舌刺联合头帽颏兜与前方牵引矫治前牙反[牙合]的疗效比较

A comparative study of tongue appliance combined with chin-cup and facemask in the treatment of anterior crossbite

目的:应用头影测量分析,评价舌刺联合头帽颏兜和前方牵引器矫治前牙反[牙合]的疗效,以及对舌骨位置和气道的影响,以期为临床提供参考。方法:选择应用舌刺联合头帽颏兜和前方牵引器2种矫治方法矫治完成的前牙反[牙合]病例各30例,应用Winceph 9.0软件及AutoCAD 2016软件对治疗目前、后的头颅侧位片进行测量分析。采用SPSS21.0软件包对数据进行统计学分析。结果:2种矫治器治疗后,SNA角显著增大(P<0.01)、ANS-PNS线距显著增加(P<0.05)、SN-MP角显著增大(P<0.05)。上前牙唇倾(P<0.01),下前牙舌倾(P<0.05),覆盖显著改善(P<0.01)。治疗后2组UL-E显著增加(P<0.05),舌刺联合头帽颏兜组PLA显著增大(P<0.05)。舌骨位置H-C3距显著变小(P<0.05),H-S及H-Ar距均显著增大(P<0.01),舌骨向后下移位。气道宽度PNS-UPW距均显著增加(P<0.01),前方牵引组U-MPW距显著增大(P<0.01)。结论:前方牵引器和舌刺联合头帽颏兜均能促进上颌骨发育,并使下颌骨顺时针旋转,有效地纠正前牙反[牙合]。前方牵引器和舌刺联合头帽颏兜均会导致舌骨位置向后下移位。前方牵引器可使气道的鼻咽段、腭咽段宽度增加,但舌刺联合头帽颏兜仅使鼻咽段宽度增加。

PURPOSE: To compare the efficacy of tongue appliance combined with chin-cup and facemask in the treatment of anterior crossbite, as well as the effects on the position of hyoid bone and airway, so as to provide reference for clinic. METHODS: Sixty cases with anterior crossbite were selected after treatment, using tongue appliance combined with chin-cup(n=30) and facemask(n=30). Cephalometric radiographs were taken before and after treatment, skeletal,dental, hyoid, and airway space measurements were analyzed with Winceph 9.0 and AutoCAD 2016. SPSS 21.0 software package was used for statistical analysis. RESULTS: Both appliances had a good effect on anterior crossbite. After treatment, SNA, ANS-PNS significantly increased(P<0.05), and SN-MP significantly increased(P<0.05). The upper anterior teeth showed a buccal inclination(P<0.01), the lower anterior teeth had a lingual inclination, and the overjet became normal(P<0.01). UL-E increased in both groups(P<0.05), PLA significantly increased in tongue appliance combined with chin-cup group(P<0.05). H-C3 decreased in both groups(P<0.05), while H-S, H-Ar increased(P<0.01), suggesting that the hyoid bone moved backward and downward. PNS-UPW increased in both groups(P<0.01), and U-MPW increased in facemask group(P<0.01). CONCLUSIONS: Facemask and tongue appliance combined with chin-cup can both promote the development of the maxilla, cause a clockwise rotation of the mandible, and effectively correct the anterior crossbite. Both methods can cause a backward and downward displacement of hyoid bone. Facemask can enlarge the width of nasopharynx and palatopharynx airway, while only the width of nasopharynx can be increased by tongue appliance combined with chin-cup.