唇腭裂患者手术辅助快速上颌扩弓的CBCT研究

发布时间：2018-04-27 03:07

本文选题：单侧完全性唇腭裂 + 手术辅助上颌扩弓　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的:通过比较唇腭裂患者手术辅助快速上颌扩弓前后3个月的CBCT影像,测量扩弓前后牙颌系统三维方向上的变化,探讨唇腭裂患者进行手术辅助扩弓的临床机制,为唇腭裂患者的临床治疗提供参考。方法:选择2012~2014年就诊于福建医科大学附属第一医院口腔正畸科的11名单侧完全性唇腭裂患者,均处于生长发育期或生长发育高峰期。手术前拍摄CBCT,然后进行双侧颊侧骨皮质切开术,术后利用铸造型Hyrax螺旋扩弓器进行快速扩弓,扩弓完成后去除扩弓装置拍摄CBCT。运用EZ3D2009软件测量扩弓前后CBCT影像中,上颌骨牙及牙槽骨的变化以及上下颌骨在三维方向的位移变化。利用SPSS19.0软件对测量结果采用配对样本t检验或者Wilcoxon秩和检验进行统计分析。结果:1.两侧支抗牙的牙槽嵴顶高度变化无明显变化。2.两侧第一前磨牙以及第一磨牙均在牙合方1/3处颊侧牙槽骨厚度减小,舌侧牙槽骨厚度增加,差异有统计学意义。根中1/3及根尖1/3处颊舌侧牙槽骨厚度变化无统计学意义。3.第一前磨牙、第一磨牙处牙槽骨宽度均显著增加,分别为差异有统计学意义。牙槽骨前部扩弓量大于后部。4.裂隙侧与健侧支抗牙均发生颊向倾斜;裂隙侧与健侧支抗牙牙冠和牙根均有明显的颊向移位,差异有统计学意义。5.UI-NS减小,上切牙舌向移动。6.A点、ANS点变化无统计学意义,说明上颌没有发生向前的移位。SN-PP变化无统计学意义,说明上腭平面没有发生明显旋转。7.Go Gn-SN无明显改变,说明下颌骨没有发生明显的旋转。结论:生长发育期及生长发育高峰期的唇腭裂患者进行手术辅助扩弓可以达到较为满意的临床效果。扩弓未造成明显的牙周组织损害。裂隙两侧支抗牙的扩展基本对称。扩弓前后的主要变化发生在上颌骨的水平向上,上下颌骨在矢状向和垂直向上变化很小。
[Abstract]:Objective: To compare the CBCT images of 3 months before and after the rapid maxillary expansion of the patients with cleft lip and palate, to measure the changes in the three-dimensional direction of the dental system before and after the expansion of the pantograph, and to explore the clinical mechanism of the surgical assisted expansion of the cleft lip and palate patients to provide reference for the clinical treatment of the cleft lip and palate patients. Method: select the medical treatment in Fujian medicine for 2012~2014 years. 11 side complete cleft lip and palate patients in the orthodontic Department of the First Affiliated Hospital of the University Affiliated to the University were at the growth stage or the peak period of growth and development. Before operation, CBCT was taken and bilateral buccal cortical incision was performed. After the operation, the rapid expansion of the arch was carried out by the cast Hyrax spiral extender, and the expansion of the pantograph was removed and the CBCT. transport was taken after the expansion of the arch. EZ3D2009 software was used to measure the changes of maxillary teeth and alveolar bone in the CBCT images before and after the expansion of the arch and the changes in the displacement of the maxillary and mandible in the three-dimensional direction. The results of the measured results were statistically analyzed by the paired sample t test or the Wilcoxon rank test with the SPSS19.0 software. Results: there was no obvious change in the height of the alveolar crest at the 1. sides of the teeth. The thickness of the cheek alveolar bone of the first molar and the first molar on both sides of the.2. decreased, and the thickness of the alveolar bone in the lingual side of the tongue was increased. The thickness of the alveolar bone in the buccal and lingual side of the root 1/3 and the apex 1/3 had no statistical significance in.3. first premolar and the width of the alveolar bone at the first molar was significantly increased, the difference was the difference, respectively. There was statistical significance. The amount of arch expansion in the anterior part of the alveolar bone was greater than that in the posterior.4. fissure side and the lateral branch of the teeth. The buccal displacement was obvious in the cleft side and the lateral branch of the dental crown and root, and the difference was statistically significant.5.UI-NS, the upper incisor tongue moved to.6.A point, and the ANS point was not statistically significant, indicating that the maxilla had no hair. There was no significant change in the shift of.SN-PP in the forwards, indicating that there was no obvious change of.7.Go Gn-SN in the palate plane, indicating that there was no obvious rotation in the mandible. Conclusion: the surgical assisted expansion of the cleft lip and palate in the growth and development period and the peak period of growth and development can achieve a satisfactory clinical effect. The expansion of the teeth on both sides of the fissure is basically symmetrical. The main changes before and after the expansion of the arch occur at the level of the maxilla, and the upper and lower jaw changes very little in the sagittal and vertical direction.

【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R783.5

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