无托槽隐形矫治对替牙期上颌横向发育不足患者扩弓的骨性效应  

Skeletal expansion effect of clear aligners in mixed dentition patients with constricted maxilla

作　　者：韦梦瑶 胡心怡[1] 李晅 WEI Mengyao;HU Xinyi;LI Xuan(Department of Stomatology,Children’s National Medical Center,Children’s Hospital of Fudan University,Shanghai 201102,China;Department of Orthodontics,Shanghai Stomatological Hospital,Fudan University;Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases,Fudan University)

机构地区：[1]国家儿童医学中心,复旦大学附属儿科医院口腔科,上海201102 [2]上海市口腔医院口腔正畸科 [3]上海市颅颌面发育与疾病重点实验室

出　　处：《山西医科大学学报》2023年第5期702-706,共5页Journal of Shanxi Medical University

基　　金：上海申康医院发展中心促进市级医院临床技能与临床创新能力三年行动计划重大临床研究项目(SHDC2020CR2043B);上海市卫生健康委员会基金面上项目(201940022);中国牙病防治基金会科研项目(A2021-11);上海市口腔医院重点项目(SSDC-2018-03)。

摘　　要：目的 比较替牙期上颌横向发育不足患者应用无托槽隐形矫治器扩弓后,不同支持方式和速率下的骨性扩弓效果。方法 收集替牙期上颌横向发育不足3.0~3.5 mm的患者48例,采用无托槽隐形矫治器进行扩弓治疗,根据纳入顺序,并依照不同扩弓速率(快/慢)和支持方式(混合支持/牙支持)随机分成4组:混快组、混慢组、牙快组及牙慢组,每组12例患者。扩弓完成后进入保持阶段,扩弓及保持总计6个月,扩弓总量为4 mm。治疗前后拍摄患者锥形束CT,三维测量分析治疗前后患者牙弓基骨宽度及Wilson曲角的变化。采用SPSS 20.0软件包进行统计学分析。结果 扩弓量分析结果显示,4组患者治疗后较治疗前的牙弓基骨宽度差均明显增大(P<0.01)。混快组基骨宽度增加最多,为(3.15±0.11)mm;混慢组为(3.10±0.13)mm;牙快组为(2.89±0.17)mm;牙慢组基骨宽度增加最少,为(2.87±0.12)mm。相同扩弓速率下混合支持组牙弓基骨增大量显著大于牙支持组(P<0.05);相同支持方式在不同扩弓速率下牙弓基骨宽度变化差异无统计学意义(P>0.05)。扩弓率分析发现,4组患者的扩弓率分别为(78.63±2.66)%,(77.46±3.26)%,(72.23±4.38)%和(71.67±2.96)%;相同扩弓速率下混合支持组扩弓率明显高于牙支持组(P<0.05),但相同支持方式在不同扩弓速率下扩弓率差异无统计学意义(P>0.05)。所有患者治疗后的Wilson曲角均较治疗前明显增大(P<0.01),相同扩弓速率下混合支持组较牙支持组更明显(P<0.01)。结论 无托槽隐形矫治对替牙期上颌横向发育不足的患者扩弓有骨性效应,其中混合支持式扩弓效果更好,不同扩弓速率对扩弓骨效应无明显影响;无托槽隐形矫治对整平Wilson曲线有良好效果。Objective To illuminate the maxillary expansion effects of clear aligners with different modes in mixed dentition patients with constricted maxilla.Methods A total of 48 patients with 3-3.5 mm constricted maxilla were collected and treated with clear aligners for maxillary expansion.According to different expansion speeds and support types,they were randomly divided into four groups:rapid expansion with mixed support group(RM group),slow expansion with mixed support group(SM group),rapid expansion with teeth support group(RT group),and slow expansion with teeth support group(ST group).The active expansion was followed by the passive retention.Total treatment(expansion and retention)maintained six months,with the expansion of 4 mm for all the patients.Cone-beam CT images were taken before and after treatment and reconstructed in three dimensions.The width of basal bone and the curve of Wilson were measured before and after the expansion.All data were processed by SPSS20.0 software package for statistical analysis.Results The width of basal bone in four groups was significantly increased after expansion(P<0.01).The most increase was(3.15±0.11)mm in RM group,followed by(3.10±0.13)mm in SM group,(2.89±0.17)mm in RT group,and(2.87±0.12)mm in ST group.The width of basal bone in mixed support groups increased more than that in teeth support groups with the same expansion speed(P<0.05).However,there was no significant difference between rapid and slow expansion groups with the same support type(P>0.05).The expansion rate was(78.63±2.66)%,(77.46±3.26)%,(72.23±4.38)%and(71.67±2.96)%in RM group,SM group,RT group and ST group,respectively.The expansion rates in mixed support groups were higher than those in teeth support groups with the same expansion speed(P<0.05),and there was no significant difference between rapid expansion group and slow expansion group with the same support type(P>0.05).Furthermore,the angle of the curve of Wilson increased in all groups after the treatment(P<0.01),and the increases in mixed-su

关 键 词：上颌横向发育不足 无托槽隐形矫治 上颌扩弓 骨性效应 替牙期 锥形束CT 

分 类 号：R783[医药卫生—口腔医学]