安氏Ⅱ~1类错（牙合）不同矫治方法的对比研究
发布时间：2018-08-26 16:11
【摘要】：目的： 对处于生长发育高峰期安氏Ⅱ1类错(?)畸形的患者采用Twin-block和Forsus矫治器前导下颌,通过矫治前后头颅定位侧位片的测量分析比较两种矫治器治疗前后上下颌骨、牙齿及软组织的生长改建效果,探讨矫治机理,为临床选用适宜的矫治方法提供参考。 方法： 选取2006-2014年间在天津医科大学口腔正畸科治疗完成的安氏II1类下颌后缩患者60例(男33例,女27例),处于生长发育高峰期,平均年龄在11.3±0.6岁,恒牙早期。本研究病例分别采用Twin-block和Forsus矫治器进行矫治,每组30例。治疗前后分别拍摄头颅定位侧位片,运用改良Pancherz分析法、Downs分析法等测量分析上下颌骨、牙和软组织变化。应用SPSS16.0软件对各测量结果处理后进行组内配对样本t检验及组间独立样本t检验,并对检验结果进行讨论。 结果： 本研究运用Twin-block、Forsus矫治器对处于生长发育高峰期的安氏II’类下颌后缩患者进行治疗,平均疗程18个月,均有良好的生长引导、促进作用,收到良好的临床治疗效果。 X线头影测量显示： 1.骨骼改变： 1)分别对比Twin-block组(下文简称T组)和Forsus组(下文简称F组)治疗前后：下颌位置均前移,表现为B-Y、Po-Y, SNB角均显著增大、ANB角减小(P0.05)；有效促进下颌骨的生长,表现为下颌综合长度(Ar-Po)、下颌升支高度(Ar-Go)、下颌体长(Go-Gn)及全面高(N-Me)、下面高(ANS-Me)均显著增加。 2)T组和F组在对下颌升支高度(Ar-Go)、下面高(ANS-Me)进行组间对比时有统计学差异(P0.05)。 3)T组下颌平面角(MP/SN)治疗后变大(P0.05),而F组MP/SN在治疗前后没有明显变化,两组在对MP/SN进行组间对比时有统计学差异(P0.05)。 4)T组和F组对SNA变化量(ΔSNA)进行组间对比时有统计学差异(P0.05)；两组在对A点位置变化量(△A-Y)进行组间对比时有统计学差异(P0.05)。 2.牙(?)改变： 1)T组和F组均存在上颌切牙舌倾,下颌切牙唇倾,上颌磨牙远中倾斜,下颌磨牙向近中倾斜,但程度不同。 2)骨牙比例：T组在6.02mm的覆盖减少量和3.00mm的磨牙关系改善中,牙齿效应分别占51.4%和56.93%,骨骼效应占48.60%和43.07%；F组在6.70mm的覆盖减少4.90mm的磨牙关系改善中,牙齿效应分别占48.52%和52.96%,骨骼效应占51.48%和47.04%。 3)T组和F组覆(?)分别减小了3.30±0.91mm,3.70±1.94mm。 3.软组织测量变化：T组和F组颏部改善,两组间对颏唇沟深度变化量、上唇凹深度变化量进行组间对比时有统计学差异(P0.05)。 结论： 1. Twin-block、Forsus矫治生长发育高峰期的安氏Ⅱ1类下颌后缩患者,有效促进了下颌骨矢状向的发育,Ⅱ类骨面型趋于正常,侧貌改善。 2.与Twin-block相比,Forsus能更好地促进下颌升支的生长。Twin-block在矫治后下颌平面发生顺时针旋转,而Forsus矫治前后下颌平面基本不变。 3.与Twin-block相比,Forsus对上颌生长及上牙弓生长有一定的抑制作用,对上颌磨牙向远中倾斜、下颌磨牙向近中倾斜的作用较为明显；下前牙更加唇倾。 4. Twin-block矫治器磨牙关系的调整及前牙覆(?)、覆盖的减小主要由牙齿效应引起,而Forsus矫治器既有牙齿的位移也有牙槽骨的改变,其前牙覆盖关系的调整主要由骨骼效应引起。 5.与Twin-block相比,Forsus适用范围广。促进下颌骨矢状向生长的同时又促进下颌升支高度的增加,下颌平面角基本不变,所以正常偏高角病例可优先考虑。Forsus易使下前牙唇倾,不适用于下前牙中度拥挤、唇倾度较大的病例。
[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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.5
[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.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.5
【参考文献】
相关期刊论文 前10条
1 牟兰;葛振林;焦鑫;徐庚池;韩耀辉;;双期和单期矫治安氏Ⅱ类错疗效的Meta分析[J];现代口腔医学杂志;2013年05期
2 李丽华;高翔;宋锦t，
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