单侧完全性唇裂患者行术前鼻牙槽塑形治疗后牙槽突变化的三维测量分析

Three-dimensional analysis of alveolar changes of complete unilateral cleft lip patients after presurgical nasoalveolar molding treatment

目的应用三维测量分析法对单侧完全性唇裂患者行术前鼻牙槽塑形(PNAM)治疗后牙槽突的变化进行评价。方法选取2013年11月—2015年6月于广西医科大学附属口腔医院完成PNAM治疗的单侧完全性唇裂患者30例,分别于PNAM治疗前后制取腭部口腔石膏模型,以锥形束CT(CBCT)采集DICOM数据,应用Mimics 15.0进行三维重建,并测量牙槽突裂隙宽度、牙槽突末端宽度、上唇系带中线距离、牙槽突移动距离、牙槽突长度,采用SPSS 17.0软件进行对比分析。结果 PNAM治疗前后,患者的牙槽突裂隙宽度、上唇系带中线距离明显缩小(P<0.05),牙槽突末端宽度差异无统计学意义(P>0.05),较大侧牙槽突移动距离明显大于较小侧(P<0.05),双侧牙槽突长度均有明显增长(P<0.05),较大侧牙槽突增长量明显大于较小侧(P<0.05)。结论印模+CBCT扫描法可以获得准确的牙槽突三维数据,经过PNAM治疗后,牙槽突形态得到显著改善。

ObjectiveThis study analyzed the alveolar changes of complete unilateral cleft lip （UCCL） patients after pre-surgical nasoalveolar molding （PNAM） treatment using a three-dimensional method.Methods Palate impressions of thirty UCCL patients who underwent PNAM treatment in the Affiliated Stomatology Hospital of Guangxi Medical University were taken pre- and post-PNAM. The plaster impressions were scanned using cone beam computed tomography （CBCT）. The DICOM files were exported and 3D models reconstructed in Mimics 15.0. The following parameters were analyzed in SPSS 17.0： cleft alveolar gap width, alveolar arch end width, upper lip frenulum-median plane distance, alveolar shift distance, and length of alveolar section.Results After PNAM treatment, the cleft alveolar gap width and upper lip frenulum-median plane distance decreased significantly （P〈0.05）. No statistically significant change was observed in the alveolar arch end width （P〉0.05）. Alveolar shift distances for both sides increased significantly （P〈0.05）, and the shift distance of major alveolar sec-tion had a more significant increase than the minor alveolar section. The lengths of the alveolar section of both sides increased significantly （P〈0.05） with the length of the major alveolar section increasing more significantly than the minor alveolar section.Conclusion The impression-CBCT method supply accurate three-dimensional data of the alveolar process. The PNAM treatment can significantly correct alveolar deformity and improve appearance.