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ly.tornado 的博客

真正的专业是要放下自己的本位主义与好恶,从顾客的角度去体会他们的需要,,

 
 
 

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●RME(RAPID MAXILLARY EXPANDER)的臨床介紹   

2009-11-26 19:26:01|  分类: 默认分类 |  标签: |举报 |字号 订阅

  下载LOFTER 我的照片书  |

 

中臉部的發育不足產生矯正需求的案例,在臨床上可以說是屢見不鮮,而且令許多矯正醫師傷透腦筋,特別是下顎骨的生長發育是不能精準的預測,有些案例必須等到成年後再經過OGS(正顎手術)來達到改善

在臨床上,大多數的病人常合併有鼻過敏,容易感冒,呼吸道產生狹窄的問題,甚至引起咬合不良,外貌上的差異性,都是極需要矯正的治療予以解決,使這些併發症得到改進

美國台裔醫生DR.陳秀娟針對生長期中的中臉部發育不足及前牙產生錯咬的案例,採用上顎快速擴大器,配合頭帽的戴用,及蒸氣鼻子呼吸訓練的治療方法,讓病人的上顎骨(MAXILLA)及鼻樑向前突出,下顎骨向後旋轉,從而改善戽斗的臉部外型,且使鼻樑更形挺出,合併嚴重的打鼾或是經年鼻塞的案例,在經過治療後有非常明顯的改善,證明此項方法有明顯的療效,

這一方面可以改善病人的生活品質(如同睡者必須忍受打鼾聲),另一方面可以避免將來必須開刀改善的痛苦,

這次在台北的兩岸四地齒顎矯正研討會,DR.陳秀娟與DR.羅秋美分別都針對此問題提出她們的治療經驗與臨床病例報告,

病人在經過21~25天的快速上顎擴大裝置(RME)的使用,輔以頭帽(CHIN CAP)的戴用,配合1天50次呼氣的蒸氣療法,也就是每天5回合,每回10次的吸&呼氣

RME每轉一圈可以有0.25mm的擴大量,每天早晚各一次轉一圈,

dr.陳秀娟說,這就是把上顎像發酵的麵團一樣,讓它逐漸膨脹起來,達到上顎的生長量,改變外貌

RME的形態結構可以有多樣的變化,從DR.陳秀娟SHOW出的範例基本上都是以HYRAX APPLIANCE為基本架構,做形態上的改變

注意:在治療的過程中,上顎被擴大,中門牙間會出現大量的間隙(SPACE),看起來很可怕,這是顎中縫(MID-PALATAL SUTURE)被打開的關係,3個月後自然會回彈回來

還有,病人戴用CHIN -CUP務必要24小時執行,最少也要一天戴滿21小時,這是為了要讓嘴巴閉起來,利用鼻子來呼吸(而非口呼吸),讓蒸氣療法達到目的

如果病人不能利用21~25天的時間熬過去,療效是會打折扣的,這一點千萬要注意!!

至於白天,由於病患可能要上學,所以一般建議戴一頂帽子(越像騎馬者所戴的帽子那樣),這樣別人看你才不會更奇怪,在美國,老師還會開玩笑的問學生~~WHERE IS YOUR HORSE?(你的馬呢?)

以下是圖例,感謝我的好友台北新華南牙科診所蔣金玉醫師的提供照片

●RME(RAPID MAXILLARY EXPANDER)的臨床介紹  - lytornado - ly.tornado 的博客

●RME(RAPID MAXILLARY EXPANDER)的臨床介紹  - lytornado - ly.tornado 的博客



利用RME和頭帽及下頦帽來治療嚴重的戽斗並可改善口呼吸

致謝:

感謝 陳秀娟醫師 ,日本近藤悅子(dr. Etsuko kondo)醫師,蔣金玉醫師,羅秋美醫師

以前的報導:

旅居加州的華人牙醫陳秀娟研發出新型齒顎矯正法,無須開刀,只要3周就能完成,讓原本臉部

內凹的「上弦月」也能變成俊男美女。
陳秀娟在加州執業,是美國賓州大學矯正臨床指導老師,本月16日於台北榮總、23日於高醫
附設醫院演講,介紹這種「RME」快速上頜擴張(Rapid Maxillary Expander)矯正法。這項新治療法已發表於WJO世界矯正學刊。


「RME」矯正法,是在戽斗患者的上顎內裝進快速擴張器,配合頭帽,加上吸蒸氣,21天就可
完成矯正。陳秀娟在7年內已完成百餘病例。半年前她到台灣,長庚醫院兼任主治醫師羅秋
美,習得此技術。羅秋美說,近半年來以RME法治療30個病例。

以下是羅秋美醫師的網頁~~戽斗矯正實例

Effective maxillary orthopedic protraction for growing Class III patients,a clinical application stimulates distraction osteogenesis(劉人文dr.的雙軸式擴大器的文獻)

(此文獻裡有dr.劉人文在演講時show出的裝置案例圖解)

Sleep Apnea from an Anatomical, Anthropologic and Developmental Perspective(這一篇相當有看頭,圖文並茂的power points)

Bone born Rapid Maxillary Expansion (RME)Dresden Distractor (DD-RME)

Correlations between Rapid Maxillary Expansion (RME) and the Auditory Apparatus

Meta-analysis of immediate changes with rapid maxillary expansion treatment

A Comparison of the Effects of Rapid Maxillary Expansion and Fan-Type Rapid Maxillary Expansion on Dentofacial Structures

Stability of Rapid Maxillary Expansion

CORRECTION OF CLASS III MALOCCLUSION USING RAPID MAXILLARY EXPANSION ( RME )

Early Treatment in Orthodontics

Malocclusion and upper airway obstruction

Obstructive sleep apnoea syndrome: treatment update

Nasal cavity changes and the respiratory standard after maxillary expansion

Evaluation of the Rapid Maxillay Expansion Appliances Effects on skeletal,dental and upper airway with posteroanterior graphics

A Cephalometric Comparison of Pharynx and Soft palate in subjects treated with Rapid Maxillary Expansion

Changes in Dental Arch Dimension among Dental Class II Patients after Rapid Maxillary Expansion Therapy

Exploratory Work on the Effect of Rapid Maxillary Expansion on Nasal Airway Dimensions

The Influence of Nasal Obstruction and Chronic Mouth Breathing on Dentofacial Aesthetics

Sleep-disordered Breathing in Children

Rapid Maxillary Expansion (Park Jeong Hyun ,Dept. of Orthodontics, Gil Medical Center)非常有意義的data

Surgically Assisted Rapid Maxillary Expansion; surgical and orthodontic aspects

Nasal obstruction and facial growth: The strength of evidence for clinical assumptions

AN ASSESSMENT OF THE MAXILLA AFTER RAPID MAXILLARY EXPANSION USING CONE BEAM COMPUTED TOMOGRAPHY IN GROWING CHILDREN

 Effects of rapid maxillary expansion on Holdaway soft tissue measurements

Lower anterior face height and lip incompetence do not predict nasal airway obstruction

Rapid Maxillary Expansion and Surgically Assisted Rapid Maxillary Expansion Effects on Nasal Volume

Rapid Palatal Expansion Effects on Nasal Airway Dimensions as Measured by Acoustic Rhinometry

 Rapid Maxillary Expansion and Conductive Hearing Loss

Rapid Palatal Expansion In Adults With and Without Surgery

Cited (引用)by(点PDF就可以觀看)

Oral  Sokucu, H. Huseyin  Kosger, A. Altug  B?cakci, Hasan  Babacan. (2009) Stability in Dental Changes in RME and SARME: A 2-Year Follow-up. The Angle Orthodontist 79:2, 207-213
Online publication date: 1-Mar-2009.
Abstract | Full Text | PDF (207 KB) 
Nihat  Kilic, Ali  Kiki, Hüsamettin  Oktay, Erol  Selimoglu. (2008) Effects of Rapid Maxillary Expansion on Conductive Hearing Loss. The Angle Orthodontist 78:3, 409-414
Online publication date: 1-May-2008.
Abstract | Full Text | PDF (53 KB) 
Oral  Sökücü, F?rat  Öztürk, Hasan  Babacan, Ali Altu?  B?çakç?. (2008) Does Rapid Maxillary Expansion Affect the Eruption of Upper Third Molars?. The Angle Orthodontist 78:2, 195-200
Online publication date: 1-Mar-2008.
Abstract | Full Text | PDF (150 KB) 
Daniela Gamba  Garib, JoséFernando Castanha  Henriques, Paulo Eduardo Guedes  Carvalho, Simone Carinhena  Gomes. (2007) Longitudinal Effects of Rapid Maxillary Expansion. The Angle Orthodontist 77:3, 442-448
Online publication date: 1-May-2007.
Abstract | Full Text | PDF (103 KB) 
Hasan  Babacan, Oral  Sokucu, Cenk  Doruk, Sinan  Ay. (2006) Rapid Maxillary Expansion and Surgically Assisted Rapid Maxillary Expansion Effects on Nasal Volume. The Angle Orthodontist 76:1, 66-71
Online publication date: 1-Jan-2006.
Abstract | Full Text | PDF (185 KB) 
Lisa K.  Wendling, James A.  McNamara  Jr, Lorenzo  Franchi, Tiziano  Baccetti. (2005) A Prospective Study of the Short-term Treatment Effects of the Acrylic-splint Rapid Maxillary Expander Combined with the Lower Schwarz Appliance. The Angle Orthodontist 75:1, 7-14
Online publication date: 1-Jan-2005.
Abstract | Full Text | PDF (100 KB) 
Cenk  Doruk, Ali Altug  Bicakci, Faruk Ayhan  Basciftci, Ugur  Agar, Hasan  Babacan. (2004) A Comparison of the Effects of Rapid Maxillary Expansion and Fan-Type Rapid Maxillary Expansion on Dentofacial Structures. The Angle Orthodontist 74:2, 184-194
Online publication date: 1-Apr-2004.
Abstract | Full Text | PDF (254 KB) 
Michiru  Takeuchi, Eiji  Tanaka, Daisuke  Nonoyama, Junko  Aoyama, Kazuo  Tanne. (2002) An Adult Case of Skeletal Open Bite with a Severely Narrowed Maxillary Dental Arch. The Angle Orthodontist 72:4, 362-370
Online publication date: 1-Aug-2002.
Abstract | Full Text | PDF (942 KB) 
F. A.  Basciftci, A. I.  Karaman. (2002) Effects of a Modified Acrylic Bonded Rapid Maxillary Expansion Appliance and Vertical Chin Cap on Dentofacial Structures. The Angle Orthodontist 72:1, 61-71
Online publication date: 1-Feb-2002.
Abstract | Full Text | PDF (820 KB) 
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