正畸配合根尖下截骨术治疗严重双牙弓前突的临床研究

Clinical study on severe bimaxillary protrusion patients corrected by subapical osteotomy combined with orthodontic treatment

目的探讨骨性双牙弓前突患者经正畸正颌联合治疗后，颌面部硬组织、软组织在矢状方向上的变化及其相互关系，为临床矫治方法的选择提供参考。方法临床选择10例安氏Ⅰ类重度骨性双牙弓前突符合正颌手术的患者，术前正畸矫治完成后实施上、下前颌部截骨后退术（术中去除上下第一前磨牙牙骨块），术后进一步正畸治疗以改善咬合关系。通过手术前后头影测量分析，比较颌面部硬组织，软组织在矢状方向上后退量及其相互关系。结果10例重度骨性双牙弓前突患者，经正畸一正颌联合矫治后，效果非常显著。上颌切牙平均后退7．13mm，上颌牙槽骨平均后退6．48mm，上颌软组织唇突点平均后移5．66nm。上颌硬、软组织后退的比例为1：0．87；下颌切牙平均后退6．62mm，下颌牙槽骨平均后退6．91mm，下颌软组织唇突点平均后移5．89mm。硬软组织后移的比值为1：0．85。结论重度骨性的双牙弓前突患者，应首选正畸正颌联合治疗，可彻底纠正前突的面型，上、下颌的硬软组织显著的内收，达到十分满意的疗效。

Objective To investigate the profile changes and relationship between changes of hard and soft tissues of patients with bimaxillary protrusion corrected by combined surgical and orthodontic treatment. Methods 10 patients with severe bimaxillary protrusion, who needed orthognathic surgery treatment were included in the study. After presurgical orthodontic treatment, anterior maxillary and mandibular subapical osteotomy （to remove the bone around the upper and lower first premolar in the treatment） were performed. Orthodontic treatment was continued to improve the occlusion relationship after surgery. Cephalograms taken before and after combined surgical and orthodontic treatment was analyzed to study the sagittal changes of hard and soft tissues. Results Satisfactory results were obtained after combined surgical and orthodontic treatment. The upper incisors, alveolar jaw and upper lip were retracted with average values of 7. 13 mm, 6. 48 mm and 5.66 turn respectively, and the ratio between hard and soft tissue in upper arch was 1 ： 0. 87. The lower incisors, alveolar jaw and lower lip were retracted with average values of 6.62 mm, 6.91 mm and 5.89 mm respectively, and the ratio between hard and soft tissue in lower arch was 1 ： 0. 85. Conclusions Combined surgical and orthodontic treatment should be the first choice for patients with sewre skeletal bimaxillary protrusion. Hard and soft tissues were retracted significantly.