成人上颌骨性扩弓疗效评价及对面中部相邻骨块的影响

doi:10.19439/j.sjos.2021.03.019

上海口腔医学 ›› 2021, Vol. 30 ›› Issue (3): 316-322.doi: 10.19439/j.sjos.2021.03.019

成人上颌骨性扩弓疗效评价及对面中部相邻骨块的影响

郑美里^1,*, 吕政展^1,*, 朱柏恺¹, 汪席均¹, 瞿然奕¹, 樊林峰^2#, 江凌勇^1#

1.上海交通大学医学院附属第九人民医院口腔颅颌面科,上海交通大学口腔医学院, 国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海 200011;
2.上海交通大学医学院附属第九人民医院放射科,上海 200011

收稿日期:2021-02-11 修回日期:2021-03-18 出版日期:2021-06-25 发布日期:2021-08-05
通讯作者: 江凌勇,E-mail: jianglingyong@sjtu.edu.cn;樊林峰,E-mail: 847472535@qq.com。^#共同通信作者
作者简介:郑美里（1993-）,女,硕士研究生,E-mail: miri_jung@hotmail.com; 吕政展（1996-）,男,硕士研究生,E-mail: bluesclera15@qq.com。^*并列第一作者
基金资助:
上海市优秀学术/技术带头人计划（20XD1422300）; 上海市“医苑新星”青年医学人才培养资助计划—杰出青年医学人才项目（HWJRS2019-72）; 上海交通大学医学院附属第九人民医院临床研究推助计划（临+计划）（JYLJ201807）; 上海申康医院发展中心临床创新三年行动计划（SHDC2020CR4084）

Effects of mid-palatal suture opening and midfacial bony structure changes induced by maxillary skeletal expansion in adults

CHUNG Miri¹, LYU Zheng-zhan¹, ZHU Bo-kai¹, WANG Xi-jun¹, QU Ran-yi¹, FAN Lin-feng², JIANG Ling-yong¹

1. Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine; College of Stomatology, Shanghai Jiao Tong University; National Center for Stomatology; National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology; Shanghai 200011;
2. Department of Oral Radiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China

Received:2021-02-11 Revised:2021-03-18 Online:2021-06-25 Published:2021-08-05

摘要/Abstract

摘要： 目的: 利用锥形束CT（CBCT）测量、分析上颌骨性扩弓（maxillary skeletal expander, MSE）治疗前、后在腭中缝扩开、牙与牙槽骨在横向上的变化及面中部上颌相邻骨块的移动,评估成人上颌骨性扩弓的疗效及对相邻骨块的影响。方法: 选择12例成人骨性上颌牙弓狭窄病例（男4例,女8例）,平均年龄（21.33±3.14）岁,采用MSE扩弓器治疗,治疗后解除后牙反,上颌牙弓宽度达到理想牙弓宽度,分别于扩弓前和扩弓完成后拍摄CBCT,测量相关骨性和牙性项目。采用SPSS 26.0软件包对数据进行统计学分析。结果: 扩弓后前部腭中缝宽度增加（2.38±1.01） mm、后部腭中缝宽度增加（2.25±1.08） mm（P<0.01）;上颌第一磨牙牙冠处平均扩开（5.56±1.38） mm、上颌第一磨牙牙根处平均扩开（4.14±1.29） mm（P<0.01）;双侧上颌第一磨牙倾斜度治疗前后变化无显著差异（P>0.05）;蝶骨翼突外侧板角度,蝶骨翼突外侧板宽度,上颌骨前部间距与上、下颧骨间距扩弓后有显著差异（P<0.01）;颞骨后部间距、双侧颧颌角扩弓后变化无显著差异（P>0.05）。结论: MSE对于成年患者具有良好的骨性扩弓效应,实现腭中缝的平行扩开。扩弓后牙出现一定程度的颊向倾斜,但牙相对于牙槽骨无明显移动。面中部相邻骨块受到矫治力影响,在三维方向上也将发生一定移动。

关键词: 成人, 上颌骨性扩弓, 锥形束CT, 面中部骨块, 腭中缝

Abstract: PURPOSE: To analyze the opening of mid-palatal suture, transverse changes in dental and dentoalveolar measurements and shift of midfacial bony structures induced by maxillary skeletal expansion (MSE) with cone-beam CT (CBCT), and to evaluate the effect of maxillary skeletal expansion and its influence on adjacent bony structures in adults. METHODS: The study sample consisted of 12 adult patients with maxillary transverse deficiency (4 males, 8 females) at a mean age of (21.17±4.13) years old. All patients were treated with MSE. After treatment, the posterior crossbite was corrected, and the width of the maxillary arch was achieved the optimal width. Pre- and post-treatment CBCT exams were taken before and after MSE treatment. Multiplanar coronal and axial slices obtained from CBCT images were used to measure the changes in transverse widths, angular changes and tooth inclination with Dolphin Imaging 11.9. SPSS 26.0 software package was used for statistical analysis. RESULTS: After MSE treatment, the anterior nasal spine width increased by (2.38±1.01) mm, posterior nasal spine width increased by (2.25±1.08) mm (P<0.01). The inter-crown and inter-apex distance at the first molar increased by (5.56±1.38) mm and (4.14±1.29) mm, respectively (P<0.01). No significant difference was seen in terms of tooth inclination of the first molar(P>0.05). Pterygoid process angle, pterygoid process width, anterior inter-maxillary distance, upper and lower inter-zygomatic distance were significantly larger after treatment (P<0.01), while the inter-temporal distance and bilateral zygomaticomaxillary angle remained unchanged(P>0.05). CONCLUSIONS: MSE has a favorable effect in adult patients with parallel skeletal expansion of the mid-palatal suture achieved after expansion. The teeth present with certain buccal inclination but show no significant movement relative to the alveolar bone. The midfacial bony structures also shift in three-dimensional under the effect of the expansion force.

Key words: Adults, Maxillary skeletal expansion, Cone-beam CT, Midfacial bony structures

中图分类号:

R783.5

郑美里, 吕政展, 朱柏恺, 汪席均, 瞿然奕, 樊林峰, 江凌勇. 成人上颌骨性扩弓疗效评价及对面中部相邻骨块的影响[J]. 上海口腔医学, 2021, 30(3): 316-322.

CHUNG Miri, LYU Zheng-zhan, ZHU Bo-kai, WANG Xi-jun, QU Ran-yi, FAN Lin-feng, JIANG Ling-yong. Effects of mid-palatal suture opening and midfacial bony structure changes induced by maxillary skeletal expansion in adults[J]. Shanghai Journal of Stomatology, 2021, 30(3): 316-322.

参考文献

[1] Mommaerts MY.Transpalatal distraction as a method of maxillary expansion[J]. Br J Oral Maxillofac Surg, 1999, 37(4): 268-272.
[2] Schimming R, Feller KU, Herzmann K, et al.Surgical and orthodontic rapid palatal expansion in adults using Glassman's technique: retrospective study[J]. Br J Oral Maxillofac Surg, 2000, 38(1): 66-69.
[3] Northway WM, Meade JB.Surgically assisted rapid maxillary expansion: a comparison of technique, response, and stability[J]. Angle Orthod, 1997, 67(4): 309-320.
[4] Angelieri F, Franchi L, Cevidanes LHS, et al.Cone beam computed tomography evaluation of midpalatal suture maturation in adults[J]. Int J Oral Maxillofac Surg, 2017, 46(12): 1557-1561.
[5] Carlson C, Sung J, McComb RW, et al. Microimplant-assisted rapid palatal expansion appliance to orthopedically correct transverse maxillary deficiency in an adult[J].Am J Orthod Dentofacial Orthop, 2016, 149(5): 716-728.
[6] Wilmes B, Nienkemper M, Drescher D.Application and effectiveness of a mini-implant- and tooth-borne rapid palatal expansion device: the hybrid hyrax[J]. World J Orthod, 2010, 11(4): 323-330.
[7] Wertz R, Dreskin M.Midpalatal suture opening: a normative study[J]. Am J Orthod, 1977, 71(4): 367-381.
[8] Timms DJ.A study of basal movement with rapid maxillary expansion[J]. Am J Orthod, 1980, 77(5): 500-507.
[9] Pinsky HM, Dyda S, Pinsky RW, et al.Accuracy of three-dimensional measurements using cone-beam CT[J]. Dentomaxillofac Radiol, 2006, 35(6): 410-416.
[10] Angelieri F, Cevidanes LH, Franchi L, et al.Midpalatal suture maturation: classification method for individual assessment before rapid maxillary expansion[J]. Am J Orthod Dentofacial Orthop, 2013, 144(5): 759-769.
[11] Andrews LF, Andrews WA.The six elements of orofacial harmony[J]. Andrews J, 2000, 1(1): 13-22.
[12] Li J, Shi L, Zhang X, et al.Evaluating the effect of midpalatal corticotomy-assisted rapid maxillary expansion on the upper airway in young adults using computational fluid dynamics[J]. J Zhejiang Univ Sci B, 2021,22(2): 146-155.
[13] Melsen B.Palatal growth studied on human autopsy material. A histologic microradiographic study[J]. Am J Orthod, 1975, 68(1):42-54.
[14] Persson M, Thilander B.Palatal suture closure in man from 15 to 35 years of age[J]. Am J Orthod, 1977, 72(1): 42-52.
[15] Wehrbein H, Yildizhan F.The mid-palatal suture in young adults. a radiological-histological investigation[J]. Eur J Orthod, 2001,23(2):105-114.
[16] Shin H, Hwang CJ, Lee KJ, et al.Predictors of midpalatal suture expansion by miniscrew-assisted rapid palatal expansion in young adults: a preliminary study[J]. Korean J Orthod, 2019, 49(6): 360-371.
[17] Lee KJ, Park YC, Park JY, et al.Miniscrew-assisted nonsurgical palatal expansion before orthognathic surgery for a patient with severe mandibular prognathism[J]. Am J Orthod Dentofacial Orthop, 2010, 137(6): 830-839.
[18] Lagravère MO, Carey J, Heo G, et al. Transverse, vertical,anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion: a randomized clinical trial[J]. Am J Orthod Dentofacial Orthop, 2010, 137(3): 304.e1-e12.
[19] Park JJ, Park YC, Lee KJ, et al.Skeletal and dentoalveolar changes after miniscrew-assisted rapid palatal expansion in young adults: a cone-beam computed tomography study[J]. Korean J Orthod, 2017, 47(2): 77-86.
[20] Cantarella D, Dominguez-Mompell R, Moschik C, et al.Zygomaticomaxillary modifications in the horizontal plane induced by micro-implant-supported skeletal expander, analyzed with CBCT images[J]. Prog Orthod, 2018, 19(1): 41-48.
[21] Lin L, Ahn HW, Kim SJ, et al.Tooth-borne vs bone-borne rapid maxillary expanders in late adolescence[J]. Angle Orthod, 2015, 85(2): 253-262.
[22] Haas AJ.The treatment of maxillary deficiency by opening of the midpalatal suture[J]. Angle Orthod, 1965, 35: 200-217.
[23] Gardner GE, Kronman JH.Cranioskeletal displacements caused by rapid palatal expansion in the rhesus monkey[J]. Am J Orthod, 1971, 59(2): 146-155.
[24] Leonardi R, Sicurezza E, Cutrera A, et al.Early post-treatment changes of circumaxillary sutures in young patients treated with rapid maxillary expansion[J]. Angle Orthod, 2011, 81(1): 36-41.
[25] 贾海潮, 厉松, 刘松林, 等 . 种植钉辅助上颌快速扩弓治疗年轻成人上颌牙弓狭窄的CBCT分析[J]. 中华口腔正畸学杂志, 2016, 23(3): 126-131.
[26] Cunha ACD, Lee H, Nojima LI, et al.Miniscrew-assisted rapid palatal expansion for managing arch perimeter in an adult patient [J]. Dental Press J Orthod, 2017, 22(3): 97-108.
[27] Cantarella D, Dominguez-Mompell R, Moschik C, et al.Midfacial changes in the coronal plane induced by microimplant-supported skeletal expander, studied with cone-beam computed tomography images[J]. Am J Orthod Dentofacial Orthop, 2018, 154(3): 337-345.
[28] Cantarella D, Dominguez-Mompell R, Mallya SM, et al.Changes in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging[J]. Prog Orthod, 2017, 18(1): 34-46.

成人上颌骨性扩弓疗效评价及对面中部相邻骨块的影响

Effects of mid-palatal suture opening and midfacial bony structure changes induced by maxillary skeletal expansion in adults

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	李苏娜, 宋文尚, 刘子略, 杜月茹, 蔡世新. 义齿咬合板联合综合物理疗法对颞下颌关节盘不可复性前移位的疗效评价[J]. 上海口腔医学, 2024, 33(3): 273-278.
[2]	潘耀耀, 马晓楠, 陈呈. iRoot BP plus对成人龋源性露髓治疗疗效及对牙髓血流的影响[J]. 上海口腔医学, 2024, 33(2): 160-163.
[3]	彭源浩, 庄昕仪, 喻婷, 吕冬梅, 温秀杰, 程钎. 青少年颧牙槽嵴区皮质骨厚度的锥形束CT测量及其与颈椎骨龄的相关性研究[J]. 上海口腔医学, 2023, 32(6): 623-629.
[4]	黄仲敏, 张赟, 李小兵. 替牙列早期上颌慢速扩弓对上颌中段牙及牙槽嵴的影响[J]. 上海口腔医学, 2023, 32(5): 501-507.
[5]	胡祥莹, 王璧霞, 袁卫军, 朱敏, 肖燕. 成人正畸患者口腔健康素养现状及影响因素分析[J]. 上海口腔医学, 2023, 32(5): 545-550.
[6]	李贵宏, 谢思静, 林梓桐, 张婷, 汤旭娜, 胡勤刚. 下颌第二磨牙C形根管治疗前后根管壁厚度测量分析[J]. 上海口腔医学, 2023, 32(4): 395-400.
[7]	王文丽, 傅亚婷, 刘华, 马潇. 上颌前牙美学区牙龈三维形态的锥形束CT测量分析[J]. 上海口腔医学, 2023, 32(2): 177-182.
[8]	张薇, 陈威, 陈志方. 可调式活动牵引器治疗上颌唇侧倒置阻生中切牙效果评价[J]. 上海口腔医学, 2023, 32(2): 193-197.
[9]	宋珏, 刘好好, 刘嘉靓, 陈美华. 上颌磨牙与上颌窦黏膜增厚发生的相关性分析[J]. 上海口腔医学, 2022, 31(6): 638-642.
[10]	吕云松, 李朝晖. 颞下颌关节紊乱综合征伴偏侧咀嚼患者锥形束CT特征分析[J]. 上海口腔医学, 2022, 31(6): 653-656.
[11]	周子芊, 陈振琦. 上颌窦底对上颌第一磨牙近中移动的影响[J]. 上海口腔医学, 2022, 31(6): 661-667.
[12]	林翔, 傅裕杰, 任根强, 温佳欢, 陈宇飞, 张旗. U-Net神经网络分割锥形束CT影像中下颌磨牙牙体与牙髓腔及其准确性验证[J]. 上海口腔医学, 2022, 31(5): 454-459.
[13]	马智菲, 周梦琪, 王丽珍, 承清, 洪瑾. Er:YAG 激光在小型猪牙髓血运重建术中的应用效果评价[J]. 上海口腔医学, 2022, 31(4): 367-373.
[14]	黄锦程, 赵华强, 李国菊. Stafne骨腔影像学特征：基于CBCT的回顾性分析[J]. 上海口腔医学, 2022, 31(4): 439-444.
[15]	林怡君, 鄢洁雅, 王天鸽, 周志捷, 廖盛轩, 毛丽霞, 刘加强. 减数正畸治疗中中切牙牙根及牙槽骨形态变化的锥形束CT测量分析[J]. 上海口腔医学, 2022, 31(2): 211-216.