快速成型打印技术在唇腭裂矫形中的应用

Application of rapid prototyping technology on nasoalveolar molding for cleft lip and palate

目的探讨快速成型技术用于制备唇腭裂矫形术前鼻齿槽矫治器的可行性及效果。方法以2014年6月—2016年9月收治的17例单侧完全性唇腭裂患儿作为试验组,通过数字化模拟唇腭裂矫治过程,设计数字化模型,并采用快速成型技术制备不同治疗阶段的鼻齿槽矫治器,进行术前矫形。与同期采用传统鼻齿槽矫治器及方法治疗的22例患儿(对照组)进行比较。两组患儿性别、年龄、唇腭裂侧别、初始裂隙宽度比较,差异无统计学意义(P>0.05)。记录两组矫治期间门诊次数、矫治时间以及并发症发生情况,测量矫治前后齿槽裂隙变化相关指标。结果矫治期间,试验组门诊次数显著少于对照组(P<0.05),两组矫治时间比较差异无统计学意义(P>0.05)。对照组矫治期间发生组织皮疹16例(72.2%)、黏膜溃疡3例(13.6%)、口内出血1例(4.5%),矫治后发生1例(4.5%)牙槽弓形态呈T形不对称;试验组发生组织皮疹11例(64.7%)、黏膜溃疡3例(17.6%)。两组并发症发生率比较,差异均无统计学意义(P>0.05)。矫治后,两组齿槽前方裂隙宽度、水平裂隙宽度、矢状裂隙宽度、健侧齿槽近中弧度角及齿槽前缘与后齿槽基线夹角、唇系带点至中线距离均较矫治前减小(P<0.05),裂隙缘最前方交角、唇系带点与后方齿槽基线夹角较矫治前增大(P<0.05)。但以上指标矫治前后差值组间比较,差异均无统计学意义(P>0.05)。矫治后,两组后方齿槽宽度、中间齿槽宽度、垂直裂隙宽度、患侧齿槽近中弧度角及齿槽前缘与后齿槽基线夹角与矫治前比较,差异均无统计学意义(P>0.05)。结论将快速成型技术制作的鼻齿槽矫治器用于唇腭裂术前矫形,其疗效与传统鼻齿槽矫治器相似,但可减少门诊次数,为唇腭裂序列治疗提供一种更可靠和简便的方法。

Objective To apply rapid prototyping （RP） technology on pre-fabricating nasoalveolar molding （NAM） appliances, and compare clinical outcomes and complications with traditional NAM appliances. Methods Between June 2014 and September 2016, 39 children with unilateral cleft lip and palate were included in study. Seventeen children （test group） had received novel NAM protocol by pre-fabricating NAM appliances using RP technology, and the other 22 children （control group） had received traditional NAM protocol. There was no significant difference in gender, age, the side of cleft lip and palate, and the width of the alveolar cleft gap before treatment between 2 groups （P〉O.05）. The change of width of the alveolar cleft gap, number of clinic visit, treatment time, and complications were compared between 2 groups. Results The number of clinic visit was less in test group than in control group （P〈0.05）. There was no significant difference in treatment time between 2 groups （P〉0.05）. During treatment, there was 16 children （72.2%） of skin irritation, 3 （13.6%） of mucosal ulceration, 1 （4.5%） of intraoral bleeding, 1 （4.5%） of alveolar arch T-shap asymmetry in control group. And there were 11 children （64.7%） of skin irritation, 3 （17.6%） of mucosal ulceration in test group. There was no significant difference in the incidence of complications between 2 groups （P〉0.05）. After treatment, theanterior alveolar cleft width, horizontal cleft width, sagittal cleft width, antero-medial alveolar ridges angle of the healthy side, angle between anterior alveolar and posterior alveolar baseline of the healthy side, perpendicular distance from buccal frenum point to sagittal line were significantly reduced when compared with the values before treatment （P〈0.05）. The angle between the anterior segments of two sides, angle between buccal frenum point and posterior baseline were significant increased when compared with the values before treatment （P〈0.05）. There was no significant difference in the differences between pre- and post-treatment of above indexes between 2 groups （P〉0.05）. There also was no significant difference in posterior alveolar width, the width between the middle parts of alveolar, vertical cleft width, antero-medial alveolar ridges angle of the affected side, and angle between anterior alveolar and posterior alveolar baseline of the affected side between pre- and post-treatment in each group （P〉0.05）. Conclusion Clinical outcome of novel approach was equivalent to traditional protocol; however, the number of clinic visit decreased. With improving of RP technology, it would provide a more consistency and convenient way for sequential treatment with cleft lip and palate.