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

• 临床总结 • 上一篇    下一篇

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. 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. 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: 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

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