Twin-block与高位头帽肌激动器功能矫治后上切牙区牙槽骨改建的对比研究  

Comparative study of alveolar bone remodeling around the upper incisor area after Twin-block and high-pull headgear-activator functional orthopedic therapy

作　　者：徐娟 邱靓星[1] 任嫒姝[1] 张林[1] 杨红梅[1] 王华桥[1] XU Juan;QIU Liang-xing;REN Ai-shu;ZHANG Lin;YANG Hong-mei;WANG Hua-qiao.(Department of Orthodontics,Stomatological Hospital of Chongqing Medical University,Chongqing KeyLaboratory of Oral Diseases and Biomedical Sciences,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering ofHigher Education. Chongqing40J147,China)

机构地区：[1]重庆医科大学附属口腔医院正畸科口腔疾病与生物医学重庆市重点实验室重庆市高校市级口腔生物医学工程重点实验室,重庆401147

出　　处：《上海口腔医学》2019年第1期41-47,共7页Shanghai Journal of Stomatology

基　　金：国家自然科学基金(81400541);中国博士后科学基金(2013M542248);重庆市卫生局面上项目(2012-2-131;2015MSXM051);2016年重庆高校创新团队建设计划资助项目(CXTDG201602006);重庆市高校市级口腔生物医学工程重点实验室资助项目

摘　　要：目的:探讨生长发育高峰期患者功能矫治后上颌切牙位移及牙槽骨改建情况。方法:选择使用高位头帽肌激动器(HGAC)和Twin-block功能矫治器矫治成功的30例骨性Ⅱ类下颌骨后缩患者为研究对象,根据使用矫治器的不同将其分为HGAC组和Twin-block组,每组15例患者。治疗前及治疗后分别拍摄锥形束CT(CBCT),观察上颌中切牙在牙槽骨内的相对位置变化及牙槽骨改建情况。采用SPSS 20.0软件包对治疗前、后唇腭侧牙槽骨厚度、中切牙及牙槽骨角度变化进行分析。结果:在水平方向上,HGAC组和Twin-block组中切牙切缘均发生舌侧移动,而HGAC组根尖发生舌侧移动,Twin-block组根尖发生唇向移动;在垂直方向上,所有患者中切牙切缘均发生向下移动,根尖发生向上移动,但HGAC组切缘垂直方向向下移动较少,根尖垂直方向向上移动较多。HGAC组多数位点牙槽骨厚度增加,而Twin-block组唇侧牙槽骨厚度均减少,腭侧牙槽骨厚度增加。2组牙槽骨总厚度均增加,但Twin-block组牙槽骨总厚度增加更多,HGAC组牙槽骨角度减小更多。结论:2种功能矫治器均可使上切牙区牙槽骨发生积极的生长改建。HGAC在对上切牙实现控制性倾斜内收的同时,可使切牙有一定程度的压入,同时使上切牙区牙槽骨生长角度发生一定变化,而这种变化有利于改善Ⅱ类骨面型。Twin-block可使上切牙倾斜内收,提示在Twin-block功能矫治后行固定正畸内收前牙时,需更加注意前牙转矩的控制。PURPOSE: The aim of this clinical study was to evaluate the changes of alveolar bone morphology around the upper incisors before and after functional treatment in adolescents using cone-beam CT(CBCT). METHODS: Thirty patients with skeletal Class II mandibular retrusion who were successfully treated with high-pull headgear-activator(HGAC) and Twin-block were selected and divided into 2 groups(HGAC and Twin-block groups), 15 in each group.CBCT was performed before and after treatment, to observe upper incisor movement in the alveolar bone and alveolar bone remodeling. Statistical analysis was performed using SPSS 20.0 software package to analyze the changes of alveolar bone thickness, angle of central incisor and alveolar bone before and after treatment. RESULTS: Horizontally, the edge of the maxillary incisor appeared lingual movement in both groups, while the root apex appeared lingual movement in HGAC group and labial movement in Twin-block group. Vertically, the edge of the maxillary incisor was moved down and the root apex was moved up in all patients, whereas the moving distance was less in the edge and larger in the root apex in HGAC group. The thicknesses of major areas in the alveolar bone significantly increased in HGAC group, while in Twinblock group the labial thickness of the alveolar bone showed significant decrease and the palatal thickness showed significant increase. Moreover, the total thickness of the alveolar bone showed significant increase in both groups, yet Twin-block group showed more increase, and the angle of the alveolar bone showed more decrease in HGAC group.CONCLUSIONS: Both functional appliances can cause positive alveolar bone remodeling in maxillary incisor area.HGAC can achieve a controlled tilt inward movement of the maxillary incisors, intrude the incisors to a certain extent, and allow certain change in the bending angle of the incisor alveolar bone at the same time, which is conducive to improving ClassⅡcraniofacial pattern. Twin-block can tilt the maxillary incisor inward,

关 键 词：功能矫治 高位头帽肌激动器:Twin-block 牙槽骨改建 锥形束CT 

分 类 号：R783.5[医药卫生—口腔医学]