牙支抗式与骨支抗式矫治早期骨性Ⅲ类错[牙合]畸形的效果比较  

Comparison of the effects of early Skeletal ClassⅢfacemask therapy between dental and skeletal anchorages

作　　者：李子煜 曹斐然 吴贝贝 杨梓[1] 王元银[1] LI Ziyu;CAO Feiran;WU Beibei;YANG Zi;WANG Yuanyin(Affiliated Stomatological Hospital Anhui Medical University,China,Hefei 230031)

机构地区：[1]安徽医科大学附属口腔医院,合肥230031

出　　处：《实用口腔医学杂志》2024年第1期109-116,共8页Journal of Practical Stomatology

基　　金：安徽医科大学校科研基金(编号:2020xkj147);安徽省卫生健康委科研项目(编号:AHWJ2021b152)。

摘　　要：目的:比较应用牙支抗式(FM)与前腭旁正中区域微螺钉种植支抗(MSI/FM)的Hyrax结合上颌前方牵引装置矫治替牙期及恒牙列早期上颌骨发育不足的骨性Ⅲ类错[牙合]畸形的效果。方法:将18例上颌骨发育不足的早期骨性Ⅲ类错[牙合]畸形患者随机分为2组(n=9),分别采用FM的Hyrax结合上颌前方牵引治疗方案(FM)和用MSI/FM支抗的Hyrax结合上颌前方牵引装置的治疗方案(MSI/FM)。两组均以交替快速上颌骨扩张和收缩(Alt-RAMEC)的方式结合双侧约3.92 N、相对于平面向前、向下30°的前方牵引力,纠正骨性Ⅲ类错[牙合]畸形。通过Lortho头影测量软件对两组矫治前后的头颅侧位片进行描画重叠并分析矫治前后头影测量指标的变化。结果:矫治后两组患者的软组织侧貌和Ⅲ类错[牙合]均得到明显改善,MSI/FM组患者的平均矫治时间较短。FM组在以下测量指标中T0和T1之间存在显著差异(P<0.05):SNA、ANB、Co-A、Co-Gn、 Wits、S-Go、Na-Me、MP、 U1-SN、UADH、LADH、Overjet、UL-EP增加,U1-L1减小。MSI/FM组在以下测量指标中T0和T1之间存在显著差异(P<0.05):SNA、ANB、Co-A、Wits、Na-Me、MP、Y轴角、U1-SN、Overjet、UL-EP增加,SNB、Co-Gn-Co-A、S-Go/N-Me、U1-L1、L1-MP减小。结论:FM和MSI/FM分别与Hyrax结合上颌前方牵引装置矫治早期骨性Ⅲ类错[牙合]畸形均可得到显著的治疗效果;MSI/FM组平均矫治时间较短、骨性效应较显著、牙性代偿较轻,上颌综合长度向前生长明显、下颌生长方向改善明显、上前牙代偿性唇倾较轻。Objective:To compare the effects of treatment with Hybrid-Hyrax-Facemask(FM)versus miniscrews in the anterior palate combined with Hybrid-Hyrax-Facemask(MSI/FM)for patients with early ClassⅢmalocclusion and maxillary deficiency.Methods:18 patients aged with early ClassⅢmalocclusion and maxillary deficiency were randomly divided into 2 groups(n=9)and treated with FM and MSI/FM respectively.Alternating rapid maxillary expansion and constriction(Alt-RAMEC)protocol combined with a maxillary protraction force of 3.92 N was applied on each side of all patients from elastics connected to the facemask in a downward and forward direction of 30°to the occlusal plane.Iortho cephalometric software was used to analyze the data of lateral cephalograms of the patients before(T0)and after(T1)treatment.Results:Improvement was verified in the facial profile and occlusion of all patients.In MSI/FM group the average treatment time was shorter.There were significant differences(P<0.05)between T0 and T1 in the following measurements in FM group:SNA,ANB,Co-A,Co-Gn,Wits,S-Go,Na-Me,MP,U1-SN,UADH,LADH,Overjet,UL-EP increased,U1-L1 decreased.There were significant differences(P<0.05)between T0 and T1 in the following measurements in the MSI/FM group:SNA,ANB,Co-A,Wits,Na-Me,MP,Y-axis,U1-SN,Overjet,UL-EP increased,SNB,Co-Gn-Co-A,S-Go/N-Me,U1-L1,L1-MP decreased.Conclusion:Both FM and MSI/FM combined with Alt-RAMEC protocol and a maxillary protraction force are effective in the treatment for ClassⅢpatients with maxillary deficiency.MSI/FM may produce more significant bone effect and reduce dental compensation,promote more forward growth of midface and more improvement in the growth direction of mandible and reduce compensatory lip inclination of anterior teeth in shorter treatment time.

关 键 词：骨性Ⅲ类错[牙合] 微螺钉种植体 骨支抗 交替快速上颌骨扩张和收缩 上颌前方牵引 

分 类 号：R783.5[医药卫生—口腔医学]