安氏Ⅱ类1分类病人正畸前后唇部软组织变化评估

LIP SOFT TISSUE CHANGES AFTER ORTHODONTIC TREATMENT IN PATIENTS WITH ANGLE CLASS Ⅱ,DIVISION 1 MALOCCLUSION

目的研究不同年龄组安氏Ⅱ类1分类病人拔牙矫治前后唇部软组织形态变化,探讨唇部软组织形态与切牙后退的相关性。方法选取40例安氏Ⅱ类1分类拔牙病人,分为青少年组与成人组,均采用MBT直丝弓矫治技术治疗,矫治前后拍摄头颅侧位X线片与正面相照片,对10个软硬组织指标进行测量,比较矫治前后唇部软组织与切牙位置变化。结果矫治后,随着切牙内收,青少年组及成人组上唇突度及下唇突度均明显减小(t=2.432~10.154,P<0.05),成人组变化更显著;两组上唇厚、下唇长矫治后均明显增大(t=2.719~3.734,P<0.05);成人组矫治后上唇高、下唇高及下唇厚均减小,差异有统计学意义(t=2.206~2.732,P<0.05)。青少年组上切牙内收与上唇突度、上唇厚均呈显著正相关(r=0.407、0.895,P<0.05);成人组上切牙内收与上唇突度、下唇突度、上唇厚、下唇高均呈显著正相关(r=0.219~0.716,P<0.05),下切牙内收与下唇突度呈正相关(r=0.108,P<0.05),上唇突度与下唇突度呈显著正相关(r=0.503,P<0.05)。青少年组上切牙上唇回收比(4.7∶1)大于成人组(2.3∶1)。结论安氏Ⅱ类1分类病人拔牙矫治时,成人病人易于通过切牙内收预测矫治前后唇部软组织突度、厚度、高度及长度的变化;而对于青少年病人,拔牙矫治后切牙内收可以预测其唇部突度、厚度的变化,但由于唇部软组织及颏部发育对软组织侧貌存在影响,相较于成人其可预测性降低。

Objective To investigate lip soft tissue changes after tooth extraction in patients of different ages with Angle ClassⅡ,division 1 malocclusion in different age groups and the association between lip soft tissue morphology and dorsal displacement of incisors. Methods A total of 40 patients with Angle ClassⅡ,division 1 malocclusion were enrolled and divided into adolescent group and adult group.The MBT straight wire appliance was used for treatment.Lateral X-ray films and face photos were obtained before and after treatment,10 indices for soft and hard tissue were measured,and lip soft tissue changes and change in the location of incisors after treatment were compared between the two groups. Results With incisor retraction after treatment,both the adolescent group and the adult group had significant reductions in upper lip protrusion and lower lip protrusion（t=2.432-10.154,P〈0.05）,and the adult group had significantly greater reductions.Both groups had significant increases in upper lip thickness and lower lip length after treatment（t=2.719-3.734,P〈0.05）.The adult group had significant reductions in upper and lower lip heights and lower lip thickness after treatment（t=2.206-2.732,P〈0.05）.In the adolescent group,upper incisor retraction was positively correlated with upper lip protrusion and upper lip thickness（r=0.407 and 0.895,P〈0.05）;in the adult group,upper incisor retraction was positively correlated with upper lip protrusion,lower lip protrusion,upper lip thickness,and lower lip height（r=0.219-0.716,P〈0.05）,lower incisor retraction was positively correlated with lower lip protrusion（r=0.108,P〈0.05）,and upper lip protrusion was positively correlated with lower lip protrusion（r=0.503,P〈0.05）.The adolescent group had a higher upper incisor/upper lip retraction ratio than the adult group（4.7∶1 vs 2.3∶1）. Conclusion In patients with Angle ClassⅡ,division 1 malocclusion,changes in lip soft tissue protrusion,thickness,height,and length after treatment can be predicted by incisor retraction in adult patients;in adolescent patients,incisor retraction after tooth extraction can predict changes in lip protrusion and thickness,but since soft tissue profile is affected by the development of lip soft tissue and the chin,the predictability in adolescents is lower than that in adults.