Sade Hoefert Claudia, Bacher Margit, Herberts Tina, Krimmel Michael, Reinert Siegmar, Göz Gernot
Department of Orthodontics, Eberhard Karl University, Tübingen, Germany.
J Orofac Orthop. 2010 Mar;71(2):136-51. doi: 10.1007/s00056-010-9931-0. Epub 2010 Apr 1.
Rapid Maxillary Expansion (RME) and Delaire facemask are a well-established treatment method for patients with cleft lip and palate and Class III malocclusion. Several roentgenocephalometric studies on skeletal effects of this therapy are known. However, there are no systematic studies on soft tissue changes. The aim of this study was to analyze three-dimensionally the soft tissue changes in facial morphology of children with cleft lip and palate and Class III malocclusion under therapy with RME and Delaire facemask.
A prospective longitudinal clinical trial was undertaken. 29 children between 4.1 and 6.4 years were divided into four groups: eight patients with unilateral cleft lip and palate (group 1), six patients with isolated cleft palate (group 2), eight patients with Class III malocclusion (group 3). The mean treatment period with RME and Delaire mask was 8.2 months. Seven untreated children with no need of orthodontic treatment were chosen as the control (group 4). Two 3D images, one at the beginning and one at the end of the study, were generated with the DSP 400((c)) imaging system. Both images were superimposed ten times and measured ten times.
We detected significant forward rotation and forward displacement of the soft tissue in the lower midface with the dentoalveolar areas in all patient groups. No significant asymmetric forward displacement of the soft tissue in the maxilla could be verified in the lower or upper midface, not even in the unilateral cleft lip and palate patients. Among the groups, the Class III malocclusion patients showed greater maxillary soft tissue changes.
The RME and the Delaire facemask demonstrated the greatest effectiveness in the lower midface soft tissue in terms of forward displacement and forward rotation in the cleft lip and palate patients, particularly in the Class III patients. The 3D data allowed us to discriminatively interpret the effects of the orthopedic mask on the entire maxillary complex and maxillary alveolar process. In the unilateral cleft lip and palate patients, there was descriptively both symmetric and asymmetric advancement of the midface soft tissue.
快速上颌扩弓（RME）和戴莱尔面罩是治疗唇腭裂和III类错牙合患者的一种成熟治疗方法。已知有几项关于该疗法骨骼效应的X线头影测量研究。然而，尚无关于软组织变化的系统性研究。本研究的目的是三维分析唇腭裂和III类错牙合儿童在接受RME和戴莱尔面罩治疗时面部形态的软组织变化。
进行了一项前瞻性纵向临床试验。29名年龄在4.1至6.4岁之间的儿童被分为四组：8名单侧唇腭裂患者（第1组），6名单纯腭裂患者（第2组），8名III类错牙合患者（第3组）。使用RME和戴莱尔面罩的平均治疗期为8.2个月。选择7名无需正畸治疗的未治疗儿童作为对照组（第4组）。使用DSP 400((c))成像系统生成研究开始时和结束时的两张三维图像。两张图像叠加十次并测量十次。
我们在所有患者组中均检测到面中下部软组织连同牙槽区域有明显的向前旋转和向前移位。在上颌或面中下部，甚至在单侧唇腭裂患者中，均未证实上颌软组织有明显的不对称向前移位。在各分组中，III类错牙合患者的上颌软组织变化更大。
对于唇腭裂患者，尤其是III类患者，RME和戴莱尔面罩在面中下部软组织向前移位和向前旋转方面显示出最大效果。三维数据使我们能够区分性地解读矫形面罩对整个上颌复合体和上颌牙槽突的影响。在单侧唇腭裂患者中，面中软组织在描述上既有对称的也有不对称的前移。
