华西口腔医学杂志 ›› 2020, Vol. 38 ›› Issue (3): 301-307.doi: 10.7518/hxkq.2020.03.013
收稿日期:
2019-08-15
修回日期:
2020-04-08
出版日期:
2020-06-01
发布日期:
2020-05-28
通讯作者:
陈莉莉
E-mail:chenlili1030@hust.edu.cn
作者简介:
程锋,住院医师,硕士,E-mail: 2445032652@qq.com
基金资助:
Cheng Feng, Jian Zhishan, Zhu Ying, Zhang Chunyan, Hu Li, Chen Lili()
Received:
2019-08-15
Revised:
2020-04-08
Online:
2020-06-01
Published:
2020-05-28
Contact:
Chen Lili
E-mail:chenlili1030@hust.edu.cn
Supported by:
摘要:
目的 探讨传动直丝弓技术矫正骨性Ⅲ类错牙合畸形的疗效及优势。方法 选择2012年1月—2017年1月因骨性Ⅲ类错牙合就诊于华中科技大学同济医学院附属协和医院口腔医学中心,拒绝手术治疗而采用正畸掩饰性治疗的患者97名进行回顾性研究。根据骨性畸形的程度分为2组:轻中度骨性组(-4°≤ANB角<0°)和重度骨性组(-8°≤ANB角<-4°),每组按照采用的矫治技术不同又分为2组:传动矫治技术(T组)和MBT矫治技术(M组)。结果 97名患者均已结束治疗。轻中度骨性组:59名患者前牙反均解除,磨牙恢复Ⅰ类关系,面型明显改善,但T组中U1/SN角、L1/MP角、Lip-Diff等指标矫治前后的差值与M组相比差异有统计学意义(P<0.05),T组与M组相比上下切牙区牙根吸收程度更轻(P<0.05);重度骨性组:38名患者前牙反解除或基本解除,其中14例出现下颌前牙过度舌倾(M组9名,T组5名),面型改善不佳。24例矫治结果较理想的患者,T组中U1-NA值、U1/SN角、L1-NB值、L1/MP角、LLP、Lip-Diff等指标矫治前后的差值与M组相比差异有统计学意义(P<0.05),T组与M组相比上下切牙区牙根吸收程度更轻(P<0.05)。结论 相对于MBT矫治技术,传动力矫治技术在治疗骨性Ⅲ类错牙合患者时,存在可使面型改善更加明显、上下前牙的代偿倾斜度更小、牙根吸收的风险率更低等优势,应用在骨性Ⅲ类错牙合中优势更明显。
中图分类号:
程锋, 简志杉, 朱莹, 张纯燕, 胡丽, 陈莉莉. 传动直丝弓技术矫正骨性Ⅲ类错牙合的疗效分析[J]. 华西口腔医学杂志, 2020, 38(3): 301-307.
Cheng Feng, Jian Zhishan, Zhu Ying, Zhang Chunyan, Hu Li, Chen Lili. Therapeutic effect analysis of skeletal class Ⅲ malocclusion treatment by transmission straight wire technique[J]. West China Journal of Stomatology, 2020, 38(3): 301-307.
表 1
主要参考指标及其意义
参考指标 | 定义 | 临床意义 |
---|---|---|
SNA角/° | 蝶鞍中心(S)、鼻根点(N)及上齿槽座点(A)所构成的角 | 上颌骨相对于颅部的前后位置关系 |
SNB角/° | S、N及下齿槽座点(B)所构成的角 | 下颌骨相对于颅部的前后位置关系 |
ANB角/° | A、N及B所构成的角度 | 上下颌骨相对于颅部的相互位置关系 |
Wits值/mm | 上下齿槽座点向功能性平面所做垂线的距离 | 上下颌骨前部的位置关系 |
Y轴角/° | Y轴(蝶鞍中心与颏顶点的交点)与眼耳平面(FH)相交之下内角 | 颏部的突度及面部生长发育的方向 |
NP-FH/° | 面平面(NP)与FH的相交之后下角 | 下颌的突缩程度 |
U1-NA/mm | 上中切牙切缘至鼻根点-上齿槽座点连线(NA)的垂直距离 | 上中切牙的倾斜度和突度 |
U1/SN/° | 上中切牙长轴与SN平面相交的下内角 | 上中切牙相对于前颅底的倾斜度 |
L1-NB/mm | 下中切牙切缘至鼻根点-下齿槽座点连线(NB)的垂直距离 | 下中切牙的倾斜度和突度 |
L1/MP/° | 下中切牙长轴与MP平面相交的上内角 | 下中切牙相对于下颌平面的倾斜度 |
ULP/mm | 上唇最突点(UL)到鼻下点-软组织颏前点连线(Sn-Pog’)的距离 | 上唇突度 |
LLP/mm | 下唇最突点(LL)到鼻下点-软组织颏前点连线(Sn-Pog’)的距离 | 下唇突度 |
Lip-Diff/mm | ULP与LLP之差 | 上下唇位置关系 |
H角/° | Pog’-UL连线又名H线(Holdaway线),与NB的交角 | 软组织颏部与唇的关系 |
NLA/° | 是鼻下点与鼻小柱点连线和鼻下点与上唇突点连线的前交角 | 侧脸均衡的典型指标 |
上尖牙轴倾度/° | 上尖牙临床冠长轴与平面垂线所组成的角 | 上尖牙的近远中倾斜程度 |
下尖牙轴倾度/° | 下尖牙临床冠长轴与平面垂线所组成的角 | 下尖牙的近远中倾斜程度 |
表 2
轻中度骨性组各测量指标术前术后差值比较
测量指标 | T组(n=30) | M组(n=29) | P值* | ||||||
---|---|---|---|---|---|---|---|---|---|
矫治前 | 矫治后 | 差值 | P值 | 矫治前 | 矫治后 | 差值 | P值 | ||
SNA角/° | 82.7±3.7 | 83.3±3.5 | 0.6±0.5 | <0.05 | 81.7±3.5 | 82.3±3.6 | 0.6±0.5 | <0.05 | 0.89 |
SNB角/° | 84.7±3.2 | 84.2±3.2 | -0.5±0.3 | <0.05 | 83.9±3.0 | 83.6±3.0 | -0.3±0.4 | <0.05 | 0.10 |
ANB角/° | -2.0±0.8 | -0.9±0.9 | 1.1±0.7 | <0.05 | -2.2±1.2 | -1.3±1.2 | 0.9±0.7 | <0.05 | 0.27 |
Wits值/mm | -4.0±1.6 | -2.1±1.7 | 1.8±0.7 | <0.05 | -4.4±1.6 | -2.5±1.6 | 1.9±0.9 | <0.05 | 0.57 |
Y轴角/° | 61.4±1.8 | 62.1±1.9 | 0.7±0.5 | <0.05 | 60.1±1.6 | 60.9±1.6 | 0.8±0.7 | <0.05 | 0.59 |
NP-FH/° | 88.1±1.4 | 87.6±1.5 | 0.5±0.5 | <0.05 | 87.3±2.1 | 87.0±2.1 | 0.4±0.2 | <0.05 | 0.12 |
U1-NA/mm | 0.5±0.3 | 0.7±0.3 | 0.2±0.2 | <0.05 | 0.5±0.3 | 0.6±0.2 | 0.1±0.2 | <0.05 | 0.07 |
U1/SN/° | 108.1±2.2 | 112.4±2.3 | 4.3±0.8 | <0.05 | 107.0±2.5 | 112.9±2.9 | 5.9±0.9 | <0.05 | <0.05 |
L1-NB/mm | 0.5±0.3 | 0.4±0.4 | -0.2±0.4 | 0.05 | 0.5±0.3 | 0.4±0.3 | -0.2±0.2 | <0.05 | 0.82 |
L1/MP/° | 86.7±5.1 | 83.1±5.2 | -3.6±0.8 | <0.05 | 89.9±2.9 | 83.4±3.6 | -6.5±2.0 | <0.05 | <0.05 |
ULP/mm | 7.0±0.8 | 7.9±0.8 | 0.9±0.3 | <0.05 | 6.8±0.7 | 7.6±0.8 | 0.8±0.5 | <0.05 | 0.20 |
LLP/mm | 10.4±1.0 | 9.1±1.1 | -1.3±0.6 | <0.05 | 10.1±0.7 | 8.9±0.8 | -1.2±0.4 | <0.05 | 0.16 |
Lip-Diff/mm | -3.4±0.6 | -1.2±0.8 | 2.3±0.6 | <0.05 | -3.3±0.4 | -1.3±0.7 | 2.0±0.5 | <0.05 | <0.05 |
H角/° | 8.0±1.4 | 12.1±1.3 | 4.1±1.0 | <0.05 | 8.2±1.0 | 12.5±1.5 | 4.3±1.1 | <0.05 | 0.57 |
NLA/° | 94.2±8.4 | 92.2±6.9 | -2.0±3.2 | <0.05 | 92.8±8.8 | 89.9±9.2 | -2.9±2.7 | <0.05 | 0.26 |
上尖牙轴倾度/° | 11.6±2.1 | 9.4±0.9 | -2.2±2.2 | <0.05 | 9.7±2.5 | 9.3±0.6 | -0.5±2.3 | 0.27 | <0.05 |
下尖牙轴倾度/° | 1.0±2.0 | 2.9±0.7 | 1.9±2.0 | <0.05 | 1.6±1.3 | 2.7±0.7 | 1.1±1.3 | <0.05 | 0.11 |
表 3
重度骨性组各测量指标术前术后差值比较
测量指标 | T组(n=14) | M组(n=10) | P值* | ||||||
---|---|---|---|---|---|---|---|---|---|
矫治前 | 矫治后 | 差值 | P值 | 矫治前 | 矫治后 | 差值 | P值 | ||
SNA角/° | 82.3±3.7 | 83.2±3.6 | 0.8±0.5 | <0.05 | 82.1±4.0 | 82.7±4.2 | 0.6±0.8 | 0.05 | 0.44 |
SNB角/° | 87.9±4.0 | 87.4±4.1 | -0.4±0.7 | <0.05 | 88.0±4.3 | 87.4±4.4 | -0.6±0.8 | 0.06 | 0.63 |
ANB角/° | -5.6±0.9 | -4.3±1.2 | 1.3±0.8 | <0.05 | -5.9±0.8 | -4.7±0.9 | 1.2±0.6 | <0.05 | 0.85 |
Wits值/mm | -7.5±1.3 | -5.9±1.3 | 1.6±0.7 | <0.05 | -8.3±0.9 | -6.7±0.9 | 1.6±0.6 | <0.05 | 0.91 |
Y轴角/° | 57.2±8.3 | 59.0±8.0 | 1.8±0.7 | <0.05 | 54.0±2.8 | 56.3±3.4 | 2.3±1.2 | <0.05 | 0.27 |
NP-FH/° | 94.4±5.9 | 92.7±5.7 | -1.7±0.9 | <0.05 | 94.1±4.0 | 92.2±4.0 | -1.8±0.8 | <0.05 | 0.63 |
U1-NA/mm | 0.4±0.2 | 0.7±0.3 | 0.4±0.1 | <0.05 | 0.5±0.2 | 0.6±0.3 | 0.2±0.1 | <0.05 | <0.05 |
U1/SN/° | 102.9±9.2 | 108.0±8.6 | 5.1±1.9 | <0.05 | 105.2±5.9 | 112.4±5.6 | 7.2±1.6 | <0.05 | <0.05 |
L1-NB/mm | 0.5±0.3 | 0.0±0.3 | -0.5±0.2 | <0.05 | 0.4±0.2 | 0.2±0.2 | -0.2±0.2 | <0.05 | <0.05 |
L1/MP/° | 86.5±6.2 | 78.9±6.5 | -7.7±2.0 | <0.05 | 85.7±5.2 | 74.8±5.0 | -10.9±2.6 | <0.05 | <0.05 |
ULP/mm | 6.9±1.0 | 7.5±0.9 | 0.7±0.2 | <0.05 | 6.2±0.8 | 7.1±0.8 | 0.9±0.2 | <0.05 | 0.06 |
LLP/mm | 12.9±1.3 | 9.0±1.3 | -3.9±0.5 | <0.05 | 12.1±1.9 | 10.0±2.1 | -2.1±0.3 | <0.05 | <0.05 |
Lip-Diff/mm | -6.1±1.3 | -1.5±1.3 | 4.6±0.5 | <0.05 | -5.9±1.8 | -3.0±2.0 | 3.0±0.4 | <0.05 | <0.05 |
H角/° | 5.8±0.9 | 11.7±1.5 | 5.8±1.0 | <0.05 | 5.2±0.9 | 10.6±0.7 | 5.4±0.5 | <0.05 | 0.21 |
NAL/° | 95.1±5.9 | 91.0±5.8 | -4.1±3.0 | <0.05 | 95.3±5.1 | 89.6±5.5 | -5.8±3.0 | <0.05 | 0.22 |
上尖牙轴倾度/° | 11.1±2.3 | 8.9±1.0 | -2.2±2.9 | <0.05 | 10.3±2.2 | 8.3±1.3 | -2.0±1.7 | <0.05 | 0.85 |
下尖牙轴倾度/° | 1.5±2.4 | 3.2±0.9 | 1.7±2.9 | 0.05 | 1.4±1.9 | 3.0±0.5 | 1.7±1.8 | <0.05 | 0.99 |
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