骨性错牙合畸形正畸正颌联合矫治简介

目的:研究骨性错牙合畸形正畸正颌联合矫治过程中Artex牙合架系统的作用。方法:正颌手术患者术前采用Artex全可调式合架系统转移合关系,制作手术中间及终末合板。结果:通过Artex牙合架系统可精确转移患者口内三维咬合关系及整个牙合和颅面之间的位置关系并完全模拟下颌运动状态。结论:Artex牙合架系统的应用有利于帮助诊断和分析上颌畸形,有效解决上颌牙合平面偏斜及中线偏斜问题,可精确模拟术后颌骨位置,中间及终末合板制作精细,术后咬合关系好,术后正畸调整时间相对缩短。     

计算机辅助设计结合三维打印手术导板在面部不对称畸形矫治中的应用

目的本研究旨在观察双颌手术结合三维打印技术制作的定位手术导板在矫治上颌骨垂直向发育过度和下颌前突型不对称畸形的临床应用效果。方法选取14名因单侧上颌骨垂直向发育过度伴发下颌前突的不对称畸形患者,在快速原型技术制作的定位导板的辅助下,于短面侧行上颌Le FortⅠ型骨切开术和下颌支矢状骨劈开术,于长面侧行上颌Le FortⅠ型骨切开术和下颌支垂直骨切开术。分别在手术前、术后7 d、术后1年测量并对比上颌牙合平面偏斜度、下颌支倾斜度、下颌骨偏离度、颏部偏斜度等参数。结果所有患者的颌面不对称均得以矫治并达到满意效果。两侧术前的参数有明显差异(P<0.05),然而术后并无明显区别(P>0.05)。结论计算机辅助技术结合三维打印技术制作的手术定位导板将有助于进一步提高手术可预测性与准确性。     

骨性错畸形正畸正颌联合矫治简介

目的:研究骨性错畸形正畸正颌联合矫治过程中Artex架系统的作用。方法:正颌手术患者术前采用Artex全可调式合架系统转移合关系,制作手术中间及终末合板。结果:通过Artex架系统可精确转移患者口内三维咬合关系及整个和颅面之间的位置关系并完全模拟下颌运动状态。结论:Artex架系统的应用有利于帮助诊断和分析上颌畸形,有效解决上颌平面偏斜及中线偏斜问题,可精确模拟术后颌骨位置,中间及终末合板制作精细,术后咬合关系好,术后正畸调整时间相对缩短。     

利用锥体束CT对成人颜面不对称患者颌面部三维形态的研究

目的：通过锥体束CT（cone-beam computerized tomography,CBCT）资料分析颜面不对称患者上颌复合体及下颌骨的三维形态特征,以研究其颌面部三维形态的改变。方法：对25例成人颜面不对称患者使用CBCT采集颅面部Dicom数据,使用Mimics10.01对骨组织进行三维重建,选择描述上颌复合体及下颌骨形态的56项指标进行测量及统计分析。结果：梨状孔最外侧点,眶下点,颧牙槽嵴点,上颌尖牙、第一恒磨牙颈缘中点左右不对称;偏斜侧下颌升支、下颌体的长度均小于对侧;偏斜侧下颌升支平面、下颌体平面与矢状面的成角,下颌平面角均小于对侧;下颌角、下颌孔等相关测量项目双侧均有显著性差异。结论：颜面不对称患者颌面部畸形程度有从上到下逐步加重的趋势,主要表现为下颌骨形态异常,其立体空间结构发生了代偿性的旋转。     

数字化软件辅助设计在治疗偏颌畸形患者中的应用效果研究

目的　评价数字化软件辅助设计在治疗偏颌畸形患者中的应用效果。方法　选择2016年9月至2018年9月于中国医科大学附属口腔医院口腔颌面外科就诊的偏颌畸形患者18例。所有患者术前完成三维CT检查和牙列石膏模型的光学扫描，将数据分别以DICOM格式和STL格式传送至数字化工作站。在数字化软件中构建坐标系，重建上下颌骨、血管和神经束，并完成正颌外科的手术模拟预测，最后设计并打印患者上颌骨的截骨导板、复位导板和终末咬合导板。所有患者在术后6个月到口腔颌面外科门诊复查并行上下颌骨三维CT检查。利用数字化软件测量术后6个月患者两侧上颌第一磨牙点和尖牙点到眶耳平面和冠状平面的距离，计算非对称率；测量上中切牙点和颏顶点到正中矢状面距离作为术后效果的评价指标。结果　术后6个月患者两侧上颌第一磨牙点到眶耳平面和冠状平面距离的非对称率分别为（1.8 ± 1.0）%和（3.2 ± 1.7）%；两侧上颌尖牙点到眶耳平面和冠状平面距离的非对称率分别为（1.0 ± 0.8）%和（11.0 ± 4.8）%；上中切牙点和颏顶点到正中矢状面距离分别为（0.84 ± 1.05）mm和（1.49 ± 1.23）mm。所有患者均对面型表示满意。结论　数字化软件的模拟设计能够提高手术安全性，确保术中操作的精度，提高患者术后美学效果。因此，数字化软件辅助设计在治疗偏颌畸形患者中的应用具有重要的临床意义。     

上颌中线定位在矫治下颌骨偏突颌畸形中的意义

目的:分析下颌骨偏突颌畸形(Ⅲ类)合并上颌中线偏斜的颅面形态特征,总结分析采用正畸-正颌联合治疗矫治此类畸形的特点及难点。方法:通过对20例下颌偏突颌畸形(Ⅲ类)正畸-正颌联合治疗前后资料的对比分析,探讨该类牙颌面畸形的临床特点,以及正颌手术前后合理的正畸治疗,特别是上颌中线定位对保证功能与形态效果的重要性。结果:术前正畸疗程为10～20个月,平均18个月。术后正畸疗程为5～10个月,平均8个月。术前正畸必须解决:①去除患者三维方向的牙代偿;②协调其牙弓形态及宽度的不调;③矫正上颌中线。术后正畸治疗的主要目的是对咬合关系进行精细调整。19例患者均获得满意效果,1例患者上颌中线未完全改正。结论:下颌骨偏突颌畸形(Ⅲ类)合并上颌中线偏斜的临床表现复杂,有别于单纯的骨性Ⅲ类畸形,正颌手术前后的正畸治疗是保证矫治效果达到功能形态俱佳的关键,其中术前上颌中线的准确定位尤其关键。     

下颌骨发育性不对称畸形颌面硬组织特征的研究

目的:通过对44例下颌骨发育性不对称畸形患者的X线头颅定位后前位片的定点测量与分析,研究下颌骨不对称畸形患者颌面骨组织的特征性变化。方法:应用自行设计的正颌外科电脑模拟手术系统软件,选择41个头颅标志点,对44例下颌骨发育性不对称畸形患者的头颅定位后前位片进行测量分析。测量内容包括各标志点到面中线之间的距离、面部高度及颅面角度。采用加藤信一提出的非对称率计算方法[Q=(G-K)/G×100%]计算颌面骨各点、距离及角度的非对称率。采用SPSS11.0统计软件包对所得数据进行团体t检验。结果:下颌骨发育性不对称畸形患者的颅面骨非对称率自颅面上、中、下1/3逐次递增。面上1/3中的颧额缝点的非对称率在正常范围,而眶内侧点则与正常值有显著差异。颅面部非对称率较大的部位在下颌角点、角前切迹点、磨牙点、鼻旁点以及上颌牙槽突点等。上颌骨的不对称表现在牙槽骨的高度与宽度不对称。结论:下颌骨不对称畸形可引起上颌骨的继发性畸形改变,即上颌骨尤其是牙槽骨具有一定程度的功能代偿性变化。提示对于发育性偏颌畸形患者,早期功能性矫治具有重要意义。     

19例唇腭裂患者继发牙颌畸形正畸正颌联合治疗的经验

目的：探讨正畸及正颌手术联合治疗唇腭裂术后牙颌面畸形。方法：19例唇腭裂患者，通过术前正畸，并摄X线头颅侧位定位片，用计算机预测正颌术后侧貌，采用上颌Le Fort I型截骨前移术或加双下颌支矢状劈开截骨后退术。结果：治疗后SNA、ANB的角度明显增大（P＜0．001）。结论：唇腭裂患者的术前正畸主要是排齐牙列，直立牙长轴，下前牙的去代偿。唇腭裂术后上颌严重发育不良，由于受上颌周围痕牵拉，前移幅度受限，可采取双颌手术。     

颌面部不对称畸形的正颌外科治疗--附44例报告

目的：探讨治疗颌面部不对称畸形的各种正颌手术方法组合。为治疗这种畸形提供临床参考。方法：回顾性随访第四军医大学口腔医学院颌面外科1987-1999年用正颌外科治疗的44例颌面部不对称性畸形患者，总结其临床疗效和经验。结果：除一例患者偏颌畸形术1年复发外，其余患者均恢复了对称的面部形态，咀嚼功能，咬合关系和咬合平面，治疗效果满意，结论：应根据患者不对称畸形的不同原因和部位制定相应的正颌治疗方案，选择不同的术式组合，同时结合关节手术可获得满意的疗效。     

CBCT三维头影测量正中矢状参考平面的探究

目的利用CBCT对以S、N、Ba、Cg、PNS 5点构成的10种临床常用的正中矢状参考平面进行比较,评价其准确性,为建立CBCT三维头影测量面部对称性分析系统提供参考。方法选择53例12~20岁面部基本对称的正畸患者,拍摄头颅CBCT片,以10种常用的正中矢状参考平面为基准,分别计算出每位患者的面部不对称指数。结果 10个平面间有显著性差异(P<0.05),标志点到以S、N、Ba确定的正中矢状参考平面的面部不对称指数(11.07±4.15)最小。结论基于CBCT三维头影测量,以S、N、Ba点确定的正中矢状面的准确性最高。     

个性化上颌非对称旋转矫治上颌 平面偏斜畸形

目的评估上颌非对称旋转在矫正 平面偏斜不对称畸形患者中的应用。总结治疗面部不对称畸形患者的经验,为临床治疗面部不对称畸形提供参考。 方法选取32例 平面偏斜的面部不对称畸形患者,拍摄术前螺旋CT及术前、术后头颅正位片,术前在计算机辅助下模拟手术,设计个性化手术方案,不对称旋转上颌 平面,并将模拟数据用于手术中。采用配对t检验进行统计学分析比较术前、术后面部外形差异。 结果32例患者面部形态及功能均取得了良好的治疗效果,无术中及术后并发症发生,软硬组织取得良好对称性,面部外形协调美观。术后双侧上颌骨高度差异[（0.6 ± 0.5）mm]小于术前上颌骨高度差异[（4.7 ± 1.5）mm],差异有统计学意义（t= 15.172,P<0.001）。术后<平面偏斜度[（0.5 ± 0.5）°]小于术前<平面偏斜度[（4.4 ± 1.7）°],差异有统计学意义（t= 12.934,P<0.001）。术后非对称率[（0.7 ± 0.6）%]小于术前非对称率[（5.5 ± 1.7）%],差异有统计学意义（t= 15.640,P<0.001）。 结论（1）数字化计算机辅助外科技术能够模拟手术过程,设计手术方案,重建术后软硬组织形态并指导正颌手术的准确截骨;（2）上颌非对称旋转能够矫正上颌 平面偏斜畸形,达到面部软硬组织对称协调,改善面部不对称畸形。     

����������ǻ�����ܱ仯�о���չ

随着口腔正畸学的发展与成熟,口腔正畸医生和颌面外科医生通过良好的合作,有效地将口腔正畸学与颌面外科学紧密地结合起来,形成口腔正畸-正颌外科联合治疗骨性错耠畸形的治疗手段。正颌外科对于颌面部和牙弓形态学的改善已经得到学术界的普遍认可,并且获得越来越多患者的接受。正颌手术治疗后,患者颌骨和牙齿均有移动,打破了原有的口颌系统,重建咬合平衡。近些年来,关于患者正颌手术治疗后口颌系统功能改变的研究一直受到广泛关注并存在很多争议。本文就近年来正颌手术治疗后口腔生理功能变化的相关研究进展做一综述。     

平面与下颌矢状向位置关系的 X线头影测量研究

目的明确下颌处于不同矢状向位置时的牙形态,以及下颌矢状向位置与平面倾斜度的关系,为下颌矢状向位置异常患者的非手术正畸治疗提供策略依据。方法选取114例女性正畸患者治疗前的114张头影侧位片,根据ANB角的大小分为3组,每组各测量25项指标。对3组之间及两两组之间的差异进行方差分析和多重比较分析,对骨性指标与牙性指标的相关性进行直线相关分析。结果后牙平面（OP-P）倾斜度和上颌第二磨牙的垂直高度与下颌矢状向位置相关（P<0.05）。下颌后缩时,上颌第二磨牙垂直向萌出相对不足,OP-P倾斜度增加;下颌前伸时,上颌第二磨牙垂直向萌出相对过度,OP-P更平坦。当下颌处于不同位置时,牙轴近远中倾斜度有不同的代偿。下颌后缩患者上颌牙列牙轴远中倾斜,下颌牙列牙轴近中倾斜;下颌前突患者上颌牙列牙轴近中倾斜,下颌牙列牙轴远中倾斜。结论不同骨性环境下形态各有不同,正畸治疗下颌位置异常的患者时应重视后牙垂直高度的控制和对OP-P倾斜度的改变。     

Cephalometric and in vivo measurements of maxillomandibular anteroposterior discrepancies: a preliminary regression study

One of the aims of the present investigation was to assess three-dimensionally the anteroposterior discrepancy of dental bases using a noninvasive direct procedure. A second aim was to verify the relationship of three-dimensional soft-tissue measurement to the well-established two-dimensional cephalometric assessments of anteroposterior discrepancy. Dental and facial landmarks were directly digitized on 20 orthodontic and maxillofacial surgery patients aged 8 to 26 years using an electromagnetic three-dimensional computerized digitizer. The anteroposterior maxillomandibular discrepancy was measured by calculating the linear distances between the projections of subnasal and sublabial landmarks on the occlusal plane, subnasal and sublabial landmarks on Camper's plane, and insertion of maxillary and mandibular median labial frenula on the occlusal plane. From lateral cephalograms of the same patients, the following measurements were obtained: subspinale point-nasion-supramentale point (ANB) angle; corrected ANB angle that compensates for the position of the maxilla and rotation of the mandible relative to the cranial base; Wits appraisal; MM-Wits, linear distance between the projections of points A and B on the bisector of the palatal plane to mandibular plane angle; and soft-tissue Wits, linear distance between the projections of soft-tissue points A and B on the bisecting occlusal plane. The best two-dimensional vs three-dimensional linear regression (r = 0.91) was found between Wits appraisal and the linear distances between the projections of maxillary and mandibular median labial frenula on the occlusal plane (Wits = -1.05 x 3D measurement - 3.75). The three-dimensional evaluation of the sagittal discrepancy of the jaws directly performed in vivo may allow a more complete analysis of a patient's soft-tissue drape together with the underlying hard-tissue structure.     

女性骨性Ⅱ类高角患者牙合平面与上下颌骨矢状向位置关系的相关性研究

目的 探讨女性骨性Ⅱ类高角患者牙合平面与上下颌骨矢状向位置关系之间的相互关系。方法 选取48例成人女性骨性Ⅱ类高角患者正畸治疗前头颅侧位片,各测量27项指标。应用Pearson相关分析上下颌骨矢状向位置关系与牙合平面指标、牙合平面指标与牙齿指标的相关性。结果 ANB角与后牙牙合平面倾斜度（OPP-FH）相关性显著。OPP-FH与上颌第二磨牙垂直高度及倾斜度相关性显著。结论 女性骨性Ⅱ类高角患者上下颌骨矢状向位置关系与后牙牙合平面倾斜度关系密切。     

Dynamic orthognathic surgical procedure (DOSP) in asymmetric maxillomandibular dysmorphism secondary to unilateral micrognathia: Outcomes of 12 consecutive cases

This study aimed to evaluate the outcomes following a dynamic orthognathic surgical procedure performed at the end of growth to treat asymmetric maxillomandibular deformities linked to unilateral micrognathia when conventional orthognathic surgery was not feasible.The dynamic orthognathic surgical procedure (DOSP) combined concomitant mandibular distraction osteogenesis with contralateral poorly stabilized sagittal split osteotomy and Le Fort I osteotomy. Cephalometric studies were retrospectively conducted on pre- and postoperative lateral and frontal cephalographs, and maxillomandibular movements were calculated. Outcome scores were computed by both experts and laypersons based on photographic analyses.There was a significant postoperative increase in height of the micrognathic ramus in all patients (n = 12; p = 0.002). The angle between the occlusal cant and horizontal reference plane decreased significantly in all of the patients, as did the angle between the midline sagittal plane and mandibular tilt (p < 0.001). Postoperative outcome scores showed significant improvements in all cases, according to both expert and layperson groups.This procedure allows correction of maxillomandibular asymmetries linked to micrognathia. However, it cannot resolve all the factors participating in facial asymmetry, such as those originating in the oculo-auriculo-ventricular spectrum or complex tumor sequelae, and second-step procedures may be required.     

Stomatognathic function of patients who seek orthognathic surgery to correct dentofacial deformities

To determine the craniomandibular functional status of patients who seek orthognathic surgery, 48 adults with various dentofacial deformities were examined, and the functional parameters of the patients were compared with those of a normal population. The relationship between function and morphology was also studied. The method of study included a clinical examination of dysfunction, an evaluation of the number and intensity of occlusal contacts, a kinesiographic analysis of mandibular movements at the incisors, an evaluation of ramal and condylar vertical symmetry by means of dental rotational panoramic radiography, and an examination of profile and frontal cephalograms. Results of the examinations showed that the patients seeking orthognathic surgery showed craniomandibular functional patterns different from those of the normal group or healthy population. However, because no significant correlations were found among specific morphologic and functional characteristics and dysfunctional status (with the exception of condylar asymmetry, the maximal deviation of a maximal opening-closing movement defined on the sagittal plane, and the inclination of the maxillary central incisor in relation to the anterior cranial base), no clear cause-effect relationship was proved.     

Changes in bite force and dentoskeletal morphology in prognathic patients after orthognathic surgery

OBJECTIVE: We sought to evaluate the changes in bite force and dentoskeletal morphology in prognathic patients after orthognathic surgery. STUDY DESIGN: Twenty-four patients underwent orthognathic surgery to correct Class III skeletal and dental malocclusions. Ten patients who underwent Le Fort I and bilateral sagittal split ramus osteotomy of the mandible (ie, surgical correction of 2 jaws) and 14 patients who underwent only bilateral sagittal split ramus osteotomy (ie, surgical correction of 1 jaw) were compared. Bite force was measured preoperatively and at 3, 6, and 12 months postoperatively. The dentoskeletal morphology was assessed through lateral cephalograms obtained preoperatively and 12 months postoperatively. RESULTS: Twelve months postoperatively, the bite force was significantly greater in the patients who underwent surgery on 1 jaw than in the patients who underwent surgery on 2 jaws. Significant decreases in the gonial angle, occlusal plane angle, and anterior facial height were observed postoperatively in the patients with 1 surgically corrected jaw, but not in the patients with 2 surgically corrected jaws. Patients with 2 surgically corrected jaws experienced a greater increase in the Frankfort mandibular plane angle and a greater decrease in the posterior facial height than did those with 1 surgically corrected jaw. CONCLUSION: The difference in the preoperative-to-postoperative change in dentoskeletal morphology between the 2 groups is one of the factors responsible for the significant difference in postoperative bite force between the 2 groups.     

虚拟手术设计在双颌正颌手术中的精准性研究

目的评估虚拟手术设计在双颌正颌手术中的精准性,以期为临床提供参考。方法纳入需行双颌正颌手术的患者30例,利用CT数据和牙弓平面扫描数据建立复合颅骨模型,在Dolphin Imaging 11.7 Premium软件上模拟上颌骨LeFort I型骨切开术和双侧下颌支矢状骨劈开术,必要时行颏成形术,利用3D打印的手术导板将虚拟手术设计转移到术中。选择3个平面:眶耳平面(FHP)、面中平面(垂直于FHP且通过鼻根点)和冠状面(垂直于FHP且通过蝶鞍点)。选择6个标志点:上、下颌中切牙的近中接触点(UI、LI)以及上下颌第一磨牙的近中颊尖(U6-R、U6-L、L6-R、L6-L)。在虚拟手术模型和真实术后模型上测量选定标志点和对称平面之间的距离,并计算两模型之间的线性差异和总体平均线性差异(UI、LI、U6-R、U6-L、L6-R、L6-L分别与眶耳平面、面中平面和冠状面之间距离的平均差异)。确定由咬合平面、腭平面和下颌平面分别与眶耳平面和面中平面构成的角度值,并计算虚拟手术模型和真实术后模型之间的角度差异和总体平均角度差异。结果借助3D打印手术导板,虚拟手术设计被成功转移至实际手术中,所有患者术后对面型和咬合都很满意。虚拟与真实模型间的总体平均线性差异为0.81 mm(上颌骨0.71 mm,下颌骨0.91 mm);总体平均角度差异为0.95°(相对于眶耳平面的平均角度差异为1.10°,相对于面中平面的平均角度差异为0.83°)。结论虚拟手术设计有助于牙颌面畸形的诊断和治疗计划的制定,可以增加双颌正颌手术中骨块定位的精准性。     

Three-dimensional analysis of the occlusal plane related to the hamular-incisive-papilla occlusal plane in young adults

The planes which serve as references for cranium and face in dental clinical application included the occlusal plane, Frankfort plane, Camper's plane and hamular-incisive-papilla (HIP) plane. The HIP occlusal plane is a horizontal plane passing through the bilateral hamular notches and the incisive papilla (Dent Surv. 1975;51:60). The aim of this study was to estimate the relationship between the various occlusal planes and the HIP plane in Taiwanese young adults with approximately optimal occlusion. Study casts of 100 young adults (50 men and 50 women) were selected in this study. All market points on the maxillary casts were measured by a three-dimensional precise measuring device. The angular relationship between the four various occlusal planes and the HIP plane were investigated. The vertical distances between the cusp tips and incisal edges of maxillary teeth to the HIP plane were measured. Data were performed by the Statistic analysis software programme (JMP 4.02). The Student's t-test and Pearson's correlation test were used to test the statistical significance (P < 0.05). The results showed that the occlusal plane defined as the incisal edge of maxillary central incisor to mesiobuccal cusp tips of maxillary second molars had the smallest included angle with the HIP plane (2.61 +/- 0.81 degrees). The incisal edge of maxillary right central incisal to mesiopalatal cusp tips of maxillary first molars had the largest included angle with the HIP plane (7.72 +/- 1.60 degrees). The curve is drawn through the buccal cusp tips of maxillary teeth had better parallelism with the HIP plane.