TCHSA 079-2024 唇腭裂患者替牙期錯牙合畸形矯治指南

ICS11.060.01CCS

C05團(tuán) 體 標(biāo) 準(zhǔn)T/CHSA079—2024唇腭裂患者替牙期錯????畸形矯治指南Guidelinesfortheorthodontictreatmentofmalocclusionduringmixeddentitioninpatientswithcleftlipandpalate2024-11-29發(fā)布 2024-12-29實(shí)施中華口醫(yī)學(xué)會 發(fā)布T/CHSA079—2024T/CHSA079—2024IIII前 言本文件按照GB/T1.1—2020《標(biāo)準(zhǔn)化工作導(dǎo)則第1部分：標(biāo)準(zhǔn)化文件的結(jié)構(gòu)和起草規(guī)則》的規(guī)定起草。本文件由中華口腔醫(yī)學(xué)會歸口。T/CHSA079—2024T/CHSA079—2024IIIIII引 言????????????????????????T/CHSA079—2024T/CHSA079—2024PAGEPAGE1唇腭裂患者替牙期錯????畸形矯治指南范圍????????本文件適用于各級醫(yī)院的口腔正畸醫(yī)師對替牙期唇腭裂患者的矯治。本文件不適用于唇腭裂替牙期垂直向關(guān)系不調(diào)的治療。本文件沒有規(guī)范性引用文件。下列術(shù)語和定義適用于本文件。替牙期 earlymixeddentition6～8替牙期 latemixeddentition替牙期的晚期階段，此時乳尖牙、乳磨牙開始脫落，恒尖牙及前磨牙開始萌出，此階段年齡一般為9～11歲。恒牙期 earlypermanentdentition????唇腭裂患者替牙期????頜面評估內(nèi)容[1]評估唇腭裂的發(fā)生部位、畸形程度以及臨床特征，唇腭裂相關(guān)手術(shù)的時間及方式。了解唇腭裂患者的家族患病情況及頜骨畸形情況。通過頸椎骨齡或手腕骨齡判定患者的生長發(fā)育階段。評估唇腭裂患者的牙齒發(fā)育情況，包括形態(tài)異常、結(jié)構(gòu)異常、萌出及脫落異常、數(shù)目異常等。系建議采用GoslonYardstick分級系統(tǒng)進(jìn)行綜合評價[2]，雙側(cè)唇腭裂患者牙弓關(guān)系建議采用Yardstick[3]評估唇腭裂患者替牙期牙弓間隙狀況，關(guān)注乳、恒牙的替換情況。評估唇腭裂患者牙體、牙周情況，包括牙齒齲壞、牙列缺損、牙齦炎癥及口腔衛(wèi)生狀況等。（CBCT）（6～8CBCTCBCT唇腭裂患者替牙期????頜面評估時機(jī)唇腭裂患者替牙期????頜面評估時機(jī)如下：——頜骨三維方向發(fā)育的評估：替牙早期，6～8歲，頸椎骨齡CVS分期Ⅰ-Ⅲ期；——牙槽突裂植骨術(shù)前的評估：替牙早期，6～8歲，上頜中切牙萌出，上頜尖牙牙根發(fā)育1/3左右[6]；——替牙期牙弓間隙的評估：替牙期全程，6～12歲。????嚴(yán)格掌握唇腭裂患者替牙期矯治適應(yīng)證，以解決影響患者????頜面生長發(fā)育及口頜系統(tǒng)功能的錯????????????顯????????????唇腭裂患者替牙期錯????畸形矯治內(nèi)容包括：頜間關(guān)系異常的矯治：包括上頜骨矢狀向發(fā)育不足引起的前牙反????????；????????（-2°＜ANB＜0°）????[7,8]500g，????30°～40°斜向12h（A、B期）[9,10][11]（-4°＜ANB≤-2°）可以嘗試使用種植釘或者微鈦板支持式前方牽引，矯形力可以通過種植釘或微鈦板直接傳遞到骨[8,12]（ANB≤-4°）建議待生長發(fā)育高峰期后進(jìn)行正畸-正頜聯(lián)合治療，或考慮進(jìn)行牽張成骨增加上頜骨長度[13]。????[14]????????1/3????（6～8[15]治療的方法，避免過度上頜擴(kuò)弓導(dǎo)致治療結(jié)果的不穩(wěn)定[16,17]。唇腭裂患者的牙弓狹窄主要發(fā)生在牙弓前段和中段，上頜寬度擴(kuò)展以擴(kuò)展牙弓尖牙區(qū)和前磨牙區(qū)[19,20]????????Hyrax（）W[17,21]????[23][24][25][26][27][28,29]X????CBCT2????唇腭裂患者替牙期牙性錯????畸形矯治的適應(yīng)證及治療方法????2×4[31]頭帽口外弓或J替牙期唇腭裂患者牙性錯????畸形矯治的注意事項(xiàng)????????????????T/CHSA079T/CHSA079—2024PAGEPAGE6附錄A（資料性）唇腭裂患者替牙期錯??畸形矯治流程圖矢狀向評價寬度評價矢狀向評價寬度評價牙性前牙反?或前牙嚴(yán)重扭轉(zhuǎn)伴有?創(chuàng)傷?墊舌簧/固定矯治2*4矯治必要時調(diào)整裂隙兩側(cè)錯位的骨段及牙齒必要時調(diào)整裂隙鄰近牙齒（扭轉(zhuǎn)、斜軸、舌傾）滿足植骨手術(shù)操作即可替牙期間隙管理（6-12歲替牙期全程）必要時進(jìn)行植骨前寬度調(diào)整滿足植骨手術(shù)操作即可重度矢狀向不調(diào)(ANB≤-4°）成年階段正畸-正頜聯(lián)合治療或嘗試牽張成骨中度矢狀向不調(diào)（-4°<ANB≤-2°）種植釘或微鈦板支持式前方牽引輕度矢狀向不調(diào)（-2°<ANB<0°）牙支持式前方牽引若存在矢狀向不調(diào)必要時進(jìn)行植骨后正畸根據(jù)患者錯?情況評價再次評估?頜面發(fā)育必要時進(jìn)行相應(yīng)調(diào)整若無寬度不調(diào)若無矢狀向不調(diào)植骨后正畸乳磨牙早失導(dǎo)致間隙喪失頭帽口外弓/擺式矯治器植骨手術(shù)植骨前正畸植骨前正畸評價（6-8歲，中切牙萌出，尖牙牙根發(fā)育1/3左右）伴有牙槽突裂?頜面發(fā)育的評估（6-8CVSI-III期）若存在寬度不調(diào)輕中度寬度不調(diào)根據(jù)牙弓形態(tài)選擇擴(kuò)弓器（若伴嚴(yán)重矢狀向不調(diào)，成年階段正畸-正頜聯(lián)合治療）重度寬度不調(diào)成年階段正畸-正頜聯(lián)合治療圖A.1唇腭裂患者替牙期錯??畸形矯治流程圖T/CHSA079—2024T/CHSA079—2024PAGEPAGE7參 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