安氏Ⅱ类下颌后缩患者隐形前导矫治器矫治后气道CBCT变化

CBCT changs of upper airway and hyoid bone position in patients with Angle ClassⅡmolacclution and mandibular retraction after invisible leading appliance treatment

目的应用锥形束计算机断层扫描(CBCT)观察发育中的安氏Ⅱ类1分类错[牙合]伴下颌后缩患者经隐形前导矫治器治疗后上气道的形态变化,并与未治疗的Ⅱ类患者进行比较。方法选取郑州大学第一附属医院口腔科2017年2月—2019年7月收治的20例完成隐形前导治疗的青少年患者纳入实验组。对照组20例选自诊断相同且未接受隐形前导治疗的患者。收集实验组和对照组治疗前(T_(1))和治疗后(T_(2))的CBCT扫描数据。对T_(1)和T_(2)数据进行三维重建和配准后,测量隐形前导矫治器治疗过程中上气道的形态学变化。对实验组T_(1)和T_(2)数据以及T_(2)和对照组数据进行统计学处理,并进行t检验。结果治疗期间,下颌骨水平方向前移(3.52±62.14)mm,垂直方向前移(3.77±62.10)mm。舌骨位置更靠前,位置更靠下。上气道在鼻咽、口咽和下咽明显增大。此外,鼻咽变得更圆,口咽变得更椭圆形。但下咽的横断面形态无明显差异。T_(2)组与对照组比较,仅舌骨水平运动、口咽、下咽容积扩张、口咽横形变化有显著性差异。结论与未治疗的Ⅱ类患者相比,生长中的安氏Ⅱ类1分类错[牙合]伴下颌后缩患者的上气道在口咽、下咽明显增大,口咽横形呈椭圆形,经隐形前导矫治器治疗后舌骨前移,与未治疗的Ⅱ类患者相比,下颌后缩的患者上气道明显增大,口咽部横断面呈椭圆形,舌骨前移,与未治疗的Ⅱ类错[牙合]畸形患者相比,下颌后缩的患者上气道明显增大。

Objective The purpose of this study was to evaluate the morphological changes of upper airway after invisible leading appliance treatment in growing patients with ClassⅡdivision 1 malocclusion and mandibular retrusion compared with untreated ClassⅡpatients by Cone Beam Computed Tomography(CBCT).Methods Twenty growing patients who have completed invisible leading appliance treatment were recruited into invisible leading appliance group.The control group(n=20)was selected from the patients with the same diagnosis and experimental treatment.CBCT scans of the pre-treatment(T_(1))and post-treatment(T_(2))data of invisible leading appliance group and control data were collected.After three-dimensional(3 D)reconstruction and registration of T_(1) and T_(2) data,the morphological changes of upper airway during invisible leading appliance treatment were measured.The statistical differences between T_(1) and T_(2) data of invisible leading appliance group as well as T_(2) and control data were accessed by test.Results During the invisible leading appliance treatment,the mandible moved advanced by(3.52±62.14)mm in the horizontal direction and(3.77±62.10)mm in the vertical direction.The hyoid bone was in a more forward and inferior place.The upper airway showed a significant enlargement in nasopharynx,oropharynx and hypopharynx.In addition,the nasopharynx turned more circular,and the oropharynx became more elliptic in transverse shape.However,the transverse shape of the hypopharynx showed no significant difference.After comparison between T;and control data,only the horizontal movement of the hyoid bone,the volumetric expansion of the oropharynx and hypopharynx,and changes of the oropharyngeal transverse shape showed significant difference.Conclusion Compared to the untreated ClassⅡpatients,the upper airway of growing patients with ClassⅡdivision 1 malocclusion and mandibular retrusion showed a significant enlargement in the oropharynx and hypopharynx as well as a more elliptic transverse shape in the oropharynx,and the hyoid bone moved to an anterior position after invisible leading appliance treatment.