上颌快速扩弓的口周力研究
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摘要
自从1873年Tomes首次提出了口周力的概念以及牙弓内外肌压力平衡理论以来，至今已有一百多年的历史了。口周力的研究已成为口腔基础研究的重要课题之一。
上颌牙弓狭窄，后牙反(牙合)是临床上常见的错(牙合)畸形之一。1860年Angell首先报道应用上颌快速扩弓(rapid maxillary expansion,RME)矫治此类错(牙合)。此后学者们进行了广泛的动物实验和临床观察，其中RME的治疗及保持是临床医生非常关注的问题，但RME引起的口周力变化以及这种变化与RME治疗和保持的关系鲜有报道，国内尚未开展此项研究。
本课题应用自行研制的口周力测量系统研究了RME引起的口周力在治疗前后以及保持后的分布特征和变化，旨在为临床研究和治疗提供实验依据和理论指导。
论文分为两部分：
一． 口周力测量系统的建立
该系统由硬件和软件两部分组成。
硬件包括微力传感器、KZ-I型口周力测量仪和PC机。KZ-I型口周力测量仪由接线桥盒，高精度放大器，直流稳压电源，数字显示部分及PC机接口组成，其性能稳定、使用方便，完全满足口周力的测试要求。由于采用了温度补偿片，可靠的粘贴技术，接线桥盒，零位输出的细微补偿，高精度、高增益、低漂移的放大电路，故而使传感器的输出较为稳定，保证获得可靠的测量数据。PC机配置：硬件：586以上CPU，8M以上内存，1G以上硬盘，1.44M软驱，14″彩显，24倍速光驱，主板上至少有一个空闲的“ISA"扩展槽。软件：UCDOS7.0。PC机采集信息及处理数据的速度极快，所以本系统能够扑捉到口周力的瞬息变化，通过快速分析处理数据，在屏幕
第四军医大学硕士学位论文
上真实描绘出口周力的瞬间变化情况，误差小，效率高，为口周力
的科学研究提供了一个直观真实的依据。
软件采用C语言编写，程序采用模块化结构，可以进行口周力
值的显示、绘图、统计、存储及查询，实现了口周力测量过程的微
机化，便于科研和临床实际应用。
二．上颌牙弓狭窄患者RME 治疗前后以及保持后口周力分布
特征和变化
筛选出患者18人，男9人，女9人，年龄范围门．3～15．8岁，
选择标准如下：恒牙列早期，下领牙弓宽度正常，上颌牙弓狭窄，
双侧多数后牙反腊，下颌第一磨牙宽度之差）4mm，无口腔不良习
惯，全身发育正常，未做过正畸及手术治疗。
测量患者RME治疗前后以及保持后上下颌两侧第一磨牙、第
一双尖牙、尖牙颊（唇）舌侧口周力，并进行分析，结论如下：
1．RME治疗后，随着牙弓宽度的增加，上颌颊侧压力有显著
性增加，下颌颊侧压力有显著性减少；舌的位置趋于正常，上颌舌
侧压力有显著性增加，下颌舌侧压力有显著性减少。
2．RME保持后，颊肌发生适应性变化，与正常后牙覆盖时上
下颌颊侧压力分布特征相似；舌处于正常位置，舌侧压力趋于稳定。
3．牙弓形态的改变能引起口周软组织的显著性变化，经过保持，
口周软组织能适应变化了的牙弓形态。
4．RME治疗后必须采取良好的保持措施，以使口周软组织能
够发生适应性变化。
It is more than one hundred years since Tomes initially put forward the concept of perioral muscle pressure and the Equilibrium Theory. Afterwards, plentiful results were achieved. Research on this field is of great importance in orthodontics.
Maxillary constriction with posterior teeth crossbite is one of the common types of malocclusion in clinic. Treatment using Rapid Maxillary Expansion (RME) was first reported by Angell in 1860.Then,animal experiments and clinical observation were done in the following one hundred years with focus on treatment and retention after RME. However, there were few reports on the changes in perioral muscle pressures following RME treatment and retention and none domestically.
In this study, a new perioral muscle measuring system was invented to measure the values and changes in cheek and tongue pressures before, after treatment and retention in order to supply experiment foundation and theoretical guiding for clinical research and treatment.
The study consisted of two parts as follows:
In the first part, we invented a new perioral muscle measuring system. The system comprised the hardware and software. The hardware included the resistance strain gauge transducer, the perioral muscle pressure measuring instrument and computer. The perioral muscle pressure measuring instrument consisted of connection bridge box, magnifying apparatus, direct current power supply, digital monitor and meeting gob to computer. It had stable capability and convenience. Many methods were adopted including the temperature compensating piece, connection bridge box, reliable sticking technique, slight compensation on zero digit output and magnifying circuit of high precision. For the computer, 586CPU, 8M internal storage, 1G hard plate, 1.44 soft drive, 14" indicator and one "ISA" extending slot were enough. Software designing was based on UCDOS7.0. The computer had high speed of collecting and managing data resulting in capture of the change of pressure immediately and showing it on the screen. The system was of small error and high efficiency to provide a direct and true foundation for the scientific research. The software was written with Visual C and the program had modularization structures. So the system could display, plot, count , store and inquire about the data. It is easy to the practical use in research and clinic.
In the second part, the characteristics and changes of cheek and tongue pressures were studied following RME. 18 patients were selected. They were 9 boys and 9 girls aged 11.3 to 15.8 . The situation of their oral cavity were as follows: early permanent dentition, normal width in mandibular arch, constricted maxillary arch, the difference of width in upper and lower arch^4mm,no oral babbits.
Pressures acting on upper and lower first molars, first premolars and cuspids were measured buccally and lingually. There were such conclusions as follows:
1.Cheek pressures and tongue pressures after treatment in maxillary regions were higher than those before treatment and in mandibular regions were lower than those before treatment.
2.After treatment,cheek pressures were similar with those with normal posterior overjet. Tongue was located in the normal position so tongue pressures were stable.
3.The change in arch form could cause significant changes in perioral soft tissues. After retention, perioral soft tissues were adaptive to the changed arch form.
4.Good retention measures after RME must be taken so that perioral soft tissues could have adaptive changes.
上颌牙弓狭窄，后牙反(牙合)是临床上常见的错(牙合)畸形之一。1860年Angell首先报道应用上颌快速扩弓(rapid maxillary expansion,RME)矫治此类错(牙合)。此后学者们进行了广泛的动物实验和临床观察，其中RME的治疗及保持是临床医生非常关注的问题，但RME引起的口周力变化以及这种变化与RME治疗和保持的关系鲜有报道，国内尚未开展此项研究。
本课题应用自行研制的口周力测量系统研究了RME引起的口周力在治疗前后以及保持后的分布特征和变化，旨在为临床研究和治疗提供实验依据和理论指导。
论文分为两部分：
一． 口周力测量系统的建立
该系统由硬件和软件两部分组成。
硬件包括微力传感器、KZ-I型口周力测量仪和PC机。KZ-I型口周力测量仪由接线桥盒，高精度放大器，直流稳压电源，数字显示部分及PC机接口组成，其性能稳定、使用方便，完全满足口周力的测试要求。由于采用了温度补偿片，可靠的粘贴技术，接线桥盒，零位输出的细微补偿，高精度、高增益、低漂移的放大电路，故而使传感器的输出较为稳定，保证获得可靠的测量数据。PC机配置：硬件：586以上CPU，8M以上内存，1G以上硬盘，1.44M软驱，14″彩显，24倍速光驱，主板上至少有一个空闲的“ISA"扩展槽。软件：UCDOS7.0。PC机采集信息及处理数据的速度极快，所以本系统能够扑捉到口周力的瞬息变化，通过快速分析处理数据，在屏幕
第四军医大学硕士学位论文
上真实描绘出口周力的瞬间变化情况，误差小，效率高，为口周力
的科学研究提供了一个直观真实的依据。
软件采用C语言编写，程序采用模块化结构，可以进行口周力
值的显示、绘图、统计、存储及查询，实现了口周力测量过程的微
机化，便于科研和临床实际应用。
二．上颌牙弓狭窄患者RME 治疗前后以及保持后口周力分布
特征和变化
筛选出患者18人，男9人，女9人，年龄范围门．3～15．8岁，
选择标准如下：恒牙列早期，下领牙弓宽度正常，上颌牙弓狭窄，
双侧多数后牙反腊，下颌第一磨牙宽度之差）4mm，无口腔不良习
惯，全身发育正常，未做过正畸及手术治疗。
测量患者RME治疗前后以及保持后上下颌两侧第一磨牙、第
一双尖牙、尖牙颊（唇）舌侧口周力，并进行分析，结论如下：
1．RME治疗后，随着牙弓宽度的增加，上颌颊侧压力有显著
性增加，下颌颊侧压力有显著性减少；舌的位置趋于正常，上颌舌
侧压力有显著性增加，下颌舌侧压力有显著性减少。
2．RME保持后，颊肌发生适应性变化，与正常后牙覆盖时上
下颌颊侧压力分布特征相似；舌处于正常位置，舌侧压力趋于稳定。
3．牙弓形态的改变能引起口周软组织的显著性变化，经过保持，
口周软组织能适应变化了的牙弓形态。
4．RME治疗后必须采取良好的保持措施，以使口周软组织能
够发生适应性变化。
It is more than one hundred years since Tomes initially put forward the concept of perioral muscle pressure and the Equilibrium Theory. Afterwards, plentiful results were achieved. Research on this field is of great importance in orthodontics.
Maxillary constriction with posterior teeth crossbite is one of the common types of malocclusion in clinic. Treatment using Rapid Maxillary Expansion (RME) was first reported by Angell in 1860.Then,animal experiments and clinical observation were done in the following one hundred years with focus on treatment and retention after RME. However, there were few reports on the changes in perioral muscle pressures following RME treatment and retention and none domestically.
In this study, a new perioral muscle measuring system was invented to measure the values and changes in cheek and tongue pressures before, after treatment and retention in order to supply experiment foundation and theoretical guiding for clinical research and treatment.
The study consisted of two parts as follows:
In the first part, we invented a new perioral muscle measuring system. The system comprised the hardware and software. The hardware included the resistance strain gauge transducer, the perioral muscle pressure measuring instrument and computer. The perioral muscle pressure measuring instrument consisted of connection bridge box, magnifying apparatus, direct current power supply, digital monitor and meeting gob to computer. It had stable capability and convenience. Many methods were adopted including the temperature compensating piece, connection bridge box, reliable sticking technique, slight compensation on zero digit output and magnifying circuit of high precision. For the computer, 586CPU, 8M internal storage, 1G hard plate, 1.44 soft drive, 14" indicator and one "ISA" extending slot were enough. Software designing was based on UCDOS7.0. The computer had high speed of collecting and managing data resulting in capture of the change of pressure immediately and showing it on the screen. The system was of small error and high efficiency to provide a direct and true foundation for the scientific research. The software was written with Visual C and the program had modularization structures. So the system could display, plot, count , store and inquire about the data. It is easy to the practical use in research and clinic.
In the second part, the characteristics and changes of cheek and tongue pressures were studied following RME. 18 patients were selected. They were 9 boys and 9 girls aged 11.3 to 15.8 . The situation of their oral cavity were as follows: early permanent dentition, normal width in mandibular arch, constricted maxillary arch, the difference of width in upper and lower arch^4mm,no oral babbits.
Pressures acting on upper and lower first molars, first premolars and cuspids were measured buccally and lingually. There were such conclusions as follows:
1.Cheek pressures and tongue pressures after treatment in maxillary regions were higher than those before treatment and in mandibular regions were lower than those before treatment.
2.After treatment,cheek pressures were similar with those with normal posterior overjet. Tongue was located in the normal position so tongue pressures were stable.
3.The change in arch form could cause significant changes in perioral soft tissues. After retention, perioral soft tissues were adaptive to the changed arch form.
4.Good retention measures after RME must be taken so that perioral soft tissues could have adaptive changes.
引文
1. Tomes CS. The bearing of the development of the jaws on irregularities. Dental Comos, 1873,15:292.
2．李克非，林珠．正常(牙合)青少年唇(颊)、舌肌肉对牙齿压力的测量研究．实用口腔医学杂志，1993，9：190．
3. Feldtein L. An instrument for meauring musclar forces acting on the teeth. Am J Orthod ,1950;36:856
4. White RA, Sacke AM. Effect of progressive muscular pystrophy on occlusion. J Am Dent, 1954,49:449
5. Luffingham JK. Pressure exerted on the teeth by the lips and cheeks.Dent Prac ,1968,19:16
6. Faigenblum MJ. Negtive oral pressures. Dent Prac ,1966,16:214
7. Thǖer U, Ingervall B. Pressure from the lip on the teeth and malocclusion. Am J Orthod Dentofac Orthop, 1986,90(3):234
8．任薇，詹淑仪，赵美英．正常(牙合)青少年唇舌肌对牙齿压力的研究 华西口腔医学杂志，1988,6(3)：174
9. Winders RV. A study of a development of an electronic technique to measure the forces exerted on the dentition by the perioral and lingual musculature .Am J Orthod, 1956,42:645
10. Proffit WR. Equilibrium theory revisited: Factors influencing position of the teeth. Angle Orthod,1978,48:175.
11. Archer SY, Vig PS. Effect of head posture on intraoral pressures in class Ⅰ and classⅡ adults. Am J Orthod Dentofac Orthop,1985,87:311
12. Yoshiyuki Kato. Perioral forces measuring by a radiotelemetry device. Am J Orthod Dentofac Orthop, 1989,95:294
13. Gould MSE.,Picton DCA. A method of measuring forces acting teeth from the lips, cheeks and tongue. Bri Dent J,1962,112:235
14．李克非，林珠等．口周力大小与青少年年龄性别的关系研究．实用口腔医学杂志，1993，9：188
15．张新海．计算机辅助口周力测量系统的建立及替牙期前牙反(牙合)口周力研究．第四军医大学博士论文，2000年．
16. Solow B. Tallgren A. Head posture and craniofacial morphology.Am J Phys Anthropol., 1976,44:417
17． Wood L. The relationship variations in head postion to lip and tongue pressures. M.S.thesis,University of North Carolina ,1981
18． Hensel S. Kopfhaltung and weichteilfunktion experimentelle untersunchungen. Stomatologic der DDK, 1983,33:249
19． Ingervall B, Thuer U. Cheek pressure and head posture. Angle Orthod, 1988,58:47
20． Thuer U, Janson T, Ingervall B. Application in children of a new method for the measurement of forces from the lips on the teeth. Eur J Orthod,1985,58:63
21． 袁虹，傅民魁．正常(牙合)口周肌压力的研究．中华口腔医学杂志， 1998，33：30
22． Faigenblum MJ. Negtive oral pressures. Dent Pract Dent Rec,1966,16:214
23． Winders RV. A study of a development of an electronic technique to measure the forces exerted on the dentition by the perioral and lingual musculature. Am J Orthod.,1956,42:645
24． Winders RV. Forces exerted on the dentition by the perioral and lingual musculature swallowing. Angle Orthod.,1962,32:28
25． Proffit WR, Glone RE, Barrett MJ. Lip and pressures related to dental arch and oral cavity size in Australian Aborigines. J Dent Res,1975,54:1161
26． Rogers AT. Muscle training and its relation to orthodntic. Int J Orthod,1918,4:555．
27． Moyers RE. Tempromandibular muscle contraction patterns in Angle Class Ⅱ, division 1 malocclusion: An electromyographic analysis. Am J Orthod, 1949,35:837．
28． Swinehart DT. The importance of the tongue in the development of normal occlsion. Am J Orthod, 1950,36:813．
29． Weinstein S. On an equilibrium theory of tooth position. Angle Orthod, 1963,33:1．
30． Frankel R. Decrowding during eruption under the screening influence of vestibular shields. Am J Orthod,1974,65:372．
31． Ingervall B, Eliasson GB. Effect of lip training in children with short upper lip. Angle Orthod, 1982,52:222．
32． Owman M, Ingervall B. Effect of oral screen treatment on dentition,
lip morphology and function in children with incompetent lips. Am J Orthod Dentofac Orthop, 1984,85:3 7.
33. Burstone CJ. Lip posture and its significance in treatment planning.Am J Orthod, 1967,53:262.
34. Subrelny JD. Examination of current philosophies associated with Swallowing behavior. Am J Orthod, 1965,51:161.
35. Winders RVA. A study in the dovelopment of an electronic technique to measure the forces exerted on the dentition by the perioral and ligual musculature. JADA, 1957,55:646.
36. Luffiham JK. Lip and cheeks pressure exerted upon teeth in three adult groups with different occlusion. Arch Oral Biology,1969,14:337.
37．李克非，林珠，张健．正常咬合牙弓两侧肌压力对称性的研究．实用口腔医学杂志，1993，9：187．
38..Proffit WR. Muscle pressure and tooth position: North American whites and Australian aborigines. Angle Orthod, 1975,45:1.
39. Proffit WR. Adaptations in lip posture and pressure following orthognathic surgery. Am J Orthod Dentofac Orthp, 1988,93:294.
40. Sims FW. The pressure exerted on the maxillary and mandibular central incisors by the perioral and lingual musculature in acceptable occlusion. Am J Orthod, 1958,44:64.
41. Sessle B, Woodside DG. Effect of functional appliances on jaw muscle activity. Am J Orthod Dentofac Orthop, 1990,98:222.
42. Toshio, Toshifumi. Statistics of differential Lissajous EMG for normal occlusion and class Ⅱmalocclusion. Am J Orthod Dentofac Orthop, 1994,105:42.
43. Lear, Moorrees. Buccolingual muscle forces and dental arch form. Am J Orthod, 1969,56:379.
44. Angll EC. Treatment of irregularities of the permanent or adult teeth. Dent Cosmos, 1860,1:540
45. Bishara SE, Staley RN. Maxillary expansion: clinical implications. Am J Orthod Dentofac Orthop,1987,91:3
46．袁虹，傅民魁．成人骨性安格氏Ⅲ类错(牙合)口周肌压力的研究．口腔正畸学，1999；6(2)：57
47．袁虹．口周肌压力与错(牙合)畸形．见：张丁主编．口腔正畸学的临
床基础．北京：中国医药科技出版社，1999． 83
48． Moyers R. Handbook of orthodontics. Chicago. 1966 Year Book Medical Publishers,Inc.
49． Gould MSE, Picton DCA. A study of pressure exerted by the lips and cheeks on the teeth of subjects with Angle's Class Ⅱ division 2 and class Ⅲ malocclusions compared with those of subjects with normal occlusions. Archives of Oral Biology, 1968,13:527
50． Mass AJ. Palatal expansion:Just the beginning of dentofacial orthopedics. Am J Othod,1970,57:219
51． Froblich K, Ingervall B, Thuer U. Further study of the pressure from the tongue on the teeth in young adults. Euro J Orthod, 1992,14:229
52． Weinstein S, Ho TP.,Bowley WW. Extensibility characteristics of the human cheeks:a pilot study. J Dent Res ,1983,62(3) :344
53． Thuer U, Sieber R, Ingervall B. Cheek and tongue pressures in the molar arears and the atmospheric pressure in the palatal vault in young adults. Euro J Orthod, 1999,21:299
54． Halazonetis DJ, Katsavrias E, Spyropoulos MN. Changes in cheek pressures following rapid maxillary expansion. Euro J Orthod,1994,16:295
55． Soo N, Moore R. A technique for measurement of intraoral lip pressures with lip bumper therapy. Am J Orthod Dentofac Orthop,1991,99:409
56． Ackerman JL, Proffit WR.Soft tissue limitation in Orthodontics :Treatment planning guidelines. Angle Orthod, 1997,67(5) 327
57． Enlow DH. Handbook of facial growth. 3rd Edition .Philadelphia:Saunders,1990．
58． Tardieu C, Tabary JC. Adaptation of sarcomere numbers to the lenghth imposed on the muscle. In Advances in physiological sciences,Vol 24 Mechanism of muscle adaptation to functional requirements. Budapest,Hungary:Pergamon Press, 1981:99
59． Goldspink G.Sarcomere length during post-natal growth of mammalian muscle fibers. J Cell Sci,1968,3:539
2．李克非，林珠．正常(牙合)青少年唇(颊)、舌肌肉对牙齿压力的测量研究．实用口腔医学杂志，1993，9：190．
3. Feldtein L. An instrument for meauring musclar forces acting on the teeth. Am J Orthod ,1950;36:856
4. White RA, Sacke AM. Effect of progressive muscular pystrophy on occlusion. J Am Dent, 1954,49:449
5. Luffingham JK. Pressure exerted on the teeth by the lips and cheeks.Dent Prac ,1968,19:16
6. Faigenblum MJ. Negtive oral pressures. Dent Prac ,1966,16:214
7. Thǖer U, Ingervall B. Pressure from the lip on the teeth and malocclusion. Am J Orthod Dentofac Orthop, 1986,90(3):234
8．任薇，詹淑仪，赵美英．正常(牙合)青少年唇舌肌对牙齿压力的研究 华西口腔医学杂志，1988,6(3)：174
9. Winders RV. A study of a development of an electronic technique to measure the forces exerted on the dentition by the perioral and lingual musculature .Am J Orthod, 1956,42:645
10. Proffit WR. Equilibrium theory revisited: Factors influencing position of the teeth. Angle Orthod,1978,48:175.
11. Archer SY, Vig PS. Effect of head posture on intraoral pressures in class Ⅰ and classⅡ adults. Am J Orthod Dentofac Orthop,1985,87:311
12. Yoshiyuki Kato. Perioral forces measuring by a radiotelemetry device. Am J Orthod Dentofac Orthop, 1989,95:294
13. Gould MSE.,Picton DCA. A method of measuring forces acting teeth from the lips, cheeks and tongue. Bri Dent J,1962,112:235
14．李克非，林珠等．口周力大小与青少年年龄性别的关系研究．实用口腔医学杂志，1993，9：188
15．张新海．计算机辅助口周力测量系统的建立及替牙期前牙反(牙合)口周力研究．第四军医大学博士论文，2000年．
16. Solow B. Tallgren A. Head posture and craniofacial morphology.Am J Phys Anthropol., 1976,44:417
17． Wood L. The relationship variations in head postion to lip and tongue pressures. M.S.thesis,University of North Carolina ,1981
18． Hensel S. Kopfhaltung and weichteilfunktion experimentelle untersunchungen. Stomatologic der DDK, 1983,33:249
19． Ingervall B, Thuer U. Cheek pressure and head posture. Angle Orthod, 1988,58:47
20． Thuer U, Janson T, Ingervall B. Application in children of a new method for the measurement of forces from the lips on the teeth. Eur J Orthod,1985,58:63
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