前方牵引对早期前牙反(牙合)患者软组织侧貌的影响

目的:探讨前方牵引矫治对早期前牙反软组织侧貌的影响。方法:选择前牙反伴有颜面形态异常(审美线明显异常)的儿童60人,男27人,女33人,年龄范围8～11岁,平均年龄9.3岁,将样本随机分为对照组和前方牵引治疗组,观察及治疗周期为11～13个月,平均12.1个月。治疗前后分别拍摄头颅侧位X线片,进行头影测量分析,统计学分析采用配对t检验。结果:治疗组矫治后的面突角、全面突角、下唇基角及鼻唇角明显减小,上下唇基角明显增大,上唇突点到审美线距离明显改善,与对照组间的差异均呈高度显著性,而上唇基角及下唇突点到审美线的距离治疗前后无明显变化。结论:前方牵引矫治后面部软组织侧貌明显改善,凹面型变为直面型或者接近正常面型,鼻、上唇、下唇以及颏部四者间的关系趋于协调,唇部曲线变得平缓、协调。     

种植钉辅助上颌快速扩弓治疗年轻成人上颌牙弓狭窄的CBCT分析

目的 探讨种植钉辅助上颌快速扩弓治疗年轻成人上颌狭窄的效果.方法 样本包括15.5～28.0岁上颌骨性狭窄病例10例(男3例,女7例),平均年龄(20.1±5.4)岁.使用种植钉辅助上颌快速扩弓技术,分别于治疗前、扩弓后和保持3个月后拍摄CBCT,并对资料进行统计分析.结果 扩弓后腭中缝前部和后部分别增加3.49 mm和2.94 mm,后部腭中缝增量占扩弓器扩大量的47.9％,后部腭中缝增量占第一磨牙间宽度增量的52.3％.鼻腔宽度、上颌基骨和牙槽宽度扩弓后增加(P＜0.05),且保持三个月后增加量无明显改变.牙槽骨高度变化无统计学意义(P＞0.05).结论 种植钉辅助上颌快速扩弓能有效开展年轻成人腭中缝,矫正骨性牙弓狭窄,并减少牙支抗扩弓引起的副作用.     

前方牵引治疗单侧完全性唇腭裂患者术后前牙反[牙合]畸形的研究

目的探讨前方牵引治疗单侧完全性唇腭裂（UCLP）患者术后前牙反[牙合]畸形的效果。方法进行前瞻性临床研究设计,UCLP术后骨性前牙反[牙合]患者治疗组18例,年龄9．63±1．24岁,观察对照组14例,平均8．71±1．92岁,均处于生长发育高峰前期。使用前方牵引进行治疗,治疗或观察前后拍摄头颅侧位片并测量,进行成组设计和配对设计t检验。结果UCLP治疗组前方牵引后,上颌骨前移;下颌后移合并后下旋转;上下颌间关系和面型改善明显,上颌与下颌改变的比值为1：1．7。对照组上下颌不调、前牙反覆盖、凹面型加重。结论UCLP术后轻中度骨性前牙反[牙合]畸形,前方牵引能够促进上颌骨向前,改善上下颌骨关系和软组织面型,应该早期矫形治疗。     

Volumetric upper airway assessment in patients with transverse maxillary deficiency after surgically assisted rapid maxillary expansion

Transverse maxillary deficiency is commonly found in patients with sleep apnea and is also related to abnormal breathing patterns. Maxillary expansion procedures promote widening of the nasal floor and reduce the resistance to airflow, and have a positive influence on nasopharynx function. In order to evaluate volume changes in the upper airway, 15 adult patients with transverse maxillary deficiency underwent surgically assisted rapid maxillary expansion (RME) until a slight overcorrection of the crossbite was obtained. Cone beam computed tomography (CBCT) volumetric images were obtained at three predefined time points. The mean age of the patients was 30.2 (±7.4) years; nine were females and six were males. The area, volume, and the smallest transverse section area of the airway were assessed using Dolphin Imaging 3D software. Statistical comparisons were made of the changes between time periods. No statistically significant differences were found for volume or area. However a significant difference was found between the preoperative and immediate postoperative smallest transverse section area (P < 0.05). Maxillary expansion, as an isolated procedure, does not result in a statistically significant improvement in the airway dimensions and results in an inferior relocation of the smallest transverse section area.     

前突患者上切牙内收前的牙根吸收状况及因素分析

目的 调查前突患者上切牙内收前的牙根吸收状况,并且对该阶段牙根吸收的影响因素进行初步的探索.方法 选择上颌需要拔除双侧第一前磨牙且需要强支抗的前突患者50名,分别于正畸治疗前（T1）和上切牙内收前（T2）拍摄上颌切牙的平行投照根尖片和头颅侧位片,通过测量和评价,得到每颗切牙的牙根吸收量、治疗前牙根形态及上中切牙的角度位置及变化量,并记录其他诊断和治疗因素.对牙根吸收量作描述性统计,对各因素作多因素分析.结果 ①前突患者上切牙内收前,中切牙的牙根吸收平均为（0.73±0.53）mm,侧切牙为（0.84±0.70）mm.②有3％的中切牙和6％的侧切牙牙根吸收大于2mm.③多元线性回归表明T1期牙根形态异常、内收前疗程长、上中切牙根尖距唇侧骨皮质的距离减小量大、T1期U1/PP角小、上颌前部拥挤为中切牙牙根吸收的危险因素.T1期牙根形态异常、上颌前部拥挤、内收前疗程长、T1期牙齿长度长为侧切牙牙根吸收的危险因素.结论 前突患者上切牙内收前有一定量的牙根吸收,个别高危患者其牙根吸收状况较严重.我们的研究因素中存在此阶段与上切牙牙根吸收相关的因素,但这些因素对于牙根吸收的解释仅为30％左右.     

上颌骨缺损赝复体修复前后语音效果分析

目的 评价赝复体修复上颌骨缺损的语音效果,比较开放式赝复体和封闭式赝复体语音效果的差异.方法 对7例单侧上颌骨缺损患者的录音资料进行过高鼻音判听、宽带语图及线性预测技术(linear predictive coding,LPC)谱分析.应用SPSS11.5对评价结果行随机区组方差分析.结果 患者戴用开放式或封闭式赝复体时较未戴赝复体时的过高鼻音判听分数降低,[a]、[i]、[u]、[ü]的宽带语图及谱上鼻音共振峰消失或振幅降低,高频区能量衰减减少,[u]F2频率值及[i]能量衰减指数(energy damping index,EDI-i)升高,差异均具有显著的统计学意义(P＜0.05).EDI-i与过高鼻音判听分数呈中等程度的负相关(相关系数r=-0.72).戴用开放式赝复体时过高鼻音判听分数较戴用封闭式赝复体时降低,EDI-i升高,但差异无统计学意义(P＞0.05).结论 赝复体可显著降低上颌骨部分缺损患者的过高鼻音程度.开放式赝复体与封闭式赝复体的效果相近.     

乳牙与替牙期唇腭裂患者上颌宽度不足的管控

唇腭裂是颌面部最为常见的先天性发育畸形.许多唇腭裂患者表现为上颌宽度发育不足,合理治疗上颌宽度不足,对于获得理想和稳定的唇腭裂序列治疗效果具有重要意义.正畸治疗是唇腭裂序列治疗的重要组成部分,本文就乳牙与替牙期正畸治疗中针对上颌宽度不足的合理管控进行了论述.     

Adjustable selective maxillary expansion combined with one-stage maxillomandibular surgery: A prospective study of osseous widening in fifty-five consecutive patients

Objective

SARME is often considered to be the only available treatment for significant or severe maxillary transverse palatal deficiencies (MTD) in skeletally-mature patients. Despite this observation, the aim of our study was to assess a new type of maxilla distraction osteogenesis. Using two innovative tools, we performed selective expansion: the site to be widened and the amount of increase were both pre-selected. Patients were treated in a single maxillomandibular procedure. Our study focuses primarily on the extent of osseous widening.

Reconstruction of the oral commissure in patients with unilateral transverse facial cleft

The normal commissure is not a simple joint of the upper and lower lip, but a triangular mucosal area. To reconstruct a symmetrical oral commissure in patients with a unilateral transverse facial cleft, we designed composite vermilion flaps, including triangular flaps. We retrospectively studied 17 patients with unilateral transverse facial clefts from 2013–2016. Three-dimensional images were obtained with a 3-dimensional photogrammetry system at the 1-year follow-up, and we used an anthropometric method to evaluate the postoperative symmetry of the commissure. No obvious deformity was found during the follow-up examination, and comparison of the cleft and non-cleft sides by the paired samples t test showed that in all cases both horizontally and vertically symmetrical commissures had been achieved.     

上颌骨性扩弓器对成年女性眼眶容积的评价

评价上颌骨性扩弓器（MSE）治疗成年女性上颌骨宽度不足（MTD）对眼眶容积及眶周骨骼间宽度的影响。     

Extraction treatment of a Class II division 2 malocclusion with mandibular posterior discrepancy and changes in stomatognathic function

This case report describes the successful extraction treatment of a Class II division 2 malocclusion with mandibular posterior discrepancy and a congenitally missing maxillary lateral incisor on the left side. The posterior space in the mandibular arch was small, and the mandibular second molars were impacted, with distal tipping. The discrepancies in the maxillary and mandibular arches were resolved by extraction of the maxillary lateral incisor on the right side and the mandibular second premolars on both sides. The mesial movement of the mandibular first molars occurred appropriately, with the second molars moving into an upright position. A lip bumper was used with a preadjusted edgewise appliance in the maxillary dentition to reinforce molar anchorage and labial movement of the retroclined incisors. Despite the extraction treatment, a deep bite could be corrected without aggravation as a result of the lip bumper and utility arch in the mandibular dentition. Thus, an Angle Class I molar relationship and an ideal overbite were achieved. The occlusal contact area and masticatory muscle activities during maximum clenching increased after treatment. The maximum closing velocity and the maximum gape during chewing increased, and the chewing pattern changed from the chopping to grinding type. The findings in the present case suggest that the correction of a deep bite might be effective for improving stomatognathic function.     

Minimally-invasive anterior maxillary distraction technique in patients with cleft lip and palate and maxillary deficiency: an evaluation of 106 patients

Our aim was to evaluate the feasibility of a minimally-invasive surgical technique for anterior maxillary distraction osteogenesis to correct maxillary hypoplasia in patients with clefts. A modified Y distractor was placed intraorally in 106 patients with cleft- associated maxillary deficiency to facilitate protraction of the maxilla. Subsequently the patients had an anterior maxillary osteotomy through a minimally invasive incision, followed by activation of the appliance at the rate of 0.8 mm/day until positive overjet was achieved. The patient’s lateral cephalograms were evaluated preoperatively (T1), after activation (T2), and one year postoperatively (T3). Collected data were assessed with the paired t test, and probabilities of < 0.001 were accepted as significant. A mean (SD) of 10.4 (2.58) mm anterior maxillary advancement was obtained in all patients after 10-13 days of distraction. The sella–nasion-point A (SNA) angle increased from 75.37° to 83.01°. When we compared the cephalometric variables at T1 and T2, the mean maxillary length and overjet at T2 were significantly higher (p < 0.001). The comparison of mean values at T2 and T3 was not significant. Minimally invasive anterior maxillary distraction with the modified Y distractor resulted in changes after activation that were consistent one year postoperatively, making it a conservative, less traumatic, and effective treatment of cleft-related maxillary deficiency.     

Evaluation of canting correction of the maxillary transverse occlusal plane and change of the lip canting in Class III two-jaw orthognathic surgery

Objective:To compare the effect of canting correction in anterior maxillary transverse occlusal planes (AMTOP) and posterior maxillary transverse occlusal planes (PMTOP) on the change of lip canting (LC) in two-jaw surgery (TJS) cases.Materials and Methods:The samples consisted of eight young adult patients (three males and five females, mean age  =  24.1 ± 4.5 years) who had skeletal Class III malocclusion (CIII), facial asymmetry (FA), and LC and who underwent TJS. Two-dimensional lateral and posteroanterior cephalograms and three-dimensional facial scanning taken 1 week before (T1) and 6 months after TJS (T2) were combined using the Morpheus 3D program. Six linear and angular variables were measured and statistically analyzed.Results:When comparing the values of the linear and angular variables at the T1 and T2 stages there was significant canting correction of AMTOP (1.7 mm vs −0.3 mm; 3.0° vs 0.1°), PMTOP (3.5 mm vs 0.1 mm, 3.3° vs −0.1°), and LC (3.0 mm vs 0.7 mm, 4.7° vs 2.1°) (all P < .05). Although the angular change ratios (ΔLC/ΔAMTOP and ΔLC/ΔPMTOP) did not exhibit a significant difference (0.99 vs 0.83), the linear change ratio of ΔLC/ΔAMTOP was significantly higher than that of ΔLC/ΔPMTOP (1.67 vs 0.74, P < .05). The angular change of ΔLC showed a significant correlation with ΔAMTOP (r²  =  0.64; P < .05). However, the linear change of ΔLC was significantly correlated with both the angular and linear changes of ΔAMTOP (r²  =  0.62 and 0.66; both P < .05). Therefore, the amount of LC change was more related to the canting correction of AMTOP than to that of PMTOP.Conclusion:In TJS cases with CIII, FA, and LC, the amount of canting correction of the AMTOP should be considered to predict the actual LC change.     

正颌外科手术矫正唇腭裂继发颌骨畸形术后上颌稳定性的研究

目的 探讨正颌外科手术矫正唇腭裂继发颌骨畸形患者术后上颌骨的稳定性及相关影响因素.方法 34例唇腭裂继发上颌骨发育不足的患者,均行改良LeFortⅠ型截骨术前徙上颌骨,其中29例患者同期行BSSRO和/或颏成形术,术后随访时间≥12月.分别在术前、术后即刻及术后随访时拍摄头颅定位侧位片.通过头影测量分析,测量上齿槽座（A）点、后鼻嵴（PNS）点、∠SNA的变化.结果 34例患者术后1年以上（平均19个月）水平向复发率为（20.10±18.09）％;垂直向复发率为（34.78±32.89）％.∠SNA术前平均为77.9°,术后即刻为82.3°,术后1年以上为81.4°.水平向复发率与上颌骨前徙量无相关性（P＞0.05）,但垂直向的复发率与上颌骨下移量呈正相关性（P＜0.05）.通过对15例连续随访患者资料的方差分析提示,上颌骨术后复发主要发生在术后3个月内.结论 唇腭裂患者上颌骨前徙术后具有一定程度的复发,其复发主要发生在术后3个月内.垂直向的复发率与颌骨下移量成正相关.     

不同种植体外形设计对上颌窦提升术后种植体周围应力分布的影响

目的：比较不同种植体外形设计对上颌窦提升术后种植体周围生物力学的影响。方法：在D3型上颌骨简化模型上利用三维有限元法分析3种不同外形设计的种植体在植骨与不植骨条件下的应力分布情况。假设所有材料都是线弹性、连续材料,向种植体施加150 N的倾斜力,测量种植体周围骨组织的最大等效力（equivalent von-Mises,EQV）。采用Ansys Workbench 14.5软件包对数据进行测量分析,采用SPSS 17.0软件包对数据进行统计学分析。结果：各组应力集中区域均位于种植体颈部皮质骨区域。不同种植体外形设计对种植体周围皮质骨最大EQV值无显著影响,但锥形种植体较其他种植体的周围松质骨最大EQV值显著上升,上颌窦提升术后植骨可以降低各组种植体周围最大EQV值。结论：锥形种植体用于上颌后牙区种植修复时,可能引起种植体周围松质骨应力变大,增加种植体周围骨吸收的风险。上颌窦提升后植骨,可降低种植体周围压力负载。     

萌出诱导矫治器治疗儿童上颌中切牙间隙的临床初探及三维数字化技术分析

目的 探讨萌出诱导矫治器治疗儿童上颌中切牙间隙的效果,并借助三维数字化技术进行分析.方法 对13例存在上颌中切牙间隙的病例应用萌出诱导矫治器进行矫治,应用SmartOptics Activity 880牙颌模型扫描仪,获取患儿治疗前后三维牙颌数字模型,应用三维逆向工程软件测量上、下中切牙在三维方向上的移动变化.对矫治前后覆(牙合)覆盖的测量值,应用配对t检验进行比较,以双侧P＜0.05为差异有统计学意义.结果 11例病例上中切牙间隙完全关闭,左右上中切牙平均近中位移量分别为1.17±0.20 mm和1.23±0.22 mm,平均覆(牙合)由治疗前的4.97±1.49 mm减小为治疗后的2.61±0.79 mm(t=8.083,P＜0.05),平均覆盖由治疗前的4.95±1.86 mm减小为治疗后的2.66±0.58 mm(t=5.723,P＜0.05),差异均有显著性.结论 萌出诱导矫治器可以治疗儿童上颌中切牙间隙,在关闭牙间隙的同时有改善覆(牙合)覆盖的作用.     

唇腭裂上颌骨发育畸形的早期牵引治疗

目的应用正畸上颌骨前牵引技术对唇腭裂患者在混合牙列早期出现的骨性反进行阻断治疗,研究上颌骨位置的变化情况。方法比较患者治疗前后的头影测量结果,将治疗后的结果与儿童头测量正常值比较,明确上颌骨位置的变化情况。结果治疗后上颌骨的位置前移变化有显著性（P＜0.01）,但与正常值之间也存在一些差异。结论后腭裂患者在混合牙列期,使用正畸方法进行上颌前牵引,可明显促进上颌骨发育.但单纯使用正崎尚不能完全矫正唇腭裂继发的颌骨畸形,必须采用综合治疗。