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.     

唇腭裂患者上颌前部牙槽骨厚度及骨开窗、骨开裂的三维评价研究

目的　利用锥形束CT（cone-beam CT,CBCT）评价不同类型唇腭裂患者上颌前部牙槽骨厚度和形态,以及上前牙骨开窗、骨开裂情况。方法　选择016年8月至019年10月间在南京医科大学附属口腔医院就诊拟行口腔正畸治疗的唇腭裂患者85例（男51例,女34例,平均年龄（14.65±4.95）岁）,其中单侧唇裂伴牙槽突裂（unilateral cleft lip and alveolus,UCLA）患者19例,单侧完全性唇腭裂（unilateral complete cleft lip and palate,UCLP）患者5例,双侧完全性唇腭裂（bilateral complete cleft lip and palate,BCLP）患者14例。在正畸治疗开始前均予以拍摄颌面部CBCT,应用Image J软件测量其上前牙唇腭侧牙槽骨厚度（alveolar bone thickness,ABT）,计算骨开窗、骨开裂发生率,并比较不同唇腭裂类型患者上颌前部ABT及上前牙骨开窗、骨开裂发生率的差异。结果　UCLP、UCLA患侧上前牙骨开裂发生率（34.9%、4.9%）显著高于其健侧（10.7%、11.1%）,但骨开窗发生率无统计学差异。UCLP健侧上中切牙（5.9%）、侧切牙（9.7%）骨开裂发生率低于UCLA。UCLA、UCLP、BCLP三组间患侧上前牙骨开裂及骨开窗发生率均无统计学差异。UCLP、UCLA患侧上前牙ABT在多部位小于其健侧。除UCLP/UCLA患侧侧切牙外,UCLA、UCLP、BCLP各类型上前牙唇侧平均ABT均小于腭侧。UCLA、UCLP、BCLP三组间患侧上前牙唇腭侧平均ABT无统计学差异。UCLP患侧上侧切牙、尖牙分别在唇侧和腭侧根颈处ABT大于UCLA。结论　单侧唇腭裂患者患侧上前牙骨开裂发生率高于健侧,ABT则在多部位小于其健侧;而三种类型患者上前牙唇侧ABT均小于其腭侧。单侧唇裂伴牙槽突裂与单侧完全性唇腭裂患者健侧上中切牙、侧切牙骨开裂发生率及患侧侧切牙、尖牙根颈处牙槽骨厚度存在差异;单侧与双侧完全性唇腭裂间上前牙骨开窗、骨开裂发生率及牙槽骨厚度则无差异。     

前方牵引治疗唇腭裂术后与非唇腭裂前牙反(牙合)疗效的比较

目的探讨生长发育高峰前期单侧完全性唇腭裂(UCLP)术后前牙反与非唇腭裂前牙反患者对前方牵引治疗反应的异同,以利于UCLP前牙反的治疗。方法进行前瞻性临床研究设计,UCLP术后前牙反患者18例,年龄(9·6±1·2)岁;非唇腭裂前牙反患者18例,年龄(9·8±1·4)岁,均处于生长发育高峰前期。使用前方牵引进行治疗,治疗前后拍头颅侧位片并测量,进行成组设计和配对设计t检验。结果前方牵引治疗后UCLP组SNA增加1·45°,A-TFH增加2·19mm,非唇腭裂组SNA增加1·42°,A-TFH增加2·12mm,两组差异无统计学意义(P>0·05)。UCLP组SNB减小2·18°,ANB增加3·64°,MP/SN增加2·78°,LL-EP增加0·88mm;非唇腭裂组SNB减小1·32°,ANB增加2·68°,MP/SN增加1·47°,LL-EP减小1·37mm,两组差异有统计学意义(P<0·05)。结论通过前方牵引治疗,生长发育高峰前期UCLP术后轻中度骨性前牙反患者与非唇腭裂前牙反患者的上下颌骨关系、软组织面型得到改善。两组上颌骨对治疗的反应相似。UCLP组较非唇腭裂组颌间关系改变大,下颌向后向下旋转多;UCLP组患者治疗后下唇变化不如非唇腭裂组明显。     

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.     

A long-term study of transverse stability of maxillary teeth in patients with unilateral complete cleft lip and palate

summary The aim of this study was to investigate the long term post-treatment transverse stability of the maxillary dental arch in subjects with unilateral complete cleft lip and palate (UCLP) treated by the Harvold/Bøhn method of orthodontic expansion and prosthodontic retention. The treatment of 22 consecutive patients, primarily operated on during the period 1957–60, was completed at a mean age of 18.1 years by the provision of a fixed partial retention prosthesis across the cleft using the cleft side central incisor and canine only as abutment teeth. The cleft side lateral incisor was missing in each case. Dental casts were made at the time of abutment preparation and at six subsequent times with the final observation 13·5 years after treatment completion. Measurements of any shift in the transverse position of cleft side and non-cleft side canines, premolars and first molars were made on standardized photographs of the casts. A constructed antero-posterior palatal line served as 'midline' reference. A mean reduction of width at the final observation, as recorded from the palatal surface to the reference line, was for the cleft side canine: −0·4 mm, the premolar immediately distal to the prosthesis and the first molar: both −1·2 mm. The corresponding mean width reductions on the noncleft side were: canine −0·9 mm, premolar −1·2 mm, first molar −1·6 mm. The rate of movement towards the midline decreased linearly with in(time) for all variables (P < 0·02) but for the cleft side canine.     

前方牵引治疗替牙期唇腭裂术后反（牙合）对患者咬合功能的影响

目的 研究前方牵引治疗替牙期唇腭裂术后反（牙合）对患者咬合功能的影响.方法 以15名替牙期单侧完全性唇腭裂术后反（牙合）患者作为研究对象,对其进行前方牵引治疗,并在治疗前后进行咬合功能检查.结果 牙尖交错位（intercuspal position,ICP）习惯咬牙状态（habitual biting）（ICP-HB）时,从最初牙尖接触到最大牙尖交错所需的时间（occlusion time,OT）在治疗前后无明显变化.治疗后咬合接触点增加（P＜0.05）,颞肌前部、咬肌肌电值增加（P＜0.05）,咬合力不对称指数和颞肌前部、咬肌肌电不对称指数无明显变化.牙尖交错位最大力紧咬牙状态（maximal clenching）（ICP-MC）时,治疗后颞肌肌电值增加（P＜0.05）,咬肌肌电值有增加趋势,但无统计学意义.结论 替牙期唇腭裂术后反（牙合）患者在前方牵引治疗后,能在一定程度上改善咬合功能,但仍需要二期系统正畸治疗完善咬合关系的调整.     

The prevention of relapse after maxillary osteotomies in cleft palate patients

The use of segmental osteotomies to treat surgically severe malocclusion in cleft patients is discussed. The coordinated approach by orthodontist and surgeon is advocated and the advantage of such an approach is stressed. The method allows for the simultaneous correction of the skeletal deformity and closure of residual oro-nasal perforation. The relapse tendency in both antero-posterior and transverse dimensions appeared to be minimal as found in this study of 18 patients.     

Alterations in velopharyngeal function after maxillary advancement in cleft palate patients

Velopharyngeal function was assessed aerodynamically prior to surgery and at least 1 year following surgery in 24 cleft palate patients who underwent maxillary advancement. In 5 patients (23%) deterioration and in 5 patients (23%) improvement of velopharyngeal function was observed. In those patients whose velopharyngeal function improved, a pharyngeal flap was in place at surgery. Of the 5 patients whose velopharyngeal function deteriorated, 4 had adequate and 1 borderline adequate velopharyngeal function prior to surgery. In the remaining 14 patients, velopharyngeal function was unchanged. No relationship between the amount of maxillary advancement or the "need ratio" and velopharyngeal function was observed.     

Crown-root ratio of permanent teeth in cleft lip and palate patients

Objectives:To determine root lengths of fully developed permanent teeth of cleft lip and palate (CLP) patients and to define their crown-root (C/R) ratios.Method:Crown height and root length of permanent teeth were measured from panoramic radiographs of 44 CLP patients and 37 controls. A total of 1397 teeth were measured, and C/R ratios were calculated.Results:Higher C/R ratios were found in CLP patients; this was statistically significant for both maxillary and mandibular incisors and canines. Bilateral CLP subjects showed higher C/R ratios in general than unilateral CLP subjects. Roots of maxillary incisors, canines, and some other teeth were significantly shorter in CLP patients than in controls.Conclusions:CLP patients should be considered to have unfavorable C/R ratios, which could be the result of short root lengths for some teeth.     

Skeletal relapse of maxillary osteotomies in unilateral cleft lip and palate patients

The outcomes of a consecutive series of 10 adults who had unilateral cleft lip and palate and who had undergone Le Fort I advancement fixed with miniplates were investigated. The amount and timing of horizontal and vertical relapse, the correlation between advancement and relapse, and the effectiveness of various methods of internal fixation were analyzed with respect to the authors' clinical experience and the data from the international literature. Tracings of the preoperative and serial postoperative lateral cephalograms--taken immediately and during the 1 1/2 to 2 postoperative years--were analyzed to calculate horizontal and vertical maxillary change. We found that the use of rigid fixation is associated with a significantly more stable postoperative result, as described by other authors. Our study suggests that this useful technique does not eliminate but reduces and controls the problem of relapse in a series of unilateral cleft lip and palate adult patients undergoing Le Fort I osteotomy.     

口腔数字化设计在唇腭裂患者前牙美学修复中的应用研究

目的 探讨口腔数字化设计技术在唇腭裂患者前牙美学修复中的应用效果.方法 选择裂隙区需要前牙美学修复的唇腭裂成年患者9例,获取患者口内前牙与周围软组织及面部的美学数字化信息,利用keynote及3shape软件进行美学修复分析设计,与患者沟通优化修复方案,生成3D诊断蜡型并打印树脂实体诊断模型,在口内制作树脂罩面指导医生...     

头颅定位测量对大年龄未手术腭裂患者上颌骨发育的研究分析

目的研究分析大年龄未手术腭裂患者上颌骨发育的情况。方法运用电脑图象测试系统，对３７名未手术的大年龄腭裂患者头颅定位Ｘ片进行测量分析，并与２０名正常成人对照。结果大年龄未手术患者上颌骨前后发育受限，而垂直向发育与正常成人无显著性差异。结论腭裂畸形本身可影响上颌骨的发育     

完全性唇腭裂婴儿期唇腭裂手术对上颌骨发育的近期影响

目的:观察婴儿早期行唇腭裂手术对完全性唇腭裂患儿上颌骨发育的近期影响.方法: 35 例完全性唇腭裂患儿分为2 组,婴儿期接受唇腭裂手术的20 例为唇腭裂一期修复组,随访时平均年龄(9.99± 0.84) 岁;15 例于婴儿期行唇裂手术未接受腭裂修复的为单纯唇裂修复组,随访时平均年龄(10.24± 1.14) 岁;另20 名无先天性唇腭裂的10 岁龄学童作为正常对照组;3 组分别取头颅侧位片与上牙颌模型,进行测量分析.结果: 2 组唇腭裂患儿之间的上颌骨发育无明显差异,与正常对照组相比较,均有生长抑制.结论:婴儿期行唇腭裂手术的完全性唇腭裂患儿在10 岁左右上颌骨发育与正常儿童存在明显差异,腭裂手术不是引起差异的主要原因,可早期完成该手术.