单侧完全性唇腭裂患者恒牙先天缺失类型分析

作者:未知

  [摘要]唇腭裂(Cleft lip and palate,CLP)患者高频率地发生牙齿数目异常是正畸治疗中的复杂因素之一,对于这类患者评估牙齿异常模式顯得尤为重要。本文对单侧完全性唇腭裂(Unilateral cleft lip and palate,UCLP)患者恒牙的先天缺失发生率及性别、裂区与非裂区、上下颌差异做概述,为临床医生制定治疗计划提供帮助,有助于恢复及改善唇腭裂患者颌面部的功能与美观。
  [关键词]唇腭裂;恒牙;错牙合畸形;发育异常;先天缺失
  [中图分类号]R782.2+2   [文献标志码]A    [文章编号]1008-6455(2021)03-0175-03
  Analysis of the Types of Permanent Teeth Congenital Missing in Patients with Unilateral Complete Cleft Lip and Palate
  Yipare·KELIMUJIANG,Gulibaha·MAIMAITILI
  (The Second Affiliated Hospital of Xinjiang Medical University,Urumqi 830028,Xinjiang,China)
  Abstract: The high frequency of abnormal tooth number in cleft lip and palate (CLP) patients is one of the complex factors in orthodontic treatment,it is very important to evaluate the abnormal pattern of teeth for this kind of patients.In this paper, the incidence of congenital missing permanent teeth in patients with unilateral cleft lip and palate (UCLP) and the differences between gender, cleft and non cleft areas, upper and lower jaw were summarized, which can help clinicians to make treatment plans, and help to restore and improve the function and beauty of maxillofacial in patients with unilateral cleft lip and palate.
  Key words:unilateral cleft lip and palate; permanent teeth; malocclusion; dental anomalies; hypodontia
  唇腭裂是最常见的颅颌面畸形,它是由遗传因素和环境因素共同作用所致的遗传性疾病[1],也是人类先天畸形中最常见的一种,每出生的500~550个胎儿中就有1例唇腭裂患儿[2],一般分为综合征性和非综合征性,其中非综合征性更为常见,约占唇腭裂的70%[3]。唇腭裂在全世界的发病率为1‰~3‰,我国的发病率为1.62‰[4]。唇腭裂常伴发口颌系统、语音及心理等方面的障碍,需进行系统的序列治疗[5]。唇腭裂患者牙齿发育异常的发生破坏了牙列的完整性和对称性,引起患儿的口颌系统功能与颌骨发育异常,形成了CLP患者复杂多样的口内情况,增加了序列治疗的复杂性和难度。先前学者研究唇腭裂患者牙齿发育异常将其概括为前牙区或全牙列区,而评估不同类型唇腭裂的牙齿异常模式也同样重要。
  1  UCLP先天缺牙的发生率
  Akcam等[6]报道96.7%的裂隙患者至少有一个牙齿异常,其中牙齿先天缺失是最常见的发育异常类型。Paranaiba[7]提出UCLP比BCLP更容易发生牙齿异常(P=0.00002),与其他类型相比更易发生牙缺失(P=0.002),这与Aizenbud D、Stahl F的研究结果一致[8-9]。Jiroutova O[10]等学者研究得出唇腭裂患者与普通人群相比,前者先天性牙齿缺失的发生率明显高于后者。国内吴华,续美如等[11-12]报道普通人群先天性牙齿缺失率为2.3%~11.3%,下颌第二前磨牙的缺失较常见[13],且单侧牙齿缺失比双侧缺失更常见[14-15],而在严重的唇腭裂患者中双侧牙齿缺失的频率是单侧缺失的两倍[16]。Cakan[17]得出PAX9、MSX1基因是唇腭裂患者牙齿缺失的相关基因,Slayton[18]提出TGFB3和MSX1基因与唇腭裂患者非裂侧牙齿的缺失有关。牙齿先天缺失可能的原因有[19]:①牙板上皮细胞的缺失或增殖被抑制;②细胞间信号传递异常;③手术破坏牙胚;④牙齿发育和面突融合存在共同的调控基因。全牙列的牙齿缺失顺序是上颌侧切牙,上颌第二前磨牙,上颌中切牙,下颌第二前磨牙[20]。前磨牙的缺失顺序为上颌第二前磨牙,下颌第二前磨牙,上颌第一前磨牙,下颌第一前磨牙[21]。多项研究表明世界各地不同地区的牙齿缺失与裂型之间的关系,发现不同地区的唇腭裂患者牙齿缺失患病率不同,说明地区差异值得重视。De Stefani A等[22]报道意大利人群中唇裂患者牙缺失率约占29.5%~77.0%,远高于普通人的2.7%~11.3%。不同地区上颌侧切牙缺失率占唇裂患者的比例不同[23-25]:日本报道56.9%,美国报道74.0%,匈牙利报道69.0%。阿依古丽· 吐尔地[26]等分析新疆80例唇腭裂患者得出UCLP裂侧恒侧切牙先天缺失的发生率为60.0%,高于正常侧。   2  UCLP牙齿先天缺失的性别差异
  普通人群中男女牙齿先天缺失的发生率无统计学差异,女性略高于男性[27]。Baek and Kim [28]研究韓国UCLP患者发现在裂侧上颌侧切牙的缺失男性大于女性,而在非裂隙侧女性的上颌第二前磨牙缺失较男性频繁。而另一些学者表明UCLP患者牙齿先天缺失并没有性别差异[18,29-30]。
  3  UCLP牙齿先天缺失裂区与非裂区的比较
  牙齿缺失通常发生在恒牙期,且一般在裂区[6,9,31],UCLP患者在裂侧发生牙齿先天缺失占48.8%~75.9%[32-33],在非裂侧为27.2%~48.8%[34-35],这说明牙齿发育不全与裂隙之间可能有关联,牙齿畸形的发生率由裂隙的类型和位置决定。缺牙与裂隙严重程度之间存在正相关关系,随着裂隙严重程度增加,牙齿缺失的频率增加[36-37]。曾有学者报道[25]UCLP患者牙齿缺失与裂侧无关联,而Derya[17]发现裂侧不同侧切牙的缺失也不同,右侧裂UCLP组右侧切牙缺失率高(P=0.0001),而左侧裂UCLP组左侧切牙缺失率高(P=0.002)。唇腭裂患者上颌侧切牙的缺失在裂侧较非裂侧更频繁,有回顾性研究报道[38-39],UCLP患者裂侧和非裂侧侧切牙缺失率分别为48.8%~58.7%和2.2%~10.9%。在非裂侧上下颌第二前磨牙的缺失最为常见[40-41]。Bartzela[31]发现并解释了UCLP患者第二前磨牙的缺失左侧多于右侧,可能因为左侧裂的UCLP患者很多[42-43],但这无法解释下颌左侧第二前磨牙的缺失较右侧多。Ranta R[20]提出侧切牙和第二前磨牙的先天缺失病因不太相同,牙齿形成阶段的手术干预可能导致裂区侧切牙缺失,而非裂区的第二前磨牙的缺失最有可能与遗传因素或基因调控有关。Lekkas[44]研究未手术的唇腭裂成年患者在非裂侧未发现牙齿缺失,这一结果表明牙齿缺失可能与腭裂闭合的手术过程有关,该手术可能会破坏非裂侧第二前磨牙牙胚的形成。
  4  UCLP牙齿先天缺失上下颌的比较
  Shapira Y研究[45]得出有18%唇腭裂患者缺失第二前磨牙,远高于普通的1.4%~1.6%(上颌)和2.9%~3.2%(下颌)[44,46]。由于裂侧的上颌多伴有先天缺牙[20],这种严重的错牙合畸形使裂侧上下颌牙齿的咀嚼效能降低,从而影响颌骨的发育。上颌侧切牙的缺失多发生在左侧,而第二前磨牙的缺失常发生在右侧[47]。下颌左侧第二前磨牙的缺失率是右侧的3倍[48],在UCLP患者中下颌第二前磨牙的缺失常呈现对称性[39,49-50]。Hermus[50]发现上颌85%的患者缺失侧切牙和/或第二前磨牙,下颌90%的患者缺失第二前磨牙或中切牙/侧切牙,对称的牙齿缺失占18.8%(上颌)和51.0%(下颌),还指出当唇腭裂患者有第三磨牙的缺失,其他牙齿的缺失频率增加两倍。
  5  小结
  先天缺牙的个体往往存在牙间隙,需通过正畸牙齿移动或种植来关闭,正畸医生应在治疗早期考虑到正畸治疗中的风险,诊断缺失牙和余留牙的数目与位置,制定综合序列治疗方案,恢复唇腭裂患者的口颌功能并改善其身心健康。
  [参考文献]
  [1]Orlagh, Hunt, Donald, et al.The psychosocial effects of cleft lip and palate:a syste- matic review[J].Eur J Orthod,2005,27(3):274-285.
  [2]Massenburg BB,Jenny HE,Saluja S,et al.Barriers to cleft lip and palate repair aro- und the world[J].J Craniofac Surg,2016,27(7):1741-1745.
  [3]Paradowska-Stolarz A,Dubowik M,Szel?g J,et al.Dental anomalies in the incisor- canine region in patients with cleft lip and palate literature review[J].Med Wieku Rozwoj,2014,18(1):66-69.
  [4]傅民魁.口腔正畸学[M].北京:人民卫生出版社,2012:700-702.
  [5]马丽雨,孙吉庆,叶之慧.口腔正畸应用于唇腭裂序列治疗的研究进展[J].临床医药文献电子杂志,2017,4(19):804-805.
  [6]Akcam MO,Evirgen S,Uslu O,et al.Dental anomalies in individuals with cleft lip and/or palate[J].Eur J Orthod,2010,32(2):207-213.
  [7]Paranaiba,Lívia Máris Ribeiro,Coletta R D,et al.Prevalence of dental anomalies in patients with nonsyndromic cleft lip and/or palate in a brazilian population[J]. Cleft Palate Craniofac J,2013,50(4):400-405.
  [8]Aizenbud D,Camasuvi S,Peled M,et al.Congenitally missing teeth in the israeli cleft population[J].Cleft Palate Craniofac J,2005,42(3):314-317.   [9]Stahl F,Grabowski R,Wigger K.Epidemiology of Hoffmeister’s genetically determ- ined predisposition to disturbed development of the dentition in patients with cleft lip and palate[J].Cleft Palate Craniofac J,2006,43(4):457-465.
  [10]Jiroutova O, Mullerova Z.The occurrence of hypodontia in patients with cleft lip and/or palate[J].Acta Chir Plast,1994,36(2):53-56.
  [11]吳华,冯海兰.6 453名17~21岁青年人恒牙发育异常的调查[J].中华口腔医学杂志,2005,40(6):489-490.
  [12]续美如,霍益亮,吕冰峰.北京地区青少年恒牙先天数目异常的分析[J].人类学学报, 2003,22(2):57-61.
  [13]Mattheeuws N,Dermaut L,Martens G. Has hypodontia increased in Caucasians during the 20 th century[J].Eur J Orthod,2004,26(1):99-103.
  [14]Bozga A,Stanciu RP,Manuc D.A study of prevalence and distribution of tooth agenesis[J].J Med Life,2014,7(4):551-554.
  [15]Polder BJ,Van’t Hof MA,Vander Linden FP,et al.A Meta analysis of the prevalence of dental agenesis of permanent teeth[J].Community Dent Oral Epidemiol,2004,32(3): 217-226.
  [16]Kim YH.Investigation of hypodontia as clinically related dental anomaly: Prevalence and characteristics[J].ISRN Dent,2011,29(6):246-254.
  [17]Cakan, Derya,Germec,et al.Dental anomalies in different types of cleft lip and palate:Is there any relation?[J].J Craniofac Surg,2018,29(5):1316-1321.
  [18]Slayton RL,Williams L,Murray JC,et al.Genetic association studies of cleft lip and/or palate with hypodontia outside the cleft region[J].Cleft Palate Craniofac J,2003,40(3):274-279.
  [19]范新新,李静,葛立宏,等.非综合征性单侧完全性唇腭裂恒牙发育异常的研究[J].中华口腔医学杂志,2011,46(5):263-266.
  [20]Ranta R.Hypodontia and delayed development of the second premolars in cleft palate children[J].Eur J Orthod,1983,5(2):145-148.
  [21]Louren O Ribeiro L,Lucimara TDN,Costa B,et al. Dental anomalies of the permanent lateral incisors and prevalence of hypodontia outside the cleft area in complete unilateral cleft lip and palate[J].Cleft Palate Craniofac J,2003,40(2):172-175.
  [22]De Stefani A,Bruno G,Balasso P,et al.Prevalence of hypodontia in unilateral and bilateral cleft lip and palate patients inside and outside cleft area: A case control study[J].Int J Clin Pediatr Dent,2019,43(2):126-130.
  [23]Suzuki A,Takahama Y.Maxillary lateral incisor of subjects with cleft lip and/or palate: Part 1[J].Cleft Palate Craniofac J,1992,29(4):376-379.
  [24]Shapira Y,Lubit E,Kftinec MM.Hypodontia in children with various types of clefts[J].Angle Orthod,2000,70(70):16-21.
  [25]?dám Berniczei-Roykó,Tappe JH,Krinner A,et al.Radiographic study of the prevalence and distribution of hypodontia associated with unilateral and bilateral cleft lip and palate in a Hungarian population[J].Med Sci Monit,2016, 22(21):3868-3885.   [26]阿依古麗·吐尔地,米丛波,潘旭.新疆地区80例唇腭裂患者牙齿异常的初步分析[J]. 中国儿童保健杂志,2010,18(2):89-90.
  [27]Endo T,Ozoe R,Kubota M,et al.A survey of hypodontia in Japanese orthodontic patients[J].Am J Orthod Dentofacial Orthop,2006,129(1):29-35.
  [28]Kim NY,Baek SH. Cleft sidedness and congenitally missing or malformed permane- nt maxillary lateral incisors in Korean patients with unilateral cleft lip and alveolus or unilateral cleft lip and palate[J].Am J Orthod Dentofacial Orthop,2006, 130(6):752-758.
  [29]Ribeiro LL,Das Neves LT,Costa B,et al.Dental development of permanent lateral incisor in complete unilateral cleft lip and palate[J].Cleft Palate Craniofac J, 2002,39(2):193-196.
  [30]Ribeiro LL,DasNeves LT,Costa B,et al.Dental anomalies of the permanent lateral incisors and prevalence of hypodontia outside the cleft area in complete unilateral cleft lip and palate[J].Cleft Palate Craniofac J,2003,40(2):172-175.
  [31]Bartzela TN,Carels CE,Bronkhorst EM,et al.Tooth agenesis patterns in unilater- al cleft lip and palate in humans[J].Arch Oral Biol,2013,58(6):596-602.
  [32]Tortora C,Meazzini MC,Garattini G,et al. Prevalence of abnormalities in dental structure,position,and eruption pattern in a population of unilateral and bilateral cleft lip and palate patients[J].Cleft Palate Craniofac J,2008,45(2):154-162.
  [33]Cassolato SF,Ross B,Daskalogiannakis J,et al.Treatment of dental anomalies in children with complete unilateral cleft lip and palate at Sick Kids hospital[J].Cleft Palate Craniofac J,2009,46(2):166-172.
  [34]Dewinter G,Quirynen M,Heidbuchel K,et al.Dental abnormalities, bone graft qua- lity, and periodontal conditions in patients with unilate- ral cleft lip and palate at dif- ferent phases of orthodontic treatment[J].Cleft Palate Craniofac J,2003, 40(4):343-350.
  [35]Lourenco Ribeiro L,Teixeira Das Neves L,Costa B,et al.Dental anomalies of the permanent lateral incisors and prevalence of hypodontia outside the cleft area in complete unilateral cleft lip and palate[J].Cleft Palate Craniofac J,2003,40(2): 172-175.
  [36]Wangsrimongkol T,Manosudprasit M,Pisek P,et al.Prevalence and types of dental anomaly in Thai non-syndromic oral cleft sample[J].J Med Assoc Thai,2013,96(14): 25-35.
  [37]Aizenbud D,Coval M,Hazan-Molina H,et al.Isolated soft tissue cleft lip: epidemiology and associated dental anomalies[J].Oral Dis,2011,17(2):221-231.
  [38]Amarlal D,Muthu MS,Kumar NS.Root development of permanent lateral incisor in cleft lip and palate children.A radiographic study[J].Indian J Dent Res,2007, 18(2):82-86.   [39]Louren?o RL,Teixeira DNL,Costa B,et al.Dental anomalies of the permanent lateral incisors and prevalence of hypodontia outside the cleft area in complete unilateral cleft lip and palate[J].Cleft Palate Craniofac J,2003,40(2):172-175.
  [40]Hellquist R,Linder-Aronson S,Norling M,et al.Dental abnormalities in patients with alveolar clefts, operated upon with or without primary periosteoplasty[J].Eur J Orthod,1979,1(3):169-180.
  [41]Jiroutová O,Müllerová Z.The occurrence of hypodontia in patients with cleft lip and/or palate[J].Acta Chir Plast,1994,36(2):53-56.
  [42]Mikulewicz M, Kachniarz K,Chojnacka K.Exposure of cleft lip and palate patients to toxic elements released during orthodontic treatment in the study of noninvasive matrices[J].PLoS One,2015,10(11):14-29.
  [43]Manyama M,Larson JR,Liberton DK,et al. Facial morphometrics of children with non syndromic orofacial clefts in Tanzania[J].BMC Oral Health, 2014,29(14): 93-102.
  [44]Lekkas C,Latief BS,Ter Rahe SP,et al.The adult unoperated cleft patient: absence of maxillary teeth outside the cleft area[J].Cleft Palate Craniofac J,2000,37 (1):17-20.
  [45]Shapira Y,Lubit EM.Congenitally missing second premolars in cleft lip and cleft palate children[J].Am J Orthod Dentofacial Orthop,1999,115(4):396-400.
  [46]Polder BJ,Van't Hof MA,Fp VDL,et al.A Meta-analysis of the prevalence of dental agenesis of permanent teeth[J].Community Dent Oral Epidemiol,2010,32(3):217-226.
  [47]Hedayati Z,Dashlibrun YN.The prevalence and distribution pattern of hypodontia among orthodontic patients in Southern Iran[J].Eur J Dent,2013,7(1):78-82.
  [48]Shapira Y,Lubit E,Kuftinec MM.Hypodontia in children with various types of clefts[J].Angle Orthod,2000,70(1):16-21.
  [49]Baek SH,Kim NY.Congenital missing permanent teeth in Korean unilateral cleft lip and alveolus and unilateral cleft lip and palate patients[J].Angle Orthod,2007, 77(1):88-93.
  [50]Hermus RR,van Wijk AJ,Tan SP,et al.Patterns of tooth agenesis in patients with orofacial clefts[J].Eur J Oral Sci,2013,121(4):328-332.
  [收稿日期]2020-04-10
  本文引用格式:伊帕熱·克力木江,古力巴哈·买买提力.单侧完全性唇腭裂患者恒牙先天缺失类型分析[J].中国美容医学,2021,30(3):175-177.
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