唇腭裂患者前牙区恒牙的发育异常

唇腭裂是口腔颌面部最常见的先天畸形,常伴发各种恒牙发育异常,尤其是靠近裂隙的前牙区.相较国外,目前国内对此的研究缺乏,本文对调查唇腭裂患者中切牙、侧切牙和尖牙区的形态、数目、萌出异常和牙根发育等各类发育异常的文献作回顾性概述,为临床医师早期酌情涉入治疗和适当降低序列治疗的难度和复杂性提供依据.     

唇腭裂患者颈椎异常的影像学表现

目的观察唇腭裂患者颈椎异常的影像学表现，统计颈椎异常在唇腭裂患者中的比例及分布情况。材料与方法实验组304名6岁以上唇腭裂患者（男191人，女113人），对照组6岁以上非唇腭裂223人（男132人，女91人），应用头颅侧位片观察颈椎异常的表现。结果颈椎异常的表现类型分为后弓发育缺陷和融合两大类，其中，后弓发育缺陷分为椎弓裂、发育不足和寰枢对位不良三个亚类，融合分为寰枕融合和椎体融合两个亚类。寰枢对位不良在以往的研究中未曾报道。实验组中，55人（18．1％）发现颈椎异常，对照组中19人（8．5％）发现颈椎异常，差异有显著性。结论颈椎异常的表现类型分为后弓发育缺陷和融合两大类，发现新的表现类型寰枢对位不良。颈椎异常在唇腭裂患者中的发生比例高于非唇腭裂人群，差异有显著性。     

The prevalence of specific dental anomalies in a group of Saudi cleft lip and palate patients

Objective

The aims of this study were to investigate the prevalence and distribution of dental anomalies in a group of Saudi subjects with cleft lip and palate (CLP), to examine potential sex-based associations of these anomalies, and to compare dental anomalies in Saudi subjects with CLP with published data from other population groups.

Design

This retrospective study involved the examination of pre-treatment records obtained from three CLP centers in Riyadh, Saudi Arabia, in February and March 2010. The pre-treatment records of 184 subjects with cleft lip and palate were identified and included in this study. Pre-treatment maxillary occlusal radiographs of the cleft region, panoramic radiographs, and orthodontic study models of subjects with CLP were analyzed for dental anomalies.

Results

Orthopantomographs and occlusal radiographs may not be reliable for the accurate evaluation of root malformation anomalies. A total of 265 dental anomalies were observed in the 184 study subjects. Hypodontia was observed most commonly (66.8%), followed by microdontia (45.6%), intra-oral ectopic eruption (12.5%), supernumerary teeth (12.5%), intra-nasal ectopic eruption (3.2), and macrodontia (3.2%). No gender difference in the prevalence of these anomalies was observed.

Conclusions

Dental anomalies were common in Saudi subjects with CLP type. This will complicate the health care required for the CL/P subjects. This study was conducted to epidemiologically explore the prevalence of dental anomalies among Saudi Arabian subjects with CLP.     

单侧完全性唇腭裂术后牙弓问横向关系的不调及正畸矫治后变化的探讨

目的 探讨单侧完全性唇腭裂术后患者上下颌牙弓间横向关系以及正畸治疗对上颌牙弓的影响。方法 对84名单侧完全性唇腭裂术后患者的错(牙合)畸形和上下颌颌间关系进行研究;并对36名唇腭裂术后患者进行正畸治疗前后的牙(牙合)模型进行测量分析上颌牙弓宽度的变化。结果 (1)单侧完全性唇腭裂术后60.7％的患者出现牙弓间横向关系的不协调,双尖牙区较易受累。(2)在出现牙弓间横向关系不调的患者中,双侧后牙反(牙合)者为60％。(3)正畸治疗后上颌牙弓的尖牙、第一、第二双尖牙间各自的宽度均有显著增加,第一磨牙间宽度变化不显著。上颌第一、第二双尖牙间各自宽度较尖牙间、第一磨牙间宽度增加显著。结论 单侧完全性唇腭裂术后患者上颌宽度的发育受到明显的限制,牙弓间横向关系不协调的比率较高,以双尖牙区为主;正畸矫治扩弓的重点应在双尖牙区。     

单侧完全性唇腭裂患者上下颌牙弓关系的评价

目的：用Goslon Yardstick评价系统来评价替牙列期和恒牙列期单侧完全性唇腭裂患者上、下颌牙弓协调性的差异,为继发牙畸形的诊断、矫治设计和序列治疗提供依据。方法：对40例患者取牙模型并根据牙列情况分为两组,替牙列期组（n=18）和恒牙列期组（n=22）。用石膏模型,对其牙弓关系行Goslon Yardstick等级评价,并对不同牙列期组间的Yardstick等级进行统计学检验。结果：替牙列期组中,22.2%患者上下颌牙弓协调性差,属于GoslonYardstick等级4和5;Goslon Yardstick均值为2.72。恒牙列期组中,40.9%患者上下颌牙弓协调性差,属于GoslonYardstick等级4和5;Goslon Yardstick均值为3.46。结论：单侧完全性唇腭裂患者恒牙列期比替牙列期上下颌牙弓协调性差,治疗难度更大。     

The incidence of congenital anomalies associated with cleft palate/cleft lip and palate in neonates in the Konya region, Turkey

Additional congenital anomalies have often been found in patients with orofacial clefts. We wanted to find out the incidence and type of congenital malformations that may accompany cleft palate (CP) and cleft lip and palate (CLP) in babies born in the Konya region. A total of 121 newborn babies with CP or CLP were prospectively included in the study, and all were assessed in detail for congenital anomalies. Of 121 babies, 86 (71%) had CLP and 35 (29%) had CP. There was at least one congenital malformation in 80 (66%) of the cases. Additional congenital malformations were seen in 26 (74%) of the 35 with isolated CP, and 54 (63%) in the 86 patients with CLP (p<0.05). The most common congenital malformation was congenital heart disease, followed by head and neck anomalies. The most common congenital heart disease was atrial septal defect. A serious chromosomal anomaly was found in 18/121 patients with CP or CLP (15%). Of the 80 babies in whom congenital malformations were found, 31 (39%) had dysmorphic features. While 21 (68%) of dysmorphic cases had isolated CP, 10 (32%) had CLP (p<0.05). The rates of premature delivery, intrauterine growth retardation, and consanguinity between parents were higher in patients with CP or CLP. The neonatal mortality was 20% (n=24). Our results indicate that at least one congenital anomaly is also present in about two-thirds of newborn babies with CP and CLP, and these anomalies significantly increase their morbidity and mortality. All newborn babies with CP and CLP should be screened for additional congenital anomalies, particularly of the cardiovascular system.     

单侧完全性唇腭裂患者牙龄骨龄相关性的研究

目的 探讨单侧完全性唇腭裂（UCLP）患者牙龄（DCS）和颈椎骨龄（CVMS）间关系,为唇腭裂（CLP）患者选择治疗时间提供理论基础。方法 选择UCLP患者123名,非CLP患者215名。通过Demirjian法评估非CLP患者下颌左侧和UCLP患者下颌双侧尖牙,前磨牙及第二磨牙的DCS;通过Baccetti法观测CVMS。将DCS和CVMS分布行Spearman相关分析,并对相关性进行比较。结果 非CLP患者和UCLP患者的所有DCS和CVMS均具有显著相关性（非CLP患者r=0.762~0.864,P<0.05;UCLP患者r=0.809~0.914,P<0.05）。其中,UCLP患者下颌第一前磨牙DCS和CVMS相关性最高。除UCLP女性前磨牙外,其余牙齿DCS和CVMS的相关性同非CLP患者间无统计学差异（P>0.05）。结论 DCS可以作为判定UCLP患者生长发育的生物学指标。其中,下颌第一前磨牙的DCS和CVMS相关性最大。     

Genetic variation in the promoter region of beta-defensin 1 (DEFB 1) is associated with high caries experience in children born with cleft lip and palate

Objective. Caries is a common disease in humans and has a multifactorial etiology. It has been suggested that children born with cleft lip and/or palate (CL/P) have a higher susceptibility to caries, but data from several independent cohorts does not support this assumption. Previous work from our group suggested DEFB 1 is associated with higher caries experience. Since it is suspected that children born with CL/P have the same risk factors predisposing them to caries as other children of the same ages, the aim was to test if DEFB 1 was associated with caries experience in children born with CL/P. Materials and methods. Sixty-nine children born with CL/P (aged 2–12 years) were included. Twenty-seven males and seven females had cleft lip and palate (CLP), six males and seven females had cleft lip (CL) and 13 males and nine females had cleft palate (CP). Caries was evaluated with the DMFT/dmft index by a calibrated evaluator. Two single nucleotide polymorphisms in DEFB 1 were selected (rs11362 and rs1800972) based on being associated with higher caries experience in previous work. Genotyping were carried out by real-time PCR using the Taqman assay method. The statistical analysis was performed between ‘low-to-moderate caries experience group' and the ‘high caries experience group'. Odds ratio calculations between caries experience and variant alleles and chi-square of Fisher exact tests at a level of significance of 0.05 were used. Results. There was no significant difference for caries experience between cleft types (p = 0.551). An association was found for the marker rs11362 and genotype distribution (p = 0.047). When analyzed in a recessive model, the genotype GG in this polymorphism increased the risk for caries susceptibility by more than 3-times (p = 0.031; OR = 3.16; 95% CI = 0.97–10.62). Conclusion. The genetic variant rs11362 in DEFB 1 influences caries susceptibility in CL/P children. The results support the hypothesis that expression of DEFB 1 in saliva may serve as a biomarker for future caries risk.     

Skeletal,dental and facial aesthetic changes following anterior maxillary segmental distraction by tooth-borne device in patients with cleft lip and palate

Maxillary skeletal deficiency secondary to cleft lip and palate (CLP) remains a significant challenge. The aim of this study was to present the comprehensive skeletal, dental and facial aesthetic outcomes of anterior maxillary segmental distraction osteogenesis (AMSDO) for treatment of maxillary hypoplasia in patients with CLP. Twelve patients with maxillary hypoplasia treated with AMSDO by a customized tooth-borne distractor were included. Three-dimensional changes of anterior maxillary segment, upper incisor and pharyngeal space were measured by three-dimensional reconstruction derived from cone beam computed tomography (CBCT) data. Length and width of dental arch during distraction were determined in dental casts. Nasolabial angle, soft-tissue convexity and patient’s subjective satisfaction were assessed to evaluate facial aesthetic improvements. Nasopharyngoscopic evaluation and speech assessment were also performed before and after distraction. All patients successfully received AMSDO without serious complications. Following AMSDO, the anterior maxillary segments moved forward 5.56 ± 0.28 mm and slightly upward 1.15 ± 0.13 mm. AMSDO significantly lengthened maxillary dental arch, generated new bone to relieve dental crowding and improved patients’ facial aesthetic without worsening velopharyngeal closure and speech quality. AMSDO by tooth-borne distractor is an effective surgical alternative for the advancement in patients with cleft maxillary hypoplasia.     

Is missing maxillary lateral incisor in complete cleft lip and palate a product of genetics or local environment

Objective:To test the null hypothesis: Subjects with isolated complete unilateral cleft lip and palate (UCLP) show no differences in overall frequency of tooth agenesis (hypodontia), comparing a subsample with cleft-side maxillary lateral incisor (MxI2) agenesis to a subsample without cleft-side MxI2 agenesis. Findings could clarify the origins of cleft-side MxI2 agenesis.Materials and Methods:Tooth agenesis was identified from dental radiographs of 141 subjects with UCLP. The UCLP cohort was segregated into four categories according to the status and location of MxI2 in the region of the unilateral cleft: group M: subjects with one tooth, located on the mesial side of the alveolar cleft; group D: subjects with one tooth, located on the distal side of the alveolar cleft; group MD: subjects with two teeth present, one mesial and one distal to the cleft; and group ABS: subjects with lateral incisor absent (agenesis) in the cleft area.Results:The null hypothesis was rejected. Among UCLP subjects, there was a twofold increase (P < .0008) in overall frequency of tooth agenesis outside the cleft region in a subsample with cleft-side MxI2 agenesis (ABS), compared to a subsample presenting with no agenesis of the cleft-side MxI2 (M+D+MD).Conclusions:Cleft-side MxI2 agenesis in CLP subjects appears to be largely a genetically controlled anomaly associated with cleft development, rather than a collateral environmental consequence of the adjacent cleft defect, since increased hypodontia involving multiple missing teeth observed remote from a cleft clearly has a significant genetic basis.     

Caries prevalence and enamel defects in 5- and 10-year-old children with cleft lip and/or palate: A case-control study

Objective. To determine the prevalence of dental caries and enamel defects in 5- and 10-year-old Swedish children with cleft lip and/or palate (CL(P)) in comparison to non-cleft controls. Materials and methods. The study group consisted of 139 children with CL(P) (80 subjects aged 5 years and 59 aged 10 years) and 313 age-matched non-cleft controls. All children were examined by one of two calibrated examiners. Caries was scored according to the International Caries Detection and Assessment System (ICDAS-II) and enamel defects as presence and frequency of hypoplasia and hypomineralization. Results. The caries prevalence among the 5-year-old CL(P) children and the non-cleft controls was 36% and 18%, respectively (p < 0.05). The CL(P) children had higher caries frequency (initial and cavitated lesions) in the primary dentition than their controls (1.2 vs 0.9; p < 0.05). A significantly higher prevalence of enamel defects was found in CL(P) children of both age groups and anterior permanent teeth were most commonly affected. Conclusions. Preschool children with cleft lip and/or palate seem to have more caries in the primary dentition than age-matched non-cleft controls. Enamel defects were more common in CL(P) children in both age groups.     

正畸治疗对恒牙晚期单侧完全性唇腭裂患者鼻部形态影响的研究

目的　研究恒牙晚期单侧完全性唇腭裂患者正畸治疗后的鼻部形态变化。方法　21例恒牙晚期单侧完全性唇腭裂患者在正畸治疗前、治疗后分别拍摄X线头颅侧位定位片,通过12个测量参数进行治疗前后的比较分析。数据资料用SPSS 13.0软件作统计学处理,治疗前后比较用t检验。结果　患者经上颌扩弓和正畸治疗后,鼻背长由（37.0±2.3）mm增加到（41.5±4.2）mm,P<0.05;鼻背深度1由（16.1±1.3）mm增加到（18.3±1.5）mm,P<0.05;鼻背深度2由(18.5±1.9)mm增加到(20.4±2.3)mm,P<0.05;鼻唇角由(66.9±5.6)°增大到(72.2±6.6)°,P<0.05;面型角由(-5.0±2.1)°变为(4.6±3.4)°,P<0.01。结论　恒牙晚期单侧完全性唇腭裂患者经过正畸治疗后,患者的鼻部长度及深度增加,鼻部形态改善,患者侧貌更加美观。