正畸与正颌联合治疗成人骨性反后咀嚼肌肌电变化

目的 :检查对比分析成人骨性反牙合正畸与正颌手术联合矫治前后的主要咀嚼肌肌电 ,揭示正畸与正颌手术联合矫治后咀嚼肌功能的变化规律。方法 :2 0名正畸与正颌手术联合治疗的成人骨性反牙合患者 ,利用肌电图仪测试治疗前后咬肌、颞肌前束、二腹肌前腹在功能活动中肌电变化。结果 :正畸与正颌手术联合矫治对咬肌、颞肌前束、二腹肌前腹的功能活动均有不同程度的影响 ,其中对咬肌的功能影响最明显。结论 :正畸与正颌手术联合治疗成人骨性反牙合 ,咀嚼肌的异常肌张力多数得到纠正 ,但咀嚼肌的功能未能得到满意的恢复 ,咀嚼肌的功能恢复是一个复杂而长期的过程 ,还需要较长的功能锻炼恢复期     

正畸与正颌联合治疗成人骨性反殆后咀嚼肌肌电变化

目的：检查对比分析成人骨性反he正畸与正颌手术联合矫治前后的主要口咀嚼肌肌电，揭示正畸与正颌手术联合矫治后咀嚼肌功能的变化规律方法：20名正畸与正颌手术联合治疗的成人骨性反he患者，利用肌电图仪测试治疗前后咬肌、颞肌前束、二腹肌前腹在功能活动中肌电变化结果：正畸与正颌手术联合矫治对咬肌、颞肌前束、二腹肌前腹的功能活动均有不同程度的影响，其中对咬肌的功能影响最明显：结论：正畸与正颌手术联合治疗成人骨性反he．咀嚼肌的异常肌张力多数得到纠正，但咀嚼肌的功能未能得到满意的恢复，咀嚼肌的功能恢复是一个复杂而长期的过程．还需要较长的功能锻炼恢复期。     

正畸与正颌联合治疗成人骨性反(牙合)后咀嚼肌肌电变化

目的:检查对比分析成人骨性反(牙合)正畸与正颌手术联合矫治前后的主要咀嚼肌肌电,揭示正畸与正颌手术联合矫治后咀嚼肌功能的变化规律.方法:20名正畸与正颌手术联合治疗的成人骨性反(牙合)患者,利用肌电图仪测试治疗前后咬肌、颞肌前束、二腹肌前腹在功能活动中肌电变化.结果:正畸与正颌手术联合矫治对咬肌、颞肌前束、二腹肌前腹的功能活动均有不同程度的影响,其中对咬肌的功能影响最明显.结论:正畸与正颌手术联合治疗成人骨性反(牙合),咀嚼肌的异常肌张力多数得到纠正,但咀嚼肌的功能未能得到满意的恢复,咀嚼肌的功能恢复是一个复杂而长期的过程,还需要较长的功能锻炼恢复期.     

正颌治疗前后咀嚼肌肌电变化的初步研究

目的 颌面部的骨性畸形,必须通过正畸和外科手术联合的正颌治疗,才能达到功能和美观的正常。作者对正颌手术前后主要的咀嚼肌收缩力进行检查,以期发现术后口颌系统咀嚼效率的变化特征。方法 肌电图仪测试咬肌,颞肌,二腹肌在功能活动时的肌电变化,并对正颌前后作对比研究。     

唇腭裂术后反合患者正畸治疗后颅面形态及口颌功能改变

本文对１９名单侧完全性唇腭裂术后反　患者的正畸治疗做了分析，并对１０名患者正畸治疗后颅面形态与口颌功能的变化做了说明。（１）患者经过正畸治疗，颅面形态的改变多为牙齿、齿槽的变化，软硬组织侧貌改善不理想，但患者下唇外翻得到改善。（２）正畸治疗后，患者息止间隙减小，下颌各种功能运动得到改善，颞颌关节状况改善。（３）经过正畸治疗，咀嚼肌功能得到提高，肌肉活动协调，但唇肌肌电活动无明显变化。     

下颌前突患者正颌术前后咀嚼肌肌电图的变化及其评价

为揭示下颌前突患者正颌手术前后咀嚼肌肌电活动的特征，作者对２７例患者进行手术前后咀嚼肌肌电图的检测。结果显示：术前肌电电压值偏低，双静息期（ｓｉｌｅｎｔｐｅｒｉｏｄ，ＳＰ）检出率明显高于正常人。术后肌电电压值有以下变化：①正中咬合时嚼肌和颞肌的肌电电压值均明显上升；②前伸边缘运动时嚼肌的肌电电压值明显升高而颞肌的变化较小；③侧方边缘运动中工作侧嚼肌和颞肌的肌电电压明显上升，非工作侧变化不明显；④息止颌位时的肌电电压值下降；⑤术后ＳＰ缩短。提示正颌手术矫治颌骨畸形的可行性和必要性，为此类患者评价治疗效果提供了理论和实践依据。     

下颌前突患者升支矢状劈开术前后咀嚼肌的肌电分析

目的测量下颌前突患者行正颌手术前后的肌电值，分析矢状劈开截骨术（SSRO）后咀嚼肌系统的变化，进一步探讨肌电的改变与术后咀嚼肌适应性改建之间的关系。方法选取18例接受SSRO治疗的下颌前突患者，记录术前及术后3个月、1年时主要咀嚼肌在功能运动中的电生理指标，计算相关参数并进行统计分析。结果下颌前突患者在正常状态下，大部分肌电指标低于健康对照组；行SSRO治疗后3个月，咀嚼肌的肌电指标有所下降，部分指标明显低于术前；术后1年，肌电指标较术前有明显上升，但部分仍低于健康对照组。结论正颌术后，咀嚼肌系统的重建是一个长期的过程，与术前相比较，咀嚼肌的性能得到了一定程度的改善。     

急性根尖周炎叩痛时的咀嚼肌肌电变化初步探讨

目的 :将肌电分析方法引入根尖周病的研究领域 ,探讨咀嚼肌肌电变化与临床检查叩痛时的关系。方法 :门诊就诊的急性根尖周炎 64例 ,患牙为第一或第二磨牙 ,叩痛 ( )。测量急性根尖周炎患牙治疗前后的咀嚼肌肌电变化。结果 :急性根尖周炎叩痛 ( )患者在正中颌位大力咬合时 ,颞肌与嚼肌的肌电幅值分别为 ( 0 .45±0 .1)mV和 ( 0 .18± 0 .0 3 )mV ,颞肌肌电幅值高于嚼肌肌电幅值 ;做开闭口运动的颞肌、嚼肌肌电幅值分别为 ( 0 .5±0 .12 )mV和 ( 0 .2 2± 0 .0 7)mV ,颞肌肌电幅值高于嚼肌肌电幅值。经根管治疗后 ,颞肌、嚼肌肌电均有显著提高 ,与治疗前有显著性差异。结论 :本实验将肌电分析方法应用于急性根尖周炎治疗前后的临床检查和疗效评价的可行性进行了探讨。     

正颌手术对咀嚼肌影响研究进展

正颌手术较为复杂,其可改变颌骨形态及咬合关系,对患者的面部美学和咬合功能等产生影响。咀嚼肌除行使咀嚼功能外,其大小和收缩力还与颌骨形态密切相关,咀嚼肌的活动可影响正颌手术效果;而当正颌手术导致颌骨形态和咬合关系发生改变时,咀嚼肌需重新适应该变化。正颌手术后颌骨形态和咬合关系的变化及美学结果是可预测的,但其对咀嚼肌的影响尚不清楚。文章就近年来正颌手术对咀嚼肌分子生物学、肌电学、影像学和功能影响的相关研究进展做一综述,以期为指导不同类型的正颌外科手术计划提供帮助。     

不同呼吸方式下咀嚼肌的肌电研究

目的研究在不同呼吸方式下健康成人在姿势位及各种下颌功能运动中,咀嚼肌的肌电活动规律,探讨呼吸方式的改变是否会引起其肌电变化。方法采用美国BioResearch公司生产的BioEMGⅡ八道最新表面肌电仪和Kistler双极表面电极,同步记录30名AngleⅠ类健康成人在鼻呼吸和口呼吸两种呼吸方式下双侧颞肌前束(TA)、颞肌后束(TP)、嚼肌(MM)以及二腹肌前腹(DA)的肌电变化。结果①姿势位:口呼吸状态TA肌电活动低于鼻呼吸,差异有高度显著性(P<0.01);②正中牙合位最大紧咬:口呼吸状态MM、DA肌电活动高于鼻呼吸,差异有高度显著性(P<0.01);③前伸运动:均未见显著性差异(P>0.05);④后退运动:口呼吸状态DA肌电活动高于鼻呼吸,差异有高度显著性(P<0.01),MM高于鼻呼吸,差异有显著性(P<0.05);⑤左右侧方运动:口呼吸状态同侧MM及左右侧DA肌电活动均高于鼻呼吸,差异有高度显著性(P<0.01)。结论口呼吸是引起咀嚼肌肌电变化的因素之一,呼吸方式的改变可导致咀嚼肌出现异常肌电活动,影响咀嚼肌功能的正常发挥。     

成人骨性安氏Ⅱ类1分类错(牙合)的正颌-正畸联合治疗

目的采用正畸-正颌手术联合治疗骨性安氏Ⅱ类Ⅰ分类错(牙合)患者,介绍手术前后正畸及术前的准备工作.方法11例成人骨性安氏Ⅱ类Ⅰ分类错(牙合)患者,均经术前正畸-正颌手术-术后正畸的治疗过程.手术前后正畸目的是矫正上下颌前牙前突,排齐牙列,协调上下牙弓,平整牙(牙合)曲线,建立正颌术后良好的咬合关系.术前准备包括术前电脑模拟手术、模型外科、(牙合)板制作.结果11例患者建立了良好的咬合关系及协调的上下颌骨关系,面容美观改善.结论骨性错(牙合)畸形患者采用正畸-正颌联合治疗,能获得功能和美观的满意效果,术前正畸、电脑模拟手术、模型外科、(牙合)板制作及术后正畸,每一操作步骤的精确到位均十分重要.     

成人骨性反畸形的手术前后正畸

目的:以本院近期收治10例骨性反的患者为例,介绍采用正畸正颌手术联合治疗的手术前后正畸及术前的准备工作。方法:正畸主要是去代偿,矫正上下颌前牙唇舌倾斜,后牙的颊舌倾斜,排齐牙齿,协调上下牙弓,平整曲线,建立正颌术前良好的牙关系。术前准备主要是:术前电脑模拟手术,模拟外科,板制作。结果:正颌治疗后患者建立了良好的咬颌关系,协调的上下颌骨关系,获得面容的美观。结论:治疗颌面部的骨性畸形,经过术前正畸正颌手术术后正畸的过程,其中每一步都很重要,术前电脑模拟手术,模型外科,板制作可以使正颌治疗更精确。     

正颌-正畸联合治疗成人骨性Ⅲ类错[牙合]30例临床分析

目的：采用正颌-正畸联合治疗30例成人骨性Ⅲ类错[牙合]患者，评价其治疗效果。方法：成人骨性Ⅲ类错[牙合]患者30例．年龄19～26岁．平均年龄22．5岁。所有患者均经术前正畸-正颌手术，术后正畸。术前正畸旨在排齐牙列，去代偿，协调上下牙弓，平整[牙合]曲线，建立术后良好的咬合关系。术后正畸进一步排齐牙列，精细调整[牙合]关系。治疗前、后摄取头颅定位侧位片，采用SPSS11．0软件包对数据进行独立样本t检验。结果：30例患者术后面形改善，上、下牙弓协调。咬合关系良好。测量数据治疗前、后均有显著差异（P〈0．01）。结论：成人骨性Ⅲ类错[牙合]患者采用正畸-正颌联合治疗，能获得功能和美观的满意效果。     

Correction of skeletal Class III malocclusion with clockwise rotation of the maxillomandibular complex

A 19-year-old woman with skeletal Class III malocclusion, paranasal depression, and a low mandibular plane angle was treated with orthodontics and orthognathic surgery. Dental decompensation and protraction of maxillary right third molar to replace maxillary right second molar were performed before surgery. Clockwise rotation of maxillo-mandibular complex was applied by Le Fort I osteotomy and bilateral sagittal split osteotomies to achieve facial balance. The active treatment period was 12 months. The stable occlusion and skeletal relationship were observed after a 10-month follow-up period.     

Masticatory function in retrognathic patients, before and after mandibular advancement surgery.

PURPOSE: Mandibular retrognathia is a dentofacial deformity that can be surgically corrected. The purpose of this study was to evaluate the influence of orthognathic surgery on masticatory function in a sample of retrognathic patients and to compare these findings with those of controls. PATIENTS AND METHODS: Eleven retrognathic patients were tested before and 1 to 1.5 years after mandibular advancement surgery and compared with 12 controls. The median particle size after chewing a silicon rubber test food, the maximum bite force, and the electromyographic activity (EMG) of the anterior temporalis and the masseter muscles during isometric clenching and during chewing were determined. Patients, before and after treatment, and controls were statistically compared by analysis of variance. RESULTS: Surgical correction of mandibular retrognathia did not change chewing efficiency, maximum bite force, EMG during maximal clenching, EMG during chewing, or the EMG/bite-force relationship. Compared with controls, the chewing efficiency, maximum bite force, EMG during maximal clenching, and EMG during chewing values were lower. No difference for the EMG/bite-force ratio at maximal clenching was found, indicating similar muscle efficiency for patients and controls. However, in the range of 10% to 40% of the maximum bite force, the slope of the EMG/bite-force regression line was steeper for the patients than for the controls, indicating decreased muscle efficiency for patients. CONCLUSIONS: The results of this study suggest that in retrognathic patients, function of the masticatory system is impaired. Oral function was not influenced by mandibular advancement surgery.     

Evidence-based orthodontics

Abstract

We describe a 28-year-old man who sought orthodontic treatment complaining about the esthetics of his smile and difficulties associated with masticatory function. The patient had a straight facial profile, skeletal and dental class III relationship, anterior open bite and posterior crossbite. He refused orthognathic surgery and was therefore treated with camouflage orthodontics supplemented with the placement of one mini-implant in each side of the mandible to facilitate movement of the lower dentition distally, tooth-by-tooth. At the end of treatment, a class I molar relationship was obtained, with an ideal overjet and overbite and excellent intercuspation. Furthermore, the open bite and crossbite were corrected. Analysis 2 years after treatment revealed good stability of treatment outcome.     

Improving quality of life with a team approach: a case report

An adolescent female who presented amelogenesis imperfecta with severe anterior open bite, long face, facial asymmetry, high angle, and Class III skeletal pattern was treated with an interdisciplinary (orthodontics, orthognathic surgery, and prosthodontics) treatment approach. Presurgical orthodontic treatment was followed by surgical maxillary posterior impaction with anterior advancement and mandibular setback operation with vertical chin reduction and genioplasty. After the surgery, anterior ceramic laminate veneers and posterior full ceramic onlay-crowns were performed. The results showed that function and esthetics were achieved successfully with interdisciplinary collaboration.     

成人严重骨性Ⅲ类错牙合术前正畸及手术设计

提要：骨性Ⅲ类错牙合的正畸-正颌联合治疗是临床中比较复杂的情况之一。正畸-正颌联合治疗一般包括术前正畸、正颌手术及术后正畸3个阶段：排齐上下牙列,去除牙代偿,协调上下颌牙弓;采用颏成形术、单颌或双颌手术后退下颌骨或（和）前移上颌骨,改善侧貌美观;术后精细调整,形成良好咬合关系。治疗应根据患者颌骨畸形的严重程度、上下唇形态、颏部位置、牙列拥挤度、牙齿倾斜度等畸形特征,具体分析,严格把握适应证,对于边缘病例尤应重视。矫治过程中,应重视术前正畸和手术设计,为正颌手术提供便利。     

The predictability of inferior medial canthus as a stable external vertical reference point in maxillary repositioning surgery

The purpose of this study was to investigate the predictability of using the inferior medial canthus as a stable external reference point for establishment of the vertical dimension in maxillary orthognathic surgery. Ten consecutive patients with skeletal Class II malocclusion and open bite who underwent orthognathic reconstructive surgery were included in the study. Prediction tracings were completed preoperatively and superimposed on an immediate postoperative lateral cephalometric radiograph. In 7 patients, the vertical positioning of the maxillary incisal edge on the immediate postoperative lateral cephalometric radiograph showed no difference from the superimposed preoperative prediction tracing. One patient showed 1 mm difference and 2 patients showed 2 mm difference from the preoperative prediction tracings. All cases resulted in acceptable maxillary incisal exposure relative to upper lip stomion. It is concluded that the inferior medial canthus can be used as a reproducible external vertical reference for orthognathic surgery when the technique described herein is used.