安氏Ⅱ^1错软组织变化的临床研究

CLINICAL STUDY OF THE SOFT TISSUE CHANGES IN CLASS Ⅱ^1 MALOCCLUSION

目的：探讨安氏Ⅱ^1错畸形病人在MBT直丝弓矫治技术配合斜面导板矫治前后的整体容貌的变化及软组织变化规侓,为临床对安氏Ⅱ^1错畸形的诊断及治疗提供参考依据。方法：选择40例符合标准的病例,不拔牙矫治,采用MBT直丝弓矫治技术配合斜面导板,按矫治的不同阶段分为：矫治前,矫治中（上颌排齐阶段）,矫治后（摘斜导及矫治结束阶段）,每一病例在每个阶段结束后,均在同一台头颅定位仪X光机（Kodak 8000 c全景片机）拍摄X线头颅侧位定位片,利用头影测量分析软件（Winceph 8.0软件）标定软组织标志点、绘图,测量出软组织各测量项目值,对颌面部软组织的变化进行投影测量分析。其中标志点为S（蝶鞍点,Sella）,N’（软组织鼻根点,Nassion of Soft Tissue）,Sn（鼻下点,Subnasale）,B’（下唇凹点,颏唇沟Mentolabial sulcus最凹处）,Cm（鼻小柱点,Columella）,Po（颏前点,Pogonion）,Ls（上唇突点,Labrale Superius）,Li（下唇突点,Labrale Inferius）。7项软组织测量指标为：Ls-E（上唇审美平面距,上唇突点到审美平面的垂直距离）,Li-E（下唇审美平面距,下唇突点到审美平面的垂直距离）,S-N’-Sn（上唇基角,由蝶鞍点、软组织鼻根点和鼻下点构成）,S-N’-B’（下唇基角,由蝶鞍点、软组织鼻根点和下唇凹点构成）,Cm-Sn-Ls（鼻唇角,Cm、Sn、Ls三点连线所成的角）,N’-Sn-Po（面突角）,Z角（颏前点Po与上唇或下唇最突点的连线与FH平面所成的后下角）。数据采用SPSS 13.0软件进行统计学处理,分析矫治前、中、后测量指标的变化及各指标间的相关性。结果：1、安氏Ⅱ^1错畸形的病人矫治后整体容貌的变化主要表现为：下颌后缩得以改善,侧貌实现协调与美观的效果。2、安氏Ⅱ^1病例矫治前、中、后软组织测量项目的变化：鼻唇角增大和面突角减小,上下唇到审美平面距减少。S-N’-Sn和Ls-E、和Cm-Sn-Ls变大（P〈0.05）,有统计学意义。结论：1、对于恒牙早期安氏Ⅱ^1下颌后缩的病人,采用MBT直丝弓矫治器联合斜面导板早期治疗,能有效改变软组织的侧貌,实现颌、、面的协调与美观。2、在治疗过程中,Cm-Sn-Ls、N’-Sn-Po、Z角、S-N’-Sn、S-N’-B’Ls-E和Li-E的变化,与上下颌切牙倾斜度和颌骨的位置相关,因此,在正畸治疗中,根据硬组织的改变来预测软组织的变化具有重要的指导意义。

Objective： To investigate the overall appearance and soft tissue changes in Class Ⅱ^1 malocclusion patients treated with MBT straight wire technology combining with inclined plane appliance in different stages,and discuss the clinical efficacy for diagnosis and treatment in Class Ⅱ^1 malocclusion. Methods： 40 cases of patients that conform to the standard were selected with non-extraction treatment. According to the different stages of treatment using MBT straight wire appliance with inclined plane,the whole course of treatment was divided into three stages： pre-treatment,mid-treatment（ maxillary aligned phase）,post-treatment（ end of treatment phase and remove the inclined plane）.All the cases at the end of each stage had shot positioning cephalometric X-ray film in the same skull X-ray machine locator（ Kodak 8000 c panoramic machine）. Using cephalometric analysis software（ Winceph 8. 0 software） to demarcate hard and soft tissue landmarks（ see below） and draw,then measuring the value of each hard and soft tissue measurements to analyze the changes of maxillofacial soft tissue. 7 soft tissue markers were： Ls-E,Li-E,S-N＇-Sn,S-N＇-B＇,Cm-Sn-Ls,N＇-Sn-Pg＇,Z angle. The data was statistically analyzed by using SPSS 13. 0 software in each stage to analyze the changes of hard and soft tissue and the correlation between the index. Results： 1. The overall appearance changes of the Class II 1 patients mainly represent for correcting mandibular retraction and achieving coordinated and beautiful side appearance effects after treatment. 2. The measurement changes of soft tissue in Class II 1 malocclusion in each stage including the teeth tongue backward in the maxillary anterior over-jet decreases. The high front,high back and the length of the mandibular body increased and the S-N＇-Sn,Ls-E,and Cm-Sn-Ls were larger（ P〈0. 05）,which had statistically significance. Ul-SN angle become smaller（ P〈0. 05）,had statistically significance. Conclusion： 1.For Class II 1 patients with characteristic as mandibular retraction in the early permanent,using MBT straight wire appliance combined with inclined plane can change the appearance of the soft tissue profile and achieve coordination and beautiful in jaw,occlusal,and face effectively. 2 During the treatment,the changes of Cm-Sn-Ls angle,N＇-Sn-Pg＇,Z angle,S-N＇-Sn（ base angle of the upper lip）,S-N ＇-B ＇（ base angle of the lower lip）,Ls-E（ distance from the upper lip to aesthetic plane）,and Li-E（ distance from the lower lip to aesthetic plane） are related to the mandibular incisors and the position of the mandible. Therefore,according to the changes of hard tissue angles to predict diversification of the soft tissue has important significance in guiding orthodontic treatment.