成人骨性反（牙合）伴下颌偏斜的正畸疗效观察

Orthodontic treatment of adult skeletal crossbite with mandibular deviation

目的探讨正畸矫治成人骨性反（牙合）伴下颌偏斜的临床疗效,以期为临床提供参考。方法选择成年骨性反（牙合）伴下颌偏斜的安氏Ⅲ类错（牙合）畸形患者18例,男性5例,女性13例。矫治初期上颌使用直丝弓矫治器；下颌配戴附拉钩的全牙列活动性垫,解除前牙反（牙合）,排齐整平上前牙,并通过垫上的拉钩进行斜牵引,纠正下颌偏斜。矫治前后拍摄头颅侧位X线片,采用配对t检验分析各头影测量项目的矫治前后差异。结果总疗程（18．0±3．5）个月,18例患者前牙反（牙合）及下颌偏斜均得到纠正,前牙建立正常覆覆盖关系。上颌前牙显著前移, U1-NA 角由矫治前的（26．25±3．89）°增加至矫治后的（38．25±1．77）°,U1-SN角由矫治前的（104．75±2．48）°增加至矫治后的（117．50±2．12）°,矫治前后差异均有统计学意义（P〈0．01）。结论正畸治疗可成功矫治成人骨性反伴下颌偏斜的安氏Ⅲ类错（牙合）畸形；矫治初期下颌配戴附拉钩的全牙列活动性垫,可明显改善患者正侧貌。

Objective To investigate the effects of orthodontic treatment of skeletal crossbite adults with mandibular deviation. Methods Eighteen skeletal Class Ⅲ adult patients with borderline skeletal crossbite and mandibular deviation were selected （5 males,13 females）. The mean age was 25 years. All cases were treated with straight-wire appliance in upper arch and occlusal plate in the lower arch. Elastics were applied to correct mandibular deviation. Cephalometric analysis was carried out before and after treatment. Paired t-test was performed. Results After treatment, the anterior crossbite was corrected and Class Ⅰ molar and canine relationships were achieved. The inclination of upper incisors was increased significantly. Conclusions Straight-wire appliance combined with occlusal plate was effective on correcting adult patients with mild, moderate skeletal crossbite and mandibular deviation.