palate

Palatalized articulation is one of the major articulation disorders which patients with cleft palate face after palatoplasty. Various causal factors have been suggested to date, but the main cause remains poorly understood. To clarify the possible causes of palatalized articulation in speakers with cleft palate, three-dimensional palatal morphology in patients with/without palatalized articulation in unilateral cleft lip and palate (UCLP) was analyzed.Twelve UCLP patients with palatalized articulation (P group) and 20 UCLP patients with normal articulation (N group) participated in the present study. Speech was assessed in the two groups at the age of about four. Dental casts of the maxilla taken at the same time were analyzed three-dimensionally, and measurements in the horizontal, frontal, and sagittal planes were compared between patients with palatalized articulation and those with normal articulation. All dental casts were measured with a non-contact 3D laser scanner and the 3D data were analyzed with 3D-analyzing software.Our study demonstrated three major findings of palatal morphology in UCLP patients with palatalized articulation when compared with their non-palatalized counterparts : 1) the posterior region of the palate was narrow in the horizontal plane, 2) asymmetry of the anterior palate was severe in the frontal plane, and 3) the palate was flat and shallow in the sagittal plane.These findings suggested that palate deformities can affect the lingual-contact pattern, and may account for the backward movement of the articulation point.     

Vertical palatal bone dimensions on lateral cephalometry and cone-beam computed tomography: implications for palatal implant placement

Objectives: To evaluate the necessity of three‐dimensional imaging (computed tomography [CT]/cone‐beam computed tomography [CBCT]) for paramedian insertion of palatal implants. Material and methods: Lateral radiographs and CBCT scans were performed from 18 human skulls. For lateral cephalometry, the nasal floor (right/left) and the oral hard palate of all skulls were lined with a tin foil for contrast enhancement. The quantity of vertical bone as measured on lateral radiographs was compared with CBCT measurements obtained in median and parasagittal planes and at minimum bone height. Spearman's rank correlation coefficients were determined for bivariate correlation analysis. Results: The median palatal bone height on CBCT (mean 8.98 mm; standard deviation [SD] 3.4) was markedly higher than the vertical height seen on lateral radiographs (mean 6.6 mm; SD 3.2). Comparing lateral cephalometry with CBCT, the strongest association was observed at the minimum palatal bone height (r=0.926; P<0.001; Spearman's rank correlation coefficient). Conclusions: Lateral radiographs allow accurate and adequate assessment of vertical bone before paramedian insertion of palatal implants. The vertical bone dimension as displayed on lateral cephalometry reflects the minimum bone height rather than maximum bone in the median plane. Therefore, a preoperative CT or CBCT is only indicated when the lateral cephalometry reveals a marginal quantity of bone. To cite this article:
Jung BA, Wehrbein H, Heuser L, Kunkel M. Vertical palatal bone dimensions on lateral cephalometry and cone‐beam computed tomography: implications for palatal implant placement.
Clin. Oral Impl. Res. 22 , 2011; 664–668
doi: 10.1111/j.1600‐0501.2010.02021.x     

Panoramic Images versus Three‐Dimensional Planning Software for Oral Implant Planning in Atrophied Posterior Maxillary: A Clinical Radiological Study

Purpose: The objectives of this radiographic study were to determine to what degree the available residual bone area for implant placement was underestimated on panoramic radiographs (by comparison with multislice computed tomography CT/cone beam CT images combined with planning software) and to what degree the rate of severely resorbed posterior maxillae requiring sinus lift was overestimated on panoramic radiographs (by comparison with planning software in combination with strategic implant placement). Materials and Methods: During a 2‐year period, every patient who presented for the placement of implants in the posterior maxilla was examined by three practitioners to discuss the treatment plan. When two to three practitioners indicated a sinus lift with creation of a lateral window, a CT scan was performed and examined using dedicated three‐dimensional software by a clinician familiar with the Computer Assisted Design/ Computer Assisted Manufacturing (CAD/CAM) implant placement protocol. For each tooth to be replaced, the presence of anatomical features such as anterior or posterior wall, palatal curvature, and septa were examined in view of the placement of an 8‐mm or longer implant. Results: One hundred one patients were studied in this case series for the treatment of 135 edentulous spans accounting for 301 missing teeth. After examination of the CT data on the three‐dimensional software, 202 teeth (67.1%) could be replaced using a CAD/CAM procedure; 60.7% of the edentulous spans could be completely repaired by a crown or bridge supported by implants. In addition, 67.3% of edentulism with no teeth posterior to the span could be completely repaired using a fixed prosthesis supported by implants. Conclusion: This radiological study demonstrates that the use of a panoramic exam for oral implant planning in severely resorbed maxillae overestimates the need for a sinus augmentation procedure when compared with the use of both three‐dimensional planning software and strategic implant placement on small remaining bone volume.     

The effect of ethnicity and age on palatal size and shape: a study in a northern Chilean healthy population

Race and ethnicity influence the form of the human craniofacial complex in varying ways. The aim of the present investigation was to quantify the effects of ethnicity (mestizos, Aymara, non-Aymara), age (adolescents and adults), and sex on the form (size and shape) of the hard palate in normal Native American individuals. From the dental casts of 51 individuals with a complete permanent dentition, the x, y, and z coordinates of several standardized palatal landmarks were obtained with a computerized 3-dimensional digitizer. Palatal landmarks were used to derive a mathematical equation for palatal shape in the frontal and sagittal planes. Palatal width and length, frontal and sagittal heights, sagittal slope, and deviation of the raphe from the midline were also calculated. In the Aymara subjects, there was no effect of sex on palatal size, but there was an effect on palatal shape independent of size, especially with respect to male growth. Indeed, female palates apparently did not change their shape between adolescence and adulthood, while male palates increased their posterior "height." Overall, the 3 ethnic groups appeared to possess similar palatal size, with small significant differences. In the adult individuals, ethnicity did not seem to influence palatal shape. In contrast, adolescent males showed differences: non-Aymara subjects had the "highest" palatal shape, Aymara the "lowest," and mestizos an intermediate position. In conclusion, ethnicity does not seem to be a factor of major variability of human hard palate morphology, at least in the present 3 northern Chilean groups, as already found for dental arch shape. Age probably has a larger effect, particularly in the posterior part of the palate, where the eruption of the second and third molars between adolescence and young adulthood may play a role. A further development of the present investigation may involve larger samples of individuals from different ethnic groups.     

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??Objective    To analyze the correlation between OSAHS children's minimal width measured in cephalometrical film and the minimal cross section area in CBCT to determine the accuracy of airway 2D measurement in the diagnosis of airway obstruction. Methods    48 OSAHS children??10-12y??diagnosed by PSG were selected. All the subjects took cephalometrical film and CBCT at the same time. We got the airway volume and minimum cross section area by inputing DICOM form data into the dolphin. Make the Pearson correlation analysis concerning the minimum width and minimum cross section area. Results    The minimal upper airway site measured in cephalometrical film was at the same place where the minimal cross section area lied. The mean value of the most narrow sagittal width was??3.79 ± 2.40??mm??the minimal cross section area measured in CBCT was??103.30 ± 34.47??mm2. Pearson correlation R = 0.670??P < 0.05??. Conclusion    2D and 3D upper airway measurement in OSAHS children has strong correction. Cephalometrical film can reflect the airway condition and can be used in the primary diagnosis of airway obstruction site and degree.     

CT在唇腭裂二期牙槽突植骨疗效评价中的应用

目的 探讨唇腭裂二期牙槽突植骨后牙槽骨三维结构,以确保唇腭裂牙槽突植骨术后正畸 治疗的顺利进行。方法 选择唇腭裂二期牙槽突植骨术后半年以上的唇腭裂患者７名,病人的唇腭类型 分别为：单侧完全性唇腭裂６人,双侧完全性唇腭裂１人,牙槽突裂隙为８侧。病人的平均年龄为１５岁, 年龄范围 １１岁至 ２６岁。ＣＴ扫描平面与　面平行,从眶下缘至牙冠的根 １／３,每 ２毫米扫一层并进行三维 重建。结果ＣＴ可以真正反映唇腭裂牙槽突植骨部位的三维结构,能够发现唇腭侧存在的骨骼缺陷,有 利于唇腭裂序列治疗的顺利进行。结论 唇腭裂牙槽突植骨后,正畸治疗前采用ＣＴ这一先进手段进行 裂隙部位牙槽骨高度的三维评价,对于牙槽突植骨后正畸治疗及唇腭裂序列治疗具有十分重要的意义, 使牙槽突植骨的评价进入了三维时代。     

The adult unoperated cleft patient: absence of maxillary teeth outside the cleft area.

OBJECTIVE: The purpose of this study was to investigate the possible absence of teeth in the postcanine region of the upper jaw of the unoperated adult cleft patient. METHOD: The study was performed on 266 dental casts of fully unoperated adult cleft patients. The patients were divided into four groups according to the type of the cleft: unilateral cleft lip and alveolus, unilateral cleft lip and palate, bilateral cleft lip and alveolus, and bilateral cleft lip and palate. RESULTS: No absence of permanent teeth in the canine and postcanine area of the upper jaw could be found. CONCLUSION: The results are in contradiction with the established hypothesis that absence of teeth outside the cleft area of the maxilla is due to an unknown congenital factor. On the contrary, the findings support the hypothesis that surgery for the closure of the hard palate in early childhood is the most important etiological factor for the absence of teeth outside the cleft area in the early operated cleft patient. The superficial position of the tooth germs (at the time of the palatal surgery), especially those of the premolars, supports this hypothesis.     

Are panoramic images reliable in planning sinus augmentation procedures?

Objective: The inherent deformation and two‐dimensional nature of panoramic radiographs jeopardise their interpretation and quantitative measurements. This study aims to estimate the degree of underestimation of available mesio‐distal bone in the premolar area (comparing panoramic radiographs with multi‐slice/cone‐beam computer tomography [CT]) to determine the prevalence, width, length and position of the bony canal [artery] in the lateral sinus wall and to explore the prevalence, width and length of another (newly detected) bony canal at the palatal aspect of the upper canine. Material and methods: The distance between the distal side of the canine/first premolar and the mesial side of the first molar or the anterior wall of the maxillary sinus was measured on panoramic radiographs and corresponding multi‐slice/cone‐beam CT images (65 patients). Measurements were made at apical, mid‐radicular and crestal regions, parallel to the occlusal plane. The presence and dimensions of the two above‐mentioned intra‐osseous canals were verified on multi‐slice CT scans (144 patients) using reformatted cross‐sectional images and/or axial slices. Results: For all 65 patients, panoramic radiographs underscored the mesio‐distal distance of available bone in the upper premolar region (mean 2.9 mm, range 0.1–7.5 mm). An intra‐osseous canal in the lateral maxillary sinus wall was clearly visible in 49.5% of the cases (mean diameter 1.4 mm). In the canine region, a bony canal was obvious in 32.9% of the cases, with a mean diameter of 1.23 mm. For both canals, there was no correlation between diameter and patient's age. Conclusions: Based on the present data, cone‐beam CT imaging can be recommended for visualising anatomical structures during planning of sinus augmentation procedures. To cite this article:
Temmerman A, Hertelé S, Teughels W, Dekeyser C, Jacobs R, Quirynen M. Are panoramic images reliable in planning sinus augmentation procedures?
Clin. Oral Impl. Res. 22 , 2011; 189 –194.
doi: 10.1111/j.1600‐0501.2010.02000.x     

Posterior palatal seal adaptation: influence of processing technique, palate shape and immersion

Accuracy of fit of denture bases is critical to adequate retention. This study compared the dimensional change of a newer continuous-injection technique with a standard trial-pack technique as determined by measuring the posterior palatal border opening. The influence of palate shape and immersion were also assessed.
Stone casts were made from master moulds with either a high or flat palate. Denture base adaptation was measured at 5 mm intervals across the entire posterior palatal border. Measurements were made after deflasking, trimming and polishing, and after immersion in room temperature water for l h, 1 day and 1 week. Statistical analysis ( P < 0.05) showed that where differences occurred between the two techniques, openings were always smaller for the continuous-injection technique. It was also shown that dimensional changes were always larger for the flat palate compared with the high palate. Dimensional change using the continuous-injection technique was reduced by immersion in water, while no influence was observed for the trial-pack technique. It was concluded that the continuous-injection technique showed smaller dimensional changes compared with the standard trial-pack technique, and that these changes were influenced by palate shape and immersion in water.     

锥形束CT测量不同矢状骨面型无鼾症成年错(牙合)畸形患者上气道形态

目的 研究不同矢状骨面型无鼾症成年错(牙合)患者上气道形态的差异.方法 对I类、Ⅱ类和Ⅲ类矢状骨面型无鼾症成年错殆畸形患者各20例进行锥形束计算机体层摄影术(CBCT)扫描,借助Ez 3D 2009图像分析软件分别测量硬腭至会厌底段上气道的矢状径、横径、横截面积、长度、容积等,并对测量结果进行统计学分析.结果 不同矢状骨面型组各测量平面的气道截面积,SP平面、TE平面、EB平面气道矢状径,腭咽段上气道容积及上气道总容积的差异有统计学意义(P<0.05),I类、Ⅱ类矢状骨面型组各测量平面截面积、SP、TE、EB平面矢状径,腭咽容积、上气道总容积均小于Ⅲ类矢状骨面型组,差异有统计学意义(P<0.05).结论 不同矢状骨面型无鼾症成年错(牙合)畸形患者上气道形态间差异有统计学意义.无鼾症成年错(牙合)畸形患者上气道形态受矢状向颌骨关系影响.     

软腭肌解剖与重建对软腭组织结构影响的实验研究

目的:观察软腭肌解剖与重建复位对软腭肌组织结构的影响.方法:9只成年家猫,以一侧翼突钩至腭中线为界将半侧软腭均分为3 部分,作为软腭肌不同的解剖程度范围的标志.依照肌肉解剖程度范围的不同随机分为3组,轻度组(<1/3组),中度组(1/3-2/3组),最大程度组(>2/3组);对照组为任一家猫正常侧软腭肌.实验对象行一侧软腭肌的解剖剥离并重新缝合至原位,术后1、2、3月切取实验侧软腭肌与正常肌肉分别行常规HE染色和透射电镜观察.结果:解剖范围小到中等时(0～2/3区域),软腭肌组织学形态和超微结构与正常对照组无明显变化.解剖范围较大(>2/3区域)时,术后早期(1 月)肌纤维排列稍紊乱,不致密,较多炎性细胞浸润,伴新生的肌纤维形成;术后2～3月,肌肉排列较整齐和致密,新生的肌纤维变得逐渐成熟,炎性细胞明显减少.超微结构显示:术后1 月肌节排列略疏松,Z线欠清晰,肌纤维变少,变窄;术后2～3月,肌节排列较为整齐,Z线清晰.结论:软腭肌的解剖与重建对软腭组织结构的影响较小,术后短期内肌肉的损伤可修复和再生.