正畸临界病例拔牙与非拔牙治疗其硬组织变化的长期观察  

Long-term changes of hard-tissue in borderline cases with extraction vs. nonextraction treatment

作　　者：刘妍[1] 黄微[1] 许天民[1] 

机构地区：[1]北京大学口腔医学院.口腔医院正畸科,北京100081

出　　处：《北京大学学报（医学版）》2008年第6期633-638,共6页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(30672350)资助~~

摘　　要：目的:对比正畸临界病例采用拔牙与非拔牙治疗其硬组织的长期变化。方法:由北京大学口腔医院正畸科5位具有副高职称的医师对一批正畸病例进行拔牙或不拔牙或临界的判断,判断得到治疗资料完整的临界病例54例。追踪随访治疗结束至少2年病例,共获得21例,其中拔牙组8例,非拔牙组13例。对样本治疗前后及随访时的头颅侧位片进行计算机定点测量。结果:拔牙组随访阶段骨骼指标变化差异有统计学意义(P<0.05),矢状向上SNB、SNPg角增大,垂直向上MP/SN减小,ArGo/ANSMe增大;上切牙唇向回复,U1/PP、U1/NA、U1-AP增大(P<0.05),但覆盖无明显回复。非拔牙组随访阶段骨骼变化差异无统计学意义,仅下切牙舌向回复,L1/MP减小,且覆盖有所增大(P<0.05)。两组对比,治疗前骨骼和牙齿指标中仅MP/SN、ArGoGn差异有统计学意义;治疗结束时上下切牙倾斜度及唇舌向位置(L1/NB、L1-NB、L1-AP、U1-AP、U1/L1)在两组间差异有统计学意义;随访时仅非拔牙组的L1/MP明显大于拔牙组(P<0.05)。结论:临界病例拔牙组与非拔牙组在随访阶段前牙均表现出一定的回复趋势,从而使治疗对两组造成的差异逐渐缩小。但拔牙组表现出下颌骨逆时针旋转的骨性变化,从而覆盖保持稳定;非拔牙组下切牙少量舌向回复且无骨骼变化,覆盖有所增大。Objective：To investigate hard-tissue changes in borderline cases with extraction and nonextraction during treatment and follow-up stages. Methods： Five associate professors, who were from Peking University School and Hospital of Stomatology, were asked to make judgment on the cases with full pre-treatment records for discriminating the borderline cases from extraction and non-extraction cases. Fif- ty-four borderline cases with full treatment records which had been out of treatment for at least 2 years were followed. Twenty-one cases with follow-up records were collected including 8 extraction cases and 13 non-extraction cases. Cephalometric measurements were preceeded in IDAS （Image and Database Analysis System） software program. Results： In extraction group, significant changes of SNB, SNPg in A-P di- rection and that of ArGo/ANSMe, MP/SN in vertical direction were present during the follow-up stage, while the overjet was stable. In non-extraction group, only decrease of proclination of lower incisor and increase of overjet were present without any skeletal changes during the follow-up stage. In comparison of the two groups, no skeletal and dental changes showed statistically significant difference except for MP/SN and ArGoGn in pre-treatment stage, while dental characteristics in relation to upper and lower incisor（L1/NB, L1-NB, L1-AP, U1-AP, U1/L1 ） showed statistically significant difference between the two groups after treatment. But in follow-up stage, the skeletal and dental pattern tended to be similar for both groups only except for the proclination of lower incisor. Conclusion： The similarities of skeletal and dental pattern are demonstrated in extraction and non-extraction group before treatment. Dental changes are the major posttreatment changes in the two groups. In follow-up stage, counter-clockwise rotation of mandible is unique in extraction group, which is hkely a hepful factor for stability of overjet, while lingual tipping of lower incisor in non-extraction group without skelet

关 键 词：正畸学 矫正 拔牙 测颅法 对比研究 

分 类 号：R783.5[医药卫生—口腔医学]