安氏Ⅱ类亚类错（牙合）成人患者牙颌对称性的CBCT研究

发布时间：2018-02-19 19:43

  本文关键词： 安氏Ⅱ类亚类错牙合畸形 CBCT 牙弓形态 下颌骨 中线偏斜　出处：《河北医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：Angle将一侧磨牙关系呈远中关系、另一侧磨牙关系呈中性关系的错牙合畸形定义为安氏Ⅱ类亚类错牙合畸形。与之相关的治疗一直是临床上的重点和难点。对这种特殊的错牙合畸形特点的准确分析，有利于指导临床治疗的有效进行。本研究通过锥形束CT(cone-beam computerizedtomography，CBCT)资料对安氏Ⅱ类亚类错牙合畸形成人患者的牙颌对称性进行分析，比较其与正常牙合人群的差异，研究安氏Ⅱ类亚类错牙合畸形成人患者上下颌牙弓形态特征、下颌骨形态及位置特征。 方法：研究对象分为两组。自2011年10月-2013年10月，于河北医科大学口腔医院正畸科门诊就诊的患者中选取安氏Ⅱ类亚类错牙合畸形患者30例（男18例，女12例，年龄范围19.1-34.1岁，平均年龄24.6岁）作为Ⅱ类亚类组；从河北医科大学在校学生中选取个别正常牙合30例（男9例，女21例，年龄范围18.1-25.8岁，平均年龄21.5岁）作为正常牙合组。所有研究对象知情同意。对每个研究对象在牙尖交错位时进行CBCT扫描，所得解剖结构图像以二维数字成像和医学通信文件（2-D digitalimaging and communications in medicine, DICOM）形式保存并导入Invivo5软件，对原始图像数据进行读取，进行上下牙列和下颌骨的三维重建，定位标记点，对上下颌牙列及下颌骨进行各线距和角度的测量。 通过确定上颌牙列中点、切牙孔点、上颌磨牙点、下颌牙列中点、下颌磨牙点、髁突顶点、下颌角点、颏下点和髁突中点等标志点，确定相应的测量项目：上颌牙弓弧形长度、上颌牙弓弧形长度投影、上颌牙弓直线长度、上颌牙弓直线长度投影、上颌磨牙位置、上颌磨牙位置投影、上颌磨牙夹角、上颌中线、下颌牙弓弧形长度、下颌牙弓弧形长度投影、下颌牙弓直线长度、下颌牙弓直线长度投影、下颌磨牙夹角、下颌磨牙位置、下颌磨牙位置投影、下颌中线、下颌升支长度、下颌体部长度、下颌骨长度、下颌角度、髁突角度、髁突位置、髁突间距、髁突夹角、喙突位置、喙突间距、喙突夹角、磨牙间距。用两侧测量值的差值（Ⅱ类亚类组：远中侧-中性侧，正常牙合组：左侧-右侧）及上颌磨牙夹角、下颌磨牙夹角、髁突间距、髁突夹角、喙突间距、喙突夹角、上颌中线、下颌中线和牙列中点间距（下颌中线-上颌中线）表示两侧间差异，作为统计指标，用磨牙间距表示Ⅱ类亚类组远中侧咬合关系异常的严重程度。定义各统计指标的基准值（即两侧完全对称时的值），除上颌磨牙夹角、下颌磨牙夹角、髁突夹角及喙突夹角为90外，其他指标的基准值均为0。与基准值不同即可认为存在不对称。使用SPSS13.0统计学分析软件①对Ⅱ类亚类组和正常牙合组表示两侧间差异的统计指标分别与基准值进行单样本t检验，分析两侧的对称性；②对两组统计指标间进行两独立样本t检验，分析两组间是否存在统计学差异；③将Ⅱ类亚类组各统计指标分别与磨牙间距进行Pearson相关分析。检验标准α定为0.05。 结果： 1Ⅱ类亚类组中①上中线正、下中线偏向远中侧的占60%（18例），②下中线正、上中线偏向中性侧的占23%（7例），③上下中线均发生偏斜的占17%（5例）。 2对正常牙合组的对称性检验结果显示：只有上颌磨牙位置差值和上颌磨牙位置投影差值表现出统计学意义（P0.05）。左侧的上颌磨牙位置、上颌磨牙位置投影均大于右侧，差值分别为0.67±1.22mm和0.81±1.34mm。其它指标差异均无统计学意义（P0.05）。 3对Ⅱ类亚类组的对称性检验结果显示：Ⅱ类亚类组远中侧的下颌牙弓弧形长度投影、下颌磨牙位置、下颌磨牙位置投影、下颌体部长度小于中性侧，差值分别为-0.44±1.11mm，-1.62±2.17mm，-1.00±1.78mm，-1.15±1.91mm，差异有统计学意义（P0.05）；另外，上颌磨牙夹角为90.6±1.6°、下颌磨牙夹角为87.6±2.5°，上颌中线为-0.36±0.92mm，下颌中线为0.95±1.14mm，牙列中点间距为1.31±0.79mm。其它指标均未表现出统计学意义（P0.05）。 4对Ⅱ类亚类组与正常牙合组的统计指标进行的两独立样本t检验结果显示：Ⅱ类亚类组两侧上颌磨牙位置投影差值、下颌磨牙位置差值、下颌体部长度差值均小于正常牙合组，差值分别为1.05mm，1.41mm，1.21mm，而下颌中线和牙列中点间距大于正常牙合组，差值分别为1.09mm和1.30mm（P0.05）。 5对Ⅱ类亚类组各统计指标与磨牙间距进行Pearson相关分析后，发现Ⅱ类亚类组的下颌磨牙夹角与磨牙间距呈中等强度负相关，而下颌牙弓直线长度差值、下颌牙弓直线长度投影差值和牙列中点间距与磨牙间距呈中等强度正相关（P0.05）；另外，与磨牙间距表现出正的弱相关性，下颌升支长度差值、下颌骨长度差值、下颌磨牙位置差值和下颌磨牙位置投影差值与磨牙间距表现出负的弱相关性。 结论： 1安氏Ⅱ类亚类错牙合常伴有牙列中线的偏斜，且多发生在下颌； 2Ⅱ类关系的形成主要与下颌磨牙位置相关，，与上颌磨牙位置和下颌骨及升支的长度也有一定相关性。
[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..
Result锛

本文编号：1517951