生长发育高峰后期骨性Ⅲ类错牙合畸形患者改良前方牵引的疗效分析

李帅臣; 霍娜; 周孙欣; 李红坤; 王恒心; 许诺; 蔡川; 张彤

doi:10.12435/j.issn.2095-5227.2024.093

生长发育高峰后期骨性Ⅲ类错牙合畸形患者改良前方牵引的疗效分析

Effect of modified maxillary protraction on skeletal class Ⅲ malocclusion patients at later period of pubertal peak

摘要

摘要:
背景对于上颌骨发育不良的骨性Ⅲ类错牙合畸形患者多采用上颌前方牵引治疗，而其在生长发育高峰后期的疗效存在争议。
目的通过头影测量分析生长发育高峰后期骨性Ⅲ类错牙合畸形患者改良前方牵引治疗前后硬组织的变化。
方法选取2017 — 2023年于解放军总医院第一医学中心口腔正畸科就诊的生长发育高峰后期(颈椎骨龄分期CVM Ⅴ-Ⅵ期)骨性Ⅲ类错牙合畸形患者。使用改良牙合垫式口内矫治器配合口外双杆式上颌前方牵引器进行治疗。治疗前后分别拍摄头颅侧位片，测量分析面部骨性和牙性指标的变化。
结果本研究共纳入26例患者，其中男性16例，女性10例，年龄12-15岁，平均疗程8.2个月。改良前方牵引治疗后，上颌骨矢状向位置指标SNA增加2.67° ± 1.29°(P＜0.001)、ss/OLP增加(3.91 ± 1.98) mm(P＜0.001)、Or/OLP增加(1.57 ± 2.00) mm(P＝0.001)、Ptm/OLP增加(0.64 ± 1.39) mm(P＝0.028)；上前牙倾斜度(U1-SN)平均增加1.07°；下前牙倾斜度(IMPA)减小1.41° ± 4.64°(P＝0.133)。
结论应用改良牙合垫式口内矫治器配合口外双杆式上颌前方牵引器能有效刺激生长发育高峰后期骨性Ⅲ类错牙合畸形患者上颌骨的前移，较好地控制了上前牙唇倾和下前牙舌倾。

Abstract:
Background For patients with skeletal class III malocclusion due to underdevelopment of maxilla, maxillary protraction is commonly used, but its efficacy at later period of pubertal peak is controversial.
Objective To evaluate the treatment effects of modified maxillary protraction on hard tissue changes in patients with skeletal class Ⅲ malocclusion at later period of pubertal peak using cephalometric measurements.
Methods Patients with skeletal class Ⅲ malocclusion at later period of pubertal peak (CVM Ⅴ-Ⅵ stage) who visited the Department of Orthodontics, the First Medical Center, Chinese PLA General Hospital from 2017 to 2023 were selected. The treatment was carried out using a modified pad intraoral appliance combined with an extraoral double-rod maxillary anterior distractor. Before and after treatment, lateral cephalometric radiographs were taken to measure and analyze the changes of facial bone and dental indices.
Results Of the 26 cases, there were 16 males and 10 females, aged 12-15 years old, and the average course of treatment was 8.2 months. After modified maxillary protraction treatment, the sagittal position indices of maxilla increased significantly, including SNA increased by 2.67° ± 1.29° (P＜0.001), ss/OLP increased by (3.91 ± 1.98) mm (P<0.001), Or/OLP increased by (1.57 ± 2.00) mm (P=0.001), and Ptm/OLP increased by (0.64 ± 1.39) mm (P=0.028). The inclination of upper anterior teeth (U1-SN) increased by an average of 1.07°. The inclination of lower anterior teeth (IMPA) decreased by 1.41° ± 4.64°(P=0.133).
Conclusion The application of modified pad intraoral appliance combined with extraoral double-rod maxillary anterior distractor can effectively promote maxillary advancement of patients with skeletal class Ⅲ malocclusion at later period of pubertal peak, and control the lip inclination of upper anterior teeth and the tongue inclination of lower anterior teeth well.

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