快速上颌扩展矫治器

快速上颌扩展 (ＲａｐｉｄＭａｘｉｌｌａｒｙＥｘｐａｎｓｉｏｎ ,ＲＭＥ)是一种较常用的矫形方法。它使用机械矫形力分离腭中缝 ,扩大上颌牙弓 ,以治疗上颌牙弓狭窄 ,前、后牙反 ,上颌前突和牙列拥挤。自 186 0年报道了该方法后 ,学者们通过临床和动物实验研究 ,肯定了ＲＭＥ的治疗效果 ,认为ＲＭＥ能分离腭中缝 ,扩大牙弓。当时也有人认为正畸矫治力不能分离腭中缝和侧向移动上颌骨 ,只能引起支抗牙牙槽骨的改建 ,支抗牙颊向移动而增加牙弓的宽度。只有外科的强大矫形力才能通过骨折而分离腭中缝。进入 195 0年后 ,又有学者进一步证明…     

快速上颌扩展矫治替牙期上颌狭窄拥挤伴中线偏斜

目的探讨快速上颌扩展(RME)配合固定矫治技术对替牙期上颌狭窄、上牙列轻中度拥挤伴中线偏斜的矫治方法。方法选择24例替牙期上颌狭窄,上前牙轻中度拥挤,上中线偏斜大于2mm,前牙覆正常的患者,年龄8.2～11.4岁,平均9.8岁。临床检查及曲面断层片、头颅侧位定位片排除功能因素。采用Hyrax支架式快速扩大,开展的速度每日旋转2次,螺旋开大0.5mm至上后牙的舌尖咬在下后牙的颊尖为止,中切牙之间的间隙大于2mm。在快速扩弓保持期内配合固定矫治技术移动前牙,调整中线。结果腭中缝扩大后,上牙弓宽度增加,牙弓周长增加,为排齐牙列调整中线提供间隙,6个月保持期间配合固定矫治排齐上前牙,对正中线。结论 RME配合固定矫治技术能有效的矫治替牙期上颌狭窄、轻中度拥挤和中线偏斜。     

快速上颌扩展对颌骨和牙齿的影响

快速上颌扩展是一种常用的矫治上颌横向宽度不调的方法。本文结合近年来的国内外文献就快速上颌扩展对颌骨和牙齿影响方面的研究进展进行了回顾和总结,以期为快速上颌扩展的临床应用和研究提供参考。     

年轻成人与儿童行上颌快速腭扩展术之比较

上颌快速腭扩展可有效地扩大上颌牙弓，其不仅适用于儿童及青少年，也可成功地用于成人上颌牙弓狭窄的矫治。本文介绍了年轻成人与儿童各自应用上颌快速腭扩展术的生物学基础、存在的各种分歧、扩弓过程中磨牙及腭弓形态变化的差异、难易程度及其长期的效果与稳定性的差异、各自优势及所需要注意的问题。     

螺旋扩大器快速打开腭中缝后口颌系统横向变化的研究

目的 探讨支架半托式螺旋扩大器快速打开腭中缝后,口颌系统中牙齿、颌骨、肌肉的变化.方法 20例上颌骨发育不足伴上颌牙弓狭窄患者在快速打开腭中缝前后拍摄后前位头颅定位片,进行测量分析,同时测量颊肌压力变化.结果 上颌中切牙冠间距和根间距分别增大了（4.34±1.18） mm和（3.74±1.75） mm;上颌第一磨牙间距和上颌骨宽度分别增大了（7.83 ±1.49） mm和（5.07±1.07） mm;上颌尖牙间宽度增大了（6.79±1.82） mm;牙槽嵴间距、前鼻嵴间距和鼻腔宽度分别增大了（4.32±0.98） mm、（3.69±0.83） mm和（2.08±0.72） mm;双侧上颌第一磨牙处颊肌压力分别增大了（857.01±300.96） Pa和（772.06±296.93）Pa.结论 支架半托式螺旋扩大器可以快速打开腭中缝,牙齿、颌骨、颊肌压力均发生了显著变化.     

快速上颌扩大的研究

本文对快速上颌扩大(RME)这一正畸临床治疗方法从产生到目前的研究和使用状况进行了系统地回顾和总结。指出,RME从19世纪中期应用于正畸治疗以来,曾达到一高峰时期,以Angell为代表的学者们无限制地夸大了RME的作用;到了20世纪初期,不少学者否定了RME的作用,认为RME并不能分离腭中缝,从而使RME进入一低落期;直到近50年,通过大量的临床和实验研究,又重新更系统更全面地分析了RME的作用机理,肯定了RME的治疗作用。     

外科辅助快速腭扩展技术的研究现状

上颌横向发育不足是某些错畸形的主要表现。近年来外科辅助快速腭扩展被越来越多地应用于成人上颌横向发育不足的矫治,本文对其适应症的选择、常用术式、扩弓装置、术前正畸准备、软硬组织的变化、并发症、稳定性及保持作一综述。     

上颌交替快速扩缩结合前牵的研究进展

上颌交替快速扩缩(alternate rapid maxillary expansions and constrictions, Alt-RAMEC)是Liou在2005年提出的一种新的扩弓方法,可以更大程度地松解上颌周围骨缝,来促进上颌前牵效果。与快速扩弓辅助前牵相比,能更有效地矫正上颌发育不足,获得更多的骨骼效果。本文综述了传统Alt-RAMEC装置特点、临床效果、长期稳定性以及对气道的影响和牙周副作用,为推广临床应用提供参考。     

中国南方广东省10～15岁儿童颈椎骨发育与正畸治疗

作者利用Ｘ线头颅侧位定位片测定颅面结构和颈椎发育程度，研究１７９中国南方广东省１０～１５岁儿童颈椎骨发育与年龄的关系。结果显示随年龄的增长，颈椎骨Ｃ２～Ｃ６的面积逐渐递增，而且形态呈规律性改变。女性比男性早熟１～２年，但形态规律无性别差异。分析和建立了中国南方广东省１０～１５岁儿童颈椎发育的一系列标准．为临床诊治正畸病人评定骨龄提供一个简便经济而实用的参考指标。     

Asymmetric rapid maxillary expansion in true unilateral crossbite malocclusion: A prospective controlled clinical study

Objective:To investigate the short-term effects of the asymmetric rapid maxillary (ARME) appliance on the vertical, sagittal, and transverse planes in patients with true unilateral posterior crossbite.Materials and Methods:Subjects were divided into two groups. The treatment group was comprised of 21 patients with unilateral posterior crossbite (mean age  =  13.3 ± 2.1 years). Members of this group were treated with the ARME appliance. The control group was comprised of 17 patients with Angle Class I who were kept under observation (mean age  =  12.3 ± 0.8 years). Lateral and frontal cephalograms were taken before the expansion (T1), immediately after expansion (T2), and at postexpansion retention (T3) in the treatment group and at preobservation (T1) and postobservation (T2) in the control group. A total of 34 measurements were assessed on cephalograms. For statistical analysis, the Wilcoxon test and analysis of covariance were used.Results:The ARME appliance produced significant increases in nasal, maxillary base, upper arch, and lower arch dimensions (P < .01) and a clockwise rotation of the occlusal plane (P  =  .001).Conclusion:The ARME appliance created asymmetric increments in the transversal dimensions of the nose, maxilla, and upper arch in the short term. Asymmetric expansion therapy for subjects with unilateral maxillary deficiency may provide satisfactory outcomes in adolescents, with the exception of mandibular arch expansion. The triangular pattern of expansion caused clockwise rotation of the mandible and the occlusal plane and produced significant alterations in the vertical facial dimensions, whereas it created no displacement in maxilla in the sagittal plane.     

The effects of rapid maxillary expansion on voice function

Objective:To evaluate the effects of rapid maxillary expansion (RME) on vocal function in patients with bilateral maxillary crossbite.Materials and Methods:We designed our research as a prospective, controlled, clinical study. The treatment group and the control group each had 20 subjects for a total of 40 subjects. Acoustic voice samples were recorded from all patients at T₁ and T₂ by the Multi-Dimensional Voice Program (MDVP Model 5105) for acoustic analysis in Computerized Speech Lab (CSL).Results:No statistically significant differences were found between the treatment and control groups in the means of any parameters.Conclusions:RME does not change vocal quality or resonance, so it can be safely used with patients.     

上颌快速扩大兔腭中缝组织改建的连续组织学研究

目的研究上颌快速扩大腭中缝牵张成骨的连续过程及规律，了解快速扩张腭中缝的缝组织反应和组织再生机理。方法选用处于生长期新西兰大白兔52只，随机分为13组，实验组5组、对照组6组，荧光标记的实验组和对照组各1组。采用螺旋分裂基托扩大矫治器（Haas矫正器）扩张兔上牙弓，快速扩张期2周，固定期4周。扩张速率为0．25mm／12h，共扩张牵引14天，分别于即刻、第7、14、21、28、42天取材，标本常规进行组织学观察。并利用激光共聚焦扫描显微镜及荧光标记观察快速扩张腭中缝成骨活动的情况。结果快速扩张2周后可见腭中缝明显增宽，可见创伤性反应，成骨和成纤维细胞大量增殖，大量胶原纤维沿扩张力方向有序排列，成骨活动沿骨缝边缘平行沉积。快速扩张的腭中缝有强烈的血管生成反应，新生骨组织改建活跃，直至新的骨缘形成。缝恢复正常的形态。荧光标记观察实验组骨沉积带明显宽于对照组。结论扩张的腭中缝新骨改建主要发生在腭中缝骨缘。腭中缝改建的过程是纤维修复和骨组织再生过程。     

Dentofacial changes from fan-type rapid maxillary expansion vs traditional rapid maxillary expansion in early mixed dentition: A prospective clinical trial

Objective:To test the null hypothesis that there is no difference between the effects of fan-type rapid (FRME) and rapid maxillary expansion (RME) used with an acrylic bonded expansion appliance on dentofacial structures in early occlusal stages.Materials and Methods:This was a prospective clinical trial. The FRME group had an anterior constricted maxillary width with a normal intermolar width, and the RME group had bilateral constricted maxillary width. The FRME group consisted of 20 patients (mean age, 8.96 ± 1.19 years), and the RME group consisted of 22 patients (mean age, 8.69 ± 0.66 years). Lateral and frontal cephalometric radiographs and dental casts were taken before and after expansion and 3 months after completing treatment for each patient. The data were compared using repeated-measures analysis of variance. The paired-samples t-test was used to evaluate treatment and retention effects, and the independent samples t-test was used to consider the differences between the two groups.Results:The maxilla moved downward and forward in both groups. The nasal cavity and maxillary width were expanded more in the RME group, and there were only a few relapses in this group during the retention period. There was significant labial tipping of the upper incisors in the FRME expansion group. The expansion of intercanine width was similar in both groups, but the expansion of intermolar width was significantly greater in the RME group.Conclusion:The null hypothesis was rejected. There was a difference between the effects of FRME and RME used with an acrylic bonded expansion appliance on dentofacial structures in the early occlusal stages.     

Influence of activation protocol on perceived pain during rapid maxillary expansion

Objective:To investigate the influence of two different activation protocols on the timing and intensity of pain during rapid maxillary expansion (RME).Materials and Methods:A total of 112 prepubertal patients (54 males and 58 females, mean age 11.00 ± 1.80 years) with constricted maxillary arches underwent RME with two different activation protocols (group 1: one activation/day; group 2: two activations/day). Patients were provided with a numeric rating scale (NRS) and the Faces Pain Scale (FPS) to correctly assess their daily pain.Results:Subjects treated with RME at two activations/day reported statistically significantly greater amounts of pain than subjects treated with RME at one activation/day. Differences related to gender and skeletal maturity were found.Conclusion:The choice of activation protocol influences the perceived pain during RME, and less daily expansion is correlated to less pain. Pain reported during RME could be influenced by skeletal maturity and gender of the subjects under treatment.     

上颌快速扩弓的生物力学研究进展

上颌快速扩弓是临床上常用的治疗方法。上颌骨邻近组织结构复杂,而快速扩弓的矫治力作用于牙和腭部再通过骨和软组织的传导分散到整个上颌骨及其周围组织,因此其生物力学作用机制亦十分复杂。下面就其生物力学原理的国内外研究进展进行综述,以期对临床医师应用该法有所帮助。     

腭部不同类型快速扩弓配合前方牵引的应用进展

上颌快速扩弓配合前方牵引面具是早期治疗上颌骨发育不足的骨性安氏Ⅲ类错牙合常见方法之一.传统方法常用牙和黏膜支持式装置治疗替牙期及恒牙早期的骨性Ⅲ类患者,随着种植支抗的发展,种植钉被广泛应用于正畸治疗中,展示出稳定的骨性支抗效果.本文将对腭部不同类型快速扩弓配合前方牵引技术作一简要综述,为临床治疗提供参考.