唇腭裂患者正畸扩弓与植骨时机的探讨  

Evaluation of the timing of orthodontic arch expansion and graft in cleft lip and palate

作　　者：常乐[1] 王英男[1] 刘红彦[1] 

机构地区：[1]大连医科大学附属第一医院口腔科,大连116011

出　　处：《华西口腔医学杂志》2016年第2期205-209,共5页West China Journal of Stomatology

摘　　要：唇腭裂患者由于先天裂隙,早期手术的瘢痕张力和唇肌压迫等因素导致上颌骨横向发育受限,临床上常表现为上颌骨严重缩窄,宽度不足,上下牙弓不匹配,牙列反等。牙槽突植骨与正畸扩弓治疗是矫正上颌宽度不足的有效手段。本文从牙槽突植骨时机及其成功率、牙槽突植骨与正畸扩弓先后关系两方面讨论。牙槽突植骨的最佳时机为恒尖牙萌出前,其牙根发育1/2~2/3时。植骨前的快速扩弓有增大裂隙,扩大植骨量,降低植骨难度等优势,但是稳定性仍有争议。植骨后的快速扩弓可扩展腭中缝而不破坏植骨区,但是目前仍是小样本研究。慢速扩弓持续的轻力可起到较好的骨改建效应,但慢速扩弓的研究中多配合了固定矫治器,长期稳定效果有待进一步研究。Maxillary transverse growth is inhibited by congenital cleft, early surgical scar strain, and oppression of lip muscles in patients with cleft lip and palate. Clinical manifestations have shown severely constricted maxilla, insufficient maxillary width, mismatch of upper and lower dental arches, and crossbite. Alveolar bone graft and arch expansion can effectively correct the deficiency in maxillary width. This paper discusses the timing and success rate of alveolar bone graft, as well as the relationship between alveolar bone graft and arch expansion. Secondary alveolar bone graft is optimally performed before permanent canine eruption, especially when the teeth have formed between half and three quarters of their roots. Rapid maxillary expansion prior to alveolar bone graft is beneficial because this process increases the gap of the cleft, expands bone graft, and reduces the difficulty. However, the stability of this process remains controversial. Small-scale studies have reported that rapid maxillary expansion after alveolar bone graft can open the midpalatal suture without bone graft loss. Slow maxillary expansion can provide continuous light forces to reconstruct the bone. However, these studies are coordinated with fixed orthodontic treatment. Further research is necessary to determine the effects of maxillary expansion on long-term stability of teeth.

关 键 词：唇腭裂 牙槽突植骨术 快速扩弓 慢速扩弓 

分 类 号：R782.2[医药卫生—口腔医学]