两种方法矫治骨性Ⅲ类错[牙合]前、后上气道变化的临床研究

Two methods of treatment for skeletal ClassⅢmalocclusion on airway changes before and after clinical research

目的探讨微种植体支抗与颌间Ⅲ类牵引矫治成人骨性Ⅲ类错[牙合]前后上气道矢状径的变化,为临床治疗提供参考。方法选取35例成人骨性Ⅲ类错[牙合]患者,利用直丝弓矫治技术矫治,微种植体组15例(A组):骨性Ⅲ类错[牙合]重度病例(垂直高角)选择配合微种植体支抗;颌间Ⅲ类牵引组20例(B组):骨性Ⅲ类错[牙合]轻、中度病例(垂直低角、均角)选择配合颌间Ⅲ类牵引,测量分析矫治前后的头颅定位侧位片。结果矫治后颅颌面测量指标的变化:A组蝶鞍中心鼻根点下牙槽座点构成的角(sellanasionsupramental angle,SNB角)减小(P<0.05),上牙槽座点鼻根点下牙槽座点构成的角(subspinalenasionsupramental angle,ANB角)增大(P<0.05);B组SNB角减小(P<0.05),蝶鞍中心鼻根点上牙槽座点构成的角(sellanasionsubspinale angle,SNA角)、ANB角、下颌平面角(anterior skull base planemandibular plane angle,SNMP角)增大(P<0.05)。矫治后上气道矢状径测量指标的变化:A组上气道矢状径舌咽段(TBTPPW)减小(P<0.05);B组上气道矢状径鼻咽第一段(PNSR)增大(P<0.05)。矫治后A组SNB减小、ANB增大的量大于B组,差异有统计学意义(P<0.05);A组上气道TB-TPPW减小的量大于B组,差异有统计学意义(P<0.05)。结论利用微种植体支抗矫治成人骨性Ⅲ类错[牙合],对上气道矢状径舌咽段产生消极影响。

Objective To investigate the changes in the sagittal diameter of the upper airway before and after the treatment of skeletal ClassⅢmalocclusion in adults with microimplant anchorage and classⅢintermaxillary elastics and to provide a reference for clinical treatment.Methods A total of 35 adult patients with skeletal ClassⅢmalocclusion were selected to be treated with the straightwire technique.Microimplant group,15 cases(group A):patients with severe skeletal ClassⅢmalocclusion(vertical high angle)were treated with the straightwire technique combined with microimplant anchorage;classⅢintermaxillary elastics group,20 cases(group B):Patients with mild or moderate skeletal ClassⅢmalocclusion(vertical low angle and average angle)were treated with the straightwire technique combined with classⅢintermaxillary elastics,and cephalometric radiographs obtained before and after treatment in the upper airway in the two groups were measured and analyzed.Results Changes in cranial and maxillofacial measurements after correction:in group A,(sellanasionsupramental angle)the SNB angle decreased significantly(P<0.05),and(subspinalenasionsupramental angle)the ANB angle increased significantly(P<0.05).In group B,the SNB angle decreased significantly(P<0.05),while(subspinalenasionsubspinale angle)the SNA angle、ANB angle and anterior skull base planemandibular plane angle(SnMP)angle increased significantly(P<0.05).Changes in sagittal diameter of the upper airway measurements after corrections:In group A,the width of the glossopharyngeal segment of the upper airway(TBTPPW)decreased significantly(P<0.05).In group B,first segment width of the upper airway behind the hard palate(PNSR)increased significantly(P<0.05).After correction,the decreased SNB and increased ANB in group A was higher than that in group B,and the difference was statistically significant(P<0.05).The decreased of TBTPPW in upper airway of group A was greater than that of group B,and the difference was statistically significant(P<0.05).Conclusions In the treatment of skeletal classⅢmalocclusion with microimplant anchorage,the sagittal diameter of the glossopharyngeal segment of the upper airway has a negative impact.