上颌尖牙腭侧埋伏阻生的锥形束CT定位诊断

目的应用锥形束CT（CBCT）探讨上颌腭侧埋伏阻生尖牙的埋伏特征及邻牙牙根吸收情况。方法选取南京医科大学附属口腔医院正畸科就诊的上颌尖牙腭侧埋伏阻生的青少年患者22例,获取CBCT三维数据,应用Dolphin imaging 11.0软件,分析腭侧埋伏尖牙的埋伏状况、与邻牙位置关系并分类,观察邻牙牙根的吸收情况。结果上颌腭侧埋伏尖牙大多近中、腭向倾斜阻生,近中异位以Ⅰ类和Ⅳ类较为多见,分别占30.8%和38.5%;近中倾斜角度多在53.8°~68.5°,腭侧异位距正中矢状面多在5.4~8.4 mm。年龄越大,上颌腭侧埋伏尖牙近中腭向异位越远,近中倾斜角度越大。84.6%的相邻侧切牙及19.2%的中切牙牙根与埋伏尖牙接触;50%的相邻侧切牙及15.4%的邻中切牙牙根吸收,相邻侧切牙吸收多位于根尖1/3,而相邻中切牙吸收多位于根中1/3;相邻切牙牙根吸收概率与腭侧埋伏尖牙与切牙间的最小距离呈反比关系。结论CBCT能在三维方向诊断上颌尖牙埋伏状况及与邻近组织的关系,准确判断邻牙根吸收情况,准确测量埋伏尖牙倾斜度及埋伏深度,为上颌腭侧埋伏尖牙的治疗提供指导。     

硬腭前份神经支配增龄性变化的临床研究

目的 通过对替牙列期和恒牙列期患者硬腭前份麻醉效果的观察,研究硬腭前份的神经支配以及与个体发育和年龄的关系,为临床前腭部局部麻醉方式的选择以及颌面部神经发育研究提供参考.方法 182例替牙列期患者随机分为鼻腭组和腭大组,分别采用鼻腭神经阻滞麻醉和腭大神经阻滞麻醉.219例恒牙列期患者分为青少年组(13～18岁)和成人组...     

上颌埋伏阻生中切牙的影像学分类

目的:探讨上颌埋伏阻生中切牙的三维图像分类特征。方法:根据103例上颌中切牙埋伏阻生患者螺旋CT的Dicom原始数据,应用Mimics10.0软件重建出上颌埋伏阻生中切牙的三维图像,分析上颌埋伏阻生中切牙的阻生特点,并对其进行分类。结果:共有埋伏牙106颗。74颗牙为唇侧阻生,倒置阻生33颗,水平阻生28颗,倾斜阻生13颗;20颗为腭侧阻生,倾斜阻生11颗,水平阻生9颗;12颗为垂直阻生。上颌埋伏阻生中切牙根据牙冠的位置在垂直向、冠状向、矢状向可分为3类,即①唇侧埋伏阻生型,包括唇侧倾斜埋伏阻生型、唇侧前后水平埋伏阻生型、唇侧倒置埋伏阻生型;②腭侧埋伏阻生型,包括腭侧倾斜埋伏阻生型、腭侧后前水平埋伏阻生型;③垂直埋伏阻生型。结论:上颌埋伏阻生中切牙从三维方向上可分为3类,每一类又可分多个亚型,包括唇侧(倾斜、前后水平、倒置)埋伏阻生、腭侧(倾斜、后前水平)埋伏阻生和垂直埋伏阻生。     

冷光源反角涡轮机在上颌埋伏多生牙微创拔除中的应用体会

目的通过分析微创拔除上颌埋伏多生牙,探讨微创理念、提高临床技术应用。 方法应用X线偏心投照法或锥形束CT（CBCT）定位埋伏多生牙;采用局部麻醉、唇颊侧或腭侧个性化手术进路;使用冷光源反角涡轮机+微创拔牙刀,拔除21例上颌埋伏多生牙。 结果麻醉效果良好,手术过程顺利,无邻牙及邻近结构损伤,无并发症或后遗症发生,切口愈合良好。 结论埋伏多生牙好发于上颌前部腭侧;CBCT图像可从任意角度直观地显示埋伏多生牙在颌骨内的位置,对麻醉和手术方案制定、微创手术实施有益,可作为术前常规检查;精确定位、个性化手术进路、冷光源反角涡轮手机及微创拔牙刀的应用,可降低手术创伤、缩短手术时间,对低龄儿童在局麻下完成手术有益;同时降低手术对儿童牙槽骨、颌骨发育影响的风险。     

使用导杆式矫治器治疗腭侧阻生上中切牙

目的 分析上颌腭侧埋伏阻生中切牙的正畸矫治效果及导杆式矫治器的治疗作用.方法 利用导杆式矫治器治疗7例上颌单侧中切牙腭侧埋伏的患牙,以对侧自然萌出中切牙作为对照.矫治前后拍摄全景片,测量矫治后埋伏牙和对照牙的牙全长、解剖牙根长度、解剖牙冠长度、根长/冠长,用SPSS 17.0软件进行成组t检验.结果 6例腭侧埋伏中切牙经牵引萌出后排齐,牙髓和牙周状况良好.萌出后埋伏牙解剖牙根长度比对照组牙根短4.00 mm（P=0.020）,根长/冠长值平均为1.36±0.31,小于对照组（P=0.048）.其中1例因埋伏牙骨粘连,牵引16个月后无移动而放弃牵引.结论 矫治后腭侧埋伏中切牙有足够的长度,应保留埋伏牙;导杆式矫治器是治疗上颌腭侧埋伏中切牙的一种有效方法.     

上颌正中埋伏多生牙95例的临床分析及治疗体会

目的:总结儿童上颌正中埋伏多生牙的临床特点,探索拔除方法。方法:对2008—2010年间收治的95例儿童上颌正中埋伏多生牙病例的特点及治疗进行分析。结果:95例患者共120颗埋伏多生牙,均位于上颌两中切牙之间。年龄7~14岁,男女比例为3.75∶1。其腭侧发病率为89.2%,远高于唇侧。所有患儿均于局麻下顺利拔除埋伏多生牙。结论:埋伏多生牙的拔除,术前的准确定位、术前和术中对患儿的心理诱导、良好的局部麻醉效果、合理的手术切口设计及轻柔精准的操作技巧为必备因素。     

上颌腭侧埋伏阻生尖牙 CBCT 导引下的牵引治疗

目的:探讨锥形束CT(CBCT)三维(3D)重建在上颌腭侧埋伏阻生尖牙牵引治疗中的指导作用。方法:对22例上颌尖牙(共26颗)腭侧埋伏阻生的青少年患者行CBCT检查。CBCT三维重建观察尖牙形态、腭侧埋伏状况,测量分析与邻近组织的位置关系及相邻切牙牙根吸收情况。结果:CBCT能够真实再现颌骨内埋伏的上颌尖牙。埋伏尖牙均近中倾斜,与平面平均成角61.1°±18.1°,近中异位分别为Ⅰ类埋伏尖牙8颗、Ⅱ类5颗、Ⅲ类3颗、Ⅳ类10颗。3颗相邻侧切牙及2颗中切牙因严重牙根吸收而拔除;26颗上颌腭侧埋伏尖牙均成功牵引至平面排入牙弓并建立正常咬合。结论:CBCT能立体再现上颌尖牙腭侧埋伏阻生特征及与邻近牙的关系等,对治疗方案的制定、开窗牵引具有指导作用,可提高疗效。     

上颌埋伏阻生尖牙在锥形束CT和曲面体层片中的位置分布及特征研究

目的　通过分析上颌埋伏阻生尖牙在曲面体层片上牙冠和牙根所在区域、牙轴倾斜度及牙齿长度,对照其在锥形束CT（cone-beam computed tomography,CBCT）上的位置,找出上颌埋伏阻生尖牙的曲面体层片预测因素。方法　选取2006—2018年于中国医科大学附属口腔医院正畸科就诊的单侧上颌埋伏阻生尖牙患者135例,共计上颌埋伏阻生尖牙135颗为研究组,同一患者对侧非埋伏阻生尖牙135颗为对照组。（1）采用NNT Viewer软件、Planmeca Dimaxis Pro软件分别对患者的CBCT图像和曲面体层片进行测量,将曲面体层片中上颌埋伏阻生尖牙近远中向位置分为5区（Ⅰ ~ Ⅴ区）,其唇腭侧位置由CBCT判定,分析两者相关性。（2）在曲面体层片中测量分析研究组与对照组牙冠及牙根的近远中向位置分布、牙轴倾斜度以及牙齿长度的差异。结果　（1）不同性别患者上颌埋伏阻生尖牙唇腭侧位置分布的差异有统计学意义（χ2 = 13.542,P = 0.001）。曲面体层片中上颌埋伏阻生尖牙牙根近远中向的区域定位与CBCT中相应阻生尖牙的唇腭侧位之间有显著相关性（r = 0. 225,P = 0.009）;但其牙冠间无相关性（r = 0.001,P = 0.991）。（2）两组尖牙牙冠及牙根近远中向位置分布差异有统计学意义（χ2值分别为219.263、68.447,均P < 0.001）。研究组较对照组尖牙牙齿长度短,牙轴倾斜度大（均P < 0.05）。结论　利用曲面体层片中上颌阻生尖牙牙根近远中向的区域定位可预测其唇腭侧位。在曲面体层片中牙根近远中向位置和牙齿长度的测量结果可用于预测上颌埋伏阻生尖牙的发生。     

上颌前部骨内埋伏多生牙的手术径路

目的探讨上颌前部骨内埋伏多生牙的手术径路。方法86例患者采用4种手术径路拔除上颌前部骨内埋伏多生牙,包括腭侧径路,唇侧径路,联合径路及牙槽嵴顶径路,并进行回顾性分析。结果所有的患者手术顺利,一期愈合,无严重并发症。结论4种径路均是上颌前部埋伏多生牙拔除的有效方法。     

多生埋伏牙位于重叠的中侧切牙根尖部1例

患者 ,男 ,1 9岁 ,两周前在外院做口腔拍片检查时发现上颌有两个埋伏多生牙 ,遂在该院行上颌埋伏牙拔除术 ,历时近两小时未找到埋伏牙 ,于是关闭创口。 1 999年 1 2月 1 4日患者来我院要求拔牙。检查 :牙列不齐 ,上前牙间隙大。 1 - 1间隙约 0 .3cm,双侧侧切牙颚向移位 ,几乎与两中切牙相重叠。颚粘膜可见纵行条索状隆起 ,触前牙唇颚侧骨质均无隆起 ,无压痛。拍片示两中切牙根尖处各有一倒置的埋伏牙。处理 :双侧上牙槽前 ,中神经 ,腭大神经及鼻腭神经“利”麻生效后 ,上腭正中距切牙乳头 0 .5厘米处纵行切开腭粘膜 ,向两侧翻起腭瓣 ,在 1 |…     

Effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve block technique

The purpose of this study was to assess the effectiveness of nasopalatine nerve block for anesthesia of maxillary central incisors after failure of the anterior superior alveolar nerve (ASAN) block technique. Secondarily, the possible innervation of the maxillary central incisors by the nasopalatine nerve was also investigated. Twenty-seven healthy, young adult volunteers (age: 17-26 years; gender: 9 males and 18 females) were enrolled in this study. All participants were undergraduate dental students of the University of Vale do Rio Verde de Três Cora??es. The volunteers had the anterior superior alveolar nerves anesthetized and a thermal sensitivity test (cold) was performed on the maxillary central incisors. The volunteers that responded positively to cold stimulus received a nasopalatine nerve block and the thermal sensitivity test was repeated. All participants were anesthetized by a single operator. Three patients presented sensitivity after both types of bilateral blocks and were excluded from the percentage calculations. In the remaining 24 patients, 16 had their maxillary central incisors anesthetized by the anterior superior alveolar block and 8 remained with sensitivity after the ASAN block. All these 8 patients had their maxillary central incisors successfully anesthetized by the nasopalatine block. In this study, 33.3% of the subjects had the innervation of one or both maxillary central incisors derived from the nasopalatine nerve, whilst most subjects (66.7%) had such teeth innervated by the anterior superior alveolar nerve. The nasopalatine nerve block was effective in anesthetizing the maxillary central incisors when the anterior superior alveolar nerve block failed.     

The contribution of the nasopalatine nerve to sensation of the hard palate

This study investigates which areas of the hard palate are innervated by the nasopalatine nerve and determines whether division of this nerve results in a detectable alteration in sensation. In the first part of this study the area of the hard palate from which sharp and blunt sensation could be evoked was investigated in 20 subjects after anaesthetising both anterior (formerly greater) palatine nerves. Sensation remained in the region of the incisive papilla and gingival margin of the central incisors in all patients and, in some, extended as far back as the first premolars. In the second part of the study, sharp and blunt sensation of the hard palate were tested before and after incisive bundle division. No significant alteration in sensation was found in any of the 20 patients tested.     

腭侧加压浸润麻醉在上前牙区牙槽外科的应用

目的 为解决上前牙区骨内小手术中有时镇痛不全使患儿不能合作，探索更好的局麻方法。方法 试验组用1ml皮试针管，行上前牙区腭侧粘骨膜下局部加压浸润麻醉，注入2～3ml的2％利多卡因，对照组仍用鼻腭神经阻滞麻醉，注入0．2～0．5ml的2％利多卡因。两组唇侧麻醉仍用浸润和眶下管阻滞麻醉。结果 试验组术中进入骨内时无痛，对照组进入骨内时有不同程度疼痛。结论 腭侧粘骨膜的致密组织，在加压注射时，可使足量麻药进入上前牙区骨内。此法可解决部分人因存在邻近神经交通支的汇入以及现有注射方法的不足而导致的镇痛不全，尤其适合儿童上前牙区骨埋伏多生牙拔除。     

Sensory disorders after separation of the nasopalatine nerve during removal of palatal displaced canines: prospective investigation.

During a prospective study after separation of the nasopalatine nerve at the foramen incisivum during exposure or removal of impacted and palatal displaced maxillary canines, 59 patients were examined neurologically for 4 weeks postoperatively over an investigation period of 18 months. During the first week after the operation, subjective as well as objective sensory disorders were found in all of the patients, but after 4 weeks at the most no neurological deficit could be detected in any patient.     

Maxillary nerve block anaesthesia via the greater palatine canal: A modified technique and case reports

A modification of the technique of maxillary nerve block (via the greater palatine canal) is discussed. This technique has been employed in the Exodontia and Oral Surgery Clinics of the United Dental Hospital of Sydney for more than 40 years. Clinical experience in that time has shown that once the greater palatine canal has been negotiated successfully, the palatal canal approach to the maxillary nerve is safe and reliable. The value of being able to anaesthetize the maxillary nerve and its branches is illustrated by the presentation of two clinical cases where local anaesthesia was achieved and the extractions performed in patients who would otherwise have required a general anaesthetic for the procedures.     

Sensory morbidity after palatal flap surgery--fact or fiction?

Retrospectively, a study was undertaken as to how dividing the nasopalatine nerve (whilst raising a palatal flap) effects postoperative sensory morbidity. 85 patients were separated into two groups: (a) nasopalatine nerve sectioned during surgery (45), and (b) nerve left intact (40). A clinician, blind to the patient's group, used indirect questioning, direct questioning, and examination to assess if the patient was aware of any deficit or if one existed of which he/she was unaware. The results showed that none of the patients in either group were aware of altered sensation in their palate post-operatively--two patients in the incised group experienced a temporary numbness. Examination revealed that five patients in the nerve divided group had a small area of altered sensation but this was not significant either for the patient or statistically between the groups. Conclusion--there is no significant sensory morbidity if the naso-palatine bundle is sectioned during palatal flap surgery.     

Effect of palatine tonsil hypertrophy on tongue posture and maxillofacial dentition: A pharyngeal airway computational fluid dynamics study

ObjectivesThis study aimed to clarify the effect of palatine tonsil hypertrophy-induced ventilation obstruction on maxillofacial dentition morphology using computational fluid dynamics (CFD) to represent tongue posture and maxillofacial dentition three dimensionally.Materials and methodsWe analyzed data of 20 patients with tonsil hypertrophy (tonsil hypertrophy group (TG); 9.0 years old, seven boys) and a comparison group (CG) of 20 patients without tonsil hyperplasia (comparison group; 9.4 years old, 10 boys). Cone-beam computed tomography and CFD data were used to assess the effects of palatine tonsil hypertrophy on pharyngeal airway ventilation, tongue posture, and morphology of the maxillofacial dentition.ResultsThe TG exhibited significantly greater depth, narrower width, smaller cross-sectional area of the pharyngeal airway, and narrower maxillary dental arch with Class II than the CG. Additionally, the tongue was positioned significantly more anteriorly and inferiorly in the TG than that in the CG.ConclusionsOur data suggest that hypertrophy of the palatine tonsils narrows the pharyngeal airway, resulting in a smaller cross-sectional area. Widening of the pharyngeal airway may occur due to compensatory anterior displacement of the tongue to prevent ventilation obstruction. This may decrease palatal support, disturbing the pressure balance of the maxillary molar region between the buccal and palatal sides and resulting in lateral undergrowth of the maxillary bone and narrowing of the maxillary dental arch.     

Measurement of blood flow in labial and palatal mucoperiosteal flap after sectioning the greater palatine arteries and with a labial mucosal arcuate incision

This article describes a study of determining blood flow of labial and palatal mucoperiosteal flap with radionuclide Xe-133 clearance technique before and after anterior maxillary osteotomies. The main purpose of the study was to investigate the dynamic change of blood flow. The greater palatine arteries were ligated. The studies show that compensative increasing of the blood flow of labial pedicle is seen after the operation, and that decreasing of the blood flow of palatal mucoperiosteal flap is temporary. It is suggested that the section of the greater palatine arteries is feasible. Xe-133 clearance technique is easy to operate and sensitive.     

Maxillary nerve block--a new approach using a computer-controlled anesthetic delivery system for maxillary sinus elevation procedure. A prospective study.

OBJECTIVE: The maxillary (or second division) nerve block is an effective method of achieving profound anesthesia of a hemimaxilla. This block can be used for procedures involving the maxillary sinus, including the maxillary sinus elevation procedure. The purpose of this study was to evaluate a computer-controlled anesthetic delivery system (Wand) for maxillary nerve block injection to attain maxillary sinus anesthesia for sinus floor elevation procedure. METHOD AND MATERIALS: The study population consisted of 61 healthy adult patients, ranging in age from 40 to 72 years (mean 45 years), who received 76 maxillary nerve blocks (17 having both right and left maxillary blocks) by means of the Wand system via the greater palatine nerve approach, for sinus floor elevation procedure. Two patients (3%) were excluded from the study due to the inability to negotiate the greater palatine foramen. For each block, two cartridges of 2% lidocaine hydrochloride with adrenaline (1:100,000) were administered, using a 27-gauge--long needle. After ensuring the anesthetized areas (waiting time 2.5 minutes), the sinus elevation procedure was performed. Parameters recorded were the success or failure of anesthesia, positive (blood) aspiration, bony obstructions in the greater palatine canal, and complications. RESULTS: The use of this technique increased the ability to more easily locate the greater palatine foramen. A local infiltration (at the incisor region) was needed in 13 (17%) of the blocks, and seven (9.2%) sites required an extra infraorbital block injection in addition to the maxillary nerve block. One block had a positive aspiration. There were no bony obstructions demonstrated in the canal interfering with the injection, and no complications were recorded. CONCLUSION: The Wand appears to offer a number of advantages over the hand-held syringe when the greater palatine block technique for the maxillary nerve block is used. It is suggested that, when indicated, and with the required knowledge and respect for the associated anatomy, this technique should be considered with greater ease and more confidence.