替牙期骨性Ⅲ类错[牙合]伴开抬的正畸方法初探

Preliminary investigation of orthodontic treatment in compliance with dentofacial development in patients with skeletal Class Ⅲ malocclusion and open bite

目的探讨顺应牙颌系统发育规律的正畸治疗方法矫治替牙期骨性Ⅲ类错[牙合]伴开[牙合]的有效性，为临床提供参考。方法选择11例替牙期（生长发育高峰前期）骨性Ⅲ类错[牙合]伴开骀畸形患者，年龄7-9岁，平均（8.3±0.8）岁，男性3例，女性8例。全部患者均具有手术指征但均拒绝手术治疗。对患者进行面罩前牵引、磨牙[牙合]垫、快速扩弓和固定矫治，正畸结束后随访两年。对患者矫治前后的头颅侧位X线片进行头影测量分析。结果矫治后11例患者的磨牙及尖牙均达到中性关系，前牙反[牙合]解除，达到正常的覆[牙合]覆盖关系，软组织侧貌得到明显改善。矫治后上颌骨前移，SNA角由（79.0±1.2）°增大到（81.9±0.8）°；下颌中切牙角由（25.6±2.1）°减少至（20.1±1.4）°，矫治前后的差异均有统计学意义（P〈0.01）。患者面部生长方向维持不变。两年后随访显示，矫治效果稳定。结论在充分顺应牙颌系统发育规律的基础上，引导生长发育期骨性Ⅲ类错[牙合]伴开[牙合]患者颌面部的生长，可以获得美观、稳定的矫治效果。

Objective To analyze the biologic principle of orthodontic treatment in patients with skeletal Class Ⅲ malocclusion and open bite. Methods Eleven pre-adolescent patients with severe skeletal Class m malocclusion and open bite （age range 7-9 years old, mean age 8.3±0.8） were included. All patients were surgical cases but the patients rejected surgery. The tbeatment methods used were face mask, rapid maxillary expansion occlusal splint and fixed appliance. Lateral cephalometric films were taken before and after treatment. Cephalometric analysis was performed. Results After the treatment SNA changed from （79.0±1.2）° to （81.9±0.8）°（P〈0.01）. And the inclination of lower incisors was decreased from （25.6±2.1）° to （20.1±1.4）° when measured to the NB line（P 〈 0. 01 ）. The direction of the facial growth was maintained. Conclusions Good orthodontic results could be achieved in patients with skeletal Class Ⅲ malocclusion and open bite.