上颌反复扩缩前方牵引三维变化的锥形束CT分析
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摘要
目的:利用锥形束计算机体层摄影术(cone-beam computed tomography,CBCT)探讨扩弓前牵对上颌标志点三维方向变化的影响,为骨性Ⅲ类错牙合畸形的早期治疗提供参考。方法:选择36例上颌后缩患者,使用随机化区组设计分为反复扩缩组(alternating rapid palatal expansion and constriction group,RPE/C)和对照组(rapid palatal expansion group,RPE),各18例。RPE/C按照上颌快速扩弓两周、缩弓两周的顺序重复扩缩共10周,最后两周扩弓后行面罩前方牵引,RPE上颌快速扩弓两周后行面罩前方牵引,分别于治疗前(T1)、扩弓后(T2)、前牵后(T3)拍摄CBCT。利用Mimics 10.01软件进行颌面部三维重建、上颌标志点定点和测量分析。结果:RPE/C治疗结束上齿槽座点(subspinale,A)前移(3.06±1.29)mm,RPE(2.16±1.27)mm,组间差异具有统计学意义(P<0.05);RPE/C治疗各阶段标志点变化更对称;两组患者总治疗时间差异无统计学意义(P>0.05)。RPE/C上颌骨性标志点矢状向、冠状向和水平向变化趋势:扩弓T2-T1阶段前下、增宽变化,前牵T3-T2阶段前上、缩窄变化,总治疗T3-T1阶段前下、增宽变化,其余测量项目组间差异无统计学意义(P>0.05)。结论:上颌反复快速扩缩后前方牵引对早期治疗上颌后缩畸形有效;与上颌单次扩弓前方牵引的方法相比,上颌反复扩缩前方牵引对治疗中的上颌骨前移和对称性变化有利;CBCT在正畸测量分析中的应用需要进一步探讨。
Objective: To use the cone-beam computed tomography(CBCT) to evaluate the threedimensional(3 D) changes of maxillary landmarks in the maxillary protraction with alternating rapid palatal expansion and constriction and with rapid palatal expansion,and to provide some clinical suggestions for the early treatment of Class Ⅲ malocclusion. Methods: A total of 36 maxillary retrusive patients were included and randomized in a 1 ∶ 1 ratio to either the intervention group(alternating rapid palatal expansion and constriction group,RPE/C) or the control group(rapid palatal expansion group,RPE). Randomization was accomplished with permuted block randomization based on participation sequence. The patients in the RPE/C were treated for 10 weeks(0. 5 mm/d) with the repetition of two-week palatal expansion and two-week palatal constriction. The patients in the RPE were taught to complete rapid palatal expansion for 2 weeks(0. 5 mm/d). The patients were instructed to come to the office for the follow-up to ensure the correct procedures. Damaged expanders were repaired(or replaced) and rebanded quickly.Sequential CBCT images including pretreatment(T1),post-expansion(T2) and post-protraction(T3)were required for 3 D reconstruction,establishment of landmarks,measurement and analysis by Mimics10. 01. Results: There was significant forward movement of subspinale(A) in the RPE/C after the treatment with(3. 06 ± 1. 29) mm,compared with RPE(2. 16 ± 1. 27) mm,P < 0. 05. There were more symmetrical changes of the landmarks in the RPE/C and there was no statistic significance of the entire treatment time between the two groups. Moreover,the maxillary skeletal landmarks had the following 3 D changes of a forward and downward movement during the expansion stages T2-T1,a forward and upward movement during the protraction stages T3-T2 and a forward and downward movement during the total treatments T3-T1 compared with the control group. And the width between the bilateral landmarks increased during the expansion stages T2-T1,narrowed down during the protraction stages T3-T2 and increased during the total treatments T3-T1. Conclusion: The maxillary protraction with alternating rapid palatal expansion and constriction provided clinical benefits on maxillary advancement and symmetrical changes in the orthopedic treatment of the patients with maxillary retrognathism and it required further study on the orthodontic analysis and measurements of CBCT.
Objective: To use the cone-beam computed tomography(CBCT) to evaluate the threedimensional(3 D) changes of maxillary landmarks in the maxillary protraction with alternating rapid palatal expansion and constriction and with rapid palatal expansion,and to provide some clinical suggestions for the early treatment of Class Ⅲ malocclusion. Methods: A total of 36 maxillary retrusive patients were included and randomized in a 1 ∶ 1 ratio to either the intervention group(alternating rapid palatal expansion and constriction group,RPE/C) or the control group(rapid palatal expansion group,RPE). Randomization was accomplished with permuted block randomization based on participation sequence. The patients in the RPE/C were treated for 10 weeks(0. 5 mm/d) with the repetition of two-week palatal expansion and two-week palatal constriction. The patients in the RPE were taught to complete rapid palatal expansion for 2 weeks(0. 5 mm/d). The patients were instructed to come to the office for the follow-up to ensure the correct procedures. Damaged expanders were repaired(or replaced) and rebanded quickly.Sequential CBCT images including pretreatment(T1),post-expansion(T2) and post-protraction(T3)were required for 3 D reconstruction,establishment of landmarks,measurement and analysis by Mimics10. 01. Results: There was significant forward movement of subspinale(A) in the RPE/C after the treatment with(3. 06 ± 1. 29) mm,compared with RPE(2. 16 ± 1. 27) mm,P < 0. 05. There were more symmetrical changes of the landmarks in the RPE/C and there was no statistic significance of the entire treatment time between the two groups. Moreover,the maxillary skeletal landmarks had the following 3 D changes of a forward and downward movement during the expansion stages T2-T1,a forward and upward movement during the protraction stages T3-T2 and a forward and downward movement during the total treatments T3-T1 compared with the control group. And the width between the bilateral landmarks increased during the expansion stages T2-T1,narrowed down during the protraction stages T3-T2 and increased during the total treatments T3-T1. Conclusion: The maxillary protraction with alternating rapid palatal expansion and constriction provided clinical benefits on maxillary advancement and symmetrical changes in the orthopedic treatment of the patients with maxillary retrognathism and it required further study on the orthodontic analysis and measurements of CBCT.
引文
[1]Iwagaki H.Hereditary influence of malocclusion[J].Am J Orthod Oral Surg,1938,24(4):328-336.
[2]Allwright WC,Burndred WH.A survey of handicapping dentofacial anomalies among Chinese in Hong Kong[J].Int Dent J,1964,14:505-519.
[3]Irie M,Nakamura S.Orthopedic approach to severe skeletal ClassⅢmalocclusion[J].Am J Orthod,1975,67(4):377-392.
[4]Sanborn RT.Differences between the facial skeletal patterns of ClassⅢmalocclusion and normal occlusion[J].Angle Orthod,1955,25(4):208-222.
[5]Guyer EC,Ellis EE 3rd,Mc Namara JA Jr,et al.Components of ClassⅢmalocclusion in juveniles and adolescents[J].Angle Orthod,1986,56(1):7-30.
[6]Ellis E 3rd,Mc Namara JA Jr.Components of adult ClassⅢopenbite malocclusion[J].Am J Orthod,1984,86(4):277-290.
[7]Turchetta BJ,Fishman LS,Subtelny JD.Facial growth prediction:a comparison of methodologies[J].Am J Orthod Dentofacial Orthop,2007,132(4):439-449.
[8]Yoshida I,Yamaguchi N,Mizoguchi I.Prediction of post treatment outcome after combined treatment with maxillary protraction and chincap appliances[J].Eur J Orthod,2006,28(1):89-96.
[9]Mandall N,Cousley R,Di Biase A,et al.Early ClassⅢprotraction facemask treatment reduces the need for orthognathic surgery:a multi-centre,two-arm parallel randomized,controlled trial[J].J Orthod,2016,43(3):164-175.
[10]Ngan P,Moon W.Evolution of ClassⅢtreatment in orthodontics[J].Am J Orthod Dentofacial Orthop,2015,148(1):22-36.
[11]De Clerck HJ,Proffit WR.Growth modification of the face:A current perspective with emphasis on ClassⅢtreatment[J].Am J Orthod Dentofacial Orthop,2015,148(1):37-46.
[12]Hagg U,Tse A,Bendeus M,et al.Long-term follow-up of early treatment with reverse headgear[J].Eur J Orthod,2003,25(1):95-102.
[13]Baccetti T,Franchi L,Mc Namara JA Jr.Cephalometric variables predicting the long-term success or failure of combined rapid maxillary expansion and facial mask therapy[J].Am J Orthod Dentofacial Orthop,2004,126(1):16-22.
[14]Wells AP,Sarver DM,Proffit WR.Long-term efficacy of reverse pull headgear therapy[J].Angle Orthod,2006,76(6):915-922.
[15]Masucci C,Franchi L,Defraia E,et al.Stability of rapid maxillary expansion and facemask therapy:a long-term controlled study[J].Am J Orthod Dentofacial Orthop,2011,140(4):493-500.
[16]Ishii H,Morita S,Takeuchi Y,et al.Treatment effect of combined maxillary protraction and chincap appliance in severe skeletal ClassⅢcases[J].Am J Orthod Dentofacial Orthop,1987,92(4):304-312.
[17]Shanker S,Ngan P,Wade D,et al.Cephalometric A point changes during and after maxillary protraction and expansion[J].Am J Orthod Dentofacial Orthop,1996,110(4):423-430.
[18]Baik HS.Clinical results of the maxillary protraction in Korean children[J].Am J Orthod Dentofacial Orthop,1995,108(6):583-592.
[19]Liou EJ,Chen KT.New orthodontic and orthopedic managements on the premaxillary deformities in patients with bilateral cleft before alveolar bone grafting[J].Ann Coll Surg Hong Kong,2003,7(3):73-82.
[20]Liou EJ,Tsai WC.A new protocol for maxillary protraction in cleft patients:a repetitive weekly protocol of alternate rapid maxillary expansions and constrictions[J].Cleft Palate Craniofac J,2005,42(2):121-127.
[21]Liou EJ.Effective maxillary orthopedic protraction for growing ClassⅢpatients:a clinical application simulates distraction osteogenesis[J].Prog Orthod,2005,6(2):154-171.
[22]Liou EJ.Tooth borne maxillary protraction in ClassⅢpatients[J].J Clin Orthod,2005,39(2):68-75.
[23]邹冰爽,高雪梅,冯光耀,等.反复扩缩式上颌快速扩弓器配合前方牵引的初步临床应用[J].口腔正畸学,2008,15(4):173-179.
[24]刘伟涛,周彦恒.两种不同扩弓方法结合上颌前方牵引的初步研究[J].中华口腔正畸学杂志,2009,16(1):45-49.
[25]刘伟涛,周彦恒.上颌反复快速扩缩口内前方牵引的临床效果研究[J].中华口腔正畸学杂志,2014,21(3):132-139.
[26]刘伟涛,周彦恒.双轴扩弓器上颌反复扩缩前方牵引的临床研究[J].北京大学学报(医学版),2013,45(1):69-76.
[27]刘伟涛,宋扬.上颌反复快速扩缩前方牵引效果的锥形束CT观察[J].中华口腔医学杂志,2015,50(2):78-83.
[28]Liu W,Zhou Y,Wang X,et al.Effect of maxillary protraction with alternating rapid palatal expansion and constriction vs expansion alone in maxillary retrusive patients:a single-center,randomized controlled trial[J].Am J Orthod Dentofacial Orthop,2015,148(4):641-651.
[29]de Moraes ME,Hollender LG,Chen CS,et al.Evaluating craniofacial asymmetry with digital cephalometric images and cone-beam computed tomography[J].Am J Orthod Dentofacial Orthop,2011,139(6):e523-e531.
[30]Mah JK,Danforth RA,Bumann A,et al.Radiation absorbed in maxillofacial imaging with a new dental computed tomography device[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2003,96(4):508-513.
[31]Tsiklakis K,Donta C,Gavala S,et al.Dose reduction in maxillofacial imaging using low dose cone beam CT[J].Eur J Radiol,2005,56(3):413-417.
[32]Varghese S,Kailasam V,Padmanabhan S,et al.Evaluation of the accuracy of linear measurements on spiral computed tomography-derived three dimensional images and its comparison with digital cephalometric radiography[J].Dentomaxillofac Radiol,2010,39(4):216-223.
[33]傅民魁,林久祥.口腔正畸学[M].2版.北京:北京大学医学出版社,2014:174-176.
[34]傅民魁,田乃学.口腔X线投影测量理论与实践[M].北京:人民卫生出版社,1991:32-104.
[35]Yilmaz BS,Kucukkeles N.Skeletal,soft tissue,and airway changes following the alternate maxillary expansions and constrictions protocol[J].Angle Orthod,2014,84(5):868-877.
[36]Weissheimer A,de Menezes LM,Mezomo M,et al.Immediate effects of rapid maxillary expansion with Haas-type and hyrax-type expanders:a randomized clinical trial[J].Am J Orthod Dentofacial Orthop,2011,140(3):366-376.
[37]Lagravère MO,Carey J,Heo J,et al.Transverse,vertical,and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion:a randomized clinical trial[J].Am J Orthod Dentofacial Orthop,2010,137(3):304.e1-304.e12.
[38]Kanomi R,Deguchi T,Kakuno E,et al.CBCT of skeletal changes following rapid maxillary expansion to increase arch-length with a development-dependent bonded or banded appliance[J].Angle Orthod,2013,83(5):851-857.
[39]Ghoneima A,Abdel-Fattah E,Hartsfield J,et al.Effects of rapid maxillary expansion on the cranial and circummaxillary sutures[J].Am J Orthod Dentofacial Orthop,2011,140(4):510-519.
[40]李磊,齐素青,王宏伟,等.上颌快速扩弓对颅颌面骨及上气道影响的锥形束CT分析[J].中华口腔医学杂志,2015,50(7):403-407.
[2]Allwright WC,Burndred WH.A survey of handicapping dentofacial anomalies among Chinese in Hong Kong[J].Int Dent J,1964,14:505-519.
[3]Irie M,Nakamura S.Orthopedic approach to severe skeletal ClassⅢmalocclusion[J].Am J Orthod,1975,67(4):377-392.
[4]Sanborn RT.Differences between the facial skeletal patterns of ClassⅢmalocclusion and normal occlusion[J].Angle Orthod,1955,25(4):208-222.
[5]Guyer EC,Ellis EE 3rd,Mc Namara JA Jr,et al.Components of ClassⅢmalocclusion in juveniles and adolescents[J].Angle Orthod,1986,56(1):7-30.
[6]Ellis E 3rd,Mc Namara JA Jr.Components of adult ClassⅢopenbite malocclusion[J].Am J Orthod,1984,86(4):277-290.
[7]Turchetta BJ,Fishman LS,Subtelny JD.Facial growth prediction:a comparison of methodologies[J].Am J Orthod Dentofacial Orthop,2007,132(4):439-449.
[8]Yoshida I,Yamaguchi N,Mizoguchi I.Prediction of post treatment outcome after combined treatment with maxillary protraction and chincap appliances[J].Eur J Orthod,2006,28(1):89-96.
[9]Mandall N,Cousley R,Di Biase A,et al.Early ClassⅢprotraction facemask treatment reduces the need for orthognathic surgery:a multi-centre,two-arm parallel randomized,controlled trial[J].J Orthod,2016,43(3):164-175.
[10]Ngan P,Moon W.Evolution of ClassⅢtreatment in orthodontics[J].Am J Orthod Dentofacial Orthop,2015,148(1):22-36.
[11]De Clerck HJ,Proffit WR.Growth modification of the face:A current perspective with emphasis on ClassⅢtreatment[J].Am J Orthod Dentofacial Orthop,2015,148(1):37-46.
[12]Hagg U,Tse A,Bendeus M,et al.Long-term follow-up of early treatment with reverse headgear[J].Eur J Orthod,2003,25(1):95-102.
[13]Baccetti T,Franchi L,Mc Namara JA Jr.Cephalometric variables predicting the long-term success or failure of combined rapid maxillary expansion and facial mask therapy[J].Am J Orthod Dentofacial Orthop,2004,126(1):16-22.
[14]Wells AP,Sarver DM,Proffit WR.Long-term efficacy of reverse pull headgear therapy[J].Angle Orthod,2006,76(6):915-922.
[15]Masucci C,Franchi L,Defraia E,et al.Stability of rapid maxillary expansion and facemask therapy:a long-term controlled study[J].Am J Orthod Dentofacial Orthop,2011,140(4):493-500.
[16]Ishii H,Morita S,Takeuchi Y,et al.Treatment effect of combined maxillary protraction and chincap appliance in severe skeletal ClassⅢcases[J].Am J Orthod Dentofacial Orthop,1987,92(4):304-312.
[17]Shanker S,Ngan P,Wade D,et al.Cephalometric A point changes during and after maxillary protraction and expansion[J].Am J Orthod Dentofacial Orthop,1996,110(4):423-430.
[18]Baik HS.Clinical results of the maxillary protraction in Korean children[J].Am J Orthod Dentofacial Orthop,1995,108(6):583-592.
[19]Liou EJ,Chen KT.New orthodontic and orthopedic managements on the premaxillary deformities in patients with bilateral cleft before alveolar bone grafting[J].Ann Coll Surg Hong Kong,2003,7(3):73-82.
[20]Liou EJ,Tsai WC.A new protocol for maxillary protraction in cleft patients:a repetitive weekly protocol of alternate rapid maxillary expansions and constrictions[J].Cleft Palate Craniofac J,2005,42(2):121-127.
[21]Liou EJ.Effective maxillary orthopedic protraction for growing ClassⅢpatients:a clinical application simulates distraction osteogenesis[J].Prog Orthod,2005,6(2):154-171.
[22]Liou EJ.Tooth borne maxillary protraction in ClassⅢpatients[J].J Clin Orthod,2005,39(2):68-75.
[23]邹冰爽,高雪梅,冯光耀,等.反复扩缩式上颌快速扩弓器配合前方牵引的初步临床应用[J].口腔正畸学,2008,15(4):173-179.
[24]刘伟涛,周彦恒.两种不同扩弓方法结合上颌前方牵引的初步研究[J].中华口腔正畸学杂志,2009,16(1):45-49.
[25]刘伟涛,周彦恒.上颌反复快速扩缩口内前方牵引的临床效果研究[J].中华口腔正畸学杂志,2014,21(3):132-139.
[26]刘伟涛,周彦恒.双轴扩弓器上颌反复扩缩前方牵引的临床研究[J].北京大学学报(医学版),2013,45(1):69-76.
[27]刘伟涛,宋扬.上颌反复快速扩缩前方牵引效果的锥形束CT观察[J].中华口腔医学杂志,2015,50(2):78-83.
[28]Liu W,Zhou Y,Wang X,et al.Effect of maxillary protraction with alternating rapid palatal expansion and constriction vs expansion alone in maxillary retrusive patients:a single-center,randomized controlled trial[J].Am J Orthod Dentofacial Orthop,2015,148(4):641-651.
[29]de Moraes ME,Hollender LG,Chen CS,et al.Evaluating craniofacial asymmetry with digital cephalometric images and cone-beam computed tomography[J].Am J Orthod Dentofacial Orthop,2011,139(6):e523-e531.
[30]Mah JK,Danforth RA,Bumann A,et al.Radiation absorbed in maxillofacial imaging with a new dental computed tomography device[J].Oral Surg Oral Med Oral Pathol Oral Radiol Endod,2003,96(4):508-513.
[31]Tsiklakis K,Donta C,Gavala S,et al.Dose reduction in maxillofacial imaging using low dose cone beam CT[J].Eur J Radiol,2005,56(3):413-417.
[32]Varghese S,Kailasam V,Padmanabhan S,et al.Evaluation of the accuracy of linear measurements on spiral computed tomography-derived three dimensional images and its comparison with digital cephalometric radiography[J].Dentomaxillofac Radiol,2010,39(4):216-223.
[33]傅民魁,林久祥.口腔正畸学[M].2版.北京:北京大学医学出版社,2014:174-176.
[34]傅民魁,田乃学.口腔X线投影测量理论与实践[M].北京:人民卫生出版社,1991:32-104.
[35]Yilmaz BS,Kucukkeles N.Skeletal,soft tissue,and airway changes following the alternate maxillary expansions and constrictions protocol[J].Angle Orthod,2014,84(5):868-877.
[36]Weissheimer A,de Menezes LM,Mezomo M,et al.Immediate effects of rapid maxillary expansion with Haas-type and hyrax-type expanders:a randomized clinical trial[J].Am J Orthod Dentofacial Orthop,2011,140(3):366-376.
[37]Lagravère MO,Carey J,Heo J,et al.Transverse,vertical,and anteroposterior changes from bone-anchored maxillary expansion vs traditional rapid maxillary expansion:a randomized clinical trial[J].Am J Orthod Dentofacial Orthop,2010,137(3):304.e1-304.e12.
[38]Kanomi R,Deguchi T,Kakuno E,et al.CBCT of skeletal changes following rapid maxillary expansion to increase arch-length with a development-dependent bonded or banded appliance[J].Angle Orthod,2013,83(5):851-857.
[39]Ghoneima A,Abdel-Fattah E,Hartsfield J,et al.Effects of rapid maxillary expansion on the cranial and circummaxillary sutures[J].Am J Orthod Dentofacial Orthop,2011,140(4):510-519.
[40]李磊,齐素青,王宏伟,等.上颌快速扩弓对颅颌面骨及上气道影响的锥形束CT分析[J].中华口腔医学杂志,2015,50(7):403-407.
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