上颌快速扩弓联合固定矫治器治疗的稳定性研究

目的 观察患者接受上颌快速扩弓联合直丝弓矫治器治疗后覆牙合、覆盖及上牙弓宽度的变化。方法 选择2003年2月—2008年1月于青岛市口腔医院进行治疗的患者37例（男19例,女18例）,将患者分为4个不同的时期进行测量（N1:治疗前;N2:进行上颌快速扩弓后;N3:固定治疗后;N4:保持1年后）。分别测量每位患者的上颌尖牙间宽度、前磨牙间宽度、磨牙间宽度,并对前牙覆盖和覆牙合进行测量。患者的平均年龄（11.3±1.4）岁（10.2～15.3岁）。结果 治疗全部结束后、尖牙间宽度、前磨牙间宽度、磨牙间宽度、覆盖、覆牙合分别增加（2.6±2.3）mm、（3.7±2.1）mm、（5.2±2.5）mm、（0.3±0.6）mm、（-0.1±1.6）mm,患者复发率在尖牙宽度为47%,前磨牙间宽度为21％,磨牙间宽度为10%,覆盖复发率为9%,覆牙合为13%。结论 患者经过上颌快速扩弓后,在固定矫治阶段复发明显,保持阶段也有一定程度的复发。 上颌快速扩弓能够减小覆牙合,增加覆盖。     

固定包绕式螺旋扩弓器扩弓对牙弓长度的影响

目的研究固定包绕式螺旋扩弓器扩弓前后牙弓宽度、长度变化及两者间的关系。方法选取上牙弓狭窄患者33例,戴用固定包绕式螺旋扩弓器扩大上牙弓,在扩弓前后的上颌石膏模型上测量牙弓宽度变化和牙弓长度变化。结果扩弓前后牙弓宽度增值为4.58±1.23mm,牙弓长度增值5.64±1.35mm。结论使用固定包绕式螺旋扩弓器扩大上牙弓后,牙弓长度增值大于牙弓宽度增值。     

扩弓辅弓与改良横腭杆扩大上颌牙弓的临床效果比较

目的比较扩弓辅弓和改良横腭杆扩大上颌牙弓的效果。方法分别应用扩弓辅弓与改良横腭杆对35例患者上颌牙弓进行扩弓,比较2组矫治前后的牙弓宽度改变。结果使用扩弓辅弓的病例第一前磨牙扩弓宽度变化不明显,增加2 mm左右,第二前磨牙和第一磨牙的磨牙宽度均有明显扩大,增加4 mm左右;使用改良横腭杆的病例第一、二前磨牙及第一磨牙间宽度均增加4 mm左右。结论上颌牙弓轻中度狭窄的病例采用扩弓辅弓和改良横腭杆扩弓均有较好的扩弓效果,可以根据各自的特点选择合适的病例。     

Skeletal and dentoalveolar effects of slow vs rapid activation protocols of miniscrew-supported maxillary expanders in adolescents: A randomized clinical trial

ObjectivesTo compare between skeletal and dentoalveolar effects of slow and rapid activation of miniscrew-supported expanders.Materials and MethodsA total of 30 patients were randomly allocated to two groups using block randomization and the allocation ratio 1:1. Both groups received maxillary expanders anchored using four miniscrews. Activation protocol was once every other day in the slow expansion (SME) group and twice daily in the rapid expansion (RME) group. Cone-beam computed tomography (CBCT) scans were obtained before expansion and after removal of the expanders. Transverse skeletal and dentoalveolar changes were measured using CBCT.ResultsA total of 12 patients in the SME group (mean age, 14.30 ± 1.37 years) and 12 patients in the RME group (mean age, 15.07 ± 1.59 years) were analyzed. RME showed significantly greater widening of the mid-palatal suture at the level of first molars (mean difference [SME − RME] = −0.61 mm), and a greater increase in right and left molar buccal inclination (mean difference= −3.83° and −2.03°, respectively). Percentage of skeletal expansion relative to the jackscrew opening was not significantly different between the groups. Palatal inflammation was evident following appliance removal. Miniscrew mobility and bending were observed with RME.ConclusionsBoth SME and RME were effective in correcting skeletal transverse maxillary deficiency. However, RME resulted in more buccal tipping of maxillary molars and in miniscrew failures and bending.     

下颌扩弓结合固定矫治后牙弓和WALA嵴宽度的变化

目的 应用下颌改良扩弓器,结合MBT直丝弓矫治技术治疗处于生长发育高峰期或末期中重度牙列拥挤伴牙弓狭窄的青少年患者,探讨矫治前后下颌牙弓和WALA嵴宽度的变化.方法 对29例10～15岁中重度牙列拥挤伴牙弓狭窄的青少年进行下颌扩弓,下颌为改良式网状支架扩弓器,运用直丝弓矫治技术完成矫治.矫治前后制取模型,采用Andrews关于牙弓,WALA嵴的定点方法测量下颌牙弓及WALA嵴宽度,并对治疗前后的测量结果进行配对t检验.结果 矫治完成后,下颌牙弓和WALA嵴宽度均不同程度增加(P＜0.05).均以第二前磨牙区扩大最多,其次是第一前磨牙区、磨牙区,而尖牙区最小,矫治效果良好.结论 下颌改良扩弓器结合固定矫治对下颌中重度拥挤伴牙弓狭窄青少年患者的矫治效果良好.     

上颌快速扩展最佳时机的初步研究

目的:通过患者年龄、牙龄、骨龄,对上颌快速扩展扩弓效应的相关性分析,期望发现应用上颌快速扩展的最佳时机。方法:选择需上颌横向扩展的患者30例,年龄11～14岁,平均12.30岁,进行上颌快速扩展。摄左手腕掌指骨片,扩展矫治前后的上颌前部咬合片、头颅正位定位片。利用SPSS11.0软件包对数据进行t检验、多元线性回归、多元逐步回归分析。结果:年龄相近,扩展效应不一;骨龄与扩展效应具有一定的相关性,偏回归系数为-6.440,P值为0.045;牙龄与扩展效应具有高度相关性,偏回归系数为-1.289,P值为0.000。随着上颌第二恒磨牙的萌出、生长和建牙合,扩展效应明显下降。结论:在上颌第二恒磨牙萌出前进行上颌快速扩展,可在较短的治疗时间内获得所需的骨骼效应。     

Dimensional changes in the palate associated with slow maxillary expansion for early treatment of posterior crossbite

Objectives:To compare palatal symmetry, dimensions, and molar angulations following early mixed-dentition slow maxillary expansion with parameters in normal controls.Materials and Methods:A total of 30 patients treated with a Haas-type expander for unilateral posterior crossbite with functional shift were compared with 30 controls matched for dental age, gender, and molar relationship. Records were taken before (T1) and after expansion (T2). Palatal width, surface area, volume, and molar angulations were measured on digitized models. Surface area and volume were split in half then divided into anterior, middle, and posterior segments to measure symmetry. Student''s t-test was used to assess group differences.Results:Mean intercanine width increased 4.65 mm, and intermolar width increased 4.76 mm. The treated mean surface area increased 127.05 mm² compared with 10.35 mm² in controls. The treated palatal volume increased 927.55 mm³ compared with 159.89 mm³ for controls. At T1, the controls showed significant differences in surface area and volume between the anterior palatal segments. At T2, this difference occurred in surface area of middle palatal segments of the treated sample. First permanent molars showed an increased buccal and distal inclination after treatment, opposite to controls. The increase in buccal inclination was greater on the crossbite side.Conclusions:The Haas-type expander results in similar expansion across the canines and first molars. A palate that is symmetrical before expansion may become asymmetric after expansion but only in the middle segment. Changes in individual molar angulation following palatal expansion can be measured without radiation imaging.     

Relationship between voice function and skeletal effects of rapid maxillary expansion

Objective:To evaluate the effects of rapid maxillary expansion (RME) on the vocal quality, maxillary central incisors, midpalatal suture, and nasal cavity in patients with maxillary crossbite.Materials and Methods:Coronal CT scans of 30 subjects (14 boys, 16 girls; mean age, 12.01 ± 0.75) were taken before RME (T0), and at the end of the expansion phase (T1). Voice samples of all patients were recorded with a high-quality condenser microphone (RODE NT2-A) on a desktop computer at T0 and T1. Statistical analyses were performed using a paired-sample t-test. The degree of association between the changes in the voice parameters and nasal width was assessed with Pearson''s correlation.Results:RME treatment produced a significant increase in the transverse dimensions of the midpalatal suture and nasal cavity between T0 and T1 (P < .05). The maximum F0 and jitter (%) results were shown to decrease statistically significantly from T0 to T1 (P < .001 and P = .042, respectively). Between T0 and T1, shimmer (%) and shimmer (dB) exhibited statistically significant increases (P = .037 and P = .019, respectively).Conclusions:After RME therapy, voice quality differences were found to be associated with increases in nasal width.     

三维激光扫描测量技术分析年轻成人快速上颌扩弓后腭部表面形态的变化

目的 探讨年轻成人快速上颌扩弓后腭部表面形态的变化.方法 选择15例年轻成人快速上颌扩弓患者为试验组,22例替牙期快速上颌扩弓患者为对照组.扩弓前(T1期)、扩弓后(T2期)分别制取患者高精度牙颌超硬石膏模型,并采用三维激光扫描技术获取腭部表面形态的数字化模型,截取6+6腭部表面形态轮廓线,采用Handelman分析法进行测量分析.采用SPSS 11.0统计软件对测量数据行统计分析.结果 1)快速上颌扩弓后腭龈缘水平宽度和腭中部宽度的增加以及腭顶宽度差两组相比较,前两项指标的差异无统计学意义(P>0.05),而腭顶宽度差的差异有统计学意义(P<0.05).2)快速上颌扩弓后上颌第一恒磨牙(牙合)平面交角的减小和腭穹隆角的增加两组相比较,差异有统计学意义(P<0.05).结论 年轻成人快速上颌扩弓能够有效地扩展上颌牙弓的宽度,扩弓主要依靠上颌磨牙和牙槽骨的颊向倾斜移位.     

上颌快速扩弓与直丝弓矫治器联合应用的临床研究

目的 评价上颌快速扩弓和直丝弓矫治器联合应用对牙弓、基骨宽度的影响。方法 对18例恒牙早期牙列中度拥挤病例以上颌快速扩弓和直丝弓矫治器进行联合治疗，通过对矫治前后牙牙台石膏模型的测量比较，观察牙弓、基骨宽度的变化。结果 治疗后牙弓、基骨的宽度比治疗前增加，统计学分析有显著性差异。结论 上颌快速扩弓和直丝弓矫治器联合应用能使牙弓、基骨宽度快速增加，对牙列拥挤病例是一种安全、有效的治疗方法。     

纵向研究0-2岁婴幼儿变异链球菌群与早期婴幼儿龋的关系

目的探讨8～32个月婴幼儿牙菌斑中变异链球菌群的定植情况,并分析其早期定植与龋病关系。方法收集广州市花都区新华镇225名8月龄婴幼儿,每半年复查一次,持续两年,至婴幼儿32月龄。复查内容包括龋病检查和前牙牙菌斑样本收集。WHO诊断标准用于龋病诊断,选择性培养基及生化实验用于变异链球菌群的分离鉴定。统计方法采用χ2检验或Fisher确切概率法。结果 8月、14月、20月、26月和32月龄变异链球菌群定植率分别为6.7%、31.2%、50.3%、61.0%和75.5%。其中,8月龄组有2名幼儿检出变异链球菌群未见乳牙萌出。变异链球菌群首次检出的平均年龄为（19.6±6.9）个月。婴幼儿乳牙变异链球菌群早期定植患龋率高于晚期定植,32月龄组差异有统计学意义（P=0.018）。结论变异链球菌群能在未萌牙口腔中检出,其定植率随年龄的增长而增加。变异链球菌群在前牙面的早期定植促进乳牙龋病的发生。     

两种扩弓方法结合前方牵引的临床效果比较性研究

目的 评价上颌反复快速扩缩结合前方牵引与单纯上颌快速扩弓结合前方牵引在治疗上颌发育不足骨性Ⅲ类患者的临床疗效。 方法 选择34例上颌发育不足的骨性Ⅲ类儿童,随机分成两组：观察组17例,采用上颌反复快速扩缩结合前方牵引,并分为低角和高角两组;对照组17例,采用单纯上颌快速扩弓结合前方牵引。对所有病例治疗前后均拍摄头颅侧位片进行投影测量分析。 结果 两组病例扩弓并进行前方牵引后上颌显著前移,下颌向下后方旋转,两组间对比：观察组A-Np和A-Y的距离分别增加了2.50 mm和3.47 mm,大于对照组的1.37 mm和2.05 mm。 结论 使用上颌反复快速扩缩法结合前方牵引的治疗方法比单纯上颌快速扩弓结合前方牵引的方法获得更多的上颌前移量。此方法中高角患者上颌前移量少于低角患者。     

上颌半快速扩弓对小型猪颊侧骨板改建影响的锥形束CT研究

目的 通过定期拍摄锥形束CT(cone-beam CT,CBCT),观察上颌半快速扩弓(semirapid maxillaryexpansion,SRME)后上颌后牙颊侧骨板变化特点,探索影响其吸收改建的相关因素.方法 10月龄雄性巴马小型猪7只,随机分为两组,SRME组(实验组)4只,对照组3只.实验组粘固铸造金属全冠式螺旋扩弓器.对照组只粘固铸造金属联冠.分别在扩弓前(T1),扩弓后第10天(T2),扩弓保持2个月(T3)后拍摄CBCT,测量并分析扩弓前后及保持后后牙颊侧牙槽骨板高度、牙槽骨板厚度、磨牙倾斜度及牙槽骨倾斜度的变化.结果 SRME组上颌后牙颊侧牙槽骨板高度、牙槽骨板厚度、磨牙倾斜度、颊侧牙槽嵴倾斜度在T2期与对照组相比均有明显差异(p＜0.05).扩弓前后颊侧牙槽骨厚度的变化与T1期颊侧牙槽骨高度和厚度之间存在线性负相关.结论 牙槽骨的高度和厚度影响扩弓过程中牙槽骨的吸收改建,上颌半快速扩弓对后牙颊侧骨板有一定的破坏,扩弓前应对牙周情况进行评估.     

利用锥形束CT研究单侧上颌尖牙埋伏阻生患者牙弓形态特点

目的 利用锥形束CT(Cone beam computed tomography,CBCT)研究单侧上颌尖牙埋伏阻生患者牙弓形态特点,为研究其病因及预防继发病症提供参考.方法 39名单侧上颌尖牙埋伏阻生患者,其中腭侧埋伏19名,唇侧埋伏20名,另设正常对照20名.三组患者年龄无显著性差异.三组患者拍摄CBCT并对牙弓的影像进行测量,比较三组之间以及阻生侧与非阻生侧的牙弓形态特点.结果 尖牙阻生患者的双侧牙弓比较显示,阻生侧前段及整侧牙弓长度均比非阻生侧小(P＜0.001).腭侧组第一磨牙到腭中缝距离(24.06±1.68) mm小于唇侧组(24.86±1.31)mm和对照组(24.88±1.12) mm,腭侧组牙弓周长(72.29±3.50) mm小于唇侧组(75.96±5.26) mm,P＜0.05.结论 上颌尖牙埋伏阻生可能与牙弓长度(尤其是前段)较短有关,且腭侧阻生可能还与牙弓宽度较小有关.     

可摘式螺旋扩弓装置配合方丝弓矫正器的临床研究

探讨一种简单,可靠,稳定的扩弓方法,方法选择１６例生长发育各期需扩弓矫治的患者,在常规戴入方丝弓矫治器的同时使用摘式螺旋扩弓装置扩大牙弓。扩弓装置平均截入时间６个月,方丝弓矫澡器戴入１－２年。结论该方法可提高扩弓效率,减少复诊次数,是一种行之有效的扩弓,适用于生长发育各期的患者。     

自攻型微型种植体支抗矫治上颌前突的临床研究

目的：探讨自攻型微型种植体支抗在严重上颌前突病例内收上颌前牙的临床疗效。方法：20例严重上颌前突拔牙矫治病例,在上颌第一磨牙与第二前磨牙之间颊侧植入微型种植体。通过头影测量分析,对矫治前后U1-NA距,U1-NA角,U1-Apog距分别进行配对t检验分析。通过上颌前牙内收量,来评判微型种植体作为强支抗的临床应用的稳定性。结果：20例平均6-8个月牙列排齐整平,10—12个月前突的前牙成功内收,拔牙间隙完全关闭,治疗过程有2枚种植体脱落,4枚种植体感染,34枚种植体整个过程保持稳定。结论：微型种植体可以提供足够稳定的强支抗内收前突前牙,矫治效果好,矫治疗程相对短。     

Effects of different rapid maxillary expansion appliances on facial soft tissues using three-dimensional imaging

Objective:To determine three-dimensional (3D) effects of three different rapid maxillary expansion (RME) appliances on facial soft tissues.Materials and Methods:Forty-two children (18 boys, 24 girls) who required RME treatment were included in this study. Patients were randomly divided into three equal groups: banded RME, acrylic splint RME, and modified acrylic splint RME. For each patient, 3D images were obtained before treatment (T1) and at the end of the 3-month retention (T2) with the 3dMD system.Results:When three RME appliances were compared in terms of the effects on the facial soft tissues, there were no significant differences among them. The mouth and nasal width showed a significant increase in all groups. Although the effect of the acrylic splint RME appliances on total face height was less than that of the banded RME, there was no significant difference between the appliances. The effect of the modified acrylic splint appliance on the upper lip was significant according to the volumetric measurements (P < .01).Conclusions:There were no significant differences among three RME appliances on the facial soft tissues. The modified acrylic splint RME produced a more protrusive effect on the upper lip.     

三种快速扩弓联合前方牵引装置作用效果的三维有限元分析

目的 应用三维有限元法比较三种快速扩弓联合前方牵引装置对颌骨及牙齿的作用效果,为临床治疗提供参考.方法 建立Hyrax联合牙性前方牵引装置、骨支持式扩弓器(maxillary skeletal expander,MSE)联合牙性前方牵引装置、MSE联合骨性前方牵引装置及颅上颌复合体的三维有限元模型,对扩弓螺旋器施加0....