不同年龄骨性Ⅲ类错粘结式快速扩弓并上颌前方牵引后的颌面变化  

Cranio-occlusional changes of skeletal class Ⅲ malocclusion in different aged patients treated with bonded maxillary expansion and maxillary protraction

作　　者：孔凡芝[1] 经海永[2] 耿丽 王玉玲[4] 佘鹏[1] 王春玲[5] 

机构地区：[1]江苏大学附属人民医院口腔科,江苏省镇江市212002 [2]江苏大学临床医学院,江苏省镇江市212013 [3]山东省鱼台县人民医院,山东省鱼台县272300 [4]山东省千佛山医院口腔科,山东省济南市250014 [5]山东大学口腔医学院,山东省济南市250012

出　　处：《中国组织工程研究与临床康复》2008年第30期5824-5828,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：江苏省科技厅社会发展项目(BS2002363)~~

摘　　要：背景:利用上颌快速扩弓和前方牵引矫治6～9岁患者效果较好,但对于10～15岁较大年龄骨性反患者,目前尚无简便有效的治疗方法。目的:观察联合应用上颌前方牵引配合粘结式快速扩弓治疗较大年龄骨性Ⅲ类错患者颌、面变化。设计、时间及地点:观察对比试验,于2003-07/2007-10在江苏大学附属人民医院口腔科完成。参试者:骨性Ⅲ类错患者60例,其中6～9岁组30例,10～15岁组30例。干预:所有患者先行粘结式上颌快速扩弓治疗,待上下颌覆盖达到3.0～4.0mm时,给予上颌前方牵引治疗,牵引约半年之后去除矫治器予以保持。主要观察指标:采用Pancherz头颅定位X射线侧位测量系统,分别测量牵引前后上下颌骨及上下切牙位置变化,包括6个骨性标志点和4个牙性标志点。结果:两组患者6个骨性标志点在水平向均有明显变化,不仅上颌骨前界前移显著(P<0.001),而其后界翼上颌裂点及后鼻棘亦有明显变化。4个牙性标志点变化显示上切牙前移,下切牙后移,上磨牙近中移动,下磨牙远中移动上颌牙弓变化均较显著,上颌尖牙间,第一、二双尖牙间、第一磨牙间宽度均显著增大。下牙弓变化中,第二双尖牙间和磨牙间宽度增加有显著性差异。结论:联合应用上颌前方牵引和粘结式快速扩弓对10～15岁骨性安氏Ⅲ类错患者骨矫形效果显著,可减轻畸形程度。BACKGROUND： Bonded maxillary expansion and maxillary protraction shows favorable effect in treating patients with skeletal class Ⅲ malocclusion aged 6-9 years, but there is no efficient treatment for patients aged 10-15 years. OBJECTIVE： To explore cranio-occlusional changes of patients with skeletal class Ⅲ malocclusion following treatment with a bonded maxillary expansion and maxillary protraction. DESIGN, TIME AND SETTING： Comparative observation was performed at the Department of Stomatology, People＇s Hospital of Jiangsu University from July 2003 to October 2007. PARTICIPANTS： Sixty cases of skeletal class Ⅲ malocclusion including thirty cases （16males, 14 females） aged 6-9 years and thirty cases （12 males, 18 females） aged 10-15 years. INTERVENTION： All patients were treated with a bonded maxillary expansion, followed by maxillary protraction for six months when the anterior teeth overbite was to 3.0-4.0 mm. MAIN OUTCOME MEASURES： The upper and lower mandible and upper and lower incisor teeth location changes before and after treatment were measured using Pancherz cephalometrics system including 6 skeletal markers and 4 tooth markers. RESULTS： The six skeletal markers of two groups showed obvious changes at horizontal level. The maxillary bone significantly forward moved （P 〈 0.001）, and the markers of pterygomaxillary fissure and posterior nasal spine showed obvious changes. Of the four teeth markers, the upper incisors forward moved, the lower incisors backward moved, the maxillary molars moved to the anterior, the mandibular molars distally moved to the middle. The width of maxillary canines, maxillary premolars and maxillary first molar significantly increased. In addition, the changes of width between second bicuspid and mandibular molars showed statistical significances. CONCLUSION： For patients of 10-15 years old with skeletal class Ⅲ malocclusion, a bonded maxillary expansion and maxillary protraction is efficient and can alleviate deformity.

关 键 词：骨性Ⅲ类错 上颌前方牵引 快速扩弓 上颌复合体 

分 类 号：R783.5[医药卫生—口腔医学]