上颌骨横向发育不足年轻成人修复前上颌快速扩弓的临床疗效观察

The clinical effect of rapid maxillary skeletal expansion in young adults with transverse maxillary deficiency before prosthodontics

目的:评价使用腭中缝骨皮质切开术辅助改良骨支持式上颌快速扩弓治疗年轻成人上颌骨横向发育不足的疗效。方法:选择16例伴有后牙反的骨性Ⅲ类错[牙合]年轻成人患者,先使用超声骨刀行腭中缝骨皮质切开术,然后行改良的骨支持式上颌快速扩弓,测量分析治疗前后双侧尖牙区、第一前磨牙区和第一磨牙区相对应的硬腭最下缘上颌基骨宽度、腭尖根尖平面上颌基骨宽度、腭尖间牙弓宽度、以及牙齿转矩的变化特征。结果:扩弓完成后所有患者后牙反[牙合]解除,腭中缝被扩开,上颌不同牙位对应的硬腭最下缘上颌基骨宽度、腭尖根尖平面的上颌基骨宽度、双侧腭尖间牙弓宽度较治疗前均显著增宽(P<0.01);上颌牙转矩显著增加(P<0.01),其中腭中缝骨性增量占比尖牙区(81.60±0.33)%、第一前磨牙区(61.70±1.23)%、第一磨牙区(53.66±0.47)%。扩弓完成6个月后复查基骨及牙弓的宽度、上颌牙转矩的减小均无统计学意义(P>0.05)。结论:使用腭中缝骨皮质切开术辅助改良骨支持式上颌快速扩弓可以有效扩大年轻成人上颌骨宽度,协调上下牙弓关系,为后期修复打下良好的基础。

Objective: To evaluate the effect of midpalatal cortex osteotomy assisted and modified rapid maxillary skeletal expansion in young adults with transverse maxillary deficiency. Methods: 16 young adult patients of skeletal class Ⅲ malocclusion with posterior teeth crossbite were selected, treated with piezosurgery to achieve midpalatal cortex osteotomy,followed by maxillary expansion utilizing modified miniscrew-assisted maxillary skeletal expansion method.Before and after treatment, the width of basal bone of hard palate, basal bone and arch of the maxilla in the canine area,the first premolar area and the first molar area, and the torque of maxillary teeth were measured and analyzed. Results:For all cases, after the maxillary expansion, the posterior teeth crossbite was corrected, and the midpalatal suture was opened. After the expansion, the width of basal bone of hard palate, basal bone and arch of the maxilla in different areas were statistically significantly increased(P<0.01). The torque of maxillary teeth increased significantly(P<0.01). Among them, the midpalatal suture increased by(81.60±0.33)% of the canine area,(61.70±1.23)% of the first premolar area,and(53.66±0.47)% of the first molar area. There was no significant difference in all width, the torque of maxillary teeth between the after expansion and the six months follow-up(P>0.05). Conclusion: Using midpalatal cortex osteotomy assisted modified rapid maxillary skeletal expansion can effectively widen the maxilla, harmonize maxillary and mandible arch in young adults, which plays an important role in prosthodontics.