种植钉配合Ⅱ类牵引矫治成人安氏Ⅱ类2分类软硬组织变化分析

Analysis of changes in soft and hard tissues of Class Ⅱ division 2 adult patients treated with mini-screw combined with Class Ⅱ elastics

目的探讨种植钉配合颌间Ⅱ类牵引矫治成人安氏Ⅱ类2分类患者的软硬组织变化量,为临床矫治成人安氏Ⅱ类2分类患者提供参考。方法选择2016—2017年在大连市口腔医院正畸科就诊并且已经完成治疗的安氏Ⅱ类2分类成人患者20例。仅拔除(若存在)上颌第三磨牙进行矫治,并于术中在上颌第一、二磨牙间牙槽嵴上方膜龈联合处倾斜植入种植钉,同时配合Ⅱ类颌间牵引辅助治疗。治疗前后均拍摄头颅定位侧位片,采用SPSS20.0软件对术前术后测量数据进行统计学分析,分析头影测量中各项指标的变化量。结果牙性指标:(1)上颌切牙根尖至Z轴的距离(U1r-Z)平均减小(3.23±0.45)mm(P<0.05);上颌切牙切缘至PP平面的距离(U1c-PP)平均减小(3.63±0.69)mm(P<0.05);(2)上颌第一磨牙牙冠近中尖至Z轴的距离(U6c-Z)平均减小(3.91±0.45)mm(P<0.05);(3)下颌第一磨牙牙冠近中尖至Z轴的距离(L6c-Z)平均增大(2.34±0.27)mm(P<0.05)。硬组织指标:SNB平均增大(1.43±0.53)°(P<0.05)。软组织指标:颏唇角平均增大(4.37±1.51)°,下唇至审美平面距离平均增大(0.91±0.04)mm(P<0.05)。结论应用种植钉配合颌间Ⅱ类牵引治疗成人安氏Ⅱ类2分类患者,不仅可以实现上颌牙列的远中移动及上前牙的压低伴以根腭向移动为主的控根移动,而且还可以适度引导下颌前移,改善患者侧貌。

Objective To investigate the changes in soft and hard tissues of Class Ⅱ division 2 adult patients treated with mini-screws combined with Class Ⅱ elastics,to provide reference for orthodontic treatment.Methods Twenty adult patients with Class Ⅱ division 2,who had completed treatment in the Department of Orthodontics at Dalian Stomatology Hospital from 2016 to 2017,were selected.Maxillary third molars(if they existed)were extracted before treatment,and miniscrews were implanted in mucogingival junction above alveolar ridge between the maxillary first and second molars paralleling with roots,and Class Ⅱ elastics were used during treatment.Lateral cephalogras were taken before and after treatment,and analyses were performed with statistical software(SPSS 20.0)to calculate amount of change in cephalometrics.Results Tooth index:(1)The distance from the root of the maxillary incisor to the Z axis(U1 r-Z)decreased by(3.23±0.45)mm(P<0.05).The distance from the margin of the maxillary incisor to the PP plane(U1 cPP)decreased by(3.63±0.69)mm(P<0.05).(2)Maxillary posterior tooth,the distance from the mid-point of the maxillary first molar crown to the Z-axis(U6 c-Z)decreased by(3.91±0.45)mm(P<0.05).(3)The distance from the midpoint of the mandibular first molar crown to the Z axis(L6 c-Z)increased by(2.34±0.27)mm(P<0.05).Hard tissue index:The SNB increased by(1.43±0.53)°(P<0.05).Soft tissue index:The inferior labial sulcus angle increased by(4.37±1.51)°(P<0.05),the distance from the lower lip to the E-Line increased by(0.91±0.04)mm(P<0.05).Conclusion Mini-screw combined with Class Ⅱ elastic used in patients with Class Ⅱ division 2 can not only distalize maxillary dentition,intrude and angulate the root palatally of maxillary anterior teeth,but also advance mandible to improve patient’s facial profile.