Tausche Eve, Hansen Lars, Schneider Matthias, Harzer Winfried
Department of Orthodontics, University Clinics, Technical University of Dresden, Dresden, Germany.
Orthod Fr. 2008 Jun;79(2):127-35. doi: 10.1051/orthodfr:2008008. Epub 2008 May 29.
Rapid palatal expansion is indicated in the orthopedic treatment of transverse maxillary deficiency for correction of severe crossbite. The fixation of the appliance at the teeth crowns leads to more tipping at the two halves of the maxilla than bodily transverse movement. Additional resorptions at the buccal cortical bone with fenestrations and gingival retraction were observed. The aim of the present study was focused on the improvement of bodily movement and optimization of the surgical osteotomy (Glassman's technique) in adult patients with application of the Dresden Distractor (DD). In 15 patients, the new method involving minimized surgical intervention and direct fixation of the hyrax screw by one implant and one bone screw was tested. The implants were loaded directly by activation of the screw two times per day. CT scans were taken before and six month after insertion of the DD. In the horizontal and the vertical planes there was a V-shaped opening of the suture in anterior, respective cranial direction, corroborating previous studies. Dental arch showed this V-shape as well, indicating tooth protection. If forces are transferred via teeth the progressive increase of skeletal resistance in anterior to posterior direction lead to dental tipping. DD is a suitable minimal invasive tooth-independent bone-borne expansion method, protecting teeth and causing skeletal as well as dental effect with 10 degree less tipping and as a precondition for stable post surgical occlusion.
快速腭扩展适用于上颌横向发育不足的正畸治疗，以矫正严重的反咬合。矫治器固定在牙冠上会导致上颌两半更多地倾斜，而不是整体横向移动。观察到颊侧皮质骨出现伴有开窗和牙龈退缩的额外吸收。本研究的目的是聚焦于成年患者应用德累斯顿扩弓器（DD）时改善整体移动并优化手术截骨术（格拉斯曼技术）。在15例患者中，测试了一种新方法，该方法包括最小化手术干预以及通过一枚种植体和一枚骨螺钉直接固定海拉克斯螺钉。通过每天激活螺钉两次直接加载种植体。在插入DD之前和之后六个月进行CT扫描。在水平和垂直平面上，缝合线分别在前方和颅侧方向呈V形开口，这证实了先前的研究。牙弓也呈现出这种V形，表明对牙齿有保护作用。如果力通过牙齿传递，从前向后方向骨骼阻力的逐渐增加会导致牙齿倾斜。DD是一种合适的微创、不依赖牙齿的骨支撑扩弓方法，可保护牙齿，产生骨骼和牙齿效应，倾斜度减少10度，是手术后期稳定咬合的前提条件。
