本文關(guān)鍵詞： 安氏Ⅱ類亞類錯牙合畸形 CBCT 牙弓形態(tài) 下頜骨 中線偏斜　出處：《河北醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：Angle將一側(cè)磨牙關(guān)系呈遠中關(guān)系、另一側(cè)磨牙關(guān)系呈中性關(guān)系的錯牙合畸形定義為安氏Ⅱ類亞類錯牙合畸形。與之相關(guān)的治療一直是臨床上的重點和難點。對這種特殊的錯牙合畸形特點的準確分析，有利于指導(dǎo)臨床治療的有效進行。本研究通過錐形束CT(cone-beam computerizedtomography，CBCT)資料對安氏Ⅱ類亞類錯牙合畸形成人患者的牙頜對稱性進行分析，比較其與正常牙合人群的差異，研究安氏Ⅱ類亞類錯牙合畸形成人患者上下頜牙弓形態(tài)特征、下頜骨形態(tài)及位置特征。 方法：研究對象分為兩組。自2011年10月-2013年10月，于河北醫(yī)科大學(xué)口腔醫(yī)院正畸科門診就診的患者中選取安氏Ⅱ類亞類錯牙合畸形患者30例（男18例，女12例，年齡范圍19.1-34.1歲，平均年齡24.6歲）作為Ⅱ類亞類組；從河北醫(yī)科大學(xué)在校學(xué)生中選取個別正常牙合30例（男9例，女21例，年齡范圍18.1-25.8歲，平均年齡21.5歲）作為正常牙合組。所有研究對象知情同意。對每個研究對象在牙尖交錯位時進行CBCT掃描，所得解剖結(jié)構(gòu)圖像以二維數(shù)字成像和醫(yī)學(xué)通信文件（2-D digitalimaging and communications in medicine, DICOM）形式保存并導(dǎo)入Invivo5軟件，對原始圖像數(shù)據(jù)進行讀取，進行上下牙列和下頜骨的三維重建，定位標記點，對上下頜牙列及下頜骨進行各線距和角度的測量。 通過確定上頜牙列中點、切牙孔點、上頜磨牙點、下頜牙列中點、下頜磨牙點、髁突頂點、下頜角點、頦下點和髁突中點等標志點，確定相應(yīng)的測量項目：上頜牙弓弧形長度、上頜牙弓弧形長度投影、上頜牙弓直線長度、上頜牙弓直線長度投影、上頜磨牙位置、上頜磨牙位置投影、上頜磨牙夾角、上頜中線、下頜牙弓弧形長度、下頜牙弓弧形長度投影、下頜牙弓直線長度、下頜牙弓直線長度投影、下頜磨牙夾角、下頜磨牙位置、下頜磨牙位置投影、下頜中線、下頜升支長度、下頜體部長度、下頜骨長度、下頜角度、髁突角度、髁突位置、髁突間距、髁突夾角、喙突位置、喙突間距、喙突夾角、磨牙間距。用兩側(cè)測量值的差值（Ⅱ類亞類組：遠中側(cè)-中性側(cè)，正常牙合組：左側(cè)-右側(cè)）及上頜磨牙夾角、下頜磨牙夾角、髁突間距、髁突夾角、喙突間距、喙突夾角、上頜中線、下頜中線和牙列中點間距（下頜中線-上頜中線）表示兩側(cè)間差異，作為統(tǒng)計指標，用磨牙間距表示Ⅱ類亞類組遠中側(cè)咬合關(guān)系異常的嚴重程度。定義各統(tǒng)計指標的基準值（即兩側(cè)完全對稱時的值），除上頜磨牙夾角、下頜磨牙夾角、髁突夾角及喙突夾角為90外，其他指標的基準值均為0。與基準值不同即可認為存在不對稱。使用SPSS13.0統(tǒng)計學(xué)分析軟件①對Ⅱ類亞類組和正常牙合組表示兩側(cè)間差異的統(tǒng)計指標分別與基準值進行單樣本t檢驗，分析兩側(cè)的對稱性；②對兩組統(tǒng)計指標間進行兩獨立樣本t檢驗，分析兩組間是否存在統(tǒng)計學(xué)差異；③將Ⅱ類亞類組各統(tǒng)計指標分別與磨牙間距進行Pearson相關(guān)分析。檢驗標準α定為0.05。 結(jié)果： 1Ⅱ類亞類組中①上中線正、下中線偏向遠中側(cè)的占60%（18例），②下中線正、上中線偏向中性側(cè)的占23%（7例），③上下中線均發(fā)生偏斜的占17%（5例）。 2對正常牙合組的對稱性檢驗結(jié)果顯示：只有上頜磨牙位置差值和上頜磨牙位置投影差值表現(xiàn)出統(tǒng)計學(xué)意義（P0.05）。左側(cè)的上頜磨牙位置、上頜磨牙位置投影均大于右側(cè)，差值分別為0.67±1.22mm和0.81±1.34mm。其它指標差異均無統(tǒng)計學(xué)意義（P0.05）。 3對Ⅱ類亞類組的對稱性檢驗結(jié)果顯示：Ⅱ類亞類組遠中側(cè)的下頜牙弓弧形長度投影、下頜磨牙位置、下頜磨牙位置投影、下頜體部長度小于中性側(cè)，差值分別為-0.44±1.11mm，-1.62±2.17mm，-1.00±1.78mm，-1.15±1.91mm，差異有統(tǒng)計學(xué)意義（P0.05）；另外，上頜磨牙夾角為90.6±1.6°、下頜磨牙夾角為87.6±2.5°，上頜中線為-0.36±0.92mm，下頜中線為0.95±1.14mm，牙列中點間距為1.31±0.79mm。其它指標均未表現(xiàn)出統(tǒng)計學(xué)意義（P0.05）。 4對Ⅱ類亞類組與正常牙合組的統(tǒng)計指標進行的兩獨立樣本t檢驗結(jié)果顯示：Ⅱ類亞類組兩側(cè)上頜磨牙位置投影差值、下頜磨牙位置差值、下頜體部長度差值均小于正常牙合組，差值分別為1.05mm，1.41mm，1.21mm，而下頜中線和牙列中點間距大于正常牙合組，差值分別為1.09mm和1.30mm（P0.05）。 5對Ⅱ類亞類組各統(tǒng)計指標與磨牙間距進行Pearson相關(guān)分析后，發(fā)現(xiàn)Ⅱ類亞類組的下頜磨牙夾角與磨牙間距呈中等強度負相關(guān)，而下頜牙弓直線長度差值、下頜牙弓直線長度投影差值和牙列中點間距與磨牙間距呈中等強度正相關(guān)（P0.05）；另外，與磨牙間距表現(xiàn)出正的弱相關(guān)性，下頜升支長度差值、下頜骨長度差值、下頜磨牙位置差值和下頜磨牙位置投影差值與磨牙間距表現(xiàn)出負的弱相關(guān)性。 結(jié)論： 1安氏Ⅱ類亞類錯牙合常伴有牙列中線的偏斜，且多發(fā)生在下頜； 2Ⅱ類關(guān)系的形成主要與下頜磨牙位置相關(guān)，，與上頜磨牙位置和下頜骨及升支的長度也有一定相關(guān)性。
[Abstract]:Objective: Angle is far between side molar relationship, the other side is neutral molar relationship between malocclusion is defined as a sub class II malocclusion. Treatment related has been the focus and difficulty of clinical. On this special malocclusion features accurate analysis. To effectively guide the clinical treatment. Through the study of cone beam CT (cone-beam computerizedtomography CBCT) analysis of dental symmetry information of class II sub malocclusion adult patients, compared with normal, of class II malocclusion sub adult patients dental arch morphology, mandibular morphology and position features.
Methods: the subjects were divided into two groups. Since the October 2011 -2013 year in October, 30 cases of malocclusion patients with class II malocclusion in selected subgroups of Orthodontics Hospital of Stomatology Hebei Medical University clinic patients (male 18 cases, female 12 cases, age range 19.1-34.1 years, mean age 24.6 years) as a class II subtype group to select individual normal occlusion; students from the Hebei Medical University in 30 cases (male 9 cases, female 21 cases, age range 18.1-25.8 years, mean age 21.5 years) as the normal occlusion group. All subjects informed consent. For each object of study of CBCT scan in the intercuspal position, the anatomical image in two dimensions digital imaging and communications in medicine (2-D digitalimaging and communications in file medicine, DICOM) and stored into Invivo5 software, to read the original image data, 3D reconstruction of lower mandible and dentition, fixed The measurement of the distance and angle of the upper and lower jaw and the mandible of the mandible.
By determining the midpoint of maxillary dentition, incisive foramen, maxillary molar, mandibular dentition midpoint, mandibular condyle, vertex, mandibular angle, gnathion and condylar point mark, determine the corresponding project: the maxillary arch arc length, maxillary arch arc length projection, maxillary teeth the bow line length, maxillary arch length projection, maxillary molar, maxillary molar position projection, maxillary molar angle, maxillary midline, mandibular arch length, mandibular arch arc length projection, mandibular arch length, mandibular arch straight line projection length, mandibular angle and mandibular molar, mandibular molar the position of the mandibular midline projection, ramus length, mandibular length, mandibular length, mandibular angle and condylar angle, condylar position, condylar spacing, condylar angle, coracoid process distance, beak, coracoid molar angle, with both sides of measuring spacing. The difference between the value of (class II subclass group: the far side neutral side of the normal occlusion group: left - right) and the maxillary molar angle, mandibular angle and condylar spacing, condylar angle, pitch angle of coronoid process, coracoid, maxillary midline, mandibular midline and dentition (mandibular midline - point spacing the difference between the two sides of maxillary midline) said, as the statistical index, with the severity of class II molar spacing subclass group distal abnormal occlusion. The definition of statistical index reference value (i.e. the value of the symmetrical on both sides), in addition to the maxillary molar angle, mandibular angle and condylar angle and the angle of coronoid process 90, other indicators of the reference value and reference value are 0. different can think that there is asymmetry. The analysis software of class II subclass group and normal occlusion group said the statistical indicators were differences between the two sides of a single sample t test and reference value using the SPSS13.0 statistics, divided The symmetry of both sides was analyzed. Secondly, two independent sample t test was conducted between two sets of statistical indicators, and there was statistical difference between the two groups. (3) Pearson correlation analysis was carried out between the statistical indexes of class II subgroups and molar spacing. The test standard was 0.05..
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本文編號：1517951