自锁托槽联合微种植体和J钩矫治安氏Ⅱ~1错的比较研究

Comparison of the treatment outcomes between self-ligating brackets with microimplant and J hook anchorages in patients with Class Ⅱ~1 malocclusion

目的:比较自锁托槽联合微种植体支抗和头帽J钩矫治安氏Ⅱ~1错支抗磨牙及上颌切牙位置变化的差异。方法:纳入40例成人安氏Ⅱ~1错患者,分为微种植体组和J钩组(n=20),拔除4颗第一前磨牙后使用自锁托槽矫治并且增强支抗,微种植体组联合微种植体支抗,J钩组联合头帽J钩,比较2组矫治前后X线头影测量的变化。结果:矫治后,两组SNA°、SNB°、ANB°变化没有统计学意义,SN-OP°都增大(P <0. 01),但组间差异没有统计学意义。微种植体组比J钩组上颌磨牙前移更少(1. 38 vs 2. 37) mm,伸长更少(0. 51 vs 2. 48) mm,上颌切牙内收更多(8. 16 vs 5. 23) mm(组间比较,P <0. 01)。J钩组上颌磨牙伸长,上颌切牙压低,SN-MP°平均增加1. 51°(P <0. 01)。结论:自锁托槽联合微种植体矫治安氏Ⅱ~1错与头帽J钩相比获得了更好的矢状向控制,临床上还应考虑生长型、平面倾斜度、覆覆盖等因素选择合适的方法进行垂直向控制。

Objective:To study the difference of the treatment outcomes between microimplant anchorage and headgear J hooks in patients with Class Ⅱ^1 malocclusion treated with self-ligature brackets.Methods:40 adult patients with class Ⅱ^1 malocclusion were divided into 2 groups:microimplant group and J hook group(n=20).All patients treated with self-ligature brackets and maximum anchorage after extraction of 4 first premolars.The patients in microimplant group received microimplant anchorage,those in J hook group received headgear J hooks.Lateral cephalometric radiographs were obtained before and after treatment.Differences in the skeletal and dental parameters between and within groups were analyzed.Results:No significant difference was observed in SNA°,SNB°and ANB°of each group after treatment.SN-OP°of each group after treatment was significantly increased(P<0.01),there was no statistical difference between the 2 groups.The microimplant group had less maxillary molar mesialization(1.38 vs 2.37)mm,less maxillary molar extrusion(0.51 vs 2.48)mm and greater anterior teeth retraction(8.16 vs 5.23)mm than the J hook group(P<0.01).Patients who received headgear J hooks had extrusion of the maxillary molar,intrusion of the maxillary incisor and increase of SN-MP°by 1.51°(P<0.01).Conclusion:Microimplant anchorage may achieve better sagital control than the headgear J hooks during the treatment of Class Ⅱ^1 malocclusion.Meanwhile,vertical dimension control might be a concern for different anchorage according to the growth pattern,occlusal plane,overjet and overbite.