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据统计在我国近四分之一的恒牙期青少年患有AngleⅡ类1分类错
畸形[1],其中骨性下颌后缩最为常见,占50%~60%[2]。上前牙唇倾、开唇露齿及下颌后缩为AngleⅡ类1分类的典型表现,对容貌的美观影响大,不利于青少年的身心健康。临床上针对处于生长发育期的AngleⅡ类1分类骨性错 畸形的病人,多采用功能性矫治器,利用其生长发育潜能,进行阻断性矫治,减少成年后进行正颌手术的概率[3-6]。近年来多位学者采用sagittal-guidance Twin-block(SGTB)矫治器联合固定矫治器对AngleⅡ类1分类骨性错 畸形进行矫治,并与一些功能性矫治器进行比较,结果尚有争论[7-8]。Forsus矫治器也是临床上矫治AngleⅡ类1分类错 畸形的常用功能性矫治器[9],少有学者将二者的临床矫治效果进行比较。本研究旨在分析SGTB矫治器在AngleⅡ类1分类骨性错 畸形方面的矫治效果并与Forsus矫治器进行对比,现作报道。 -
矫治前后,2组病人间骨骼变化各指标差异均无统计学意义(P>0.05);与治疗前比较,2组病人B点与Pg点均向前移,下颌骨的长度(Pg/OLP+Co/OLP)均增加,SNB均增大、ANB均减小,差异均有统计学意义(P < 0.01)(见表 1)。
分组 n (A/OLP)/mm (B/OLP)/mm (Pg/OLP)/mm (Co/OLP)/mm (Pg/OLP+Co/OLP)/mm SNA/(°) SNB/(°) ANB/(°) 治疗前 S组 20 74.70±3.28 70.00±3.08 71.85±2.71 10.85±1.42 82.70±3.31 82.31±2.05 75.95±1.69 6.37±0.83 F组 20 74.65±2.22 71.22±2.62 72.18±2.26 10.98±1.34 83.16±2.03 82.55±1.45 76.32±1.46 6.23±0.89 t — 0.72 1.22 0.38 0.26 0.48 0.38 0.68 0.45 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 治疗后 S组 20 75.52±3.25 74.57±3.09** 76.21±3.36** 11.04±0.88 87.25±3.60** 82.32±2.05 81.49±1.86** 0.83±1.48** F组 20 75.69±2.18 74.37±2.45** 75.67±2.83** 11.27±1.30 86.94±2.36** 82.47±1.28 81.23±1.44** 1.24±1.38** t — 0.15 0.22 0.55 0.60 0.32 0.25 0.46 0.83 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 组内配对t检验:与治疗前比较**P < 0.01 表 1 2组病人矫治前后骨骼变化情况的比较(x±s)
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矫治前,2组病人间
、下颌平面变化、牙齿变化各指标差异均无统计学意义(P>0.05);矫治后,F组L1-MP高于S组(P < 0.05),其余各指标2组间差异均无统计学意义(P>0.05)。与矫治前相比,2组病人矫治后ii/OLP、mi/OLP均增大,is/OLP、U1-NSL均减小(P < 0.05~P < 0.01),F组L1-MP升高(P < 0.01),其余各指标差异均无统计学意义(P>0.05)(见表 2)。 分组 n 牙合、下颌平面变化 牙齿变化 NSL-OL/(°) NSL-MP/(°) (is/OLP)/mm (ii/OLP)/mm (ms/OLP)/mm (mi/OLP)/mm U1-NSL/(°) L1-MP/(°) 治疗前 S组 20 17.76±1.44 32.26±1.90 83.27±2.93 75.79±2.50 56.56±2.25 53.51±2.11 112.64±3.64 93.53±3.08 F组 20 17.70±1.72 32.20±2.63 82.68±3.17 75.21±3.04 56.21±2.36 53.39±1.96 112.65±3.47 93.29±4.92 t — 0.12 0.07 0.56 0.49 0.44 0.64 0.01 0.17 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 治疗后 S组 20 17.94±1.35 33.42±3.04 80.32±2.42** 79.04±2.26** 56.31±2.09 59.08±2.46** 106.52±2.86** 93.89±3.13 F组 20 17.99±1.54 32.65±2.50 80.35±2.45* 78.49±2.56** 55.47±1.78 57.50±1.33* 106.48±2.69** 97.28±4.76** t — 0.10 0.67 0.04 0.50 1.23 0.11 0.04 2.40 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 < 0.05 组内配对t检验:与治疗前比较*P < 0.05, **P < 0.01 表 2 2组病人矫治前后牙合、下颌平面和牙齿变化的比较(x±s)
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矫治前后,2组病人间测量样本各指标差异均无统计学意义(P>0.05);与治疗前相比,2组治疗后is/OLP-ii/OLP、ms/OLP-mi/OLP、is/OLP-A/OLP均减小,S组ii/OLP-Pg/OLP治疗后减小,差异均有统计学意义(P < 0.05~P < 0.01),其余各指标治疗前后差异均无统计学意义(P>0.05)(见表 3)。
分组 n is/OLP-ii/OLP ms/OLP-mi/OLP is/OLP-A/OLP ii/OLP-Pg/OLP ms/OLP-A/OLP mi/OLP-Pg/OLP 治疗前 S组 20 7.48±1.18 3.05±0.72 8.57±3.12 3.94±2.48 -18.14±4.12 -18.34±3.59 F组 20 7.47±1.03 2.82±1.49 8.03±2.84 3.03±2.75 -18.44±3.43 -18.79±3.18 t — 0.02 0.46 0.12 1.12 0.03 0.32 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 治疗后 S组 20 1.28±0.62** -2.77±1.42* 4.80±3.04** 2.83±3.28* -19.21±3.95 -17.13±4.50 F组 20 1.86±0.58** -2.03±1.56* 4.66±2.08** 2.82±3.23 -20.22±2.41 -18.17±3.00 t — 0.77 1.57 0.15 0.21 0.85 0.58 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 组内配对t检验:与治疗前比较*P < 0.05, **P < 0.01 表 3 2组病人矫治前后测量样本变化的比较(x±s;mm)
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在前牙覆盖纠正及磨牙关系纠正方面,S组牙性因素和骨性因素引起变化的占比与F组比较差异均无统计学意义(P>0.05)(见表 4)。
分组 n 覆盖变化 磨牙关系变化 牙性 骨性 牙性 骨性 S组 20 43 57 39 61 F组 20 56 44 49 51 χ2 — 3.38 2.23 P — >0.05 >0.05 表 4 2组病人矫治前后前牙覆盖及磨牙关系的骨性、牙性变化构成情况(%)
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病人,男,首诊年龄12岁;病人主诉:上牙前突影响美观;检查:恒牙列,尖牙、磨牙关系均为远中关系,前牙为Ⅲ度深覆
,深覆盖为9 mm,上下牙列拥挤度为轻度,侧貌为凸面型,下颌明显后缩,两侧颞下颌关节无明显异常。根据头颅侧位片判断处于CVMS Ⅱ期(见图 1),诊断为AngleⅡ类1分类、骨性Ⅱ类、下颌后缩。采用SGTB矫治器联合固定矫治后效果良好(见图 2)。
SGTB矫治器在AngleⅡ类1分类骨性错 畸形矫治中的临床应用研究
Study on the clinical application of SGTB appliance in the correction of Angle class Ⅱ division 1 skeletal malocclusion
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摘要:
目的通过X线头影测量,分析SGTB矫治器对生长发育高峰期AngleⅡ类1分类骨性错 畸形病人进行矫治的临床效果。方法选取生长发育高峰期AngleⅡ类1分类错 畸形伴骨性下颌后缩的病例40例,随机分成2组,S组采用Ⅰ期SGTB矫治器导下颌向前联合Ⅱ期固定矫治;F组采用Ⅰ期固定矫治联合Ⅱ期Forsus矫治器导下颌向前。在治疗前、后拍摄X线头颅侧位片,利用Pancherz测量分析法进行分析,比较2组治疗前后的相关指标情况。结果治疗前2组间病人的各指标测量数据比较差异均无统计学意义(P>0.05)。治疗后,F组L1-MP高于S组(P < 0.05)。与治疗前比较,2组病人治疗后SNB、B/OLP、Pg/OLP、Pg/OLP+Co/OLP、ii/OLP、mi/OLP均增大,ANB、is/OLP、U1-NSL、is/OLP-ii/OLP、ms/OLP-mi/OLP、is/OLP-A/OLP均减小,F组L1-MP增大,S组ii/OLP -Pg/OLP减少,差异均有统计学意义(P < 0.05~P < 0.01);其余各指标治疗前后差异均无统计学意义(P>0.05)。在前牙覆盖的纠正中,S组牙性和骨性因素所占比分别为43%、57%, F组分别为56%、44%;在磨牙关系的纠正中,S组牙性和骨性因素所占比分别为39%、61%, F组分别为49%、51%,构成比差异均无统计学意义(P>0.05)。 结论SGTB矫治器对AngleⅡ类1分类骨性错 畸形具有良好的矫治效果,且在下切牙唇倾的控制方面优于Forsus矫治器。Abstract:ObjectiveTo analyze the clinical effects of SGTB appliance in the correction of growth peak Angle class Ⅱ division 1 skeletal malocclusion using X-ray cephalometric measurement. MethodsForty cases with Angle class Ⅱ division 1 malocclusion deformity complicated with bone retraction of mandible were randomly divided into the group S and group F.The group S and group F were treated with stage Ⅰ SGTB appliance combined with stage Ⅱ fixed mandible and stage Ⅰ fixed appliance combined with stage Ⅱ Forsus appliance, respectively.The lateral head X-ray was taken before and after treatment, the Pancherz measurement analysis was used for analysis, and the related indicators in two groups were compared between before and after treatment. ResultsBefore treatment, there was no statistical significance in the measurement data of each index between the two groups(P>0.05).After treatment, the L1-MP in group F was higher than that in group S(P < 0.05).Compared with before treatment, the SNB, B/OLP, Pg/OLP, Pg/OLP+Co/OLP, ii/OLP and mi/OLP increased, and the ANB, is/OLP, U1-NSL, is/OLP-ii/OLP, ms/OLP-mi/OLP and is/OLP-A/OLP decreased in two groups after treatment(P < 0.05 to P < 0.01).Compared with before treatment, the L1-MP in group F increased, the ii/OLP-PG/OLP in group S decreased after treatment, and the differences of which were statistically significant(P < 0.05 to P < 0.01).There was no statistical significance in other indexes between before and after treatment(P>0.05).In the correction of anterior overlaying, the proportions of dental and osseous factors in group S was 43% and 57%, repectively.In group F, 56% and 44%, repectively, respectively.In the correction of molar relations, the proportions of dental and osseous factors in group S was 39% and 61%, respectively.In group F, 49% and 51%, respectively.There was no statistical significance in the constituent ratios of above indexes between the two groups(P>0.05). ConclusionsThe SGTB appliance appliance has a good effect on the correction of Angle class Ⅱ division 1 skeletal malocclusion, and is better than Forsus appliance in the control of lip tilt of lower incisor teeth. -
Key words:
- malocclusion /
- SGTB appliance /
- Forsus appliance /
- functional appliance
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表 1 2组病人矫治前后骨骼变化情况的比较(x±s)
分组 n (A/OLP)/mm (B/OLP)/mm (Pg/OLP)/mm (Co/OLP)/mm (Pg/OLP+Co/OLP)/mm SNA/(°) SNB/(°) ANB/(°) 治疗前 S组 20 74.70±3.28 70.00±3.08 71.85±2.71 10.85±1.42 82.70±3.31 82.31±2.05 75.95±1.69 6.37±0.83 F组 20 74.65±2.22 71.22±2.62 72.18±2.26 10.98±1.34 83.16±2.03 82.55±1.45 76.32±1.46 6.23±0.89 t — 0.72 1.22 0.38 0.26 0.48 0.38 0.68 0.45 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 治疗后 S组 20 75.52±3.25 74.57±3.09** 76.21±3.36** 11.04±0.88 87.25±3.60** 82.32±2.05 81.49±1.86** 0.83±1.48** F组 20 75.69±2.18 74.37±2.45** 75.67±2.83** 11.27±1.30 86.94±2.36** 82.47±1.28 81.23±1.44** 1.24±1.38** t — 0.15 0.22 0.55 0.60 0.32 0.25 0.46 0.83 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 组内配对t检验:与治疗前比较**P < 0.01 表 2 2组病人矫治前后牙合、下颌平面和牙齿变化的比较(x±s)
分组 n 牙合、下颌平面变化 牙齿变化 NSL-OL/(°) NSL-MP/(°) (is/OLP)/mm (ii/OLP)/mm (ms/OLP)/mm (mi/OLP)/mm U1-NSL/(°) L1-MP/(°) 治疗前 S组 20 17.76±1.44 32.26±1.90 83.27±2.93 75.79±2.50 56.56±2.25 53.51±2.11 112.64±3.64 93.53±3.08 F组 20 17.70±1.72 32.20±2.63 82.68±3.17 75.21±3.04 56.21±2.36 53.39±1.96 112.65±3.47 93.29±4.92 t — 0.12 0.07 0.56 0.49 0.44 0.64 0.01 0.17 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 治疗后 S组 20 17.94±1.35 33.42±3.04 80.32±2.42** 79.04±2.26** 56.31±2.09 59.08±2.46** 106.52±2.86** 93.89±3.13 F组 20 17.99±1.54 32.65±2.50 80.35±2.45* 78.49±2.56** 55.47±1.78 57.50±1.33* 106.48±2.69** 97.28±4.76** t — 0.10 0.67 0.04 0.50 1.23 0.11 0.04 2.40 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 < 0.05 组内配对t检验:与治疗前比较*P < 0.05, **P < 0.01 表 3 2组病人矫治前后测量样本变化的比较(x±s;mm)
分组 n is/OLP-ii/OLP ms/OLP-mi/OLP is/OLP-A/OLP ii/OLP-Pg/OLP ms/OLP-A/OLP mi/OLP-Pg/OLP 治疗前 S组 20 7.48±1.18 3.05±0.72 8.57±3.12 3.94±2.48 -18.14±4.12 -18.34±3.59 F组 20 7.47±1.03 2.82±1.49 8.03±2.84 3.03±2.75 -18.44±3.43 -18.79±3.18 t — 0.02 0.46 0.12 1.12 0.03 0.32 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 治疗后 S组 20 1.28±0.62** -2.77±1.42* 4.80±3.04** 2.83±3.28* -19.21±3.95 -17.13±4.50 F组 20 1.86±0.58** -2.03±1.56* 4.66±2.08** 2.82±3.23 -20.22±2.41 -18.17±3.00 t — 0.77 1.57 0.15 0.21 0.85 0.58 P — >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 组内配对t检验:与治疗前比较*P < 0.05, **P < 0.01 表 4 2组病人矫治前后前牙覆盖及磨牙关系的骨性、牙性变化构成情况(%)
分组 n 覆盖变化 磨牙关系变化 牙性 骨性 牙性 骨性 S组 20 43 57 39 61 F组 20 56 44 49 51 χ2 — 3.38 2.23 P — >0.05 >0.05 -
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