骨性Ⅲ类错[牙合]畸形患者正畸-正颌联合治疗前后软组织侧貌的变化

Changes of the soft tissue profile in skeletal class Ⅲ patients treated with orthodontic-surgical treatment

目的探讨骨性Ⅲ类错[牙合]患者正畸-正颌联合治疗前后软组织侧貌的变化。方法选取正畸-正颌联合治疗的35例成年骨性Ⅲ类错[牙合]患者,治疗前(T0)、手术前(T1)、手术后(T2)、治疗完成拆除矫治器(T3)4个时期拍摄头颅侧位X线片,测量骨性、牙性硬组织测量项目11项,和反映软组织侧貌改变的角度、距离项目15项,各软硬组织在4个时期比较采用重复测量方差分析,2个时期组间比较采用最小显著差异法(LSD检验)。结果(1)通过正畸-正颌联合治疗(T3-T0),面凸角增大、软组织面角减小、鼻唇角增大、上唇突度增大、下唇突度减小(P<0.05),侧貌有了极大改善;(2)术前正畸治疗(T1-T0),上唇突度减小(P<0.05);(3)正颌手术前后(T2-T1),上下唇突点下降[UL-HRL增大(1.93±2.89) mm,LL-HRL增大(3.56±3.80) mm](P<0.05);(4)正颌手术后至最终治疗完成阶段(T3-T2),各软硬组织相对比较稳定(P>0.05)。结论骨性Ⅲ类错[牙合]患者通过正畸-正颌联合治疗,侧貌有了极大改善;术前正畸去代偿治疗,软组织侧貌进一步恶化;正颌手术后至最终治疗完成阶段,软硬组织相对比较稳定;需注意伴随着手术,上下唇突点的向下移位。

Objective To explore the changes of the soft tissue profile in skeletal class Ⅲ patients treated with orthodontic-surgical treatment. Methods The samples consisted of 35 skeletal class Ⅲ patients treated with orthodontic-surgical treatment. Standardized lateral cephalograms at the following stages were taken for each patient : T0(pretreatment), T1(preoperative), T2( postoperative), T3(posttreatment). Fifteen soft tissue parameters, and eleven bone and dental parameters were measured at different stages. Repeated measurement variance analysis was used for comparison of each parameter between 4 stages, and Least-Significant Difference (LSD)test was used for comparison between any 2 stages. Results (1)Between stage T0 and T3: soft tissue convexity increased. Soft tissue facial angle decreased. Nasolabial angle increased. The protrusion of the upper lip increased, and that of the lower lip decreased (P<0.05). The facial profile has been improved greatly;(2)Between stage T0 and T1: the protrusion of the upper lip decreased (P<0.05);(3) Between stage T1 and T2: the UL and LL points moved downward[UL-HRL increased (1.93±2.89)mm, LL-HRL increased (3.56±3.80)mm](P<0.05);(4)Between stage T2 and T3: soft and hard tissues were relatively stable (P>0.05). Conclusions Through orthodontic-surgical treatment, facial profile has been improved greatly in skeletal class Ⅲ patients. Through preoperative orthodontic decompensation treatment, the soft tissue profile has further deteriorated. Between stages of postsurgery and posttreatment, soft and hard tissues were relatively stable. It is necessary to pay attention to the downward movement of the UL and LL points along with the surgery.