目的: 通过对骨性Ⅱ类高角患者拔牙矫治前后面部三维扫描模型与头颅侧位片进行测量分析, 探讨软硬组织变化趋势、影响因素及其作用。方法: 选取18例骨性Ⅱ类高角行单纯拔牙矫治的成人女性患者, 对矫治前后的头颅侧位片定点描记并进行硬组织测量, 同时获得纳入患者矫治前后三维颜面数据, 在完成模型重定位及模型重叠后, 对三维软组织标志点标定并测量相应三维软组织。硬组织测量包括17个测量指标(蝶鞍点-鼻根点-上齿槽座点的夹角、蝶鞍点-鼻根点-下齿槽座点的夹角、上齿槽座点-鼻根点-下齿槽座点间的夹角、面角、颌凸角、眶耳平面-下领平面角、Y轴角、前颅底平面-下颌平面角、颏前点到鼻根点-下齿槽座点连线的垂直距离、上中切牙到鼻根点-上齿槽座点连线的垂直距离、上中切牙与鼻根点-上齿槽座点的夹角、下中切牙到鼻根点-下齿槽座点连线的垂直距离、下中切牙与鼻根点-下齿槽座点连线交角、上下中切牙角、上切牙倾斜度、下中切牙-下颌平面角和Z角), 其中11个指标测量其治疗前后变化量。测量20个软组织标志点(左/右颧骨点、左/右口角点、左/右唇峰点、软组织颏顶点、左/右下颌角点、额点、下唇下缘点、上唇上缘点、软组织颏下点、左/右下颌边缘中点、软组织颏前点、口裂点、唇下点、鼻下点和上唇点)治疗前后三维位移量, 并取9项软组织测量指标(下唇高、面突角、下唇红高、下颌轮廓角、鼻唇角、人中长度、人中宽度、上唇高和上唇红高)。对矫治前后各指标变化量进行线性回归分析, 并运用Pearson系数分析各指标间相关性。结果: 矫治前后的硬组织及软组织20个测量指标中有18个测量值变化量差异有统计学意义(P＜0.05), 主要变化表现为唇部的整体内收, 软组织颏前点存在垂直向的明显上移[(1.88±2.61) mm, P＜0.05], 同时左/右口角点[(-2.95±1.9) mm、(-2.90±1.92) mm]、上下唇缘点[(-4.94±1.95) mm、(-3.25±1.44) mm]、唇下点[(-3.10±3.5) mm]、鼻下点[(-1.23±1.06) mm]在矢状向明显内收(P＜0.05), 其他点差异无统计学意义; Z角平均增加4.10°±2.57°(P＜0.05), 其他差异无统计学意义; 矫治后颏下点移动量与眶耳平面-下领平面角(比例为:-0.183 :1)、与前颅底平面-下领平面角(比例为:-0.157 :1)呈高度相关(r>0.7), 其余存在相关性的测量指标间呈中度相关(0.7≥r>0.4), 且差异均有统计学意义(P＜0.05)。结论: 骨性Ⅱ类高角患者通过单纯拔牙矫治也可得到一定的面型改善, 主要表现为鼻、唇、颏三者矢状方向上关系的改善, 其软组织移动量与硬组织移动量间存在着一定的线性比例关系。

Objective: To investigate the hard and soft tissue changing trend and contributing factors of skeletal class Ⅱ hyperdivergent patients before and after orthodontic camouflage treatment by analyzing the cephalogram and the three dimensional (3D) facial scan data. Methods: Eighteen skeletal class Ⅱ hyperdivergent adult female patients who finished camouflage orthodontic treatment were selected. Skeletal and dental measurements were carried out with the cephalometric analysis before and after the treatment. 3D facial data before and after orthodontic treatment were acquired and the anatomical landmarks were set after the repositioning and superimposition process. Hard tissue measurement included 17 mea-surement indicators (sella-nasion-subspinale angle, sella-nasion-supramental angle, subspinale-nasion-supramental angle, facial angle, angle of convexity, Frankfort horizontal plane-mandibular plane angle (FH-MP), Y axis angle, sella-nasion plane-mandibular plane angle (MP-SN), pogonion-nasion-supramental distance, upper incisor-nasion-subspinale distance, upper incisor to sella-nasion, lower incisor-nasion-supramental distance, lower incisor-nasion-supramental angle, upper incisor to lower incisor, upper incisor to sella-nasion, lower incisor-mandibular plane angle, and Z angle), and the changes before and after treatment were measured for 11 of them. Twenty soft tissue landmarks (left/right cheekbone, left/right chelion, left/right crista philtra, soft tissue gnathion, left/right gonion, glabella, labrale infe-rius, labrale superius, soft tissue menton, left/right mid-mandibular border, soft tissue pogonion, stomion superius, sublabial, subnasale, and supralabial) and 9 soft tissue indicators (lower lip height, facial convexity, lower vermilion height, mandibular contour, nasolabial angle, philtral length, philtral width, upper lip height, and upper vermilion height) were measured and recorded for treatment changes. Linear-regression analysis and correlation analysis were carried out for analyzing the relationship between hard and soft tissue changes before and after the treatment. Results: Significant differences were noticed for 18 out of the 20 cephalometric measurements and facial measurements before and after the treatment (P < 0.05), which mainly represented the sagittal retraction of lip area after the treatment. Significant vertical displacements were revealed for soft tissue menton after treatment [(1.88±2.61) mm, P < 0.05]. Significant sagittal displacements were revealed for left/right cheilion [(-2.95±1.9) mm, (-2.90±1.92) mm], labrale inferius[(-4.94±1.95) mm], labrale superius[(-3.25±1.44) mm], sublabial [(-3.10±3.5) mm], and subnasale [(-1.23±1.06) mm] after treatment (P < 0.05). An average of 4.10°±2.57° increasement was noticed for Z angle after treatment. High correlation (r>0.7) was noticed for the displacement of menton after treatment with FH-MP, with the rate of -0.183 :1, and MP-SN, with the rate of -0.157 :1. Moderate correlations (0.7≥r>0.4) were noticed for the other measurements with correlations (P < 0.05). Conclusion: A certain extent of facial improvements could be achieved with orthodontic camouflage treatment for skeletal class Ⅱ hyperdivergent patients, which were mostly represented by the improvement of sagittal relationship of nose, lips, and chin. Certain correlations were noticed for the hard and soft tissue changes.