上颌快速扩弓中腭中缝骨组织改建的研究进展

上颌快速扩弓（Rapid maxillary expansion,RME）由Angel于1860年提出并广泛应用于牙列轻度拥挤、上颌牙弓狭窄或者反牙合等错牙合畸形的矫治中。其原理是扩弓器产生横向扩张力打开腭中缝,增加上颌牙弓宽度和周长,是解决上颌横向发育不足的主要治疗手段之一。上颌扩弓效果中腭中缝的扩张是最重要的部分,     

两种不同支抗快速扩弓的三维有限元分析

目的:比较分析两种不同支抗快速扩弓时颅面复合体的生物力学变化,为不同支抗快速扩弓的临床应用提供理论依据。方法:应用Mimics10.0、MSC.Marc.mentat 2005 R3等软件,建立颅面复合体三维有限元模型,加载80N的扩弓力模拟种植体支抗及牙支抗快速扩弓,分析不同加载条件下颅面复合体的应力分布和位移趋势。结果:两种支抗快速扩弓时颅面复合体应力的较大区域均分布在鼻额缝、颧颌缝、鼻上颌缝、翼腭缝,腭中缝呈楔形扩开。快速扩弓时种植体支抗产生的颅面复合体应力值和位移比牙支抗更小。结论:两种支抗扩弓均能有效扩展腭中缝,但种植体支抗快速扩弓时颅面复合体旋转更小,临床扩弓时的开牙合趋势减小。     

微小种植体支抗辅助螺旋扩弓器上颌快速扩弓效果的动物实验研究

目的：应用动物实验观察微小种植体辅助螺旋扩弓器上颌快速扩弓的效果，为临床使用微小种植体进行快速扩弓提供实验依据。方法：选取6个月龄雄性犬8只，随机分为两组，一组利用微小种植体作支抗，另一组按传统方法利用牙齿为支抗进行扩弓。两组实验犬均测量实验前后上颌同名中切牙、尖牙、第一磨牙之间的宽度；各组尖牙、第一前磨牙、第一磨牙牙齿倾斜角度，进行组间前后比较。结果：两组牙弓均能够有效地使上颌横向扩大，但实验组没有发生牙齿倾斜，对照组均观察到支抗牙的颊向倾斜。结论：使用微小种植体辅助螺旋扩弓器进行上颌快速扩弓能够有效地避免利用牙作支抗进行扩弓的缺陷，避免了支抗牙的颊向倾斜。     

上颌前方牵引联合快速扩弓对替牙晚期骨性Ⅲ类错牙合患者颊旁间隙的影响

目的:研究上颌前方牵引联合快速扩弓对替牙晚期骨性Ⅲ类错牙合患者颊旁间隙的影响。方法:选取2018年1月-2018年6月笔者医院收治的30例替牙晚期骨性Ⅲ类错牙合患者为研究对象,采取随机数字法分组,对照组(15例)采取上颌前方牵引治疗,观察组(15例)在对照组基础上联合快速扩弓治疗,观测患者颊旁间隙和牙弓宽度水平,同时记录患者的治疗总有效率及颊旁间隙增大的复发率。结果:治疗后,观察组颊旁间隙面积比明显低于对照组,治疗总有效率,上颌的尖牙宽度、第一前磨牙宽度、第二前磨牙宽度以及第一磨牙宽度明显高于对照组,差异均有统计学意义(P0.05)。结论:上颌前方联合快速扩弓矫治替牙晚期骨性Ⅲ类错牙合的疗效较好,可以有效扩大其牙弓宽度,减小颊旁间隙。     

快速扩弓联合直丝弓矫治牙弓狭窄的临床应用

牙弓狭窄是临床常见的错[牙合]畸形，可造成牙列拥挤、前牙前突、后牙反[牙合]等不良后果。本文收集了我院口腔科2002年以来的26例上牙弓狭窄病例，通过使用快速扩弓（rapid maxillary expansion，RME）扩开腭中缝，再联合直丝弓矫治器进行治疗，成功地解除了牙弓狭窄及其所伴有的排列拥挤及后牙反[牙合]等病症，取得良好的矫治效果。     

腭中缝骨皮质切开联合快速扩弓法治疗上颌横向宽度不足患者的临床体会

目的 对上颌横向宽度不足患者给予腭中缝骨皮质切开联合快速扩弓法治疗，分析其临床效果。方法 选取医院2019年1月至2022年1月收治的上颌骨横向宽度不足的患者42例，给予腭中缝骨皮质切开联合快速扩弓法治疗，对患者治疗前后基骨宽度、牙弓宽度、牙转矩变化进行统计并比较。结果 在上颌骨基骨宽度指标方面，与治疗前相比，治疗3个月后第一磨牙与第一前磨牙区域的鼻腔宽度（34.33±3.09） mm、（30.59±2.89） mm，硬腭底上颌宽度（67.75±4.48） mm、（46.51±4.29） mm、根尖平面上颌宽度（67.58±4.59） mm、（45.88±4.62） mm均明显增加，差异有显著性（P<0.05）；上颌牙弓宽度指标方面，与治疗前相比，患者治疗后双侧第一磨牙和第一前磨牙腭尖宽度（46.95±5.92） mm、（38.75±3.26） mm均明显增加，差异均有显著性（P<0.05）；在上颌支抗牙转矩指标方面，与治疗前比较，治疗后右侧上颌第一磨牙上颌支抗牙转矩（114.01±9.34）°、左侧上颌第一磨牙上颌支抗牙转矩（114.21±6.62）°、右侧上颌第一前磨牙...     

大鼠腭中缝牵张成骨初期SOX9表达变化的研究

目的：检测大鼠腭中缝组织在机械张力作用下,于不同时间点SOX9表达的变化规律,探讨该因子在腭中缝组织改建过程中的作用和意义.方法：选用四周龄（100g±5）雄性Wistar大鼠70只,随机分为实验组和对照组（实验组42只、对照组28只）.用自制双眼扩弓簧施加扩张力,实验组大鼠施加初始扩张力50g±5g,对照组大鼠不加力.分别于扩弓后第1、3、5、7、9、1 2、14天随机选取实验组大鼠6只、对照组大鼠4只处死并取腭中缝组织,采用荧光定量PCR法测定目的基因的变化规律.结果：荧光定量PCR结果显示实验组大鼠腭中缝组织中SOX9表达水平明显高于对照组,在扩弓后第三天时表达水平达到最高值,随后又显著下降,第9天时表达水平又开始逐渐上升,表达曲线呈曲线型.结论：大鼠腭中缝牵张成骨过程中SOX9基因表达量增加,该因子在此过程中具有重要意义.     

快速上颌扩大术矫治前后口颌系统变化的研究

目的：综合探讨快速上颌扩大术对口颌系统中牙齿、颌骨、肌肉的作用。方法：对16名上颌牙狭窄患者在快速上颌扩大术矫治前后拍摄上颌咬合片和后前位定位片，并进行测量分析；同时测量颊肌压力的变化。结果：快速上颌扩大术可以打开腭中缝，在产生矫形作用的同时也产生正畸作用，矫治后牙齿,颌骨，颊肌压力均产生显著性变化。结论：快速上颌扩大术矫治上颌牙弓狭窄可以取得理想的矫治效果，但要注意术后保持，防止复发。     

上颌快速扩弓的口周力研究

目的：研究上颌牙弓狭窄患者在上颌快速扩弓（rapid maxillary expansion,RME）治疗前后和保持后的口周力分布特征和变化。方法：选择上颌牙弓狭窄患者18例,男女各9例,年龄11.3～15.8岁,应用计算机辅助口周力测量系统在RME治疗前后及保持后上下颌双侧第一磨牙和第一双尖牙颊舌侧进行口周力测量及分析。结果：RME治疗前,同一牙弓内左右两侧的颊舌侧压力无显著性差异。RME治疗后,上颌各测量区域颊舌侧压力大于治疗前;下颌各测量区域颊舌侧压力小于治疗前。RME保持后,上下颌各测量区域与正常后牙覆盖时上下颌牙齿颊侧压力分布特征相似;上下颌各测量区域舌侧压力与治疗后无显著性差异。结论：RME治疗后,牙弓形态的改变能引起口周力发生显著性变化,经过保持,口周软组织对于变化了的牙弓形态能够发生适应性改变。RME治疗后必须采取良好的保持措施,使发生显著性变化的口周软组织对于扩大的牙弓发生适应性改变,这样RME治疗结果才能稳定。     

上颌快速扩弓在矢状方向和垂直方向上对牙颌作用的研究

目的：探讨上颌快速扩弓在矢状方向和垂直方向上对牙颌的作用。方法：对16名恒牙列早期双侧后牙反（牙合）患者在上颌快速扩弓前后拍摄头颅定位侧位片，并进行测量分析。结果：治疗后上颌前移，上下颌均向后下方旋转，面部垂直高度增加，上颌切牙舌倾伸长，上颌磨牙远中倾斜伸长。结论：上颌快速扩弓对三维方向上牙颌产生的作用，针对不同（牙合）型和骨面型患者应在上颌快速扩弓的基础上配合采用不同的矫治方法，以便获得最佳的矫治效果。     

前方牵引联合快速扩弓矫治骨性Ⅲ类错的面部软组织变化

目的：研究上颌前方牵引联合快速扩弓矫治恒牙早期骨性Ⅲ类错的软组织变化。方法：选取14例恒牙早期骨性Ⅲ类错患者为治疗组,应用联合法治疗6个月,在治疗前（T1）、治疗后（T2）拍摄头颅侧位X线片;选取12例未治疗骨性反患者为对照组,也在相应时间拍摄X线片,对两组进行头影测量分析。结果：治疗组发生显著的软组织改变,H角和软组织面凸角显著增大,软组织面角显著减小,软组织侧貌得以改善。结论：前方牵引联合快速扩弓能够对恒牙早期骨性Ⅲ类错患者的软组织侧貌产生显著的矫形效果。     

Articulation disorders associated with maxillary growth after attainment of normal articulation after primary palatoplasty for cleft palate

Little attention has been given to the connection between maxillary growth and the emergence of articulation disorders among cleft palate patients who previously successfully attained normal articulation after undergoing primary palatoplasty. Follow-up assessment of 22 surgically treated unilateral cleft lip and palate patients who attained normal articulation before school entry revealed that, during mixed dentition, half the patients exhibited palatalized articulation and half retained normal articulation. To determine the possible effect on articulation of growth changes in dental arch dimensions, a comparison was made of deciduous dentition and mixed dentition oral cavity measurements. Indications are that palatalized articulation occurs in patients with a smaller anterior palatal volume, the presence of linguoversion teeth, and poorer growth ability. Results reveal the importance of early management of dental arch dimensions, and the need for periodic assessment and management of articulation even for patients who attain normal articulation subsequent to primary palatoplasty.     

Sizes of Dental Arches in Children with the Pierre Robin Syndrome and Isolated Cleft Palate Aged from 0.2 to Six Years

Abstract

Development of the dental arches and length and weight at birth were studied from 0.2 to 6 years of age in 78 children with Pierre Robin syndrome and 58 with isolated cleft palate. The growth of the maxillary dental arches was similar in both groups before palatal closure. The anterior width of the maxillary arch did not differ between the groups during the six year follow up period, but the depths of the maxillary and mandibular arches were significantly less (< 0.001) in the group with Pierre Robin syndrome compared with those with isolated cleft palates at the age of 3 and 6 years. The mandibular width at the first and second deciduous molars in the group with Pierre Robin syndrome was also significantly smaller (<0.01) than in the other group at the age of 6 years. The weight and length at birth were similar in both groups, and they were slightly lower than among the normal Finnish population.     

舌簧活动矫治器在替牙期前牙牙性反颌早期矫治中的临床应用效果

探究舌簧活动矫治器应用于替牙期前牙牙性反颌早期矫治的临床效果。方法 选取2019年 5月-2022年5月香河县人民医院收治的80例儿童替牙期前牙牙性反颌矫正患儿为研究对象，采用随机数 字表法分为对照组和研究组，每组40例。对照组采取常规正畸方案，研究组应用舌簧活动矫治器，比较 两组临床疗效、头影测量指标矫正及治疗完成时间。结果 研究组治疗总有效率为92.50%，高于对照组的 75.00%，差异有统计学意义（P ＜0.05）；研究组治疗后上齿槽座角、下颌平面角、上下齿槽座角及上颌中 切牙与NA连线角均高于对照组，差异有统计学意义（P＜0.05）；研究组下齿槽座角、下颌中切牙与NB连 线角低于对照组，差异有统计学意义（P＜0.05）；研究组矫正治疗完成时间短于对照组，差异有统计学意 义（P ＜0.05）。结论 舌簧活动矫治器能够有效改善替牙期前牙牙性反颌矫正患儿的头影指标，其疗效较 为理想，值得临床应用。     

双期矫治恒牙早期骨性Ⅲ类错[牙合]的临床研究

目的：研究恒牙早期骨性Ⅲ类错糟先行前方牵引后行拔牙矫治的临床效果。方法：选择恒牙早期且伴有牙列拥挤的骨性Ⅲ类错袷16例,均采用上颌扩弓加上颌前方牵引治疗一年,再行拔除4个前磨牙MBT直弓矫治器矫治,对治疗前（T1）、前方牵引后（T2）、矫冶后（T3）的头颅侧位片进行测量分析。结果：采用前方牵引和拔牙矫治可以使骨性和牙性测量项目发生明显变化。SNA平均增大2．81°,ANB增大2．85°,下颌顺时针旋转2．85°,下切牙直立3．78°,U1／NA减小1．31°,U6-FHP减小5．36mm。结论：前方牵引和拔牙双期矫治法是一种治疗伴有拥挤的骨性Ⅲ类错[牙合]的有效方法。     

Maxillary Dental Arch and Occlusion in Patients with Repaired Clefts of the Secondary Palate

Abstract

Maxillary morphology and dental occlusion were studied from infancy to age 10 years in 32 patients born with isolated cleft palate. Wardill-Kilner push back repair of the palate had been done at a mean age of 7.5 months. Measurements obtained from casts of the jaws showed that the average maxillary dimensions before as well as after operation were less than those reported for children without clefts. The mean reduction was similar whether the cleft reached into the hard palate or affected the soft palate only. Preoperative anterior maxillary arch width in particular, and also distance from scar line to selected teeth seemed to influence postoperative development of the maxillary dental arch in individual patients.     

Effect of Post-Surgical Jaw-Orthopaedic Treatment in Unilateral Cleft Lip and Palate Patients

Reduction of the contraction of maxillary segments in newborn infants with unilateral cleft lip and palate by means of post-operative maxillary orthopaedic treatment was evaluated in 32 consecutive patients. Early surgery was performed in three stages and jaw-orthopaedic treatment with an acrylic plate was started one week after the first and again after the second operation. Between the first and second operation, between the second and third operation and during the period from the First operation to the age of three years there were no significant differences in changes of maxillary width dimensions between half of the children using the plates most frequently and the other half, with one exception. This difference was probably due to differences in initial values between the two groups of children. Thus, the influence on maxillary dimensions and dental occlusion of jaworthopaedic treatment, carried out according to our routines, was very limited. On the other hand, other treatment objectives might have been facilitated.