CBCT对种植钉辅助上颌快速扩弓技术治疗青少年上颌骨宽度不足的扩弓效率评价

doi:10.13481/j.1671-587x.20200524

摘要/Abstract

摘要： 目的：分析并评估应用种植钉辅助上颌快速扩弓技术（MARPE）治疗青少年上颌骨宽度不足（MTD）的扩弓效率，为制定其临床治疗方案提供参考。方法：收集20例MTD并进行MARPE治疗的青少年患者的临床资料，采用锥形束计算机断层扫描术（CBCT）测量治疗前后患者颊侧上颌宽度（BMW）、腭侧上颌宽度（PMW）、腭中缝扩大量（SE）、上颌骨性扩弓器（MSE）的扩大量（AE）和第一磨牙角度（MA）及治疗前后BMW和PMW改变值（ΔBMW和ΔPMW），计算骨性扩弓量百分比、牙槽骨的弯曲量百分比及其余效应百分比。结果：与治疗前比较，扩弓治疗后MTD患者不同牙位处BMW和PMW增大（P<0.05），双侧MA减小（P<0.05）。与第一磨牙处ΔPMW比较，第一磨牙处ΔBMW较大（t=3.047，P<0.05）；与第一磨牙处SE比较，第一磨牙处ΔBMW较大（t=9.655，P<0.05）。与第一前磨牙处ΔBMW比较，第一磨牙处ΔBMW较大（P<0.05）。由第一磨牙、第二前磨牙至第一前磨牙处骨性扩弓效率百分比逐渐降低，而牙槽骨的弯曲量百分比及其余效应百分比逐渐升高。结论：应用MARPE治疗青少年MTD，可有效打开腭中缝，骨性扩弓效率可达74%以上。

关键词: 种植钉辅助上颌快速扩弓技术, 上颌骨性扩弓器, 上颌骨宽度不足, 锥形束计算机断层扫描术, 青少年

Abstract: Objective: To analyze and evaluate the expansion efficiency of microimplant-assisted rapid palatal expansion (MARPE) in the treatment of maxillary transverse deficiency (MTD) in the adolescents, and to provide the reference for the formulation of clinical treatment plan. Methods: The clinical materials of 20 adolescent patients with MTD, who received MARPE, were selected;the buccal maxillary width(BMW), palatal maxillary width(PMW), the amount of sutural expansion(SE), the amount of MSE appliance expansion(AE), and the first molar angle (MA) and the change values of BMW and PMW (ΔBMW and ΔPMW)before and after treatment of the patients with MTD were detected by cone beam computed tomography (CBCT) before and after treatment. The percentage of bony expansion efficiency, the percentages of alveolar bone bending amount and the percentages of remaining effects were calculated. Results: Compared with before expansion treatment,the BMW and PMW at different tooth positions were increased (P<0.05),and the bilateral MA were decreased(P<0.05).Compared with the ΔPMW at the first molar, the ΔBMW at the first molar was larger (t=3.047, P<0.05);compared with the SE at the first molar, the ΔBMW at the first molar was larger (t=9.655, P<0.05).Compared with the ΔBMW at the first premolar, the ΔBMW at the first molar was larger(P<0.05).The percentages of bony expansion efficiencies from the first molar and the second premolar to the first premolar were decveased,but the percentages of alveolar bending amount and the percentages of remaining effects were increased gradually.Conclusion: MARPE can effectively open the palatal suture of the adolescents with MTD, and the efficiency of bony expansion is up to 74%.

Key words: microimplant-assisted rapid palatal expansion, maxillary skeletal expander, maxillary transverse deficiency, cone beam computed tomography, adolescents

中图分类号:

R782.11

李莹, 邱添源, 包幸福, 胡敏. CBCT对种植钉辅助上颌快速扩弓技术治疗青少年上颌骨宽度不足的扩弓效率评价[J]. 吉林大学学报(医学版), 2020, 46(05): 1050-1055.

LI Ying, QIU Tianyuan, BAO Xingfu, HU Min. Evaluation on expansion efficiency of microimplant-assisted rapid palatal expansion in treatment of maxillary transverse deficiency in adolescents with CBCT[J]. Journal of Jilin University(Medicine Edition), 2020, 46(05): 1050-1055.

参考文献

[1] REYNEKE J P,CONLEY R S.Surgical/orthodontic correction of transverse maxillary discrepancies[J].Oral Maxillofac Surg Clin North Am,2020,32(1):53-69.
[2] LOGIUDICE A,BARBATO E,COSENTINO L,et al.Alveolar bone changes after rapid maxillary expansion with tooth-born appliances:a systematic review[J].Eur J Orthod,2018,40(3):296-303.
[3] PHAM V,LAGRAVÈRE M O.Alveolar bone level changes in maxillary expansion treatments assessed through CBCT[J].Int Orthod,2017,15(1):103-113.
[4] BRESSANE L B,JANSON G,OLTRAMARINAVARRO P V P,et al.Long-term changes of alveolar buccal bone after rapid maxillary expansion in an adolescent patient[J].J World Fed Orthod,2016,5(2):64-69.
[5] CAMPS-PEREPÉREZ I,GUIJARRO-MARTÍNEZ R,PEIRÓ-GUIJARRO M A,et al.The value of cone beam computed tomography imaging in surgically assisted rapid palatal expansion:a systematic review of the literature[J].Int J Oral Maxillofac Surg,2017,46(7):827-838.
[6] VERQUIN M,DAEMS L,POLITIS C.Short-term complications after surgically assisted rapid palatal expansion:a retrospective cohort study[J].Int J Oral Maxillofac Surg,2017,46(3):303-308.
[7] GURGEL J A,TIAGO C M,NORMANDO D.Transverse changes after surgically assisted rapid palatal expansion[J].Int J Oral Maxillofac Surg,2014,43(3):316-322.
[8] MAGNUSSON A,BJERKLIN K,KIM H,et al.Three-dimensional assessment of transverse skeletal changes after surgically assisted rapid maxillary expansion and orthodontic treatment:A prospective computerized tomography study[J].Am J Orthod Dentofacial Orthop,2012,142(6):825-833.
[9] SURI L,TANEJA P.Surgically assisted rapid palatal expansion:A literature review[J].Am J Orthod Dentofacial Orthop,2008,133(2):290-302.
[10] 吕晨星,杨柳,陈璐璐,等.支抗种植体辅助上颌快速扩弓的研究进展[J].中华口腔医学杂志,2019,54(11):778-782.
[11] SUZUKI H,MOON W,PREVIDENTE LH,et al.Miniscrew-assisted rapid palatal expander (MARPE):the quest for pure orthopedic movement[J]. Dental Press J Orthod,2016,21(4):17-23.
[12] CARLSON C,SUNG J,MCCOMB R W,et al. Microimplant-assisted rapid palatal expansion appliance to orthopedically correct transverse maxillary deficiency in an adult[J].Am J Orthod Dentofacial Orthop,2016,149(5):716-728.
[13] BOERSMA E.Effects of a novel mini-implant assisted RPE in an early and late treatment group[D]. Los Angeles:University of California,2014.
[14] KREBS A.Midpalatal suture expansion studies by the implant method over a seven-year period[J].Rep Congr Eur Orthod Soc,1964,40:131-142.
[15] ZONG C,TANG BJ,HUA F,et al.Skeletal and dentoalveolar changes in the transverse dimension using microimplant-assisted rapid palatal expansion (MARPE) appliances[J].Semin Orthod,2019,25(1):46-59.
[16] GARRETT B J,CARUSO J M,RUNGCHARASSAENG K,et al.Skeletal effects to the maxilla after rapid maxillary expansion assessed with cone-beam computed tomography[J].Am J Orthod Dentofacial Orthop,2008,134(1):8-9.
[17] WERTZ RA.Skeletal and dental changes accompanying rapid midpalatal suture opening[J].Am J Orthod,1970,58(1):41-66.
[18] OH H,PARK J,LAGRACEREVICH M O.Comparison of traditional RPE with two types of micro-implant assisted RPE:CBCT study[J].Semin Orthod,2019,25(1):60-68.
[19] MACGINNIS M,CHU H,YOUSSEF G,et al.The effects of micro-implant assisted rapid palatal expansion (MARPE) on the nasomaxillary complex-a finite element method (FEM) analysis[J].Prog Orthod,2014,15:52.
[20] CLEMENT E A,KRISHNASWAMY N R.Skeletal and dentoalveolar changes after skeletal anchorage-assisted rapid palatal expansion in young adults:A cone beam computed tomography study[J].APOS Trends Orthod,2017,7(3):113-119.
[21] KORBMACHER H,SCHILLING A F,PUSCHEL K,et al.Age-dependent three-dimensional microcomputed tomography analysis of the human midpalatal suture[J].J Orofac Orthop,2007,68(5):364-376.
[22] BRUNETTO D P,SANT'ANNA E F,MACHADO A W,et al.Non-surgical treatment of transverse deficiency in adults using microimplant-assisted rapid palatal expansion (MARPE)[J].Dental Press J Orthod,2017,22(1):110-125.