儿童骨性Ⅲ类错(牙合)牙弓和基骨弓的生长发育特点

Growth and development characteristics of dental and basal arch in children with skeletal class Ⅲ malocclusion

背景:目前对于骨性Ⅲ类错(牙合)的诊断和治疗都具有一定的挑战性,主要是因为这类错(牙合)类型的患者颅面部结构生长的多样性和不可预测性,治疗决策及其成败在很大程度上取决于骨性Ⅲ类错(牙合)患者未来的生长潜力。目的:综述儿童骨性Ⅲ类错(牙合)牙弓和基骨弓生长发育的研究现状研究进展。方法:在PubMed、中国知网、万方、Medline数据库中进行相关文献检索,以“malocclusion,skeletal class Ⅲ malocclusion,dental arch,basal arch,growth and development,mixed dentition,tongue,etiology,jaw”为英文检索词进行检索,以“错(牙合)、骨性Ⅲ类错(牙合)、牙弓、基骨弓、生长发育、替牙期、舌、病因、颌骨”为中文检索词进行检索,最后纳入64篇文献进行仔细阅读分析与总结。结果与结论:①骨性Ⅲ类错(牙合)畸形是儿童(牙合)发育异常中较为常见的一种错(牙合)类型,其颌骨、牙弓、基骨弓在一定程度上也会受到遗传和环境因素的影响。②颌骨、牙弓、基骨弓作为特殊的颅颌面复合体有相同的增长变化趋势,具有协同性。③骨性Ⅲ类错(牙合)患儿的上、下颌骨生长速率与年龄和骨龄相关,颌骨长度的增长在不同生长高峰期的速率也有差异,一直持续到患儿成年。④正确预测生长发育高峰期,抑制骨性Ⅲ类儿童下颌骨的生长发育就显得尤为重要。⑤由于骨性Ⅲ类错(牙合)畸形的治疗具有复杂性,因此及时发现上、下颌骨、牙齿、牙列及咬合关系等异常发育的情况,正确诊断,早期矫治,适时干预对于引导儿童颅颌面的正常生长发育具有重要意义。⑥目前对于儿童牙弓、基骨弓生长发育的研究主要集中在正常(牙合),因为骨性Ⅲ类错(牙合)畸形患儿一旦开始治疗,就不能继续观察其生长发育特点,因此未来还需对骨性Ⅲ类错(牙合)畸形的生长发育机制进行进一步研究。

BACKGROUND:At present,the diagnosis and treatment of skeletal class Ⅲ malocclusion are challenging,mainly because of the diversity and unpredictability of craniofa cial structure growth in such patients.Treatment decisions and their success or failure much depend on the future growth potential of patients with skeetal class Ⅲ malocclusion.OBJECTIVE:To review the research progress in growth and development of dental and basal arch in children with skeletal class Ⅲ malocclusion.METHODS:Lite rature retrieval was conducted in PubMed,CNKI,WanFang,and Medline using the keywords of "malocclusion;skeletal class Ⅲ malocclusion;dental arch;basal arch;growth and development;mixed dentition;tongue;etiology;jaw" in English and Chinese,and studies and experiments of low quality and irrelevant to the to pic were excluded.Finally,64 articles were included for careful reading and analysis.RESULTS AND CONCLUSION:Skeletal class Ⅲ malocclusion is a common malocclusion type in children with abnormal occlusal development,and the jaw,dental arch,and basal arch are also affected by genetic factors to a ce rtain extent.As special craniomaxillofa cial complexes,the jawbone,dental arch and basal arch have the same growth trend and there was a synergistic effect between them.In children with skeletal class Ⅲ malocclusion,the growth rate of the maxilla and mandible is related to age and bone age,and the growth rate of the jaw bone length va ries at different growth peaks until adulthood.It is particularly important to correctly predict the peak growth period and inhibit the growth and development of the mandible in children with skeletal class Ⅲ malocclusion.Due to the complexity of its treatment,timely detection of abnormal development of the upper and lower jaws,teeth,dentition and occlusal relationship,correct diagnosis,early correction,and timely intervention are of great significance to guide the normal growth and development of the craniomaxillofa cial region.However,the current research on the growth and development of the dental arch and basal bone arch in children mainly focuses on the normal occlusion,because the growth and development characte ristics of children with skeletal class Ⅲ malocclusion cannot be observed once treatment is started.Therefore,fu rther studies are required on the growth and development mechanism of skeletal class Ⅲ malocclusion.