微种植体支抗推磨牙远中移动的临床研究

Clinical Study on Micro-Implant Anchorage for Molar Distalization

目的:探究微种植体支抗推磨牙远中移动矫治安氏Ⅱ类错牙合畸形的临床疗效。方法:回顾性分析2016年1月-2018年12月于笔者医院接受传统口外弓支抗治疗(对照组,n=60)及接受微种植体支抗治疗(研究组,n=60)的安氏Ⅱ类的错牙合畸形患者的临床资料。对比两组矫治时间,计算两组牙冠、牙根远移值[上颌第一磨牙牙冠平均远中移动值(UM1E-Y)、上颌第二磨牙牙冠平均远中移动值(UM2E-Y)、第一磨牙牙根平均远移值(UM1A-Y)、第一磨牙牙根平均远移值(UM2A-Y)],比较两组治疗前后的其他牙齿相关指标[上颌第一磨牙近中颊尖点至Y轴的距离(U6-Y)、上颌第一磨牙牙根尖点至Y轴的距离(U6a-Y)、上颌中切牙长轴与SN平面夹角(U1-SN)]、硬组织指标[上齿、下齿槽座角(SNA、SNB)、上下齿槽座角(ANB)、牙合平面与SN平面夹角(OP-SN)]、软组织相关指标[上唇突度、下唇突度、鼻唇角(NLA)、上唇突距(Ls-E)]及咀嚼功能(咬合力、咀嚼效率)的差异。结果:研究组平均矫治时间显著短于对照组(P<0.05),UM1E-Y、UM2E-Y值显著高于对照组(P<0.05)。治疗后,两组U6-Y、U6a-Y较治疗前均显著降低,且研究组上述指标均显著低于对照组(P<0.05),研究组治疗前后U1-SN无明显变化(P>0.05),而对照组较治疗前显著降低(P<0.05),两组治疗后U1-SN对比差异显著(P<0.05);治疗后,两组SNA、SNB、ANB与治疗前比较无差异(P>0.05),而OP-SN较治疗前上升(P<0.05);两组间治疗后SNA、SNB、ANB对比无显著差异(P>0.05),而研究组OP-SN显著低于对照组(P<0.05);治疗后,两组上唇突度,下唇突度、Ls-E较治疗前显著降低而NLA显著上升(P<0.05),且研究组患者上述指标显著优于对照组(P<0.05)。治疗后,两组咬合力、咀嚼效率较治疗前均显著上升(P<0.05),且研究组咀嚼功能指标显著优于对照组(P<0.05)。结论:应用微种植体支抗矫治安氏Ⅱ类错牙合畸形患者,可缩短矫治时间,有效推磨牙向远中移动,提升患者咀嚼功能,具有较好的临床应用价值。

Objective To explore the clinical efficacy of micro-implant anchorage for molar distalization in correcting Angle ClassⅡmalocclusion.Methods A retrospective analysis was performed on clinical data of patients with Angle ClassⅡmalocclusion who received traditional headgear anchorage treatment(control group,n=60)or received micro-implant anchorage treatment(study group,n=60)in our hospital from January 2016 to December 2018.The correction time was combined between the two groups,and the crown and root distalization values[average distalization value of maxillary first molar crown(UM1E-Y),average distalization value of maxillary second molar crown(UM2E-Y),average distalization value of first molar root(UM1A-Y),average distalization value of second molar root(UM2A-Y)]were calculated in the two groups.The tooth-related indicators[the distance from maxillary first molar mesiobuccal tip to Y axis(U6-Y),the distance from maxillary first molar root apex tip to Y axis(U6a-Y),angle between the long axis of maxillary central incisor and the SN plane(U1-SN)],hard tissue indicators[sella-nasion-A point,sella-nasion-B point(SNA,SNB),A point-nasion-B point(ANB),occlusal plane-SN plane angle(OP-SN)],soft tissue-related indicators[upper lip protrusion(Ls-SnPg),lower lip protrusion(Li-SnPg),nasolabial angle(NLA),upper lip protrusion distance(Ls-E)]and masticatory function(occlusal force,masticatory efficiency)before and after treatment were compared between the two groups.Results The average correction time in study group was significantly shorter than that in control group(P<0.05),and UM1E-Y and UM2E-Y were significantly higher than those in control group(P<0.05).After treatment,U6-Y and U6a-Y in the two groups were significantly decreased compared with those before treatment,and the above indicators in study group were significantly lower than those in control group(P<0.05),and there was no significant change in U1-SN in study group before and after treatment(P>0.05),and U1-SN in control group was significantly lower than that before treatment(P<0.05),and there was a significant difference in U1-SN between the two groups after treatment(P<0.05).After treatment,there were no differences in SNA,SNB and ANB in the two groups compared with those before treatment(P>0.05),and OP-SN was higher than that before treatment(P<0.05).There were no differences in SNA,SNB and ANB between the two groups after treatment(P>0.05),and OP-SN in study group was significantly lower than that in control group(P<0.05).After treatment,the Ls-SnPg,Li-SnPg and Ls-E of the two groups were significantly decreased compared with those before treatment while NLA was increased significantly(P<0.05),and the above indicators in study group were significantly better than those in control group(P<0.05).After treatment,the occlusal force and masticatory efficiency in the two groups were significantly increased compared with those before treatment(P<0.05),and the masticatory function indexes in study group were significantly better than those in control group(P<0.05).Conclusion Micro-implant anchorage for patients with Angle ClassⅡmalocclusion can shorten the correction time,effectively push the molar distalization,and improve the masticatory function,with good clinical application value.