颅骨锁骨发育不良14例的牙列异常特征及口腔综合治疗分析

Clinical characteristics and comprehensive treatment of patients with cleidocranial dysplasia

目的总结颅骨锁骨发育不良(cleidocranial dysplasia,CCD)患者的牙列异常特征并分析其治疗方法,为CCD的临床诊疗提供参考。方法对2000年1月至2020年12月于中国医科大学口腔医学院·附属口腔医院正畸科和第一门诊完成口腔综合治疗的14例CCD患者诊疗资料进行回顾,男性7例,女性7例,年龄(16.1±4.5)岁,共153颗埋伏牙,44颗多生牙;统计埋伏牙及多生牙好发部位。除术前因特殊情况需要拔除的牙齿外,采用埋伏牙闭合牵引助萌术牵引147颗埋伏牙入列。患者按年龄划分为青少年组(≥12岁且<18岁)(10例患者110颗埋伏牙)和成年组(≥18岁)(4例患者37颗埋伏牙),比较两组埋伏牙牵引失败率。选择牵引失败高发牙位,统计该牙位所有埋伏牙,分析埋伏牙不同垂直向位置(高位、中位和低位)和不同水平向位置(舌腭侧、正中和唇颊侧)牵引成功率差异。结果CCD患者上颌埋伏牙发生率[69.3%(97/140)]显著大于下颌埋伏牙[40%(56/140)](χ^(2)=24.22,P<0.001)。多生牙主要集中于前磨牙区[61.4%(21/44)],95.5%(42/44)位于恒牙舌腭侧,常与相邻恒牙位于同一高度[59.1%(26/44)]或位于其方[40.9%(18/44)]。埋伏牙牵引成功率为93.9%(138/147)。青少年组埋伏牙牵引成功率[98.2%(108/110)]显著大于成年组[81.1%(30/37)](χ^(2)=14.09,P<0.05)。牵引失败牙共9颗,其中7颗为第二前磨牙。本文病例共36颗第二前磨牙为埋伏牙,其垂直向位置(χ^(2)=11.44,P<0.05)或水平向位置(χ^(2)=9.71,P<0.05)的牵引成功率差异均有统计学意义,分别为高位15/16、中位12/13、低位2/7和舌腭侧10/17、正中19/19、唇颊侧0/0。结论埋伏牙闭合牵引助萌术是治疗CCD埋伏牙的有效术式,其埋伏牙牵引结果主要受年龄的影响。位于牙槽骨低位、舌腭侧的第二前磨牙的牵引成功率较低,治疗时需密切观察。

Objective To summarize the clinical characteristics of patients with cleidocranial dysplasia(CCD)and analyze their treatment methods.Methods From January 2000 to December 2020,patients with CCD who completed comprehensive treatment in the Department of Orthodontics and the First Dental Clinic,School and Hospital of Stomatology,China Medical University were retrospectively analyzed.A total of 14 CCD patients[7 males and 7 females,aged(16.1±4.5)years]were collected.There were 153 impacted permanent teeth in this study.In addition to the teeth that needed to be extracted due to special conditions,147 impacted teeth were pulled into the dentition using closed traction.Patients were divided into adolescent group(≥12 years and<18 years,10 patients)and adult group(≥18 years,4 patients).Failure rate of traction was compared between the two groups.Factors affecting the success rate of closed traction such as vertical position of teeth(high,middle and low)and horizontal position of the teeth(palatal,median and buccal)were analyzed.Results The incidence of maxillary impacted teeth[69.3%(97/140)]was higher than that of mandibular impacted teeth[40%(56/140)].The difference was statistically significant(χ^(2)=24.22,P<0.001).The supernumerary teeth were mainly located in the premolar area 61.4%(21/44),and most of them were in the palatal region of the permanent teeth 95.5%(42/44).They were generally located at the same height or the occlusal side of the corresponding permanent teeth.The success rate of closed traction was 93.9%(138/147).The success rate in the adolescent group[98.2%(108/110)]was higher than that in the adult group[81.1%(30/37)],and the difference was significant(χ^(2)=14.09,P<0.05).Failure after closed traction of 9 teeth was found totally,including 7 second premolars.The success rate of traction in impacted second premolars at different vertical(χ^(2)=11.44,P<0.05)and horizontal(χ^(2)=9.71,P<0.05)positions in alveolar bone was different significantlly.The success rates of the second premolars were high(15/16),middle(12/13),low(2/7),and lingual palatine(10/17),median(19/19),lip-buccal(0/0),respectively.Conclusions The closed traction of impacted teeth in patients with CCD was effective,and the age was the main variable affecting the outcome.The success rate of traction in impacted second premolars located in low position vertically or in palatal position was low,which required close observation during treatment.