成人轻中度上颌牙-牙槽前突畸形非减数矫治前后的软硬组织研究

Changes of hard and soft tissues in mild and moderate maxillary dento-alveolar protrusion adults with non-extration treatment

目的探讨非减数矫治方案,配合使用微种植钉支抗,整体远中移动上颌牙列,矫治成人轻、中度上颌牙-牙槽前突畸形病例的软硬组织侧貌变化。方法 15例轻中度上牙-牙槽前突畸形成年患者,拔除第三恒磨牙,共30颗种植钉植入双侧上颌颧牙槽嵴区,用镍钛拉簧牵引上牙列整体向远中移动。对所有病例矫治前、后的头颅定位侧位片进行软硬组织头影测量,并对所得数据进行统计学分析。结果 (1) 30颗种植钉,其中4颗松动后重新植入,其余均保持稳固。(2) SNA、SNB等骨骼方面的测量值矫治前、后差异无统计学意义(P>0.05),说明正畸没有改变上下颌的基骨;上中切牙长轴与鼻根点-上牙槽座点连线的交角(U1/NA)、上中切牙切缘至鼻根点-上牙槽座点连线的距离(U1-NA)、下中切牙长轴与鼻根点-下牙槽座点连线的交角(L1/NB)、上中切牙切缘至鼻根点-上牙槽座点连线的距离(L1-NB)及上下中切牙交角(U1/L1)的变化差异具有统计学意义(P <0.05),表明上、下前牙突度和倾斜度明显减小。(3)鼻唇角(Cm-Sn-UL)增大、面突角(G-Sn-Pos)减小(P <0.01),上下唇相对于审美平面的距离减小(P <0.01),变化差异具有统计学意义,说明软组织面部侧貌得到改善。结论使用微种植钉作为强支抗能有效牵引上颌全牙列整体远中移动,使其软硬组织均发生明显变化,是非减数方案矫治成人轻中度上颌牙-牙槽前突畸形病例的可行方法。

【Objective】To study the changes of hard and soft tissues in mild and moderate maxillary dento-alveolar protrusion adult patients with non-extraction treatment by moving the whole upper dentition distal with micro-implants anchorage.【Methods】？Fifteen adult patients with mild and moderate maxillary dento-alveolar protrusion were selected in this study. The third molars should be extracted before the treatment. Thirty micro-implant anchorages were inserted into the zygomatic alveolar ridge of bilateral maxilla. A NiTi coil spring was attached to the micro-implant dragging the whole upper dentition distal. Cephalometric were taken before and after treatment, and the data of the cephalometrics were studied in hard and soft tissues.【Results】（1） All thirty micro-implants remained stable. Although there were four implants having a second insert procedure after failure.（2） SNA, SNB had no significant changes（P〈0.05）, which means the maxilla and the mandible remain the same position. The changes of U1/NA, U1-NA, L1/NB, L1-NB and U1/L1 had significant difference（P〈0.05）, which means the torque and tip of the upper and lower anterior teeth were decreased significantly.（3） Cephalometric analysis showed that lateral appearance improved and soft tissue measurements such as Cm-Sn-UL increased, G-Sn-Pos decreased, the distance of the lips to the E plane decreased significantly（P〈0.01）.【Conclusion】Micro-implant anchorage can provide excellent heavy anchorage in moving the whole dentition distally, which would lead to significant improvement in the profile of soft and hard tissues. This non-extraction treatment plan can be used in adult patients with mild and moderate maxillary dento-alveolar protrusion.