BACKGROUND Palatal expansion treatment has been used to expand the constricted maxillary arch and has become a routine procedure in orthodontic practice over the past decades.However,the long-term stability of expansi...BACKGROUND Palatal expansion treatment has been used to expand the constricted maxillary arch and has become a routine procedure in orthodontic practice over the past decades.However,the long-term stability of expansion in the permanent dentition without a surgical approach is uncertain.CASE SUMMARY We present the case of a 15-year-old boy with Class II malocclusion and constricted arches.The patient was treated with rapid palatal expansion(RPE)followed by a fixed orthodontic appliance.A 7-year follow-up evaluation was performed by analyzing cephalometric radiographs,plaster models,and photographs.The patient’s constricted maxillary and mandibular arches were relived after the expansion treatment.A Class I occlusion and normal arch form were established and maintained in the long-term.CONCLUSION RPE treatment is successful in solving constricted dental arch in the permanent dentition without a surgical approach.Permanent retention and even occlusal contact help prevent long-term relapse.展开更多
Rapid maxillary expansion(RME),as a common treatment for craniomaxillofacial deformity,faces the challenge of high relapse rates and unsatisfactory therapeutic effects.In this study,a standardized Sprague-Dawley(SD)ra...Rapid maxillary expansion(RME),as a common treatment for craniomaxillofacial deformity,faces the challenge of high relapse rates and unsatisfactory therapeutic effects.In this study,a standardized Sprague-Dawley(SD)rat RME model was first established with a modified expander as well as retainer design and optimized anterior maxillary expanding force of 100 g which exerted the most synchronized mobility of mid-palatal suture and incisors.Via the standardized model,the high relapse rate was proven to be attributed to insufficient osteogenesis in expanded suture,requiring long-term retainer wearing in clinical situations.To reduce the relapse rate,mesoporous bioactive glass/fibrin glue(MBG/FG)composite hydrogels were developed for an in situ minimal invasive injection that enhance osteogenesis in the expanded palate.The component of 1 wt%MBG was adopted for enhanced mechanical strength,matched degradation rate and ion dissolution,excellent in vitro biocompatibility and osteoinductivity.Effects of 1%MBG/FG composite hydrogel on osteogenesis in expanded mid-palatal sutures with/without retention were evaluated in the standardized model.The results demonstrated that injection of 1%MBG/FG composite hydrogel significantly promoted bone formation within the expanded mid-palatal suture,inhibited osteoclastogenesis and benefited the balance of bone remodeling towards osteogenesis.Combination of retainer and injectable biomaterial was demonstrated as a promising treatment to reduce relapse rate and enhance osteogenesis after RME.The model establishment and the composite hydrogel development in this article might provide new insight to other craniomaxillofacial deformity treatment and design of bone-repairing biomaterials with higher regenerative efficiency.展开更多
目的·利用锥形束计算机断层扫描(cone-beam computed tomography,CBCT)技术分析中国人群中翼腭缝(pterygopalatine suture,PPS)的解剖及宏观形态特征,并初步探讨其发育模式及其与矫正上颌发育不足之间的关联。方法·纳入2023年...目的·利用锥形束计算机断层扫描(cone-beam computed tomography,CBCT)技术分析中国人群中翼腭缝(pterygopalatine suture,PPS)的解剖及宏观形态特征,并初步探讨其发育模式及其与矫正上颌发育不足之间的关联。方法·纳入2023年7月—8月在上海交通大学医学院附属第九人民医院拍摄的134例CBCT影像资料,根据年龄分为6组。以PPS标志点为依据,计算得出PPS整体的横向位置(transverse position of PPS,X_(PPS)),PPS整体的矢状向位置(sagittal position of PPS,Y_(PPS)),以及PPS的锥突嵌入角(insertion angle of PPS,IAP)、锥突嵌入宽度(insertion width of pyramidal process,IWP)和锥突嵌入深度(insertion depth of pyramidal process,IDP),并通过多平面观察确定翼上颌联合情况。采用回归分析评估各参数与年龄、性别的相关性,并通过两两比较确定参数变化的稳定年龄段。采用配对t检验及配对χ^(2)检验分析双侧参数的差异性。结果·Y_(PPS)、IDP与年龄无显著相关性,而X_(PPS)、IAP、IWP、翼上颌连接的发生率均与年龄呈显著正相关(P<0.01)。性别差异仅在X_(PPS)中显著,男性大于女性(P<0.01)。参数的年龄变化趋势分析表明:X_(PPS)在组1(6岁≤年龄<9岁)和组2 (9岁≤年龄<12岁)间差异显著(女性:P=0.006;男性:P=0.004);IAP在组2与组3 (12岁≤年龄<15岁)间差异显著(P=0.042),98.5%样本的IAP大于45°;IWP在组1与组3间差异显著(P=0.016);翼上颌联合情况在组1、2、3间差异显著(组1、2间P<0.001,组2、3间P=0.037,组1、3间P<0.001),成人发生率高于90%。各项指标双侧比较均未见统计学差异。结论·6岁以后Y_(PPS)及IDP未表现出明显改变,上颌骨与翼突趋于融合。PPS整体横向位置在12岁左右趋于稳定,而IAP及IWP持续增长,至15岁左右达到稳定且翼腭缝锥突嵌入翼切迹的方向偏向矢状向。展开更多
Midpalatal corticotomy-assisted rapid maxillary expansion(MCRME)is a minimally invasive treatment of maxillary transverse deficiency(MTD)in young adults.However,the effect of MCRME on respiratory function still needs ...Midpalatal corticotomy-assisted rapid maxillary expansion(MCRME)is a minimally invasive treatment of maxillary transverse deficiency(MTD)in young adults.However,the effect of MCRME on respiratory function still needs to be determined.In this study,we evaluated the changes in maxillary morphology and the upper airway following MCRME using computational fluid dynamics(CFD).Twenty patients with MTD(8 males,12 females;mean age 20.55 years)had cone-beam computed tomography(CBCT)images taken before and after MCRME.The CBCT data were used to construct a threedimensional(3 D)upper airway model.The upper airway flow characteristics were simulated using CFD,and measurements were made based on the CBCT images and CFD.The results showed that the widths of the palatal bone and nasal cavity,and the intermolar width were increased significantly after MCRME.The volume of the nasal cavity and nasopharynx increased significantly,while there were no obvious changes in the volumes of the oropharynx and hypopharynx.CFD simulation of the upper airway showed that the pressure drop and maximum velocity of the upper airway decreased significantly after treatment.Our results suggest that in these young adults with MTD,increasing the maxillary width,upper airway volume,and quantity of airflow by MCRME substantially improved upper airway ventilation.展开更多
基金Supported by the National Natural Science Foundation of China No.81970909(to Liu DW),No.51903003(to Yu TT)the New Clinical Technology Fund of PKUSS,No.PKUSSNCT-11A07(to Liu DW)Peking University Medicine Seed Fund for Interdisciplinary Research,No.BMU2018MX007(to Liu DW).
文摘BACKGROUND Palatal expansion treatment has been used to expand the constricted maxillary arch and has become a routine procedure in orthodontic practice over the past decades.However,the long-term stability of expansion in the permanent dentition without a surgical approach is uncertain.CASE SUMMARY We present the case of a 15-year-old boy with Class II malocclusion and constricted arches.The patient was treated with rapid palatal expansion(RPE)followed by a fixed orthodontic appliance.A 7-year follow-up evaluation was performed by analyzing cephalometric radiographs,plaster models,and photographs.The patient’s constricted maxillary and mandibular arches were relived after the expansion treatment.A Class I occlusion and normal arch form were established and maintained in the long-term.CONCLUSION RPE treatment is successful in solving constricted dental arch in the permanent dentition without a surgical approach.Permanent retention and even occlusal contact help prevent long-term relapse.
基金the National Natural Science Foundation of China(No.81970973,No.81771036,No.82071097,No.82071096)China Postdoctoral Science Foundation(2020T130422)Shanghai Sailing Program(19YF1425500,19YF1426500).
文摘Rapid maxillary expansion(RME),as a common treatment for craniomaxillofacial deformity,faces the challenge of high relapse rates and unsatisfactory therapeutic effects.In this study,a standardized Sprague-Dawley(SD)rat RME model was first established with a modified expander as well as retainer design and optimized anterior maxillary expanding force of 100 g which exerted the most synchronized mobility of mid-palatal suture and incisors.Via the standardized model,the high relapse rate was proven to be attributed to insufficient osteogenesis in expanded suture,requiring long-term retainer wearing in clinical situations.To reduce the relapse rate,mesoporous bioactive glass/fibrin glue(MBG/FG)composite hydrogels were developed for an in situ minimal invasive injection that enhance osteogenesis in the expanded palate.The component of 1 wt%MBG was adopted for enhanced mechanical strength,matched degradation rate and ion dissolution,excellent in vitro biocompatibility and osteoinductivity.Effects of 1%MBG/FG composite hydrogel on osteogenesis in expanded mid-palatal sutures with/without retention were evaluated in the standardized model.The results demonstrated that injection of 1%MBG/FG composite hydrogel significantly promoted bone formation within the expanded mid-palatal suture,inhibited osteoclastogenesis and benefited the balance of bone remodeling towards osteogenesis.Combination of retainer and injectable biomaterial was demonstrated as a promising treatment to reduce relapse rate and enhance osteogenesis after RME.The model establishment and the composite hydrogel development in this article might provide new insight to other craniomaxillofacial deformity treatment and design of bone-repairing biomaterials with higher regenerative efficiency.
文摘目的·利用锥形束计算机断层扫描(cone-beam computed tomography,CBCT)技术分析中国人群中翼腭缝(pterygopalatine suture,PPS)的解剖及宏观形态特征,并初步探讨其发育模式及其与矫正上颌发育不足之间的关联。方法·纳入2023年7月—8月在上海交通大学医学院附属第九人民医院拍摄的134例CBCT影像资料,根据年龄分为6组。以PPS标志点为依据,计算得出PPS整体的横向位置(transverse position of PPS,X_(PPS)),PPS整体的矢状向位置(sagittal position of PPS,Y_(PPS)),以及PPS的锥突嵌入角(insertion angle of PPS,IAP)、锥突嵌入宽度(insertion width of pyramidal process,IWP)和锥突嵌入深度(insertion depth of pyramidal process,IDP),并通过多平面观察确定翼上颌联合情况。采用回归分析评估各参数与年龄、性别的相关性,并通过两两比较确定参数变化的稳定年龄段。采用配对t检验及配对χ^(2)检验分析双侧参数的差异性。结果·Y_(PPS)、IDP与年龄无显著相关性,而X_(PPS)、IAP、IWP、翼上颌连接的发生率均与年龄呈显著正相关(P<0.01)。性别差异仅在X_(PPS)中显著,男性大于女性(P<0.01)。参数的年龄变化趋势分析表明:X_(PPS)在组1(6岁≤年龄<9岁)和组2 (9岁≤年龄<12岁)间差异显著(女性:P=0.006;男性:P=0.004);IAP在组2与组3 (12岁≤年龄<15岁)间差异显著(P=0.042),98.5%样本的IAP大于45°;IWP在组1与组3间差异显著(P=0.016);翼上颌联合情况在组1、2、3间差异显著(组1、2间P<0.001,组2、3间P=0.037,组1、3间P<0.001),成人发生率高于90%。各项指标双侧比较均未见统计学差异。结论·6岁以后Y_(PPS)及IDP未表现出明显改变,上颌骨与翼突趋于融合。PPS整体横向位置在12岁左右趋于稳定,而IAP及IWP持续增长,至15岁左右达到稳定且翼腭缝锥突嵌入翼切迹的方向偏向矢状向。
基金supported by the National Natural Science Foundation of China(No.81970978)the Zhejiang Provincial Natural Science Foundation of China(No.LQ18H140004)the Zhejiang Provincial Medical Health&Hygienic Science and Technology Project of China(Nos.2018KY365,2019RC156,and 2020KY449)。
文摘Midpalatal corticotomy-assisted rapid maxillary expansion(MCRME)is a minimally invasive treatment of maxillary transverse deficiency(MTD)in young adults.However,the effect of MCRME on respiratory function still needs to be determined.In this study,we evaluated the changes in maxillary morphology and the upper airway following MCRME using computational fluid dynamics(CFD).Twenty patients with MTD(8 males,12 females;mean age 20.55 years)had cone-beam computed tomography(CBCT)images taken before and after MCRME.The CBCT data were used to construct a threedimensional(3 D)upper airway model.The upper airway flow characteristics were simulated using CFD,and measurements were made based on the CBCT images and CFD.The results showed that the widths of the palatal bone and nasal cavity,and the intermolar width were increased significantly after MCRME.The volume of the nasal cavity and nasopharynx increased significantly,while there were no obvious changes in the volumes of the oropharynx and hypopharynx.CFD simulation of the upper airway showed that the pressure drop and maximum velocity of the upper airway decreased significantly after treatment.Our results suggest that in these young adults with MTD,increasing the maxillary width,upper airway volume,and quantity of airflow by MCRME substantially improved upper airway ventilation.
