多平面重建颧骨上颌骨复合体部软硬组织结构的测量分析
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摘要
背景:研究表明骨性Ⅲ类错畸形涉及到患者整个颅颌面部的软硬组织异常,严重者需行正畸正颌联合治疗。对于上颌发育不足的骨性Ⅲ类错患者常伴有面中部组织的塌陷,颧上颌复合体作为面中部的重要骨性支撑影响面部外形,因此正畸或正颌治疗设计需将该部分的软硬组织形态特征作为重要参考。目的:通过锥形束CT多平面重建视野测量上颌发育不足的骨性Ⅲ类患者与正常对照组人群颧上颌复合体部软硬组织形态差异。方法:选择30例上颌发育不足骨性Ⅲ类患者为试验组,另取30例正常人群为对照组。收集所有患者锥形束CT图像,所得图像以DICOM格式导入MIMCS19.0进行多平面重建,确定参考平面后,定义矢状向水平向共6个测量平面,其并与颧上颌复合体前表面相交于8点,在水平位图像上测量各点处的软硬组织厚度、在轴向和矢状向测量角度。结果与结论:(1)试验组颧上颌复合体表面各测量位点硬组织厚度小于正常对照组(P <0.05),软组织厚度差异无显著性意义(P> 0.05);(2)试验组S2,S3,I1处测量角度矢状向上颌角、矢状向颧突角小于对照组,而IMTA大于对照组(P <0.05);(3)伴上颌发育不足的骨性Ⅲ类患者颧骨上颌骨复合体各测量位点处硬组织矢状向发育不足,表面软组织厚度两组间差异不显著,因此推测伴上颌发育不足的骨性Ⅲ类患者颧上颌部外观可能更显平坦。
BACKGROUND: Skeletal class III malocclusion has been shown to involve the whole eranio-maxillofacial soft and hard tissues, and severe cases require orthodonti-orthognathic surgery treatment. The zygomaticomaxillary complex, as an important bone support in the middle of the face, affects the facial appearance. Therefore, the morphological characteristics of soft and hard tissues in this part should be taken as an important reference in the design of orthodontic or orthodonti-orthognathic surgery.OBJECTIVE: To measure the morphological differences of soft and hard tissues in the zygomaticomaxillary complex between skeletal class III malocclusion with maxillary deficiency patients and the normal control group by cone-beam CT multi-planner reconstruction technique.METHODS: Thirty patients with skeletal class III malocclusion and maxillary deficiency were selected as the trial group and 30 normal people as the control group. Cone-beam CT images of all subjects were collected, and the Mimics 19.0 software was used to reconstruct the original image. A total of six horizontal and sagittal planes, intersection points were determined to analyze the thickness of hard and soft tissues and angle of zygomaticomaxillary complex.RESULTS AND CONCLUSION:(1) The thickness of hard tissue at each measurement site on the surface of zygomaticomaxillary complex in the trial group was less than that in the normal control group(P < 0.05), and there was no significant difference in soft tissue thickness(P >0.05).(2) The measurement angles of sagittal maxillary angle, and sagittal zygomatic angle at S2, S3, and I1 in the trial group were smaller than those in the normal control group, but IMTA was larger than that in the normal control group(P < 0.05).(3) Compared with the normal control group, the development of the zygomaticomaxillary complex in the patients with skeletal class III malocclusion and maxillary deficiency was insufficient and zygomatic appearance was more flat. The difference in surface soft tissue thickness between the two groups was insignificant. Therefore, this difference should be considered in the preoperative diagnosis and analysis of orthodontics and orthodontics.
BACKGROUND: Skeletal class III malocclusion has been shown to involve the whole eranio-maxillofacial soft and hard tissues, and severe cases require orthodonti-orthognathic surgery treatment. The zygomaticomaxillary complex, as an important bone support in the middle of the face, affects the facial appearance. Therefore, the morphological characteristics of soft and hard tissues in this part should be taken as an important reference in the design of orthodontic or orthodonti-orthognathic surgery.OBJECTIVE: To measure the morphological differences of soft and hard tissues in the zygomaticomaxillary complex between skeletal class III malocclusion with maxillary deficiency patients and the normal control group by cone-beam CT multi-planner reconstruction technique.METHODS: Thirty patients with skeletal class III malocclusion and maxillary deficiency were selected as the trial group and 30 normal people as the control group. Cone-beam CT images of all subjects were collected, and the Mimics 19.0 software was used to reconstruct the original image. A total of six horizontal and sagittal planes, intersection points were determined to analyze the thickness of hard and soft tissues and angle of zygomaticomaxillary complex.RESULTS AND CONCLUSION:(1) The thickness of hard tissue at each measurement site on the surface of zygomaticomaxillary complex in the trial group was less than that in the normal control group(P < 0.05), and there was no significant difference in soft tissue thickness(P >0.05).(2) The measurement angles of sagittal maxillary angle, and sagittal zygomatic angle at S2, S3, and I1 in the trial group were smaller than those in the normal control group, but IMTA was larger than that in the normal control group(P < 0.05).(3) Compared with the normal control group, the development of the zygomaticomaxillary complex in the patients with skeletal class III malocclusion and maxillary deficiency was insufficient and zygomatic appearance was more flat. The difference in surface soft tissue thickness between the two groups was insignificant. Therefore, this difference should be considered in the preoperative diagnosis and analysis of orthodontics and orthodontics.
引文
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[2]Ren CC,Bai YX.Effectiveness and long-term stability of maxillary protraction.Zhonghua Kou Qiang Yi Xue Za Zhi.2018;53(10):649-652.
[3]Sendyk M,de Paiva JB,Abr?o J,et al.Correlation between buccolingual tooth inclination and alveolar bone thickness in subjects with Class III dentofacial deformities.Am J Orthod Dentofacial Orthop.2017;152(1):66-79.
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[6]Frey ST.New diagnostic tenet of the esthetic midface for clinical assessment of anterior malar projection.Angle Orthod.2013;83(5):790-794.
[7]Bao T,Yu D,Luo Q,et al.Quantitative assessment of symmetry recovery in navigation-assisted surgical reduction of zygomaticomaxillary complex fractures.J Craniomaxillofac Surg.2019;47(2):311-319.
[8]Hayashi T,Arai Y,Chikui T,et al.Clinical guidelines for dental cone-beam computed tomography.Oral Radiol.2018;34(2):89-104.
[9]De Vos W,Casselman J,Swennen GR.Cone-beam computerized tomography(CBCT)imaging of the oral and maxillofacial region:a systematic review of the literature.Int J Oral Maxillofac Surg.2009;38(6):609-625.
[10]傅民魁.口腔正畸学[M].北京:人民卫生出版社,2012.
[11]Johnston L,许天民,腾起民.Johnston头影测量技术图解手册[M].北京:北京大学医学出版社,2011.
[12]Chen D,Chen CH,Tang L,et al.Three-dimensional reconstructions in spine and screw trajectory simulation on 3D digital images:a step by step approach by using Mimics software.J Spine Surg.2017;3(4):650-656.
[13]Almeida GA.Class III malocclusion with maxillary deficiency,mandibular prognathism and facial asymmetry.Dental Press JOrthod.2016;21(5):103-113.
[14]Chien PC,Parks ET,Eraso F,et al.Comparison of reliability in anatomical landmark identification using two-dimensional digital cephalometrics and three-dimensional cone beam computed tomography in vivo.Dentomaxillofac Radiol.2009;38(5):262-273.
[15]Nocini PF,Boccieri A,Bertossi D.Gridplan midfacial analysis for alloplastic implants at the time of jaw surgery.Plast Reconstr Surg.2009;123(2):670-679.
[16]崔娅铭.现代各主要人群中面部3D几何形态的对比[J].人类学学报,2016,35(1):89-100.
[17]Park HC,Lee JW.Study of horizontal skeletal pattern and dental arch in skeletal Class III malocclusion patients.Korean J Orthod.2008;38(5):358-370.
[18]Kamburo?lu K,Kir?an Büyükko?ak B,Acar B,et al.Assessment of zygomatic bone using cone beam computed tomography in a Turkish population.Oral Surg Oral Med Oral Pathol Oral Radiol.2017;123(2):257-264.
[19]Enlow DH,McNamara JA Jr.The neurocranial basis for facial form and pattern.Angle Orthod.1973;43(3):256-270.
[20]Choi JY,Lee SH,Baek SH.Effects of facial hard tissue surgery on facial aesthetics:changes in facial content and frames.J Craniofac Surg.2012;23(6):1683-1686.
[21]Precious D,Delaire J.Balanced facial growth:a schematic interpretation.Oral Surg Oral Med Oral Pathol.1987;63(6):637-644.
[22]Enlow DH,Hans MG.Essentials of Facial Growth.W.B.Saunders Company,1996.
[23]Nguyen T,Cevidanes L,Cornelis MA,et al.Three-dimensional assessment of maxillary changes associated with bone anchored maxillary protraction.Am J Orthod Dentofacial Orthop.2011;140(6):790-798.
[24]胡骁颖.上颌牵引应力分布三维有限元分析及Angle'sⅢ错上颌前牵引临床矫治研究[D].石家庄:河北医科大学,2012.
[25]刘艳丽,赵薇,张碧莹,等.生长发育期骨性III类错畸形骨支抗上颌前牵引的研究进展[J].国际口腔医学杂志,2019,46(1):112-117.
[26]Morris DE,Moaveni Z,Lo LJ.Aesthetic facial skeletal contouring in the Asian patient.Clin Plast Surg.2007;34(3):547-556.
[27]李海涛,李鸣,董刚,等.不同垂直颅面结构年轻女性嚼肌超声厚度及肌电活动的相关性研究[J].中国美容医学,2011,20(5):131-132.
[28]Kim MG,Lee JW,Cha KS,et al.Three-dimensional symmetry and parallelism of the skeletal and soft-tissue poria in patients with facial asymmetry.Korean J Orthod.2014;44(2):62-68.
[29]刘艳丽,赵薇,张碧莹,安晓莉.生长发育期骨性Ⅲ类错畸形骨支抗上颌前牵引的研究进展[J].国际口腔医学杂志,2019,46(1):112-118.
[30]Jung JH,Kim SS,Son WS,et al.Soft tissue change of the midface in skeletal class III orthognathic surgery patients.Korean J Orthod.2008;38(2):83-94.
[2]Ren CC,Bai YX.Effectiveness and long-term stability of maxillary protraction.Zhonghua Kou Qiang Yi Xue Za Zhi.2018;53(10):649-652.
[3]Sendyk M,de Paiva JB,Abr?o J,et al.Correlation between buccolingual tooth inclination and alveolar bone thickness in subjects with Class III dentofacial deformities.Am J Orthod Dentofacial Orthop.2017;152(1):66-79.
[4]Shi Y,Shang H,Tian L,et al.Three-dimensional study of facial soft tissue changes in patients with skeletal ClassⅢmalocclusion before and after orthognathic surgery.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi.2018;32(5):612-616.
[5]De Clerck H,Cevidanes L,Baccetti T.Dentofacial effects of bone-anchored maxillary protraction:a controlled study of consecutively treated Class III patients.Am J Orthod Dentofacial Orthop.2010;138(5):577-581.
[6]Frey ST.New diagnostic tenet of the esthetic midface for clinical assessment of anterior malar projection.Angle Orthod.2013;83(5):790-794.
[7]Bao T,Yu D,Luo Q,et al.Quantitative assessment of symmetry recovery in navigation-assisted surgical reduction of zygomaticomaxillary complex fractures.J Craniomaxillofac Surg.2019;47(2):311-319.
[8]Hayashi T,Arai Y,Chikui T,et al.Clinical guidelines for dental cone-beam computed tomography.Oral Radiol.2018;34(2):89-104.
[9]De Vos W,Casselman J,Swennen GR.Cone-beam computerized tomography(CBCT)imaging of the oral and maxillofacial region:a systematic review of the literature.Int J Oral Maxillofac Surg.2009;38(6):609-625.
[10]傅民魁.口腔正畸学[M].北京:人民卫生出版社,2012.
[11]Johnston L,许天民,腾起民.Johnston头影测量技术图解手册[M].北京:北京大学医学出版社,2011.
[12]Chen D,Chen CH,Tang L,et al.Three-dimensional reconstructions in spine and screw trajectory simulation on 3D digital images:a step by step approach by using Mimics software.J Spine Surg.2017;3(4):650-656.
[13]Almeida GA.Class III malocclusion with maxillary deficiency,mandibular prognathism and facial asymmetry.Dental Press JOrthod.2016;21(5):103-113.
[14]Chien PC,Parks ET,Eraso F,et al.Comparison of reliability in anatomical landmark identification using two-dimensional digital cephalometrics and three-dimensional cone beam computed tomography in vivo.Dentomaxillofac Radiol.2009;38(5):262-273.
[15]Nocini PF,Boccieri A,Bertossi D.Gridplan midfacial analysis for alloplastic implants at the time of jaw surgery.Plast Reconstr Surg.2009;123(2):670-679.
[16]崔娅铭.现代各主要人群中面部3D几何形态的对比[J].人类学学报,2016,35(1):89-100.
[17]Park HC,Lee JW.Study of horizontal skeletal pattern and dental arch in skeletal Class III malocclusion patients.Korean J Orthod.2008;38(5):358-370.
[18]Kamburo?lu K,Kir?an Büyükko?ak B,Acar B,et al.Assessment of zygomatic bone using cone beam computed tomography in a Turkish population.Oral Surg Oral Med Oral Pathol Oral Radiol.2017;123(2):257-264.
[19]Enlow DH,McNamara JA Jr.The neurocranial basis for facial form and pattern.Angle Orthod.1973;43(3):256-270.
[20]Choi JY,Lee SH,Baek SH.Effects of facial hard tissue surgery on facial aesthetics:changes in facial content and frames.J Craniofac Surg.2012;23(6):1683-1686.
[21]Precious D,Delaire J.Balanced facial growth:a schematic interpretation.Oral Surg Oral Med Oral Pathol.1987;63(6):637-644.
[22]Enlow DH,Hans MG.Essentials of Facial Growth.W.B.Saunders Company,1996.
[23]Nguyen T,Cevidanes L,Cornelis MA,et al.Three-dimensional assessment of maxillary changes associated with bone anchored maxillary protraction.Am J Orthod Dentofacial Orthop.2011;140(6):790-798.
[24]胡骁颖.上颌牵引应力分布三维有限元分析及Angle'sⅢ错上颌前牵引临床矫治研究[D].石家庄:河北医科大学,2012.
[25]刘艳丽,赵薇,张碧莹,等.生长发育期骨性III类错畸形骨支抗上颌前牵引的研究进展[J].国际口腔医学杂志,2019,46(1):112-117.
[26]Morris DE,Moaveni Z,Lo LJ.Aesthetic facial skeletal contouring in the Asian patient.Clin Plast Surg.2007;34(3):547-556.
[27]李海涛,李鸣,董刚,等.不同垂直颅面结构年轻女性嚼肌超声厚度及肌电活动的相关性研究[J].中国美容医学,2011,20(5):131-132.
[28]Kim MG,Lee JW,Cha KS,et al.Three-dimensional symmetry and parallelism of the skeletal and soft-tissue poria in patients with facial asymmetry.Korean J Orthod.2014;44(2):62-68.
[29]刘艳丽,赵薇,张碧莹,安晓莉.生长发育期骨性Ⅲ类错畸形骨支抗上颌前牵引的研究进展[J].国际口腔医学杂志,2019,46(1):112-118.
[30]Jung JH,Kim SS,Son WS,et al.Soft tissue change of the midface in skeletal class III orthognathic surgery patients.Korean J Orthod.2008;38(2):83-94.