骨性Ⅲ类畸形上颌前方牵引治疗的三维测量分析  

Three dimensional measurement and analysis of maxillary protraction treatment in skeletal Class Ⅲ malocclusion

作　　者：秦燕军[1] 沈云娟[1] 谷妍[2,3] 王珊[2,3] 刘可[4] 赵春洋[2,3] 

机构地区：[1]常州市口腔医院口腔正畸科,江苏常州213003 [2]南京医科大学口腔医学研究所 [3]南京医科大学附属口腔医院口腔正畸科,江苏南京210029 [4]南京军区南京总医院口腔科,江苏南京210002

出　　处：《上海口腔医学》2014年第6期699-703,共5页Shanghai Journal of Stomatology

基　　金：江苏省高校优势学科建设工程资助项目~~

摘　　要：目的：通过锥形束CT（cone-beam computed tomography,CBCT）研究骨性Ⅲ类错畸形患者上颌前方牵引治疗前后的变化,从三维方向上探讨上颌前方牵引治疗的机制。方法：选取14例恒牙列早期骨性Ⅲ类错畸形患者,男6例,女8例,年龄10-12岁,平均10.9岁,采用上颌前方牵引治疗。牵引治疗前、后,进行CBCT三维扫描,采用Dolphin 11.0对骨组织及牙进行三维重建、建立三维坐标体系,选择23个标志点进行测量、分析。测量结果使用SPSS 17.0软件包进行统计学分析。结果 ：上颌前方牵引后,A-冠状面的距离、SNA、ANB均显著增大（P〈0.01）;A-水平面的距离显著增大（P〈0.05）,ANS-PNS增大,有显著差异（P〈0.05）,上颌骨向前、向下生长。Po-S-N显著增大（P〈0.01）,SNB显著减小（P〈0.05）,提示颏部向下、向后旋转,下颌生长得到抑制。U1j-冠状面的距离显著增大（P〈0.01）,提示上切牙前移;U1牙长轴-SN交角显著增大（P〈0.05）,提示上切牙唇倾。U6j-水平面的距离、U6j-冠状面的距离均显著增大（P〈0.05）,提示上颌磨牙近中移动、伸长。额颌缝等4条骨缝三维方向上均有变化,但无显著差异（P〉0.05）。结论：上颌前方牵引后,经CBCT三维测量,证实翼腭缝等骨缝的生长改建在上颌骨生长过程中发挥了重要作用,上颌骨及上颌牙明显向前、向下生长;下颌骨生长得到抑制。PURPOSE： To study the three-dimensional mechanism of maxillary protraction in skeletal Class Ⅲ malocclusion by cone-beam CT （CBCT）. METHODS： Fourteen patients （6 males and 8 females with a mean age of 10.9 years） of early permanent dentition with skeletal ClassⅢ malocclusion were treated with maxillary protraction. CBCT was used to obtain the Dieom data both before and after treatment, and then digitized with the software Dolphin 11.0 was used to reconstruct and establish the tridimensional coordinate system. 23 landmarks were chosen for measurement and analysis. The data was analyzed using SPSS 17.0 software package. RESULTS： After maxillary protraction, A- coronal plane distance, SNA and ANB increased significantly （P〈0.01）; A- horizontal plane distance, ANS-PNS increased significantly （P〈0.05）, suggest maxillary growth was forward and downward. Po-S-N increased significantly （P〈0.01）, while SNB decreased significantly （P〈0.05）, suggesting that the chin was rotated downward and backward, and mandibular growth was inhibited. Ulj - the coronal plane distance increased significantly （P〈0.01）, suggesting that the upper incisor moved forward; U1-SN angle increased significantly （P〈0.05）, suggesting anterior teeth inclined labially. The distance between U6j- horizontal plane and U6j- the coronal plane increased significantly （P〈0.05）, suggesting that maxillary molarelongated and moved mesially. Frontomaxillary suture changed on the three-dimensional direction, but without significant difference （P〉0.05）. CONCLUSIONS： Three-dimensional measurements confirm that growth and remodeling of bone suture （such as pterygopalatine suture） play an important role in maxilla development. The maxilla and maxillary teeth move forward and downward, while the mandibular growth is inhibited after maxillary protraction.

关 键 词：骨性Ⅲ类错 前方牵引 骨缝 锥形束CT 三维测量 

分 类 号：R783.5[医药卫生—口腔医学]