骨性Ⅲ类错牙合畸形患者正畸-正颌联合治疗的稳定性

doi:10.19723/j.issn.1671-167X.2019.01.016

摘要/Abstract

摘要：

目的:测量骨性Ⅲ类错牙合畸形患者经过正畸-正颌联合治疗后及治疗结束3~12年软、硬组织的变化, 探讨正畸-正颌联合治疗后颌面部组织的长期稳定性。方法: 回顾2000年1月1日至2009年1月1日就诊于北京大学口腔医院行正畸-正颌联合治疗的骨性Ⅲ类患者22例,收集正畸-正颌联合治疗结束时及3~12年随访复诊的头颅侧位片,测量各牙性硬组织、骨性硬组织及软组织变化的项目。利用SPSS 17.0软件进行配对t检验,P<0.05为差异有统计学意义。结果:比较联合治疗术后3~12年和治疗结束时的牙性硬组织变化如下:上中切牙-SN角由110.98°±6.77°减少为109.21°±5.80°(P = 0.005),上中切牙-NA角由28.31°±6.80°减少为26.49°±6.18°(P = 0.002),上下切牙角由123.51°±8.14°增大为125.7°±10.01°(P = 0.035), 其余牙性硬组织项目变化均差异无统计学意义,说明联合治疗后3~12年相比联合治疗结束时,患者的上前牙有直立趋势。骨性硬组织变化中全面高由124.98°±11.98°减少为122.4°±11.05°(P = 0.024), 其余骨性硬组织项目变化均差异无统计学意义,提示联合治疗后3~12年骨性硬组织具有相对稳定性。比较联合治疗术后3~12年和治疗结束时的软组织测量值,上唇凸点至EP平面距离由(-2.78±2.20) mm减少为(-3.29±2.44) mm (P = 0.02), H角由8.27°±3.71°减少为7.32°±3.83° (P = 0.006),其余软组织项目变化均差异无统计学意义,上唇和颏部软组织变化表现为上唇少量回缩和颏部形态的少量改变。结论: 骨性Ⅲ类错牙合畸形正畸-正颌联合治疗后3~12年牙性硬组织、骨性硬组织及软组织改变基本稳定。

关键词: 错牙合畸形, 上颌后缩, 下颌前突, 正颌手术

Abstract:

Objective:To investigate stability of skeletal hard tissues, dental hard tissues and soft tissues after orthodontic-orthognathic treatment in a long term. This study reviewed longitudinal changes in orthodontic-orthognathic patients of skeletal class Ⅲ malocculsion, using lateral cephalometric radiographs in 3-12 years after treatment in comparison to treatment finishing. Methods: Twenty-two patients with skeletal Class Ⅲ malocclusion following orthodontic-orthognathic surgery in Peking University School and Hospital of Stomatology from January 1, 2000 to January 1, 2009 were observed. The lateral cephalometric radiographs of the following stages were collected: treatment finishing (T1), 3 to 12 years after treatment (T2). Statistical analyses of cephalometrics were evaluated. Paired student t test was performed by SPSS 17.0. Results: Data of all the 22 patients were studied in longitudinal timeline after treatment and 3-12 years after treatment. From T1 to T2, we evaluated 11-SN (angle between the upper incisors axis and SN plane), 11-NA angle (angle between the upper incisors axis and NA plane), 11-NA mm (perpendicular distance from upper incisors to NA plane), 11-41(angle between the upper incisors axis and lower incisors axis), 41-NB angle (angle between lower incisors and NB plane), 41-NB(perpendicular distance from lower incisors to NB plane), 41-MP angle (angle between lower incisors and GoGn plane), and IMPA [angle between lower incisor and mandibular plane (tangent line to submandibular border)]. Most hard tissues of the teeth remained stable but upper anterior teeth angulations decreased, indicating by significantly reducing 11-SN (T1:110.98°±6.77°; T2: 109.21°±5.80°; P=0.005); reducing 11-NA(T1: 28.31°±6.80°;T2: 26.49°±6.18°; P=0.002); increasing 11-41 (T1:123.51°±8.14°;T2:125.7°±10.01°;P=0.035). From T1 to T2, we also evaluated SNA (angle of sella-nasion-A-point ), SNB (angle of sella-nasion-B-point), ANB (angle of A-point-nasion-B-point), GoGn-SN(angle between GoGn and SN plane), GoGn-FH (angle between GoGn and Frankfort plane), Y axis(angel between Sella-Gn and Frankfort plane), N-ANS (distance from nasion point to ANS point), ANS-Me (distance from ANS point to Menton point), N-Me (distance from nasion point to Menton point), ANS-Me/N-Me% (proportion of ANS-Me to N-Me), and FMA (angle between Frankfort and mandibular plane), Wits appraisal (horizontal distance between points A and B on functional occlusal plane). Skeletal hard tissues also remained relatively stable, only N-Me value changed significantly with a decreasing facial height (T1:124.98°±11.98°; T2:122.4°±11.05°; P=0.024). From T1 to T2, we finally evaluated FH-NsPg angle (angle between NsPg and Frankfort plane), H angle (angel between H line and NB), FH-A’UL angle (angle between A’UL and Frankfort plane), FH-B’LL angle (angle between B’LL and Frankfort plane), UL-LL (angle between UL and LL), UL-EP (distance between UL and E line), LL-EP (distance between LL and E line), Sn-H(perpendicular distance between Sn point and H line), Nls-H (distance of nose-lip-sulcus to H line), Li-H (lower lip to H line), Si-H (lower lip sulcus to H line), and NLA (nasolabial angle, angle of Cm-Sn-UL-point).Soft tissues changes were observed in decreasing UL-EP [T1: (-2.78±2.20) mm; (-3.29±2.44) mm; P=0.02] and H angle(T1: 8.27°±3.71°; 7.32°±3.83°; P=0.006).Other soft tissues remained relatively stable by retruding upper lip position and chin changes with no statistical significance. Conclusion: Orthodontic-orthognathic treatment can improve esthetics and occlusal function in patients of skeletal class Ⅲ malocclusion with a stable long-term outcome.

Key words: Malocclusion, Maxillary retrognathism, Mandibular prognathism, Orthognathic surgery

中图分类号:

R783.5

王秀婧,张怡美,周彦恒. 骨性Ⅲ类错牙合畸形患者正畸-正颌联合治疗的稳定性[J]. 北京大学学报（医学版）, 2019, 51(1): 86-92.

Xiu-jing WANG,Yi-mei ZHANG,Yan-heng ZHOU. Orthodontic-orthognathic treatment stability in skeletal class Ⅲ malocclusion patients[J]. Journal of Peking University(Health Sciences), 2019, 51(1): 86-92.

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参考文献 14

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Variables	T_finished	T_{finished 3-12}	t	P
SNA/(°)	82.87±4.62	82.87±4.54	-0.008	0.990
SNB/(°)	81.76±4.80	81.91±4.33	-0.320	0.752
ANB/(°)	1.10±2.26	0.97±2.35	0.657	0.518
GoGn-SN/(°)	37.17±7.77	36.52±7.44	1.124	0.274
GoGn-FH/(°)	33.61±8.00	33.70±6.36	-0.096	0.925
Y axis/(°)	70.08±4.81	69.83±4.34	0.660	0.517
N-ANS/mm	55.88±5.22	54.84±5.49	2.003	0.058
ANS-Me/mm	69.34±7.91	67.76±6.93	1.981	0.061
N-Me/mm	124.98±11.98	122.40±11.05	2.437	0.024^*
ANS-Me/N-Me/%	55.60±2.48	55.50±2.42	0.260	0.797
FMA/(°)	34.72±9.51	35.16±7.93	-0.432	0.671
Wits value/mm	-4.71±2.48	-5.11±2.74	1.455	0.160

Variables	T_finished	T_{finished 3-12}	t	P
11-SN/(°)	110.98±6.77	109.21±5.80	3.085	0.005^#
11-NA angle/(°)	28.31±6.80	26.49±6.18	3.471	0.002^#
11-NA/mm	10.04±8.63	8.87±6.07	0.870	0.394
11-41/(°)	123.51±8.14	125.70±10.01	-2.251	0.035^*
41-NB angle/(°)	27.13±6.95	26.80±8.15	0.425	0.675
41-NB/(mm)	7.56±5.74	6.94±4.59	0.782	0.442
41-MP/(°)	88.24±9.04	88.33±10.18	-0.097	0.923
IMPA/(°)	87.38±8.90	87.45±9.92	-0.078	0.928

Variables	T_finished	T_{finished 3-12}	t	P
FH-NsPg/(°)	89.22±8.63	88.64±7.69	0.723	0.478
H angle/(°)	8.27±3.71	7.32±3.83	3.031	0.006^#
FH-A’UL/(°)	70.62±8.89	72.24±8.67	-1.279	0.215
FH-B’LL/(°)	47.61±19.11	46.26±17.88	1.422	0.170
UL-LL/(°)	110.64±25.60	115.30±12.98	-0.960	0.348
UL-EP/mm	-2.78±2.20	-3.29±2.44	2.511	0.020^*
LL-EP/mm	0.03±2.17	-0.26±2.44	1.113	0.278
Sn-H/mm	4.22±3.52	4.99±3.73	-2.051	0.053
Nls-H/mm	7.77±2.33	10.09±14.49	-0.757	0.457
Li-H/mm	1.49±1.42	1.35±1.79	0.601	0.555
Si-H/mm	5.51±1.51	5.47±1.33	0.199	0.845
NLA/(°)	90.66±12.55	92.66±10.01	-1.387	0.180