国际口腔医学杂志 ›› 2020, Vol. 47 ›› Issue (4): 484-490.doi: 10.7518/gjkq.2020067

• 综述 • 上一篇    下一篇

上颌骨性扩弓器的研究进展

张恺文1,赵雪峰1,2,舒睿1,3,韩向龙1,2()   

  1. 1.口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心四川大学华西口腔医学院 成都 610041
    2.口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心四川大学华西口腔医院正畸科 成都 610041
    3.口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心四川大学华西口腔医院儿童口腔科 成都 610041
  • 收稿日期:2019-09-12 修回日期:2020-03-24 出版日期:2020-07-01 发布日期:2020-07-10
  • 通讯作者: 韩向龙 E-mail:xhan@scu.edu.cn
  • 作者简介:张恺文,学士,Email:1171697832@qq.com
  • 基金资助:
    科技部科技基础资源调查专项基金(2018FY10100003)

Research progress on maxillary skeletal expander

Kaiwen Zhang1,Xuefeng Zhao1,2,Rui Shu1,3,Xianglong Han1,2()   

  1. 1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & West China School of Stomatology, Sichuan University, Chengdu 610041, China
    2. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
    3. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Dept. of Pediatric Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2019-09-12 Revised:2020-03-24 Online:2020-07-01 Published:2020-07-10
  • Contact: Xianglong Han E-mail:xhan@scu.edu.cn
  • Supported by:
    This study was supported by Special Project of Investigation on Scientific and Technological Basic Resources from Ministry of Science and Technology in China(2018FY10100003)

摘要:

上颌横向发育不足(MTD)是在各年龄阶段常见的错 畸形之一,对患者口颌面发育及功能可造成不同程度的影响,其主要治疗手段为上颌扩弓。传统观点认为,对青春后期及成年患者使用快速上颌扩弓、手术辅助上颌快速扩弓等方法存在一定弊端。近年来,微型种植钉辅助上颌快速扩弓凭借其显著优势成为了治疗青春后期及成年MTD患者的新方法;然而,其装置设计、植入部位、扩弓疗效及并发症等也存在争议。作为一种特殊类型的种植钉辅助上颌快速扩弓装置,上颌骨性扩弓器将4枚微型种植钉植入上腭后部的双层骨皮质,治疗青春后期及成年患者效果显著。本文将对上颌骨性扩弓器的生物学及生物力学基础、装置设计、临床应用、治疗效果等方面进行综述。

关键词: 上颌横向发育不足, 上颌扩弓, 上颌骨性扩弓器

Abstract:

Maxillary transverse deficiency (MTD), a common malocclusion in people of all ages, affects gnathostomatic development and functions of patients at different degrees, and its main treatment is maxillary expansion. Traditionally, rapid maxillary and surgically assisted rapid palatal expansions have several disadvantages in the treatment of late adolescence and adult patients. At present, miniscrew assisted rapid palatal expansion (MARPE) has emerged as a new treatment with significant advantages in late adolescence and adult patients with MTD. However, the device design, implant sites, curative effect, and complications of MARPE are also controversial. As a special type of MARPE, maxillary skeletal expander (MSE) is positioned at the posterior palate, with four microimplants engaging the palatal bone bicortically. Such positioning results in significant expansion in late adolescence and adult patients. This article aims to review MSE in terms of biological and biomechanical bases, device design, clinical application, and curative effect.

Key words: maxillary transverse deficiency, maxillary expansion, maxillary skeletal expander

中图分类号: 

  • R783.5
[1] MacGinnis M, Chu H, Youssef G, et al. The effects of micro-implant assisted rapid palatal expansion (MARPE) on the nasomaxillary complex: a finite element method (FEM) analysis[J]. Prog Orthod, 2014,15:52.
doi: 10.1186/s40510-014-0052-y pmid: 25242527
[2] Brunelle JA, Bhat M, Lipton JA. Prevalence and distribution of selected occlusal characteristics in the US population, 1988—1991[J]. J Dent Res, 1996,75(Spec No):706-713.
[3] 徐舒豪, 黄诗言, 饶南荃, 等. 上颌横向发育不足的临床治疗进展[J]. 临床口腔医学杂志, 2016,32(4):251-253.
Xu SH, Huang SY, Rao NQ, et al. The advancements in clinical treatment of maxillary transverse defi-ciency[J]. J Clin Stomatol, 2016,32(4):251-253.
[4] Neyt NM, Mommaerts MY, Abeloos JV, et al. Pro-blems, obstacles and complications with transpalatal distraction in non-congenital deformities[J]. J Cra-niomaxillofac Surg, 2002,30(3):139-143.
[5] Brunetto DP, Sant’Anna EF, Machado AW, et al. Non-surgical treatment of transverse deficiency in adults using microimplant-assisted rapid palatal expansion (MARPE)[J]. Dental Press J Orthod, 2017,22(1):110-125.
doi: 10.1590/2177-6709.22.1.110-125.sar pmid: 28444019
[6] 李心慧, 雷雪, 许诺, 等. 上颌横向发育不足治疗方法的研究进展[J]. 现代口腔医学杂志, 2017,31(3):150-153.
Li XH, Lei X, Xu N, et al. The advancements in research of the way to treat maxillary transverse de-ficiency[J]. J Modern Stomatol, 2017,31(3):150-153.
[7] 卢淑娟, 岳杨, 杨儒, 等. 儿童错 畸形早期矫治中不可忽视的横向问题 [J]. 中国实用口腔科杂志, 2018,11(5):275-281.
Lu SJ, Yue Y, Yang R, et al. Transverse discrepancy: a problem that cannot be neglected in early ortho-dontic treatment[J]. Chin J Pract Stomatol, 2018,11(5):275-281.
[8] Moon W. Class Ⅲ treatment by combining facemask (FM) and maxillary skeletal expander (MSE)[J]. Semin Orthod, 2018,24(1):95-107.
[9] Suzuki H, Moon W, Previdente LH, et al. Miniscrew-assisted rapid palatal expander (MARPE): the quest for pure orthopedic movement[J]. Dental Press J Orthod, 2016,21(4):17-23.
doi: 10.1590/2177-6709.21.4.017-023.oin pmid: 27653260
[10] Moschik CE. Morphometric analysis of maxillary skeletal expansion effects on the nasal cavity[D]. Los Angeles: School of Dentistry, University of Ca-lifornia, Los Angeles, 2018.
[11] Suzuki SS, Braga LFS, Fujii DN, et al. Corticopun-cture facilitated microimplant-assisted rapid palatal expansion[J]. Case Rep Dent, 2018,2018:1392895.
doi: 10.1155/2018/1392895 pmid: 30627452
[12] Angelieri F, Franchi L, Cevidanes LHS, et al. Cone beam computed tomography evaluation of midpalatal suture maturation in adults[J]. Int J Oral Maxillofac Surg, 2017,46(12):1557-1561.
doi: 10.1016/j.ijom.2017.06.021 pmid: 28716474
[13] Kwak KH, Kim SS, Kim YI, et al. Quantitative eva-luation of midpalatal suture maturation via fractal analysis[J]. Korean J Orthod, 2016,46(5):323-330.
doi: 10.4041/kjod.2016.46.5.323 pmid: 27668195
[14] Betts NJ. Surgically assisted maxillary expansion[J]. Atlas Oral Maxillofac Surg Clin North Am, 2016,24(1):67-77.
doi: 10.1016/j.cxom.2015.10.003 pmid: 26847514
[15] Isaacson RJ, Wood JL, Ingram AH. Forces produced by rapid maxillary expansion. Ⅰ. Design of the force measuring system[J]. Angle Orthod, 1964,34:256-260.
[16] Cantarella D, Dominguez-Mompell R, Moschik C, et al. Midfacial changes in the coronal plane induced by microimplant-supported skeletal expander, studied with cone-beam computed tomography images[J]. Am J Orthod Dentofacial Orthop, 2018,154(3):337-345.
doi: 10.1016/j.ajodo.2017.11.033 pmid: 30173836
[17] Nelson Elias C, Jogaib Fernandes D, Souza Zanivan D, et al. Extensiometric analysis of strain in cranio-facial bones during implant-supported palatal ex-pansion[J]. J Mech Behav Biomed Mater, 2017,76:104-109.
doi: 10.1016/j.jmbbm.2017.05.028 pmid: 28576607
[18] Ma JQ, Wu YX, Zhang WB, et al. Up-regulation of multiple proteins and biological processes during maxillary expansion in rats[J]. BMC Musculoskelet Disord, 2008,9:37.
doi: 10.1186/1471-2474-9-37 pmid: 18366685
[19] Hou B, Fukai N, Olsen BR. Mechanical force-induced midpalatal suture remodeling in mice[J]. Bone, 2007,40(6):1483-1493.
doi: 10.1016/j.bone.2007.01.019 pmid: 17398175
[20] Katebi N, Kolpakova-Hart E, Lin CY, et al. The mouse palate and its cellular responses to midpalatal suture expansion forces[J]. Orthod Craniofac Res, 2012,15(3):148-158.
doi: 10.1111/j.1601-6343.2012.01547.x pmid: 22812437
[21] Garcez AS, Suzuki SS, Storto CJ, et al. Effects of maxillary skeletal expansion on respiratory function and sport performance in a Para-athlete—a case re-port[J]. Phys Ther Sport, 2019,36:70-77.
doi: 10.1016/j.ptsp.2019.01.005 pmid: 30677598
[22] Lee RJ, Moon W, Hong C. Effects of monocortical and bicortical mini-implant anchorage on bone-borne palatal expansion using finite element analysis[J]. Am J Orthod Dentofacial Orthop, 2017,151(5):887-897.
doi: 10.1016/j.ajodo.2016.10.025 pmid: 28457266
[23] Cantarella D, Dominguez-Mompell R, Mallya SM, et al. Changes in the midpalatal and pterygopalatine sutures induced by micro-implant-supported skeletal expander, analyzed with a novel 3D method based on CBCT imaging[J]. Prog Orthod, 2017,18(1):34.
doi: 10.1186/s40510-017-0188-7 pmid: 29090368
[24] Cantarella D, Dominguez-Mompell R, Moschik C, et al. Zygomaticomaxillary modifications in the horizontal plane induced by micro-implant-supported skeletal expander, analyzed with CBCT images[J]. Prog Orthod, 2018,19(1):41.
doi: 10.1186/s40510-018-0240-2 pmid: 30345476
[25] Abedini S, Elkenawy I, Kim E, et al. Three-dimen-sional soft tissue analysis of the face following micro-implant-supported maxillary skeletal expansion[J]. Prog Orthod, 2018,19(1):46.
doi: 10.1186/s40510-018-0243-z pmid: 30450504
[26] 黄金. 成人上颌骨宽度不足患者MSE治疗后上颌复合体、上气道形态学及流体力学研究[D]. 济南: 山东大学, 2018.
Huang J. Three-dimensional morphological evalua-tion of maxillary complex and upper airway and computational fluid dynamics simulation of upper airway response to maxillary skeletal expander treat-ment in adults with maxillary transverse deficiency[D]. Jinan: Shandong University, 2018.
[27] Liu SY, Xu TM, Zou W. Effects of rapid maxillary expansion on the midpalatal suture: a systematic review[J]. Eur J Orthod, 2015,37(6):651-655.
doi: 10.1093/ejo/cju100 pmid: 25700989
[28] Lione R, Ballanti F, Franchi L, et al. Treatment and posttreatment skeletal effects of rapid maxillary ex-pansion studied with low-dose computed tomography in growing subjects[J]. Am J Orthod Dentofacial Orthop, 2008,134(3):389-392.
doi: 10.1016/j.ajodo.2008.05.011 pmid: 18774085
[29] Lin YJ. Comparison of skeletal and dental changes with MSE (maxillary skeletal expander) and Hyrax appliance using CBCT imaging[D]. Los Angeles: School of Dentistry, University of California, Los Angeles, 2015.
[30] Gautam P, Valiathan A, Adhikari R. Stress and dis-placement patterns in the craniofacial skeleton with rapid maxillary expansion: a finite element method study[J]. Am J Orthod Dentofacial Orthop, 2007, 132(1): 5.e1-5.e11.
doi: 10.1016/j.ajodo.2007.05.005 pmid: 17628241
[31] Ghoneima A, Abdel-Fattah E, Hartsfield J, et al. Effects of rapid maxillary expansion on the cranial and circummaxillary sutures[J]. Am J Orthod Dento-facial Orthop, 2011,140(4):510-519.
[32] Baccetti T, Franchi L, Cameron CG, et al. Treatment timing for rapid maxillary expansion[J]. Angle Orthod, 2001,71(5):343-350.
doi: 10.1043/0003-3219(2001)071<0343:TTFRME>2.0.CO;2 pmid: 11605867
[33] Storto CJ, Garcez AS, Suzuki H, et al. Assessment of respiratory muscle strength and airflow before and after microimplant-assisted rapid palatal expansion[J]. Angle Orthod, 2019,89(5):713-720.
doi: 10.2319/070518-504.1 pmid: 30896250
[34] Park JJ, Park YC, Lee KJ, et al. Skeletal and dentoal-veolar changes after miniscrew-assisted rapid palatal expansion in young adults: a cone-beam computed tomography study[J]. Korean J Orthod, 2017,47(2):77-86.
doi: 10.4041/kjod.2017.47.2.77 pmid: 28337417
[35] Seto BH, Gotsopoulos H, Sims MR, et al. Maxillary morphology in obstructive sleep apnoea syndrome[J]. Eur J Orthod, 2001,23(6):703-714.
doi: 10.1093/ejo/23.6.703 pmid: 11890066
[36] Christie KF, Boucher N, Chung CH. Effects of bon-ded rapid palatal expansion on the transverse dime-nsions of the maxilla: a cone-beam computed tomo-graphy study[J]. Am J Orthod Dentofacial Orthop, 2010,137(4 Suppl):S79-S85.
doi: 10.1016/j.ajodo.2008.11.024 pmid: 20381765
[37] Kim SY, Park YC, Lee KJ, et al. Assessment of changes in the nasal airway after nonsurgical minis-crew-assisted rapid maxillary expansion in young adults[J]. Angle Orthod, 2018,88(4):435-441.
doi: 10.2319/092917-656.1 pmid: 29561652
[38] Baratieri Cda L, Alves M Jr, Mattos CT, et al. Trans-verse effects on the nasomaxillary complex one year after rapid maxillary expansion as the only intervention: a controlled study[J]. Dental Press J Or-thod, 2014,19(5):79-87.
[39] Vinha PP, Eckeli AL, Faria AC, et al. Effects of sur-gically assisted rapid maxillary expansion on obs-tructive sleep apnea and daytime sleepiness[J]. Schlaf Atmung, 2016,20(2):501-508.
doi: 10.1007/s11325-015-1214-y pmid: 26092279
[40] Ngan P, Moon W. Evolution of Class Ⅲ treatment in orthodontics[J]. Am J Orthod Dentofacial Orthop, 2015,148(1):22-36.
doi: 10.1016/j.ajodo.2015.04.012 pmid: 26124025
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