两种扩弓方式对骨性Ⅲ类错前方牵引效果的影响  

The effect of maxillary protraction therapy on skeletal class Ⅲ malocclusion with two different methods of rapid maxillary expansion

作　　者：熊再道 柯杰[1] 赵桂芝[1] 林清华[1] 杨鑫铭 肖依寒 

机构地区：[1]解放军空军总医院口腔正畸科,北京100136

出　　处：《中华口腔医学研究杂志（电子版）》2017年第3期169-173,共5页Chinese Journal of Stomatological Research(Electronic Edition)

摘　　要：目的通过头影测量观察比较上颌单纯快速扩弓与反复快速扩缩两种不同扩弓方式对骨性Ⅲ类错牙合患者前方牵引的治疗效果。方法选取20例上颌发育不足的骨性Ⅲ类错牙合患者按扩弓方式分为两组,于治疗前后分别拍摄头颅侧位片并进行相应的测量,采用SPSS 19.0软件对对各组治疗前后所测得数据进行配对样本t检验,对两组各测量项目的前后变化量进行独立样本t检验。结果治疗结束后,两组患者均发生了明显的上颌骨前移,下颌骨后移,其中单纯扩弓组患者SNA增加(3.18±1.92)°,SNB减小了(2.73±0.82)°,ANB增加了(3.94±0.85)°,A-VL增加了(3.53±2.29)mm,B-VL减小了(3.31±2.71)mm;反复扩缩组SNA增加(4.85±1.38)°,SNB减小了(2.49±0.65)°,ANB增加了(4.94±1.07)°,A-VL增加了(6.39±3.15)mm,B-VL减小了(3.93±1.95)mm。上前牙发生了唇倾的同时伴有下颌平面角的增大,两组U1-SN分别增加了(3.97±2.46)°、(4.07±1.68)°,MP-SN分别增加了(3.81±2.21)°、(3.51±1.34)°。其中反复扩缩组SNA(t=2.233,P=0.038)、ANB(t=2.314,P=0.033)、Wit值(t=3.474,P=0003)增加量明显高于单纯快速扩弓组,其余指标变化量组间比较差异并无统计学意义。结论对于需要前方牵引治疗的骨性Ⅲ类错牙合患者,上颌反复扩缩比单纯快速扩弓能够更有效的前移上颌骨,纠正上下颌骨异常位置关系。但是反复扩缩并不能减少下颌骨的后下旋转及减轻上下颌牙性代偿。Objective To compare the effects of maxillary protraction therapy in skeletal class Ⅲ malocclusion with alternate rapid maxillary expansion and constriction（Alt-RAMEC/FM）and with rapid maxillary expansion （RME/FM）. Methods Twenty cases of maxillary deficiency in skeletal classⅢmalocclusion patients were divided into two groups according to the types of expansion,cephalometric images and the corresponding measurements were taken before and after the treatment. The data of two groups before and after treatment were tested with paired sample t test,and the change of the quantity of each item before and after the test of the two groups was performed with independent sample t test by SPSS 19.0 software. Results After the treatment,patients of two groups had obvious maxillary advancement and mandibular retrusion,including simple expansion group SNA increased by（3.18 ± 1.92）°,SNB decreased by（2.73 ± 0.82）° ,ANB increased by（3.94 ± 0.85）° ,A-VL increased by（3.53 ± 2.29）mm,B-VL decreased by（3.31 ± 2.71）mm;and repeatedly expansion group SNA increased by（4.85 ± 1.38）° ,SNB decreased by（2.49 ± 0.65）°,ANB increased by（4.94 ± 1.07）°,A-VL increased by（6.39 ± 3.15）mm,B-VL decreased by（3.93 ± 1.95）mm,The anterior teeth labially proclined with the increase of the mandibular plane angle,the two groups of U1-SN increased by（3.97 ± 2.46）° and（4.07 ± 1.68）° respectively,the MP-SN increased by（3.81 ± 2.21）° and（3.51 ± 1.34）°. The SNA（t=2.233,P=0.038）,ANB（t=2.314,P=0.033） and Wit（t=3.474,P=0003）of the repeated expansion group were significantly higher than that of the simple rapid expansion group. No significant differences were found in other indicators. Conclusions In skeletal classⅢpatients,the Alt-RAMEC/FM protocol can induce more favorable maxillary advancement effects and a greater improvement in sagittal skeletal relationships as compared to the conventional RME/FM protocol,but it cannot reduce the clockwise rotation of mandi

关 键 词：牙正畸牵引 腭扩张术 上颌后缩 上颌前牵引 

分 类 号：R783.5[医药卫生—口腔医学]