TCHSA 079-2024 唇腭裂患者替牙期错牙合畸形矫治指南

ICS11.060.01CCS

C05团 体 标 准T/CHSA079—2024唇腭裂患者替牙期错𬌗𬌗畸形矫治指南Guidelinesfortheorthodontictreatmentofmalocclusionduringmixeddentitioninpatientswithcleftlipandpalate2024-11-29发布 2024-12-29实施中华口医学会 发布T/CHSA079—2024T/CHSA079—2024IIII前 言本文件按照GB/T1.1—2020《标准化工作导则第1部分：标准化文件的结构和起草规则》的规定起草。本文件由中华口腔医学会归口。T/CHSA079—2024T/CHSA079—2024IIIIII引 言𬌗𬌗𬌗𬌗𬌗𬌗𬌗𬌗𬌗𬌗𬌗𬌗T/CHSA079—2024T/CHSA079—2024PAGEPAGE1唇腭裂患者替牙期错𬌗𬌗畸形矫治指南范围𬌗𬌗𬌗𬌗本文件适用于各级医院的口腔正畸医师对替牙期唇腭裂患者的矫治。本文件不适用于唇腭裂替牙期垂直向关系不调的治疗。本文件没有规范性引用文件。下列术语和定义适用于本文件。替牙期 earlymixeddentition6～8替牙期 latemixeddentition替牙期的晚期阶段，此时乳尖牙、乳磨牙开始脱落，恒尖牙及前磨牙开始萌出，此阶段年龄一般为9～11岁。恒牙期 earlypermanentdentition𬌗𬌗唇腭裂患者替牙期𬌗𬌗颌面评估内容[1]评估唇腭裂的发生部位、畸形程度以及临床特征，唇腭裂相关手术的时间及方式。了解唇腭裂患者的家族患病情况及颌骨畸形情况。通过颈椎骨龄或手腕骨龄判定患者的生长发育阶段。评估唇腭裂患者的牙齿发育情况，包括形态异常、结构异常、萌出及脱落异常、数目异常等。系建议采用GoslonYardstick分级系统进行综合评价[2]，双侧唇腭裂患者牙弓关系建议采用Yardstick[3]评估唇腭裂患者替牙期牙弓间隙状况，关注乳、恒牙的替换情况。评估唇腭裂患者牙体、牙周情况，包括牙齿龋坏、牙列缺损、牙龈炎症及口腔卫生状况等。（CBCT）（6～8CBCTCBCT唇腭裂患者替牙期𬌗𬌗颌面评估时机唇腭裂患者替牙期𬌗𬌗颌面评估时机如下：——颌骨三维方向发育的评估：替牙早期，6～8岁，颈椎骨龄CVS分期Ⅰ-Ⅲ期；——牙槽突裂植骨术前的评估：替牙早期，6～8岁，上颌中切牙萌出，上颌尖牙牙根发育1/3左右[6]；——替牙期牙弓间隙的评估：替牙期全程，6～12岁。𬌗𬌗严格掌握唇腭裂患者替牙期矫治适应证，以解决影响患者𬌗𬌗颌面生长发育及口颌系统功能的错𬌗𬌗𬌗𬌗𬌗𬌗显𬌗𬌗𬌗𬌗𬌗𬌗唇腭裂患者替牙期错𬌗𬌗畸形矫治内容包括：颌间关系异常的矫治：包括上颌骨矢状向发育不足引起的前牙反𬌗𬌗𬌗𬌗；𬌗𬌗𬌗𬌗（-2°＜ANB＜0°）𬌗𬌗[7,8]500g，𬌗𬌗30°～40°斜向12h（A、B期）[9,10][11]（-4°＜ANB≤-2°）可以尝试使用种植钉或者微钛板支持式前方牵引，矫形力可以通过种植钉或微钛板直接传递到骨[8,12]（ANB≤-4°）建议待生长发育高峰期后进行正畸-正颌联合治疗，或考虑进行牵张成骨增加上颌骨长度[13]。𬌗𬌗[14]𬌗𬌗𬌗𬌗1/3𬌗𬌗（6～8[15]治疗的方法，避免过度上颌扩弓导致治疗结果的不稳定[16,17]。唇腭裂患者的牙弓狭窄主要发生在牙弓前段和中段，上颌宽度扩展以扩展牙弓尖牙区和前磨牙区[19,20]𬌗𬌗𬌗𬌗Hyrax（）W[17,21]𬌗𬌗[23][24][25][26][27][28,29]X𬌗𬌗CBCT2𬌗𬌗唇腭裂患者替牙期牙性错𬌗𬌗畸形矫治的适应证及治疗方法𬌗𬌗2×4[31]头帽口外弓或J替牙期唇腭裂患者牙性错𬌗𬌗畸形矫治的注意事项𬌗𬌗𬌗𬌗𬌗𬌗𬌗𬌗T/CHSA079T/CHSA079—2024PAGEPAGE6附录A（资料性）唇腭裂患者替牙期错𬌗畸形矫治流程图矢状向评价宽度评价矢状向评价宽度评价牙性前牙反ꩀ或前牙严重扭转伴有ꩀ创伤ꩀ垫舌簧/固定矫治2*4矫治必要时调整裂隙两侧错位的骨段及牙齿必要时调整裂隙邻近牙齿（扭转、斜轴、舌倾）满足植骨手术操作即可替牙期间隙管理（6-12岁替牙期全程）必要时进行植骨前宽度调整满足植骨手术操作即可重度矢状向不调(ANB≤-4°）成年阶段正畸-正颌联合治疗或尝试牵张成骨中度矢状向不调（-4°<ANB≤-2°）种植钉或微钛板支持式前方牵引轻度矢状向不调（-2°<ANB<0°）牙支持式前方牵引若存在矢状向不调必要时进行植骨后正畸根据患者错ꩀ情况评价再次评估ꩀ颌面发育必要时进行相应调整若无宽度不调若无矢状向不调植骨后正畸乳磨牙早失导致间隙丧失头帽口外弓/摆式矫治器植骨手术植骨前正畸植骨前正畸评价（6-8岁，中切牙萌出，尖牙牙根发育1/3左右）伴有牙槽突裂ꩀ颌面发育的评估（6-8CVSI-III期）若存在宽度不调轻中度宽度不调根据牙弓形态选择扩弓器（若伴严重矢状向不调，成年阶段正畸-正颌联合治疗）重度宽度不调成年阶段正畸-正颌联合治疗图A.1唇腭裂患者替牙期错𬌗畸形矫治流程图T/CHSA079—2024T/CHSA079—2024PAGEPAGE7参 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