儿童青少年髁突肋(软)骨移植术后咬合诱导的初步研究  

Preliminary analysis of the occlusive guidance of children and adolescents after condylar reconstruction with autogenous costochondral graft

作　　者：李晶[1] 余婷婷[1] 柳大为[1] Li Jing;Yu Tingting;Liu Dawei(Department of Orthodontics,Peking University School and Hospital of Stomatology&National Center for Stomatology&National Clinical Research Center for Oral Diseases&National Engineering Research Center of Oral Biomaterials and Digital Medical Devices&Beijing Key Laboratoryof Digital Stomatology,Beijing 100081,China)

机构地区：[1]北京大学口腔医学院·口腔医院正畸科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京100081

出　　处：《中华口腔正畸学杂志》2023年第1期22-26,共5页Chinese Journal of Orthodontics

基　　金：国家自然科学基金(81970909, 82271009, 51903003);北京大学口腔医院青年基金(20110203, 20170109);中国牙病防治基金会项目(A2021057);北京大学口腔医院国家重大疾病多学科合作能力建设项目(PKUSSNMP202020);北京大学口腔医院新技术新疗法项目(PKUSSNCT-20A07);中国科协青年人才托举工程项目(2021QNRC001)

摘　　要：目的通过影像学、模型分析探讨儿童及青少年髁突肋(软)骨移植后,使用正畸功能矫治器促进牙列发育,诱导建[牙合]的治疗疗效.方法本研究为回顾性研究,选择髁突肋(软)骨移植后的儿童、青少年患者进行正畸功能矫治共9例.利用头颅侧位片观察下颌生长;通过石膏模型观察咬合关系变化.配对样本差值符合正态分布时,使用配对t检验统计学分析;不符合时使用Wilcoxon符号秩检验.结果治疗后患者颏部及口内咬合偏斜显著改善.头影测量显示患者下颌矢状向SNB角增加4.13°±1.49°,P<0.001,ANB角减小3.51°±1.95°,P<0.001.垂直向,MP-FH角增加2.23°±1.29°,P<0.001;Y轴角增加量M(Q_(1),Q_(3))为1.30°(0.80°,1.60°),P=0.0149.模型分析显示前牙覆盖减小(2.49±1.43)mm,P<0.001;上颌第一前磨牙/乳磨牙间宽度增加(4.97±2.13)mm,P<0.001;上颌第一恒磨牙间宽度增加(2.30±1.90)mm,P<0.001;下颌第一前磨牙/乳磨牙间宽度增加(2.60±1.25)mm,P<0.001.结论接受髁突肋(软)骨移植术的儿童、青少年,术后正畸功能矫治可以促进患儿牙列发育,可诱导建[牙合],改善咬合功能.提示正畸-髁突手术联合治疗具有临床应用前景.Objective In children and adolescents who received condylar reconstruction with autogenous costochondral graft,to investigate the effects of orthodontic functional appliance on the development of the dentition and dental occlusion.MethodsIt is a retrospective study,which include nine patients who received condylar reconstruction with autogenous costochondral graft and followed with orthodontic functional appliance treatment.The examination of cephalometrics were performed to evaluate mandibular growth,and oral plaster models were taken to evaluate the change of occlusion.The paired t-test was performed for normal distribution data,and Wilcoxon signed rank test for abnormal distribution data.Results After treatment,the deviation of chin and lower dental arch was improved significantly.Cephalometric analysis showed that mandibular growth was significant.In sagittal direction,the SNB angle increased by 4.13°±1.49°,P<0.001;and ANB angle decreased by 3.51°±1.95°,P<0.001.In vertical direction,MP-FH angle increased by 2.23°±1.29°,P<0.001;and Y axis angle M(Qi,Q)increased for 1.30°(0.80°,1.60°),P=0.0149.As for model analysis,the overjet of anterior teeth decreased by(2.49±1.43)mm,P<0.001.The width between upper first premolars/primary molars increased for(4.97±2.13)mm,P<0.001,and that of upper first molars increased by(2.30±1.90)mm,P<0.001,and that of lower first premolars/primary molars increased by(2.60±1.25)mm,P<0.001.Conclusions This study showed that the treatment of orthodontic functional appliance after condylar reconstruction with autogenous costochondral graft in children and adolescents could help development of dentition and dental occlusion,and improve occlusal function.It indicates that combination of orthodontic treatment and condyle surgery can be clinically applied.

关 键 词：髁突骨折 肋(软)骨移植 功能矫治 正畸 

分 类 号：R783.5[医药卫生—口腔医学]