融合牙错(牙合)畸形矫治的临床研究

在正畸治疗中,融合牙错(牙合)畸形的矫治方法具有特殊性.融合牙使上下颌牙列的牙量发生异常,可以造成不同程度的上下切牙中线偏斜、牙列的尖窝咬合关系不良、磨牙关系紊乱、前牙覆(牙合)覆盖异常等错(牙合)畸形.对这种错(牙合)畸形的矫治,涉及诸多方面的因素,如Bolton指数、支抗设计、磨牙或尖牙关系以及中线关系等.由于临床上以下前牙融合多见,因此本文重点讨论下前牙融合错(牙合)畸形的正畸治疗.     

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面部不对称畸形是临床常见的牙颌面畸形之一.临床上诊断和治疗程序与其他牙颌面畸形治疗的程序相同.由于不对称畸形三维表现的特殊性,使得其在病因、诊断和治疗各个方面都有不同于对称性病例的特点.本文就不对称畸形在诊断和治疗各个阶段的特殊点作一总结,这也是临床需要特别引起重视之处.     

种植体支抗矫正错

目的探索临床应用种植体作为支抗矫正错(牙合)畸形.方法对Angle菌素Ⅱ类牙(牙合)畸形、无法常规使用磨牙作为支抗的病例,选用专用微型种植体作从上颌颊部颧牙槽嵴以及硬腭前份植入上颌骨,以此作为支抗矫正错(牙合)畸形,观察其可行性及疗效.结果对大部份病例都是极为有效的尝试.结论对Angle Ⅱ类牙(牙合)畸形的矫正使用种植体作为支抗是有效的、可行的.     

正畸治疗伴有过小牙(畸形牙)的牙列稀疏病例的体会

目的 探讨对于存在过小牙(畸形牙)的牙列稀疏病例,如何提高正畸的质量,为后期的修复提供良好的条件.方法 先采用临时冠改变过小牙(畸形牙)的形态,再行正畸关闭间隙,调整尖窝关系,待时机成熟行永久修复过小牙(畸形牙).结果 10个牙列稀疏病例(伴有14个过小牙或畸形牙)均得到有效治疗后牙尖窝关系,过小牙(畸形牙)的形态恢复,治疗效果均令人满意.结论 对于伴有过小牙(畸形牙)的牙列稀疏病例,先以临时冠恢复过小牙(畸形牙)的外形,再行正畸治疗可有效提高矫正效果,有利于过小牙(畸形牙)的永久修复.     

伴有先天缺牙的错(牙合)畸形的矫正治疗

目的通过对伴有先天缺牙的错(牙合)畸形病例进行回顾性研究,为临床治疗提供参考.方法选择正畸科门诊患者中伴有先天缺牙的错(牙合)患者30例,对缺牙数目、错(牙合)类型、矫治方法等进行了分析.结果缺牙部位最常见的是下颌切牙;多为缺失1-2个牙齿;16例采用了结合减数方法进行矫治,14例采用了集中间隙、结合修复的方法进行矫治.结论对伴有先天缺牙的错(牙合)畸形,采用结合减数矫治或采用扩大间隙、结合修复的方法进行矫治能获得满意的矫治效果.为使上下颌牙量协调,结合减数方法进行矫治,是伴有先天缺牙的错(牙合)畸形常用的矫治方法.     

种植体支抗矫正错(牙合)畸形的初步临床研究

目的:探索临床应用种植体作为支抗矫正错(牙合)畸形.方法:对Angle菌素Ⅱ类牙(牙合)畸形、无法常规使用磨牙作为支抗的病例,选用专用微型种植体作从上颌颊部颧牙槽嵴以及硬腭前份植入上颌骨,以此作为支抗矫正错(牙合)畸形,观察其可行性及疗效.结果:对大部份病例都是极为有效的尝试.结论:对Angle Ⅱ类牙(牙合)畸形的矫正使用种植体作为支抗是有效的、可行的.     

传动直丝弓矫治器及技术的研发和临床初步应用

目的 介绍传动直丝弓矫治器及技术的研发和临床初步应用.方法 传动矫治器分为适于安氏Ⅰ、Ⅱ类牙颌畸形的标准型和适于安氏Ⅲ类牙颌畸形的Ⅲ型.每套传动矫治器包括低摩擦力、移动范围大的尖牙托槽及其他牙托槽.传动矫治技术原理:传动力及传动效应.矫治程序:不拔牙病例矫治分为二期,拔牙病例为三期.结果 矫治完成了50余例牙颌畸形,均取得了满意或良好的效果.介绍2例典型病例.结论 传动矫治器及技术是高效而便捷的新直丝弓矫治器及技术.     

牙齿与颌面部不对称畸形的诊断与治疗(一)

牙齿与颌面不对称畸形是指由于牙弓或颌骨两侧不对称或因颌位偏斜形成的一种错牙合畸形 ,常表现为一侧后牙反牙合 ,造成颌面不对称畸形 ,不仅严重影响患者的颜面美观 ,而且影响咬合功能 ,甚至导致颞颌关节功能紊乱 ,是一种危害大、矫治复杂的错牙合畸形。本文将对牙齿与颌面不对称畸形的病因、临床诊断及治疗进行讨论。1　分类与病因1.1　牙型即由于牙弓两侧不对称 ,或上下牙弓宽度不协调 ,下牙弓宽于上牙弓 ,形成下颌偏斜。牙性不对称可由局部因素引起 ,如乳牙早失 ,先天性缺牙 ,也可因吮指、偏侧咀嚼等口腔不良习惯造成。牙胚发育异常可影…     

错(牙合)畸形治疗需要的研究现状及展望

错(牙合)畸形是生长发育过程中形成的牙颌面部形态变异,是一种无症状疾病,患者对治疗的需要和需求不同于其他口腔疾病.该文通过对错(牙合)畸形治疗需要的研究综述,旨在为创建新的临床医疗模式提供参考.     

成年人Angle Ⅱ''2分类患者前牙缺失的正畸与修复治疗

临床上常见成年人AngleⅡ'2分类患者,因前牙缺失或重度磨损而要求修复治疗.由于此类错(牙合)畸形的(牙合)特点,造成临床修复困难,效果欠佳.作者采用正畸联合修复治疗的方法,取得满意的疗效,现报道如下.     

Care of adolescents with cleft lip and palate: the role of the general dental practitioner

Management of the adolescent with cleft lip and/or palate is ideally undertaken by a cleft palate team which has overseen care since birth, and which provides, in a paediatric hospital setting, the specialist medical, dental and ancillary care services necessary for optimal management. However, in some countries such a team is not available and individual dental practitioners and dental specialists have to undertake the necessary treatment. This is facilitated in Australia by the Federal Government's 'Cleft Lip and Palate Scheme', which subsidizes all medical and dental treatment related to the congenital defect up to 22 years of age. In such circumstances the general dental practitioner or paedodontist may need to assume an important coordinating role. The timing and integration of phases of general dental, minor oral surgical, orthodontic, periodontic and prosthetic treatment with plastic, ENT and maxillofacial surgery, speech therapy and audiology may become his responsibility. In addition, the provision of a high standard of preventive and general dental care for the cleft patient must be maintained. To carry out this coordinating role effectively, the general dentist must know his patient and family well; must understand the current concepts, objectives, treatment and investigatory techniques used in all aspects of cleft palate management; he should be aware of the genetics of the clefting conditions, medical problems which may commonly be associated with clefts and the cleft as one feature of a syndrome. Most importantly, he should be aware of the special social adjustment problems faced by many cleft adolescents in relation to their perceived 'different' facial appearance and speech.     

Management of nasally erupting deciduous canine in operated cleft lip and alveolus patient

Nasally erupting tooth is a rare finding seen associated with cleft lip and alveolus. It may be diagnosed as a result of symptoms such as difficulty in breathing, pain on sneezing or blowing the nose or may remain asymptomatic. A case of a 4 year old male child operated for bilateral cleft lip and alveolus with unilateral right sided nasally erupting deciduous canine is presented here.     

Bilateral oblique facial cleft--tissue expansion with primary reconstruction

The oblique facial cleft may present as a cutaneous and/or an osseous cleft, with or without a cleft lip, and with or without a cleft palate. This particular case was born with complete bilateral cutaneous-osseous oblique facial clefts which extended from the oral cavity to the eye sockets with anophthalmia on the right side. The first surgical intervention included a midline nasal skeleton alignment and bilateral cleft lip and alveolus reconstruction. Urinary Foley catheters were used as facial tissue expanders and inserted adjacent to the oblique facial clefts. The second surgical procedure consisted of a partial pyramidal Le Fort II osteotomy for an inferiorly displaced nasal maxillary skeleton and a rotation and advancement of the cheek as a flap for reconstruction of the palpebral cleft and inner canthus.     

评价腭裂患者术后软腭功能的研究

腭裂术后患者腭咽闭合功能的恢复,是检查手术疗效的关键。而软腭的运动,又是腭咽闭合活动中的重要部分。本研究采用腭咽闭合图像处理定量检测系统和鼻咽腔钡剂造影X线摄片的方法,检测了90例不同手术年龄及手术方法腭裂患者的软腭功能。结果如下:采用传统性腭成形术的小年龄手术组(小于3岁)都能获得较为理想的软腭活动功能,而大年龄手术组(大于6岁)无论采用传统性腭成形术或Furlow＇s反向双Z瓣修复术,均无理想的软腭活动,证实了腭裂的手术年龄越小,软腭活动效果越理想的结论。作者并提出腭成形术宜早期进行。     

基于圆形分布法的广东省唇腭裂患儿受孕月份分析

目的探讨广东省唇腭裂患儿受孕月份的分布规律。 方法以2016—2017年在广东省范围内有产科资质的医疗机构内分娩的围产儿（孕28周至出生后7 d）及产妇为研究对象,将唇腭裂患儿受孕统计年度看成1个圆周,用圆形分布法对其中的先天性唇腭裂患儿的受孕时间进行聚集性分析。 结果2016—2017年广东省共监测围产儿3 748 435例,检出唇腭裂患儿5591例,其中男性患儿3137例、女性患儿2309例、性别不明或两性畸形患儿145例,排除性别不明患儿共包括唇裂1368例、腭裂913例、唇裂合并腭裂3165例。唇腭裂患儿的受孕高峰有时间聚集性（平均角 = 67.33,P<0.001）,唇腭裂患儿的受孕高峰在3月上旬。其中单纯唇裂和唇裂合并腭裂的受孕高峰时间分别是2月下旬和3月中旬,为春季;单纯腭裂的受孕高峰时间差异无统计学意义。女性唇腭裂患儿的受孕时间存在高峰,为3月份,男性患儿的受孕时间差异无统计学意义。 结论广东省唇腭裂患儿的受孕高峰有时间聚集性,单纯唇裂和唇裂合并腭裂与单纯腭裂可能有不同病因构成,女性患儿的发病更受到季节性影响,春季应加强预防唇腭裂危险因素的暴露。     

Treatment of midline cleft of the mandible-A 2-stage approach

Midline clefts of the lower lip and mandible are rare congenital anomalies. They may present as complete or incomplete in nature along with associated bifid tongue and ankyloglossia. Some may present with cleft of lower lip, cleft of mandible, fissured tongue, absent hyoid bone, cleft of manubrium sterni, or an extremely rare anomaly known as Tessier cleft no. 30. We present this unique case of midline cleft of the lower lip (incomplete) and mandible (complete) with initial soft-tissue surgery for the lower lip. The hard-tissue surgery for this case is deferred at a later date, and the reasons are discussed.     

Congenital lip pits and van der Woude syndrome

Van der Woude syndrome is an autosomal dominant disease characterized by lower lip pits with or without cleft lip and/or cleft palate. The lip pits commonly have salivary glands that drain into them, which leads to salivary flow from the lip pits. Lip pits may be associated with submucosal palatal cleft, velopharyngeal insufficiency, or genitourinary or cardiovascular anomalies. The pits are treated by surgical resection. The authors report a case of van der Woude syndrome with isolated lip pits and speech difficulties that had been unrecognized until the patient was 6 years old. The surgical technique is described to ensure that the often-bifurcating tracts are removed entirely.     

A preliminary study of nasal airway patency and its potential effect on speech performance.

The relationship between nasal airway size and articulatory performance was studied in a group of cleft palate patients. Articulation analysis revealed that children with bilateral cleft lip and palate were nearly twice as likely to manifest compensatory articulations as children with unilateral cleft lip and palate or with cleft palate only. When subjects were grouped according to speech performance, aerodynamic assessment indicated that children with compensatory articulations had significantly larger nasal cross-sectional areas than children without compensatory articulations. The findings suggest that children with comparatively large nasal airways may be at increased risk for developing abnormal speech patterns. If these findings are confirmed by further research, such children may be candidates for relatively early palate repair.     

MMP gene polymorphisms as contributors for cleft lip/palate: association with MMP3 but not MMP1

OBJECTIVE: Orofacial clefts result from failures of developing embryonic facial and palatal processes to either completely merge or fuse. Normal development of the facial primordia requires remodelling of the extracellular matrix, which is mediated in part by the matrix metalloproteinases (MMPs). MMPs can be considered a group of candidate proteins for the etiology of cleft lip with or without cleft palate (CL/P) due to their role in craniofacial modelling. The purpose of this study was to determine if polymorphisms in MMP1 and MMP3 gene promoters were associated with CL/P. DESIGN: DNA was extracted from buccal epithelial cells and genotypes were obtained from CL/P cases and controls through PCR with allele-specific primers (MMP3, n=333) and restriction-fragment length polymorphism techniques (MMP1, n=395). RESULTS: Significant differences between cases and controls were observed for MMP3 [5A/6A allele frequencies (p=0.00001) and genotype frequencies (p=0.00001)]; and between cleft types and controls (p=0.00001 for CL/P; p=0.04 for CP). No significant differences were found for MMP1 allele and genotype frequencies between cases and controls or between cleft types and controls. CONCLUSIONS: An association between a polymorphism in MMP3 gene and CL/P has been observed. Although the extent to which this polymorphism may actually contribute to the affected cleft status is yet to be clarified, polymorphisms of MMP genes may be good candidates as genetic factors for their role in active ECM remodelling.     

Elongated pharyngeal flap in extensive clefts of the hard and soft palate

In some cases of extensive palatal defects surgical closure may be regarded as unfeasible, and the condition treated with an obturator prosthesis. In such a case the cleft can be closed in one operation by means of a pharyngeal flap elongated through a pharyngotomy according to Bengt Johanson (1966). Eleven patients who had used obturators were operated on between 1957 and 1978. The mean age of the patients was 39 years. All patients were cleft lip and palate or cleft palate cases; two unilateral, five bilateral, and four with an isolated cleft palate. In most of these patients a temporary tracheostomy was performed after which the pharynx was opened through a neck incision. A flap was created which reached the alveolar ridge. For oral closure, mucoperiosteal flaps were used. Anterior palatal fistulas developed in two cases; one closed spontaneously and the other remained as a 3-mm fistula behind the alveolar ridge. Three patients had postoperative transient dysphagia. Phoniatric evaluation showed that two patients had better speech after operation than before with an obturator. Gross speech improvement at this late age should not be expected and is not the primary goal of the procedure. The aim of surgical closure with an elongated pharyngeal flap is to replace the obturator.