Tindlund R S, Rygh P
Department of Orthodontics and Facial Orthopedics, School of Dentistry, University of Bergen, Norway.
Cleft Palate Craniofac J. 1993 Mar;30(2):208-21. doi: 10.1597/1545-1569_1993_030_0208_mpdeof_2.3.co_2.
Since 1977 patients with anterior/posterior crossbites in the care of the Bergen CLP team have undergone an interceptive orthopedic protraction phase during the deciduous and mixed dentition period. Eighty-seven cases with complete clefts (63 unilateral and 24 bilateral) displaying anterior crossbite (negative overjet) were treated to normal occlusion. A fixed quad-helix appliance was used in combination with a facial mask. In the unilateral complete cleft lip and palate (UCLP) group, mean age at start of treatment was 6 years 10 months and mean duration was 12 months. In the bilateral complete cleft lip and palate (BCLP) group, mean age at start of treatment was 7 years and mean duration 15 months. The protraction force was 700 g. The sagittal changes during protraction in the UCLP and BCLP groups were compared, and related to the growth changes in a group of noncleft children at the same age. Dentofacial treatment effect was different in the UCLP and BCLP groups. Significant increase of maxillary prognathism (angle s-n-ss) was found only in the UCLP group, whereas the treatment effect in the BCLP group was mainly dentoalveolar. However, after protraction there was no longer a significant difference in maxillary prognathism between the two CLP groups, and the sagittal position of the upper molars was normalized in both groups. The upper incisors remained retroclined in both groups, significantly more in the BCLP group. Increase of the upper facial height (n-sp") and clockwise rotation of the occlusal line were significantly greater in the BCLP group. The computerized occlusal line was unsuitable as a reference standard for the evaluation of sagittal dentofacial treatment changes when the occlusal line was rotated during treatment.
自1977年以来，卑尔根唇腭裂治疗团队所诊治的前后牙反合患者在乳牙列和混合牙列期均经历了一期阻断性正畸前牵引阶段。87例完全性腭裂患者（63例单侧、24例双侧）伴有前牙反合（覆合为负），均接受治疗至正常咬合。采用固定四螺旋矫治器联合面罩进行治疗。在单侧完全性唇腭裂（UCLP）组，治疗开始时的平均年龄为6岁10个月，平均疗程为12个月。在双侧完全性唇腭裂（BCLP）组，治疗开始时的平均年龄为7岁，平均疗程为15个月。牵引力量为700克。比较了UCLP组和BCLP组牵引过程中的矢状向变化，并与一组同龄非腭裂儿童的生长变化进行了关联分析。UCLP组和BCLP组的牙颌面治疗效果有所不同。仅在UCLP组发现上颌前突（s-n-ss角）显著增加，而BCLP组的治疗效果主要体现在牙槽骨方面。然而，牵引后两组唇腭裂患者在上颌前突方面不再存在显著差异，且两组上颌磨牙的矢状位置均恢复正常。两组患者的上前牙均保持舌倾，BCLP组更为明显。BCLP组的面中高度（n-sp"）增加及咬合平面顺时针旋转更为显著。当治疗过程中咬合平面发生旋转时，计算机化咬合平面不适用于评估矢状向牙颌面治疗变化的参考标准。
