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J Zhejiang Univ (Med Sci)  2017, Vol. 46 Issue (2): 198-205    DOI: 10.3785/j.issn.1008-9292.2017.04.13
    
Midpalatal cortex osteotomy assisted rapid maxillary expansion for correction of maxillary transverse deficiency in young adults
WENG Luxi(),SONG Xiaojia,LI Juan,LIU Pengruofeng,LIN Jun*()
Department of Stomatology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China
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Abstract  

Objective: To evaluate the application of midpalatal cortex osteotomy assisted rapid maxillary expansion for correction of maxillary transverse deficiency in young adults. Methods: Fourteen young adult patients with maxillary transverse deficiency were treated with midpalatal cortex osteotomy assisted rapid maxillary expansion. Lateral cephalogram and cone beam CT (CBCT) were taken before and 3 months after treatment. The width of basal bone, arch of maxilla and the torque of anchorage teeth were compared before and after treatment. Results: The width of dental arch of maxilla was increased from 40.54±5.26 mm before treatment to 46.83±5.83 mm after treatment (P<0.05) and the width of basal bone was increased from 64.86±4.16 mm to 67.60±4.66 mm (P<0.05) at the plane of the maxillary first molars. Accordingly, the width of dental arch of maxilla was increased from 31.92±2.55 mm to 38.65±3.14 mm (P<0.05) and the width of basal bone was increased from 43.33±3.70 mm to 45.78±4.57 mm (P<0.05) at the plane of first premolar. And the torque of maxillary anchorage teeth were increased (P<0.05). Conclusion: Midpalatal cortex osteotomy assisted rapid maxillary expansion is an effective micro-invasive method in expansion of basal bone and arch of maxilla for young adult patients with maxillary transverse deficiency.



Key wordsMalocclusion/therapy      Orthodontics, corrective/methods      Maxilla/surgery      Maxilla/abnormalities      Cone-beam computed tomography      Orthotic devices      Treatment outcome     
Received: 21 January 2017      Published: 31 October 2017
Corresponding Authors: LIN Jun     E-mail: wengluxi1989@163.com;junlin2@126.com
Cite this article:

WENG Luxi,SONG Xiaojia,LI Juan,LIU Pengruofeng,LIN Jun. Midpalatal cortex osteotomy assisted rapid maxillary expansion for correction of maxillary transverse deficiency in young adults. J Zhejiang Univ (Med Sci), 2017, 46(2): 198-205.

URL:

http://www.zjujournals.com/xueshu/med/10.3785/j.issn.1008-9292.2017.04.13     OR     http://www.zjujournals.com/xueshu/med/Y2017/V46/I2/198


腭中缝骨皮质切开辅助快速扩弓矫治15~25岁上颌横向宽度不足患者临床研究

目的:评价腭中缝骨皮质切开辅助快速扩弓法对上颌横向宽度不足的年轻成人治疗效果。方法:选取上颌横向发育横向宽度不足的年轻成人患者14例,采用腭中缝骨皮质切开辅助快速扩弓法,治疗前和扩弓3个月后行头颅侧位片及锥形束CT拍摄、测量,比较上颌骨基骨宽度变化、上颌牙弓宽度变化、上颌牙转矩变化等。结果:14例患者与治疗前相比均获得了明显的横向宽度扩大效果,表现为上颌基骨宽度和牙弓宽度的增加,第一磨牙间牙弓宽度治疗前(40.54±5.26)mm,治疗后(46.83±5.83)mm,根尖平面基骨宽度由(64.86±4.16)mm增加至(67.60±4.66)mm;而第一前磨牙间牙弓宽度治疗前(31.92±2.55)mm,治疗后(38.65±3.14)mm,根尖平面基骨宽度则由(43.33±3.70)mm增加至(45.78±4.57)mm,差异均有统计学意义(均P<0.05);患者上颌支抗牙转矩增大(P<0.05)。结论:腭中缝骨皮质切开辅助快速扩弓能获得有效的扩弓效果,是年轻成人上颌横向宽度不足的微创疗法。


关键词: 错/治疗,  正畸学,矫正/方法,  上颌骨/外科学,  上颌骨/畸形,  锥束计算机体层摄影术,  矫正装置,  治疗结果 
Fig 1 Hyrax rapid maxillary expansion appliance
Fig 2 Diagrams ofmidpalatal cortex osteotomy
Fig 3 Axis adjustment of the CBCT scans
Fig 4 The distance and angle measurement of cone beam CT image
Fig 5 Measurement of the lateral cephalogram
($\bar x \pm s$,mm)
测量时间 n 硬腭底上颌 根尖平面上颌 鼻腔
M1 P1 M1 P1 M1 P1
  1:第一磨牙区域,P1:第一前磨牙区域.与治疗前比较,*P < 0.05,**P < 0.01.
治疗前 14 65.47±4.44 44.55±3.35 64.86±4.16 43.33±3.70 32.30±2.22 28.19±3.60
治疗后 14 67.55±4.55** 46.42±4.10* 67.60±4.66** 45.78±4.57* 34.25±3.01* 30.55±2.92**
Tab 1 The changes of maxillary basal bone width before and after the treatment with midpalatal cortex osteotomy assisted rapid maxillary expansion
($\bar x \pm s$,mm)
测量时间 n 第一磨牙区域 第一前磨牙区域
  与治疗前比较,**P < 0.01.
治疗前 14 40.54±5.26 31.92±2.55
治疗后 14 46.83±5.83** 38.65±3.14**
Tab 2 The changes of maxillary dental arch width before and after treatment with midpalatal cortex osteotomy assisted rapid maxillary expansion
($\bar x \pm s$,°)
测量时间 n 右侧上颌第一磨牙 左侧上颌第一磨牙 右侧上颌第一前磨牙 左侧上颌第一前磨牙
  与治疗前比较,*P < 0.05,**P < 0.01.
治疗前 14 104.57±7.79 107.57+7.09 91.95±7.45 92.70±5.00
治疗后 14 113.47±9.15** 113.94±6.52** 96.56±9.75* 95.54±5.50*
Tab 3 The changes ofthe torque of anchorage teeth before and the after treatment with midpalatal cortex osteotomy assisted rapid maxillary expansion
($\bar x \pm s$, °)
测量时间 n SNA角 SNB角 ANB角 MP-SN角 PP-SN角 U1-SN角
  与治疗前比较,*P < 0.05.
治疗前 14 81.16±3.86 78.14±3.87 4.33±3.31 40.15±4.02 12.71±4.25 101.3±5.22
治疗后 14 82.30±3.95* 78.10±3.48 5.39±2.76* 40.49±4.48 12.13±5.90 100.41±5.03
Tab 4 Thecomparison of the measurement of the lateral cephalogram before and after the treatment with midpalatal cortex osteotomy assisted rapid maxillary expansion
Fig 6 Typical case: Frontal and lateral images, intra-oral images, X-ray films and CBCT section before the treatment
Fig 7 Typical case: Frontal and lateral images, intra-oral images, X-ray films and CBCT section after the maxillary expansion
Fig 8 Typical case: CBCT reconstruction of the maxilla after the expansion
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