两种扩弓方式对骨性Ⅲ类错<inline-graphic id="IG23" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="images/1674-1366-11-03-007-F923c.png" />前方牵引效果的影响

doi:10.3877/cma.j.issn.1674-1366.2017.03.007

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。

关键词: 牙正畸牵引, 腭扩张术, 上颌后缩, 上颌前牵引

Objective

To compare the effects of maxillary protraction therapy in skeletal classⅢ 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 classⅢ patients, 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 mandibular and decrease the inclination of upper and lower incisors.

Key words: Orthodontic traction, Palatal expansion technique, Maxillary retrusion, Maxillary protraction

图1 上颌扩弓器及前方牵引装置

图2 Delaire及Rail型牵引面具

图3 头影测量主要标志点及测量项目

表1 两组患者治疗前后测量项目比较（±s）

测量项目	A组(n = 10)		t值	P值	B组(n = 10)		t值	P值
测量项目	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
SNA（°）	78.19 ± 4.42	81.37 ± 3.48	1.787	0.035^a	78.73 ± 3.06	83.58 ± 3.82	3.134	0.006^a
SNB（°）	82.68 ± 2.42	79.95 ± 3.55	2.001	0.029^a	81.66 ± 2.95	79.17 ± 2.26	2.118	0.024^a
ANB（°）	-2.73 ± 1.67	1.21 ± 1.02	6.367	0.000^a	-3.29 ± 2.07	1.65 ± 1.28	6.419	0.000^a
MP-SN（°）	33.08 ± 3.23	36.89 ± 5.18	1.970	0.032^a	34.64 ± 4.05	38.15 ± 3.64	2.038	0.028^a
SN-PP（°）	10.57 ± 2.57	11.29 ± 2.58	0.625	0.269	8.92 ± 4.22	9.48 ± 3.91	0.309	0.381
U1-SN（°）	106.35 ± 4.19	110.62 ± 3.83	2.389	0.014^a	109.89 ± 5.67	113.96 ± 4.17	1.829	0.042^a
L1-MP（°）	87.84 ± 7.55	84.10 ± 6.76	1.167	0.129	86.55 ± 7.47	83.26 ± 7.85	0.960	0.175
Wit值(mm)	-8.10 ± 3.51	-5.44 ± 2.49	1.955	0.033^a	-10.33 ± 3.63	-4.71 ± 3.57	3.491	0.001^a
A-VL(mm)	46.54 ± 3.26	50.07 ± 4.84	1.913	0.036^a	45.23 ± 2.27	51.62 ± 4.21	4.225	0.000^a
B-VL(mm)	57.47 ± 3.79	54.16 ± 4.33	1.819	0.043^a	59.04 ± 4.16	55.11 ± 3.58	2.264	0.018^a
Sn-VL(mm)	58.64 ± 4.43	62.19 ± 3.26	2.041	0.028^a	57.43 ± 6.21	63.28 ± 4.29	2.451	0.012^a
Si-VL(mm)	62.61 ± 8.15	60.37 ± 5.61	0.716	0.212	67.78 ± 7.38	64.43 ± 6.19	1.099	0.143

表1 两组患者治疗前后测量项目比较（±s）

测量项目	A组(n = 10)		t值	P值	B组(n = 10)		t值	P值
测量项目	治疗前	治疗后	t值	P值	治疗前	治疗后	t值	P值
SNA（°）	78.19 ± 4.42	81.37 ± 3.48	1.787	0.035^a	78.73 ± 3.06	83.58 ± 3.82	3.134	0.006^a
SNB（°）	82.68 ± 2.42	79.95 ± 3.55	2.001	0.029^a	81.66 ± 2.95	79.17 ± 2.26	2.118	0.024^a
ANB（°）	-2.73 ± 1.67	1.21 ± 1.02	6.367	0.000^a	-3.29 ± 2.07	1.65 ± 1.28	6.419	0.000^a
MP-SN（°）	33.08 ± 3.23	36.89 ± 5.18	1.970	0.032^a	34.64 ± 4.05	38.15 ± 3.64	2.038	0.028^a
SN-PP（°）	10.57 ± 2.57	11.29 ± 2.58	0.625	0.269	8.92 ± 4.22	9.48 ± 3.91	0.309	0.381
U1-SN（°）	106.35 ± 4.19	110.62 ± 3.83	2.389	0.014^a	109.89 ± 5.67	113.96 ± 4.17	1.829	0.042^a
L1-MP（°）	87.84 ± 7.55	84.10 ± 6.76	1.167	0.129	86.55 ± 7.47	83.26 ± 7.85	0.960	0.175
Wit值(mm)	-8.10 ± 3.51	-5.44 ± 2.49	1.955	0.033^a	-10.33 ± 3.63	-4.71 ± 3.57	3.491	0.001^a
A-VL(mm)	46.54 ± 3.26	50.07 ± 4.84	1.913	0.036^a	45.23 ± 2.27	51.62 ± 4.21	4.225	0.000^a
B-VL(mm)	57.47 ± 3.79	54.16 ± 4.33	1.819	0.043^a	59.04 ± 4.16	55.11 ± 3.58	2.264	0.018^a
Sn-VL(mm)	58.64 ± 4.43	62.19 ± 3.26	2.041	0.028^a	57.43 ± 6.21	63.28 ± 4.29	2.451	0.012^a
Si-VL(mm)	62.61 ± 8.15	60.37 ± 5.61	0.716	0.212	67.78 ± 7.38	64.43 ± 6.19	1.099	0.143

表2 两组患者治疗前后差异组间比较（±s）

测量项目	A组(n = 10)	B组(n = 10)	t值	P值
SNA（°）	3.18 ± 1.92	4.85 ± 1.38	2.233	0.038^a
SNB（°）	-2.73 ± 0.82	-2.49 ± 0.65	0.725	0.478
ANB（°）	3.94 ± 0.85	4.94 ± 1.07	2.314	0.033^a
MP-SN（°）	3.81 ± 2.21	3.51 ± 1.34	0.367	0.718
SN-PP（°）	0.72 ± 0.48	0.56 ± 0.32	0.877	0.392
U1-SN（°）	3.97 ± 2.46	4.07 ± 1.68	0.106	0.917
L1-MP（°）	-3.74 ± 2.19	-3.29 ± 1.23	0.565	0.578
Wit值(mm)	2.66 ± 1.42	5.62 ± 2.29	3.474	0.003^a
A-VL(mm)	3.53 ± 2.29	6.39 ± 3.15	2.322	0.032^a
B-VL(mm)	-3.31 ± 2.71	-3.93 ± 1.95	0.587	0.564
Sn-VL(mm)	3.55 ± 3.27	5.85 ± 3.03	1.631	0.120
Si-VL(mm)	-2.24 ± 1.21	-3.35 ± 2.33	1.337	0.198

表2 两组患者治疗前后差异组间比较（±s）

测量项目	A组(n = 10)	B组(n = 10)	t值	P值
SNA（°）	3.18 ± 1.92	4.85 ± 1.38	2.233	0.038^a
SNB（°）	-2.73 ± 0.82	-2.49 ± 0.65	0.725	0.478
ANB（°）	3.94 ± 0.85	4.94 ± 1.07	2.314	0.033^a
MP-SN（°）	3.81 ± 2.21	3.51 ± 1.34	0.367	0.718
SN-PP（°）	0.72 ± 0.48	0.56 ± 0.32	0.877	0.392
U1-SN（°）	3.97 ± 2.46	4.07 ± 1.68	0.106	0.917
L1-MP（°）	-3.74 ± 2.19	-3.29 ± 1.23	0.565	0.578
Wit值(mm)	2.66 ± 1.42	5.62 ± 2.29	3.474	0.003^a
A-VL(mm)	3.53 ± 2.29	6.39 ± 3.15	2.322	0.032^a
B-VL(mm)	-3.31 ± 2.71	-3.93 ± 1.95	0.587	0.564
Sn-VL(mm)	3.55 ± 3.27	5.85 ± 3.03	1.631	0.120
Si-VL(mm)	-2.24 ± 1.21	-3.35 ± 2.33	1.337	0.198

[1]	Ngan P, Moon W. Evolution of ClassⅢ treatment in orthodontics[J]. Am J Orthod Dentofacial Orthop，2015，148(1):22-36.
[2]	Cordasco G, Matarese G, Rustico L，et al. Efficacy of orthopedic treatment with protraction facemask on skeletal ClassⅢmalocclusion：a systematic review and meta-analysis[J]. Orthod Craniofac Res，2014，17(3):133-143.
[3]	Wilmes B, Ngan P, Liou EJ，et al. Early classⅢ facemask treatment with the hybrid hyrax and Alt-RAMEC protocol[J]. J Clin Orthod，2014，48(2):84-93.
[4]	Kaya D, Kocadereli I, Kan B，et al. Effects of facemask treatment anchored with miniplates after alternate rapid maxillary expansions and constrictions；a pilot study[J]. Angle Orthod，2011，81(4):639-646.
[5]	Wang YC, Chang PM, Liou EJ. Opening of circumaxillary sutures by alternate rapid maxillary expansions and constrictions[J]. Angle Orthod，2009，79(2):230-234.
[6]	Lione R, Buongiorno M, Laganà G，et al. Early treatment of ClassⅢ malocclusion with RME and facial mask：evaluation of dentoalveolar effects on digital dental casts[J]. Eur J Paediatr Dent，2015，16(3):217-220.
[7]	da Luz Vieira G, de Menezes LM, de Lima EMS，et al. Dentoskeletal effects of maxillary protraction in cleft patients with repetitive weekly protocol of alternate rapid maxillary expansions and constrictions[J]. Cleft Palate Craniofac J，2009，46(4):391-398.
[8]	Abe N, Kuroda S, Furutani M，et al. Data-based prediction of soft tissue changes after orthognathic surgery：clinical assessment of new simulation software[J]. Int J Oral Maxillofac Surg，2015，44(1):90-96.
[9]	Westwood PV, McNamara JA, Baccetti T，et al. Long-term effects of ClassⅢ treatment with rapid maxillary expansion and facemask therapy followed by fixed appliances[J]. Am J Orthod Dentofacial Orthop，2003，123(3):306-320.
[10]	Gencer D, Kaygisiz E, Yüksel S，et al. Comparison of double-plate appliance/facemask combination and facemask therapy in treating ClassⅢ malocclusions[J]. Angle Orthod，2014，85(2):278-283.
[11]	Haas AJ. Palatal expansion：just the beginning of dentofacial orthopedics[J]. Am J Orthod，1970，57(3):219-255.
[12]	Yepes E, Quintero P, Rueda ZV，et al. Optimal force for maxillary protraction facemask therapy in the early treatment of classⅢ malocclusion[J]. Eur J Orthod，2014，36(5):586-594.
[13]	陈析华，谢兴潜. 2种不同扩弓方法对恒牙早期骨性Ⅲ类错前方牵引的影响[J].上海口腔医学，2012，21(5):580-583.
[14]	Haas AJ. Long-term posttreatment evaluation of rapid palatal expansion[J]. Angle Orthod，1980，50(3):189-217.
[15]	Vaughn GA, Mason B, Moon HB，et al. The effects of maxillary protraction therapy with or without rapid palatal expansion：a prospective，randomized clinical trial[J]. Am J Orthod Dentofacial Orthop，2005，128(3):299-309.
[16]	李新桂，张栋杰，叶金梅，等.快速扩缩弓并前牵引矫治恒牙早期安氏Ⅲ类错的疗效[J/CD].中华口腔医学研究杂志（电子版），2014，8(5):401-407.

[1]	吴文震, 邱妮, 肖玉鸿. 一种非手术组织增量方法：正畸牵引在口腔种植的应用[J]. 中华口腔医学研究杂志(电子版), 2020, 14(06): 390-395.
[2]	徐丹, 何旭顺, 高志雄, 曾琪, 梁燕桃, 黄芳. 微创牵引复位外伤挫入年轻恒牙的临床疗效观察[J]. 中华口腔医学研究杂志(电子版), 2018, 12(01): 37-47.
[3]	谢永建, 麦理想, 卢新华. 上颌前牵引中两种口内固位装置的临床对比研究[J]. 中华口腔医学研究杂志(电子版), 2015, 09(05): 409-415.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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