截骨牵张联合骨缝牵张对腭裂修复后咬合关系影响的实验研究

目的:观察截骨牵张联合骨缝牵张对腭裂修复近期咬合关系的影响。方法:健康杂种幼犬6只,建立Ⅱ°腭裂模型,3~4周后沿腭外侧缝内侧1 mm纵行切开腭骨水平板,腭横缝区不截骨,立即以250~280 g力持续向内侧和后方牵张至硬腭裂隙关闭,裂隙关闭1周后进入保持期。分别于牵张结束即刻、1、2、4、8、12周处死动物,对牵张过程中咬合关系的变化进行观察,对牵张前后上颌牙列模型进行测量分析。结果:所有实验犬牵张5~7 d后人工裂隙逐渐关闭,牵张过程中上、下颌咬合关系稳定,上颌牙弓左、右对称,上颌牙弓长度、宽度较术前增加,有显著性差异(P<0.05)。结论:截骨牵张联合缝牵张不会导致咬合关系的改变,但对颌骨形态存在影响。     

应用牵张成骨整复腭裂的动物实验研究

目的：应用研制的腭裂整复牵张装置行腭裂牵张成骨整复术，探索腭裂功能性整复治疗的新途径。方法：以家猫14只为实验对象，用12只猫建立人工腭裂的实验动物模型，其中2只为实验对照组，另10只作为实验组，在建立腭裂的同时每只动物均在上颌腭侧安置自行研制的腭裂牵张装置，4周后，于裂侧腭部形成单骨运送盘，术后第6日起，以每次0．4mm的速度，每日2次向恒定的方向行牵张成骨术，直到腭部软硬组织裂隙完全封闭，于原位固定2，4，6，8及12周后各时间分别处死实验动物各2只，按计划项目对标本测量，X线摄片，从大体到超微结构系列检测。结果：利用该腭裂口内牵张装置，成功地进行了腭裂牵张整复术。腭部裂隙软硬组织缺损在获得相同组织修复的基础上，裂隙封闭；骨牵张间隙完全为新生骨组织取代，腭裂整复后对牙颌颅面框架及其相互关系无明显影响。结论：自行研制的口内腭裂牵张装置设计合理，性能良好，牵张成骨腭裂整复术开拓了腭裂整复治疗的新途径，为临床应用提供了理论和实验根据。     

硬腭两维牵张器的研制及体外实验研究

目的：探讨腭骨外固定两维牵张器在腭裂修复中关闭骨裂隙和后退腭骨的可行性。方法：设计并制作两维硬腭骨牵张器，在离体犬颅骨模型上制造人工腭裂模型，根据机械移动原理和牵张成骨原理，在硬腭后部设计2块可相对移动的转移盘，在一定范围内使骨块向内和向后移动，进行两维牵张成骨，并进行了手术模拟。结果：研制的两维缝牵张器可将转移盘前后方向移动16mm，近中方向左右各移动4mm，牵张器固定牢靠，转运盘稳定，牵张控制准确，在离体模型上可实现关闭裂隙、后退硬腭的设计要求。结论：设计的外固定两维牵张器可以向后、内牵张腭骨，从而达到关闭裂隙和硬腭后退的目的。     

腭裂牵张成骨整复术的新设计--动物实验结果与评价

目的在建立腭裂实验动物(猫)模型的基础上,采用研制的口内腭裂牵张装置,用于新设计的腭裂牵张成骨整复术,并观察评价其效果。方法设立空白对照组(动物2只)及实验对照组(动物3只)。设计制备个体化的纯钛口内腭裂牵张整复装置;以20只家猫为实验对象,建立腭裂实验动物模型。在实验动物的上颌腭侧,通过磨牙带环及纯钛自攻螺钉固位,安置腭裂牵张装置。4周后,实施单骨运送盘形成术,术后第6天起,以0.4mm×2次/d的速度与频率,向裂隙健侧行牵张成骨术,至健侧骨运送盘与裂缘紧接,裂隙封闭。于原位固定的不同时期分别处死实验动物各3只,取标本行大体及组织学、荧光标记、免疫组化、超微结构以及激光共聚焦显微镜与生长因子的表达等系列检测,并对矫治前后的咬合模型进行对比测量。结果在建立腭裂实验动物模型的基础上,首次采用新设计的腭裂牵张装置及术式,通过骨牵张间隙的新骨形成及覆盖黏骨膜的伸展,直至骨运送盘与健侧裂缘衔接。各项检测结果表明,所设计的新术式,在修复腭部软硬组织缺损的基础上,牵张间隙以膜内成骨方式形成新骨,成功地整复了腭裂。结论新设计的腭裂牵张成骨整复术,是一种以局部新生软硬组织的增殖为基础,在保持功能与结构稳定的前提下,关闭裂隙的功能性腭裂整复术。     

大动物腭裂模型的建立及其牵张整复研究

目的探讨外科方法建立大动物腭裂模型的解剖基础及其稳定性,以及牵张成骨术整复其硬腭部骨质缺损治疗腭裂的价值。方法20只家猫中,18只采用外科手术方法切除一侧硬腭0.8cm×2.5cm软硬组织并延长至软腭内约1.5cm,形成口鼻腔组织洞穿缺损,建立人工腭裂实验模型。腭裂实验模型中,3只为实验对照组,笼养6周后取材观察腭裂缺损畸形稳定性;实验组15只,应用新设计的牵张成骨术,以每次0.4mm的速度,每日2次的频率和恒定的方向整复其腭部软硬组织缺损,至裂隙完全封闭。术后第2、4、6、8及12周分5批处死动物,每批3只,观察缺损区及牵张间隙区组织整复情况。另设空白对照组2只,进行对比。结果建立的腭裂实验动物模型畸形症状类似人腭裂临床表现,且6周后无自行修复。牵张成骨术后12周,缺损区为骨运送盘移行封闭,且牵张间隙为原位新生骨组织修复。结论外科方法建立大动物腭裂实验动物模型,稳定性高,畸形特征典型,具有很好的治疗方法学研究应用价值。     

弹性镍钛记忆合金牵张成骨修复犬腭裂

目的:研究镍钛记忆合金牵张成骨修复犬腭裂的愈合过程。方法:健康杂种幼犬8只,建立人工腭裂模型。1周后,在6只实验组犬硬腭上制作骨转移盘,植入镍钛记忆合金牵张装置,用300g的力持续向内侧和后侧牵引,关闭硬腭裂隙后保持3周。再分别于2、4、8周处死动物模型,采用直接观察、X线和组织学方法评价记忆合金与组织的相容性及中线骨组织愈合情况。结果:牵张8～10d后裂隙关闭,骨组织后移,硬腭平均延长4.5mm,两侧骨板在中间融合。结论:记忆合金牵张成骨可使腭部两侧骨板在中线区形成骨融合。     

牵张成骨修复犬腭裂愈合过程的观察

目的:探索截骨牵张联合缝牵张修复犬腭裂中两侧骨岛在中线区愈合的机理。方法: 健康杂种幼犬6只,建立人工Ⅱ°腭裂模型3～4周后沿腭外侧缝内侧1mm纵行切开腭骨水平板,腭横缝区不截骨,立即以250～280g力持续向内侧和后方牵张至硬腭裂隙关闭,裂隙关闭1周后进入保持期。分别于牵张结束即刻、1、2、4、8、12周处死,采用直接观察、X线片和组织学方法评价中线区愈合情况。结果: 牵张5～7d后人工裂隙逐渐关闭,两侧骨岛后移,硬腭平均延长4.78mm。两侧骨岛后份在5～8mm长腭中线上呈叠瓦状重叠,表面粘膜受压凹陷,逐渐融合,4周时出现新生骨桥连结;其前方15～18mm的裂缘粘膜变薄,于正中相互接触,但并未发生组织融合。结论:截骨牵张联合缝牵张可使两侧腭裂裂缘在中线区后分发生骨性融合。     

牙附着式牵张成骨装置的研制及在牙槽突裂整复中的应用

目的:研制牙附着式口内牵张成骨装置整复牙槽突裂,探索牙槽突裂手术治疗的新途径。方法:自行研制牙附着式牵张装置,建立人工牙槽突裂的动物模型,8只成年杂种犬为实验组,对照组2只。以牙骨复合体作为转运盘,牵张器通过牙带环固定,并安装上颌牙弓弓丝。术后第7 d起,以每次0.4 mm的速度,每日2次沿弓丝方向行三维牵张成骨,直到关闭硬组织裂隙。0、14、28、63 d各处死动物2只,对照组动物在建立牙槽突裂模型12周后处死。进行X线摄片、大体标本和组织学观察。结果:利用牙附着式牵张装置,成功地进行牙槽突裂牵张成骨整复术,牙槽突硬组织裂隙关闭;骨牵张间隙完全为新生骨组织取代。结论:自行研制的牙附着式口内牵张装置设计合理,应用良好,牵张成骨提供了牙槽突裂治疗的新途径。     

应用牵张成骨术后退腭部的实验研究

目的　应用自制的腭部牵张装置后退腭裂犬的腭部 ,探讨治疗腭咽闭合不全的新方法。方法　用 7只健康青春期杂种雄性犬为实验对象。手术形成腭裂模型 ,在实验侧行牵张成骨术。手术当天 ,术后 7、1 8、6 0d分别取印模 ,灌注石膏模型。制作术后 6 0d头颅骨标本。在模型和颅骨标本上测量各标志点间的距离。结果　实验过程中未观察到明显错牙合畸形 :实验结束时 ,动物实验侧硬腭后缘均有不同程度的后退 ,牵张间隙内为新生骨组织 ,上颌骨的两侧结构保持对称。结论　应用牵张成骨术可后退腭裂模型犬的硬腭后缘 ,且对咬合关系及上颌骨短期内的生长发育无明显影响     

生长期犬上颌骨缝牵张的实验研究

目的：了解上颌骨缝牵张成骨的骨质生成方式及不同牵引力对腭横缝组织影响。方法：以3～4月龄杂种犬21只为实验动物,实验组18只,空白对照组3只。实验组在两侧腭横缝及额上颌缝安置内置式镍钛合金牵引器。设计牵引器合力分别为：900g（A组）、1200g（B组）、1500g（C组）。牵引后5、10、15、20、30、40d切取腭横缝组织,行组织学观察。分光光度仪定量分析骨组织中碱性磷酸酶含量。结果：实验组上颌骨被成功前徙,组织学观察可见腭横缝改建活跃。牵引期内Ⅰ型胶原增多明显,Ⅱ、Ⅲ型胶原逐渐减弱。各组碱性磷酸酶增高明显,差异有显著性。结论：缝牵引是早期修复上颌发育不足的一种较佳方法;缝牵张成骨方式是膜内成骨;3种作用力差异有显著性,最佳作用力是1200g。     

Relapse tendency in maxillary arch width in unilateral cleft lip and palate patients with different maxillary arch forms.

OBJECTIVE: The aim of this study was to investigate the relapse tendency in the maxillary dental arch widths in unilateral cleft lip and palate patients with different types of maxillary arch form. SUBJECTS: Thirty-two unilateral cleft lip and palate patients treated by one-stage surgical palatal closure were included. The subjects were divided into three groups according to the types of the maxillary arch forms: group A, symmetrical arch form; group B, collapse of minor segment; group C, collapse of both segments. METHODS: Using dental casts obtained at three different times, relapse in the intercanine, interpremolar, and intermolar widths in each group was assessed and differences between groups were investigated. Results: Patients in group A showed stable results in all measurements. Patients in group B showed posttreatment relapse in the intercanine width only, whereas patients in group C demonstrated significant posttreatment relapses in the interpremolar and intermolar widths. Comparison between groups showed more significant relapse in the interpremolar and intermolar widths of group C than in those of group B. CONCLUSION: The types of the maxillary arch forms in unilateral cleft lip and palate patients might play a stronger role in the stability of the maxillary dental arch widths after orthodontic treatment in patients with collapse of both segments and a severe degree of maxillary narrowness.     

自锁托槽对唇腭裂腭扩展短期效果的研究

目的：探讨自锁托槽对单侧完全性唇腭裂患者上颌腭扩展的短期治疗效果。方法选取5例恒牙期单侧完全性唇腭裂（UCLP）患者,未行牙槽突裂骨移植手术,上颌牙齿粘贴自锁托槽（AO, Time2）,放置高弹性镍钛弓丝,采集患者治疗前和腭扩展6~17个月后的牙颌模型、头颅定位后前位片进行测量,分析上颌腭扩展前后患者的牙弓、牙槽骨、腭穹窿以及颌骨的形态变化。结果牙颌模型测量结果提示：第一前磨牙区牙弓宽度明显增大,其次为尖牙区牙弓宽度,第一磨牙区牙弓宽度增加最少,第二磨牙区宽度减小。牙弓长度变化不明显。第一磨牙近中颊向扭转。腭部宽度增加,深度减小。头影测量结果提示：鼻腔宽度、上颌基骨宽度和上颌磨牙宽度稍有增加。结论唇腭裂自锁托槽腭扩展后上颌牙颌形态在横向宽度的变化较矢状向的变化明显。短期腭扩展治疗效果以牙齿移动和牙槽改建为主。     

An experimental study of the influence and mechanism of surgically induced cleft palate and palatoplasty on teeth and dental arch in dogs]

The dogs were selected as the experimental subjects in this study. The authors continuously observed the maxillary teeth and dental arch form in preoperation and 2, 4, 6, 10, 14, 18, 22, 26, 30, 34 weeks of post operation to all the animals. 40 puppies were divided into four groups, which were unoperated control group, surgically induced cleft palate group, cleft palate repaired group and cleft palate implanted bone group. The experimental result showed: there were remarkable differences at rate of itself growth between deciduous dentition and permanent dentition in the four groups. The result suggested that the cleft palate was a reason for disturbances of dental arch development, an exposed bone wound in hard palate of maxillary after palatoplasty was an important reason that it made maxillary dental arch growth problem heavier, authors could prevent the disturbs the transverse development of the maxillary dental arch from cleft palate who had or had not repaired by implanted bone in total cleft palate.     

Constriction of the maxillary dental arch by mucoperiosteal denudation of the palate.

OBJECTIVE: This study examined the influence of two factors in the constriction of the maxillary dental arch by mucoperiosteal denudation of the palate: (1) inhibition of lateral growth and (2) medial inclination of teeth. METHOD: Thirty-five male 20-day-old Wistar rats were divided into experimental and control groups. The experimental group had bilateral mucoperiosteum excised in the lateral one third of the palate. Methyl methacrylate resin-embedded frontal sections were prepared from both groups after alternate weekly injections of tetracycline and calcein in the dorsal subcutaneous area. The sections were observed and photographed under either a confocal laser scanning microscope, a fluorescence microscope, or both. Chronological changes in lateral palatal growth, maxillary dental arch width, and inclination of the upper first molars were examined up to 8 weeks after the operation. Paraffin-embedded frontal sections were also made and stained with Elastica van Gieson stain. RESULTS: The scar tissue formed on the rat palate by the mucoperiosteal denudation was tightly connected to the palatal bone and teeth. The intervals between the labeling lines of the experimental group were less definite during the first 2 weeks after the operation. Increments of palatal and maxillary dental arch widths were smaller in the experimental group than in the control group. The upper first molars in the control group gradually inclined laterally, whereas those in the experimental group inclined medially with age. CONCLUSION: Medial inclination of teeth is a stronger influence than inhibition of lateral growth on constriction of the rat maxillary dental arch.     

Maxillary arch dimensions after palatal surgery at different ages on beagle dogs

Changes of maxillary arch dimensions were studied longitudinally until maturity, after palatal surgery was performed on 37 beagle dogs at different ages. The dogs were divided into three experimental groups, a sham group, and a control group. At the age of 6, 16, or 25 weeks in the experimental groups, we created a soft-tissue cleft in the medial region of the palate, made relaxation incisions, and elevated and closed the mucoperiosteum in the midline, thus leaving two areas of denuded bone adjacent to the dentition. We made dental casts regularly until the age of 37 weeks, and studied maxillary arch dimensions. Surgery performed before or during the transition of teeth did not change maxillary arch dimensions in the deciduous dentition, but after the transition, the increase in arch width in the pre-molar region was reduced. Surgery performed after completion of the permanent dentition did not change maxillary arch dimensions. Delay of palatal surgery until the transition of teeth was completed favored normal development of the maxillary dental arch.     

Dental arches in six-year-old children with operated and unoperated submucous cleft palate and isolated cleft palate

The sizes of dental arches in 129 children with cleft palate were evaluated retrospectively from dental casts taken at the mean age 6.2 years (range 5.2-7.5). The material included 61 children with submucous cleft palate (SMCP) and 68 children with isolated cleft palate (ICP). Twenty of the children with SMCP were not operated on, while 41 had had surgical treatment, either palatal repair (n = 16, mean age at operation: 1.6 years, range 0.8-3.9) or pharyngeal flap (VPP) surgery (n = 25, mean age at operation: 4.5 years, range 2.6-6.2). In children with ICP, one-stage hard-palate and soft-palate closure had been done at the mean age of 1.5 years (range 1.0-2.1). Decreased maxillary intermolar widths were seen in children with SMCP after VPP, and especially after palatal repair. The children with ICP had the smallest maxillary dental arch widths. No significant differences were observed in the maxillary arch length or mandibular intermolar arch dimensions in children with SMCP or ICP. Surgery is associated with decreased maxillary intermolar arch widths in children with SMCP. Children with ICP had smaller maxillary dental arch widths than children SMCP.     

替牙期62例上颌尖牙阻生儿童牙弓及腭部形态特征分析

目的:比较上颌尖牙阻生与无阻生儿童牙弓及腭部形态的差异,为上颌尖牙阻生早期识别和干预提供参考.方法:选择8～11岁[平均(9.82±1.04)岁]儿童62例,分为实验组(上颌尖牙阻生)和对照组(无上颌尖牙阻生),每组31例.将2组患者石膏模型通过3D激光扫描后转化为数字模型,测量牙弓宽度、牙弓长度、基骨宽度、腭部宽度、...     

Transversal Palatal Expansion Using a Palatal Distractor

METHOD AND RESULTS: The method and first results of transversal expansion with a palatal distractor in adolescents and adults with transverse maxillary deficiencies are presented. In ten patients with a mean age of 25.8 years, a newly developed distractor was applied for bone-borne expansion of the two halves of the maxilla following osteotomy of the lateral walls of the maxillary sinuses and the midpalatal suture. After a 3-week distraction period, mean changes of 8.8 mm in intercanine distance (ICD), 8.6 mm in anterior dental arch width (ADA), and 8.3 mm in posterior dental arch width (PDA) were registered. 6 months after the subsequent multibracket appliance therapy, these values were found to be largely constant. CONCLUSION: Because of the short treatment period, the absence of relapses, and the handling simplicity for the patient, this method is recommended for clinical application.     

A randomised prospective clinical trial into the effect of infant orthopaedics on maxillary arch dimensions in unilateral cleft lip and palate (Dutchcleft)

Aim of the study was to evaluate the effect of infant orthopaedics (IO) on maxillary dimensions in infants with unilateral cleft lip and palate (UCLP). The study design was a prospective two-arm randomised controlled trial in parallel with three participating academic Cleft Palate Centres. Treatment was assigned by means of a computerised balanced allocation method. One group (IO+) wore passive maxillary plates during the first year of life, the other group (IO-) did not. Maxillary casts, made at birth, and at 15, 24, 48, 78 wk were digitised three-dimensionally. Before lip closure alveolar, midpalatal and posterior cleft width reduced significantly more in IO(+) than in IO(-). After lip closure, the alveolar cleft width reduced significantly more in IO(-). Until soft palate closure the slope of the palatal vault flattened significantly by IO. It is concluded that IO only has a temporary effect on maxillary arch dimensions that does not last beyond surgical soft palate closure. Therefore, infant orthopaedics as a tool to improve maxillary arch form could be abandoned. However, other outcome variables like facial and dental appearance, speech outcome, and cost-effectiveness need to be investigated further in order to assess the comprehensive effect of infant orthopaedics.