Hoppenreijs T J, van der Linden F P, Freihofer H P, Stoelinga P J, Tuinzing D B, Jacobs B T, van 't Hof M A
Department of Oral and Maxillofacial Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
Int J Adult Orthodon Orthognath Surg. 1998;13(1):7-22.
A sample of 130 patients with vertical maxillary hyperplasia; mandibular hypoplasia with a high mandibular plane angle; narrow, tapered maxillary dental arch form; and anterior vertical open bite were collected from three different institutions to evaluate the stability of transverse maxillary arch dimensions after correction of the open bite. Surgical treatment consisted of Le Fort I or bimaxillary osteotomies. Intermolar, interpremolar, and anterior arch widths were measured three-dimensionally on dental casts using a Reflex microscope, and transverse stability after orthodontic or surgical maxillary expansion was analyzed. Orthodontic expansion followed by a one-piece Le Fort I intrusion osteotomy was performed in 77 patients, and surgical maxillary expansion by a multisegment Le Fort I intrusion osteotomy was performed in 53 patients. The increase of transverse arch width and the relapse after orthodontic or surgical expansion were not significantly different. The transverse arch width in these two groups did not relapse in 20% of the patients after a mean follow-up of 69 months. An additional bilateral sagittal split osteotomy had no detectable effect on stability. Patients who underwent a multisegment Le Fort I osteotomy stabilized with rigid internal fixation showed better transverse stability than those with intraosseous wire fixation and maxillomandibular fixation. Maxillary intermolar and interpremolar arch width relapses were not correlated with tongue interposition or loss of interdigitation. The relapse of these arch widths showed significant correlations with clockwise rotation of the mandible but not with changes of overbite or overjet.
选取了130例患有垂直性上颌骨增生、下颌骨发育不全且下颌平面角高、上颌牙弓形态狭窄且呈锥形、以及前牙垂直开牙合的患者，这些患者来自三个不同机构，旨在评估开牙合矫正后上颌横弓尺寸的稳定性。手术治疗包括Le Fort I型或双颌截骨术。使用反射显微镜在石膏模型上三维测量磨牙间、前磨牙间和牙弓前部宽度，并分析正畸或手术扩弓后的横向稳定性。77例患者先进行正畸扩弓，随后进行整块Le Fort I型后缩截骨术，53例患者进行多节段Le Fort I型后缩截骨术进行手术扩弓。正畸或手术扩弓后横弓宽度的增加及复发情况无显著差异。这两组患者在平均随访69个月后，20%的患者横弓宽度未复发。额外的双侧矢状劈开截骨术对稳定性无明显影响。采用坚固内固定稳定的多节段Le Fort I型截骨术患者，其横向稳定性优于采用骨内钢丝固定和颌间固定的患者。上颌磨牙间和前磨牙间牙弓宽度的复发与舌部插入或牙合面交错丧失无关。这些牙弓宽度的复发与下颌顺时针旋转显著相关，但与覆牙合或覆盖的变化无关。
