唇腭裂患者上颌前部牙槽骨厚度及骨开窗、骨开裂的三维评价研究

摘要/Abstract

摘要： 目的　利用锥形束CT（cone-beam CT,CBCT）评价不同类型唇腭裂患者上颌前部牙槽骨厚度和形态，以及上前牙骨开窗、骨开裂情况。方法　选择016年8月至019年10月间在南京医科大学附属口腔医院就诊拟行口腔正畸治疗的唇腭裂患者85例（男51例，女34例，平均年龄（14.65±4.95）岁），其中单侧唇裂伴牙槽突裂（unilateral cleft lip and alveolus，UCLA）患者19例，单侧完全性唇腭裂（unilateral complete cleft lip and palate，UCLP）患者5例，双侧完全性唇腭裂（bilateral complete cleft lip and palate，BCLP）患者14例。在正畸治疗开始前均予以拍摄颌面部CBCT，应用Image J软件测量其上前牙唇腭侧牙槽骨厚度（alveolar bone thickness，ABT），计算骨开窗、骨开裂发生率，并比较不同唇腭裂类型患者上颌前部ABT及上前牙骨开窗、骨开裂发生率的差异。结果　UCLP、UCLA患侧上前牙骨开裂发生率（34.9%、4.9%）显著高于其健侧（10.7%、11.1%），但骨开窗发生率无统计学差异。UCLP健侧上中切牙（5.9%）、侧切牙（9.7%）骨开裂发生率低于UCLA。UCLA、UCLP、BCLP三组间患侧上前牙骨开裂及骨开窗发生率均无统计学差异。UCLP、UCLA患侧上前牙ABT在多部位小于其健侧。除UCLP/UCLA患侧侧切牙外，UCLA、UCLP、BCLP各类型上前牙唇侧平均ABT均小于腭侧。UCLA、UCLP、BCLP三组间患侧上前牙唇腭侧平均ABT无统计学差异。UCLP患侧上侧切牙、尖牙分别在唇侧和腭侧根颈处ABT大于UCLA。结论　单侧唇腭裂患者患侧上前牙骨开裂发生率高于健侧，ABT则在多部位小于其健侧；而三种类型患者上前牙唇侧ABT均小于其腭侧。单侧唇裂伴牙槽突裂与单侧完全性唇腭裂患者健侧上中切牙、侧切牙骨开裂发生率及患侧侧切牙、尖牙根颈处牙槽骨厚度存在差异；单侧与双侧完全性唇腭裂间上前牙骨开窗、骨开裂发生率及牙槽骨厚度则无差异。

关键词: 唇腭裂, 骨开窗, 骨开裂, 牙槽骨厚度

Abstract: Objective　 To assess the alveolar bone thickness and morphology and the prevalence of fenestration and dehiscence of maxillary anterior teeth in patients with the different types of cleft lip and palate(CLP) using cone-beam CT(CBCT). Methods　Fifty-one males and thirty-four females with CLP at an average age of 14.65, who visited the Affiliated Stomatological Hospital of Nanjing Medical University from August 2016 to October 2019, were selected. There were nineteen patients with unilateral incomplete cleft lip and alveolus (UCLA), fifty-two patients with unilateral complete cleft lip and palate (UCLP) and fourteen patients with bilateral complete cleft lip and palate (BCLP). CBCT was taken in maxillofacial region before orthodontic treatment. Image J software was used to measure the alveolar bone thickness (ABT) of the upper anterior teeth. The prevalence of fenestration and dehiscence was calculated. The differences of ABT and fenestration and dehiscence of the maxillary anterior maxilla among the patients with different types of CLP were compared. Results The prevalence of upper anterior teeth dehiscence in affected side of UCLP and UCLA (34.9%, 42.7%) was significantly higher than that of healthy side (10.7%, 11.1%), but there was no significant difference in the prevalence of fenestration. The prevalence of dehiscence in healthy upper central incisors (5.9%) and lateral incisors (9.4%) in UCLP was lower than that in UCLA. There was no significant difference in the prevalence of dehiscence and fenestration of upper central incisor, lateral incisor, canine among UCLA, UCLP and BCLP. The ABT of the affected side of UCLP and UCLA was smaller than that of the healthy side in multiple parts. In addition, except for the affected lateral incisors, the labial ABT of UCLA, UCLP and BCLP was lower than that of palatal side. The cervical ABT of upper incisors and canines on the affected side of UCLP was higher than that of UCLA. Conclusion　 The prevalence of dehiscence of the affected upper anterior teeth in patients with unilateral cleft lip and palate is higher than that of the healthy side, while labial ABT of upper anterior teeth is smaller than that of healthy side in many parts. The labial mean ABT of the three types of patients is smaller than that of the palatal side. There are significant differences in the prevalence of dehiscence in the healthy upper central incisors and lateral incisors, the cervical alveolar bone thickness of the affected lateral incisors and canines between unilateral complete cleft lip and palate and cleft lip and alveolus patients, while there is no difference in the incidence of fenestration, dehiscence and alveolar bone thickness between unilateral and bilateral complete cleft lip and palate.

Key words: cleft lip and palate, fenestration, Alveolar bone dehiscence, alveolar bone thickness

中图分类号:

R783.5

薛曼玲刘璐玮张卫兵张驰. 唇腭裂患者上颌前部牙槽骨厚度及骨开窗、骨开裂的三维评价研究[J]. 口腔医学, 2021, 41(6): 514-520.

参考文献 27

[1]	Sanjida H, Mohammad KA, Mohd FK.The effect of various factors on the dental arch relationship in non-syndromic unilateral cleft lip and palate children assessed by new approach: a retrospective study[J]. [J].BMC Pediatrics, 2017, 17:119-
[2]	Abhishekhi S, Masahiro T, Tetsutaro Y, et al.Three-dimensional evaluation of mandibular volume in patients with cleft lip and palate during the deciduous dentition period[J].Angle Orthod, 2020, 90(1):85-91
[3]	Buyuk SK, Ercan E, Celikoglu M, et al.Evaluation of dehiscence and fenestration in adolescent patients affected by unilateral cleft lip and palate: A retrospective cone beam computed tomography study[J].Angle Orthod, 2016, 86(3):431-436
[4]	Regina P, Dewi I, Annise P, et al.The Densitometric Analysis of Protein Pattern in Cleft Lip and Palate Patients[J].Journal of International Society of Preventive and Community Dentistry, 2019, 9(3):240-244
[5]	Coskun I, Kaya B.Appraisal of the relationship between tooth inclination,dehiscence,fenestration,and sagittal skeletal pattern with cone beam computed tomography[J].Angle Orthod, 2019, 89(4):544-551
[6]	邓建清.骨开窗和骨开裂与正畸治疗[J].临床口腔医学杂志, 2016, 32(7):445-447
[7]	孙良龑, 王博, 房兵.骨性Ⅲ类错颌前牙区牙槽骨开裂和牙槽骨开窗发生率的锥形束研究[J].上海口腔医学, 2013, 22(4):418-422
[8]	李丹阳, 杨昱藩.骨性Ⅲ类错合下切牙唇侧牙槽骨骨量的研究[J].内蒙古医科大学学报, 2018, 40(5):499-501
[9]	Yagci A, Veli I, Uysal T, et al.Dehiscence and fenestration in skeletal ClassⅠ,Ⅱ,andⅢ malocclusions assessed with cone-beam computed tomography[J].Angle Orthod, 2012, 82(1):67-74
[10]	Enhos S, Uysal T, Yagci A, et al.Dehiscence and fenestration in patients with different vertical growth patterns assessed with cone-beam computed tomography[J].Angle Orthod, 2012, 82(5):868-874
[11]	Evangelista K, Vasconcelos KF, Bumann A, et al.Dehiscence and fenestration in patients with ClassⅠand ClassⅡDivision 1 malocclusion assessed with cone-beam computed tomography[J].Am J Orthod Dentofacial Orthop, 2010, 138(2):133-
[12]	Celikoglu M, Buyuk SK, et al.Evaluation of dehiscence and fenestration in adolescents affected by bilateral cleft lip and palate using cone-beam computed tomography[J].Am J Orthod Dentofacial Orthop, 2017, 152(4):458-464
[13]	Pan Y, Zeng Y, Zhang Z, et al.Evaluation of alveolar bone support around incisors in patients with unilateral cleft lip,alveolus,and palate in late mixed dentition using cone beam computed tomography[J].Angle Orthod, 2018, 88(3):299-305
[14]	Ercan E, Celikoglu M, Buyuk SK, Sekerci AE.Assessment of the alveolar bone support of patients with unilateral cleft lip and palate: a cone-beam computed tomography study[J].Angle Orthod, 2015, 85(6):1003-1008
[15]	Persson RE, Hollender LG, Laurell L, Persson GR.Horizontal alveolar bone loss and vertical bone defects in an adult patient population[J].J Periodontol, 1998, 69(3):348-56
[16]	Celikoglu M, Buyuk SK, Sekerci AE, et al.Three-dimensional evaluation of the pharyngeal airway volumes in patients affected by unilateral cleft lip and palate[J]. Am J Orthod Dentofacial Orthop. 2014, 145(6):780-786.
[17]	Celikoglu M, Halicioglu K, Buyuk SK, et al.Condylar and ramal vertical asymmetry in adolescent patients with cleft lip and palate evaluated with cone-beam computed tomography[J]. Am J Orthod Dentofacial Orthop. 2013, 144(5):691-697.
[18]	Coskun I, Kaya B.Relationship between alveolar bone thickness,tooth root morphology,and sagittal skeletal pattern : A cone beam computed tomography study[J].J Orofac Orthop, 2019, 80(3):144-158
[19]	Stec M, Szczepanska J, Pypec J, Hirschfelder U.Periodontal status and oral hygiene in two populations of cleft patients[J]. Cleft Palate Craniofac J. 2007, 44(1):73-78.
[20]	William ND, Bart Morris, Ali Fatemi, et al.Gamma Knife ? icon CBCT offers improved localization workflow for frame‐based treatment[J]. J Appl Clin Med Phys 2019, 20(11):95-103.
[21]	Kurz C，Maspero M, Savenije MHF, et al.CBCT correction using a cycle-consistent generative adversarial network and unpaired training to enable photon and proton dose calculation[J].Phys Med Biol, 2019, 64(22):225004-
[22]	Sun Z, Smith T, Kortam S, et al.Effect of bone thickness on alveolar bone-height measurements from cone-beam computed tomography images[J]. Am J Orthod Dentofacial Orthop, 2011, 139:e117-e127.
[23]	Braun X, Ritter L, Jervoe-Storm PM, et al.Diagnostic accuracy of CBCT for periodontal lesions[J]. Clin Oral Investig, 2014, 18:1229-1236.
[24]	敬怡, 肖立伟.单侧完全性唇腭裂患者前牙区牙槽骨开窗、骨开裂的锥形束研究[J].上海口腔医学, 2019, 28(4):397-401
[25]	朱明敏, 李煌.成人双颌前突内收后切牙牙槽骨骨开窗率和骨开裂率的研究[J].中国美容医学, 2018, 27(3):79-83
[26]	Henry O, Andrew S, Alfa Y, et al.Quantitative evaluation of maxillary alveolar cortical bone thickness and density using computed tomography imaging[J].Am J Orthod Dentofacial Orthop, 2017, 15(1):82-91
[27]	Tian YL, Liu F, Sun HJ, et al.Alveolar bone thickness around maxillary central incisors of different inclination assessed with cone-beam computed tomography[J].Korean J Orthod, 2015, 45(5):245-252