【摘要】：目的： 對處于生長發(fā)育高峰期安氏Ⅱ1類錯(cuò)(?)畸形的患者采用Twin-block和Forsus矯治器前導(dǎo)下頜,通過矯治前后頭顱定位側(cè)位片的測量分析比較兩種矯治器治療前后上下頜骨、牙齒及軟組織的生長改建效果,探討矯治機(jī)理,為臨床選用適宜的矯治方法提供參考。 方法： 選取2006-2014年間在天津醫(yī)科大學(xué)口腔正畸科治療完成的安氏II1類下頜后縮患者60例(男33例,女27例),處于生長發(fā)育高峰期,平均年齡在11.3±0.6歲,恒牙早期。本研究病例分別采用Twin-block和Forsus矯治器進(jìn)行矯治,每組30例。治療前后分別拍攝頭顱定位側(cè)位片,運(yùn)用改良Pancherz分析法、Downs分析法等測量分析上下頜骨、牙和軟組織變化。應(yīng)用SPSS16.0軟件對各測量結(jié)果處理后進(jìn)行組內(nèi)配對樣本t檢驗(yàn)及組間獨(dú)立樣本t檢驗(yàn),并對檢驗(yàn)結(jié)果進(jìn)行討論。 結(jié)果： 本研究運(yùn)用Twin-block、Forsus矯治器對處于生長發(fā)育高峰期的安氏II’類下頜后縮患者進(jìn)行治療,平均療程18個(gè)月,均有良好的生長引導(dǎo)、促進(jìn)作用,收到良好的臨床治療效果。 X線頭影測量顯示： 1.骨骼改變： 1)分別對比Twin-block組(下文簡稱T組)和Forsus組(下文簡稱F組)治療前后：下頜位置均前移,表現(xiàn)為B-Y、Po-Y, SNB角均顯著增大、ANB角減小(P0.05)；有效促進(jìn)下頜骨的生長,表現(xiàn)為下頜綜合長度(Ar-Po)、下頜升支高度(Ar-Go)、下頜體長(Go-Gn)及全面高(N-Me)、下面高(ANS-Me)均顯著增加。 2)T組和F組在對下頜升支高度(Ar-Go)、下面高(ANS-Me)進(jìn)行組間對比時(shí)有統(tǒng)計(jì)學(xué)差異(P0.05)。 3)T組下頜平面角(MP/SN)治療后變大(P0.05),而F組MP/SN在治療前后沒有明顯變化,兩組在對MP/SN進(jìn)行組間對比時(shí)有統(tǒng)計(jì)學(xué)差異(P0.05)。 4)T組和F組對SNA變化量(ΔSNA)進(jìn)行組間對比時(shí)有統(tǒng)計(jì)學(xué)差異(P0.05)；兩組在對A點(diǎn)位置變化量(△A-Y)進(jìn)行組間對比時(shí)有統(tǒng)計(jì)學(xué)差異(P0.05)。 2.牙(?)改變： 1)T組和F組均存在上頜切牙舌傾,下頜切牙唇傾,上頜磨牙遠(yuǎn)中傾斜,下頜磨牙向近中傾斜,但程度不同。 2)骨牙比例：T組在6.02mm的覆蓋減少量和3.00mm的磨牙關(guān)系改善中,牙齒效應(yīng)分別占51.4%和56.93%,骨骼效應(yīng)占48.60%和43.07%；F組在6.70mm的覆蓋減少4.90mm的磨牙關(guān)系改善中,牙齒效應(yīng)分別占48.52%和52.96%,骨骼效應(yīng)占51.48%和47.04%。 3)T組和F組覆(?)分別減小了3.30±0.91mm,3.70±1.94mm。 3.軟組織測量變化：T組和F組頦部改善,兩組間對頦唇溝深度變化量、上唇凹深度變化量進(jìn)行組間對比時(shí)有統(tǒng)計(jì)學(xué)差異(P0.05)。 結(jié)論： 1. Twin-block、Forsus矯治生長發(fā)育高峰期的安氏Ⅱ1類下頜后縮患者,有效促進(jìn)了下頜骨矢狀向的發(fā)育,Ⅱ類骨面型趨于正常,側(cè)貌改善。 2.與Twin-block相比,Forsus能更好地促進(jìn)下頜升支的生長。Twin-block在矯治后下頜平面發(fā)生順時(shí)針旋轉(zhuǎn),而Forsus矯治前后下頜平面基本不變。 3.與Twin-block相比,Forsus對上頜生長及上牙弓生長有一定的抑制作用,對上頜磨牙向遠(yuǎn)中傾斜、下頜磨牙向近中傾斜的作用較為明顯；下前牙更加唇傾。 4. Twin-block矯治器磨牙關(guān)系的調(diào)整及前牙覆(?)、覆蓋的減小主要由牙齒效應(yīng)引起,而Forsus矯治器既有牙齒的位移也有牙槽骨的改變,其前牙覆蓋關(guān)系的調(diào)整主要由骨骼效應(yīng)引起。 5.與Twin-block相比,Forsus適用范圍廣。促進(jìn)下頜骨矢狀向生長的同時(shí)又促進(jìn)下頜升支高度的增加,下頜平面角基本不變,所以正常偏高角病例可優(yōu)先考慮。Forsus易使下前牙唇傾,不適用于下前牙中度擁擠、唇傾度較大的病例。
[Abstract]:Objective:
Twin-block and Forsus appliance were used to guide the mandible in patients with Class II malocclusion at the peak of growth and development. The effects of the two kinds of appliance on the growth and remodeling of maxilla, teeth and soft tissues before and after the treatment were compared by measuring and analyzing the lateral cephalometric films before and after the treatment. To provide reference for treatment.
Method:
Sixty patients (33 males and 27 females) with Class II1 mandibular retraction were enrolled from 2006 to 2014 in the Department of Orthodontics, Tianjin Medical University. They were at the peak of growth and development, with an average age of 11.3 (+ 0.6 years) and early permanent teeth. Twin-block and Forsus appliance were used to treat 30 patients in each group. The changes of maxilla, teeth and soft tissues were measured and analyzed by modified Pancherz analysis and Downs analysis. The paired sample t test and independent sample t test were performed by SPSS16.0 software after each measurement result was processed.
Result:
In this study, Twin-block and Forsus appliance were used to treat Angle II's mandibular retraction patients at the peak of growth and development. The average course of treatment was 18 months. All patients had good growth guidance and promotion effect, and received good clinical effect.
X-ray cephalometric analysis showed that:
1. skeletal changes:
1) Compared with Twin-block group (T group) and Forsus group (F group) before and after treatment, mandibular position moved forward, showing B-Y, Po-Y, SNB angle increased significantly, ANB angle decreased (P 0.05); effectively promoting the growth of mandible, for example, mandibular comprehensive length (Ar-Po), mandibular ramus height (Ar-Go), mandibular body length (Go-Gn) and overall height (Go-Gn). N-Me), the following high (ANS-Me) increased significantly.
2) There was significant difference between T group and F group when comparing the height of mandibular ramus (Ar-Go) and the height of mandibular ramus (ANS-Me) (P 0.05).
3) The mandibular plane angle (MP/SN) of T group became larger after treatment (P 0.05), while MP/SN of F group did not change significantly before and after treatment. There was a significant difference between the two groups when comparing MP/SN (P 0.05).
4) There was significant difference between T group and F group in SNA change (SNA) between groups (P 0.05), and there was significant difference between the two groups in A point position change (A-Y) between groups (P 0.05).
2. changes in teeth:
1) There were lingual inclination of maxillary incisors, labial inclination of mandibular incisors, distal inclination of maxillary molars, and proximal and medial inclination of mandibular molars in both groups.
2) Bone to tooth ratio: In group T, the tooth effect accounted for 51.4% and 56.93% respectively, while the bone effect accounted for 48.60% and 43.07% in group T. In group F, the tooth effect accounted for 48.52% and 52.96% respectively, and the bone effect accounted for 51.48% and 47.04% in group F.
3) the T group and F group decreased by 3.30 + 0.91mm, 3.70 + 1.94mm. respectively.
3. Soft tissue measurement changes: T group and F group chin improvement, the two groups of chin-lip groove depth changes, the changes in the depth of the upper lip fovea between the groups were statistically significant (P 0.05).
Conclusion:
1. Twin-block, Forsus corrected Class II 1 mandibular retraction patients at the peak of growth and development, effectively promoted the development of sagittal mandible, Class II bone surface became normal, and the profile improved.
2. Compared with Twin-block, Forsus can promote the growth of mandibular ramus better. Twin-block rotates clockwise on the mandibular plane after orthodontic treatment, but the mandibular plane remains unchanged before and after orthodontic treatment.
3. Compared with Twin-block, Forsus inhibited the growth of maxillary and maxillary arch, inclined the maxillary molars to the distal, the mandibular molars to the near-middle, and the lower anterior teeth to the labial inclination.
4. The adjustment of molar relationship and anterior overbite of Twin-block orthodontic appliance were mainly caused by tooth effect, while that of Forsus orthodontic appliance was mainly caused by bone effect.
5. Compared with Twin-block, Forsus has a wide range of applications. It promotes the sagittal growth of the mandible and the elevation of the mandibular ramus. The mandibular plane angle is basically unchanged, so the normal high angle cases should be given priority.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R783.5

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相關(guān)期刊論文 前10條

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本文編號：2205445