正畸-正颌手术治疗前牙区严重骨性开[牙合]畸形长期稳定性的效果

Effects of Orthodontic and Orthognathic Surgery on the Long-Term Stability of Severe Skeletal Open Bite in Anterior Region

目的比较单颌和双颌方式在正畸-正颌手术治疗前牙区严重骨性开[牙合]畸形长期稳定性中的效果。方法回顾性分析2019年3月至2020年11月许昌口腔医院收治的102例接受正畸-正颌手术的前牙区严重骨性Ⅲ类错[牙合]畸形患者作为研究对象,按照手术方式分为A组和B组,各51例。A组接受上颌Le FortⅠ型截骨术联合下颌双侧升支矢状骨劈开术,B组接受单纯下颌双侧升支矢状骨劈开术。观察治疗前(T_(0))、治疗后3个月(T_(1))、治疗后1 a(T_(2))两组患者牙齿、骨骼改变情况。结果 A组下颌骨后退距离少于B组(P<0.05);与T_(0)比较,T_(1)时两组蝶鞍中心、鼻根点与上齿槽座点夹角(SNA),上齿槽座点、鼻根点与下齿槽座点夹角(ANB),下中切牙长轴与下颌平面夹角(L1-MP),上中切牙长轴与鼻根点和上齿槽座点连线夹角(L1-NB)均增加(P<0.05),蝶鞍中心、鼻根点与下齿槽座点夹角(SNB),蝶鞍中心、鼻根点与颏前点构成角(SNPo),上中切牙长轴与前颅底平面夹角(U1-SN),上中切牙长轴与鼻根点和上齿槽座点连线夹角(U1-NA),上中切牙与下中切牙长轴夹角(U1-L1)均减小(P<0.05);与T_(1)比较,T_(2)时B组SNPo、U1-SN升高(P<0.05);T_(0)、T_(1)时两组各指标比较,差异无统计学意义(P>0.05);T_(2)时A组SNPo、U1-SN低于B组(P<0.05)。结论正畸-正颌手术治疗前牙区严重骨性开[牙合]畸形中双颌手术者较单颌手术者硬组织变化更小,稳定性更好。

Objective To compare the long-term stability of unilateral and bimaxillary orthodontic orthognathic surgery in the treatment of severe open bite in anterior teeth.Methods A total of 102 patients with severe skeletal classⅢmalocclusion in anterior teeth treated by orthodontic orthognathic surgery in Xuchang Stomatological Hospital from March 2019 to November 2020 were retrospectively analyzed.They were divided into group A and group B according to different surgical methods,with 51 cases in each group.Group A received maxillary Le FortⅠosteotomy combined with bilateral mandibular ramus sagittal osteotomy,and group B received simple bilateral mandibular ramus sagittal osteotomy.The changes of teeth and bones were observed before treatment(T_(0)),3 months after treatment(T_(1))and 1 year after treatment(T_(2))between two groups.Results The recession distance of the mandible in group A was lower than that in group B(P<0.05).Compared with T_(0),the included angle of sellar center,nasal root point,upper alveolar seating point(SNA),upper alveolar seating point,nasal root point,lower alveolar seating point(ANB),the included angle between the long axis of lower central incisor and mandibular plane(L1-MP),and the included angle between the long axis of upper central incisor and nasal root point and upper alveolar seating point(L1-NB)of T_(1) increased in both groups(P<0.05),and the included angle of sellar center,nasal root point,inferior alveolar seating point(SNB),the angle of sella turcica center,the angle formed by nasal root point and anterior chin point(SNPo),the included angle between the long axis of upper central incisor and anterior skull base plane(U1-SN),the included angle between the long axis of upper central incisor and the connecting line between nasal root point and superior alveolar seating point(U1-NA),and the included angle between the long axis of upper central incisor and lower central incisor(U1-L1)of T_(1) decreased in both groups(P<0.05).Compared with T_(1),SNPo and U1-SN in group B increased at T_(2)(P<0.05).There was no statistical difference between the two groups at T_(0) and T_(1)(P>0.05).At T_(2),SNPo and U1-SN in group A were lower than those in group B(P<0.05).Conclusion Application of orthodontic orthognathic surgery in the treatment of severe open bite deformity in the anterior teeth area,the change of hard tissue in bimaxillary surgery is smaller and the stability is better than that in single jaw surgery.