外科辅助上颌骨快速扩弓后牙-上颌骨的变化

Dental and maxillary skeletal changes following surgically assisted rapid maxillary expansion

目的通过头颅侧位片及数字化三维(Three Dimensional 3D)牙模的测量,分析上颌牙弓狭窄的患者经过外科辅助上颌骨快速扩弓(surgically assisted rapid maxillary expansion,SARME)后牙-上颌骨的变化,从而为临床的治疗提供一定的理论依据。方法收集2012年8月~2013年8月上海交通大学医学院附属第九人民医院口腔颅颌面外科经过SARME术的患者15例,无相关颅颌面综合征。术前一周及术后六个月扩弓器拆掉即刻拍摄头颅侧位片及制取石膏牙模,并将石膏牙模进行激光扫描,获取3D牙模。将所得资料进行测量分析,得出患者术后的变化。测量结果采用SPSS17.0统计包中的配对t检验进行检验。结果头颅侧位片示:SNA、NA-FH减小,术前、术后的差异具有统计学意义。3D牙模分析:ANGLE 4、ANGLE 5、ANGLE 6、R3-L3、R41-L41、R51-L51、R61-L61都明显增大,所有改变都具有统计学意义。结论SARMR后A点后退,10例患者上颌骨发生顺时针旋转,5例患者上颌骨逆时针旋转。双侧第一前磨牙及第一磨牙发生明显的倾斜,平均倾斜角度约为3.57°、3.59°。第一前磨牙、第二前磨牙、第一磨牙扩宽的距离分别是:7.36mm、7.07mm、6.59mm。

Objective The aim of this research was to investigate the effects of surgery assistant rapid maxillary expansion(SARME)about maxillary dentoalveolar structures,through lateral cephalograms and Three Dimensional(3D)cast,all cases had a maxillary width deficiency and underwent SARME,so as to imply some guides for doctors.Methods This study included 15 skeletally mature non-syndromic patients,seeking from the Department of Oral Cranial and Maxillofacial Surgery of the ninth people’s hospital affiliated to Shanghai jiaotong university school of medicine from2012 august to 2013 august.Lateral cephalograms and dental cast were obtained for each individual in one week before operation and four to six month post-expansion after removing the expander.All dental cast was scanned,then we can obtained the three dimensional dental cast.From those material we can do some measurement,Paired t-tests were used to evaluate changes within groups.Results SARME produced significant decreases in SNA、NAFH,but increases in ANGLE 4、ANGLE 5、ANGLE 6、R3-L3、R41-L41、R51-L51、R61-L61.All change shown significant.Conclusion After SARMR the A point has backward.From the Sagittal plane,10 patients’maxilla was clockwise,but the other 5 patients’maxilla was counterclockwise.Bilateral premolars and first molars occur obvious tilt,The average Angle is about 3.57°and 3.59°.First premolar,the second premolar and the first molar widen the distance are:7.36 mm,7.07 mm and 6.59 mm.