[唇腭裂正畸扩弓与植骨时机的评估]

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

作者信息

Chang Le, Wang Yingnan, Liu Hongyan

出版信息

Hua Xi Kou Qiang Yi Xue Za Zhi. 2016 Apr;34(2):205-9. doi: 10.7518/hxkq.2016.02.020.

Abstract

Maxillary transverse growth is inhibited by congenital cleft, early surgical scar strain, and oppression of lipmuscles in patients with cleft lip and palate. Clinical manifestations have shown severely constricted maxilla, insufficientmaxillary 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 wellas the relationship between alveolar bone graft and arch expansion. Secondary alveolar bone graft is optimally performed beforepermanent canine eruption, especially when the teeth have formed between half and three quarters of their roots. Rapid maxillaryexpansion prior to alveolar bone graft is beneficial because this process increases the gap of the cleft, expands bone graft, andreduces the difficulty. However, the stability of this process remains controversial. Small-scale studies have reported that rapidmaxillary expansion after alveolar bone graft can open the midpalatal suture without bone graft loss. Slow maxillary expansioncan provide continuous light forces to reconstruct the bone. However, these studies are coordinated with fixed orthodontictreatment. Further research is necessary to determine the effects of maxillary expansion on long-term stability of teeth.

摘要

先天性腭裂、早期手术瘢痕张力以及唇腭裂患者唇肌的压迫会抑制上颌横向生长。临床表现为上颌严重狭窄、上颌宽度不足、上下牙弓不匹配以及反咬合。牙槽骨植骨和扩弓能有效纠正上颌宽度不足。本文探讨了牙槽骨植骨的时机和成功率,以及牙槽骨植骨与扩弓之间的关系。二期牙槽骨植骨最佳时机是在恒牙尖牙萌出之前,尤其是当牙齿牙根形成一半至四分之三时。在牙槽骨植骨前进行快速上颌扩弓是有益的,因为这一过程会增加腭裂间隙、扩大植骨范围并降低难度。然而,这一过程的稳定性仍存在争议。小规模研究报告称,牙槽骨植骨后进行快速上颌扩弓可打开腭中缝且不会导致植骨丢失。缓慢上颌扩弓可为重建骨骼提供持续的轻力。然而,这些研究是与固定正畸治疗配合进行的。有必要进一步研究以确定扩弓对牙齿长期稳定性的影响。

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