上颌骨性扩弓器在治疗骨性Ⅲ类错[牙合]畸形的临床研究

Clinical Study of Maxillary Skeletal Extender in the Treatment of Skeletal Class Ⅲ Malocclusion

目的:比较上颌骨性扩弓器(MSE)和传统快速上颌扩弓器(RME)通过上颌交替快速扩缩(Alt-RAMEC)后再面罩(FM)前牵引,矫治生长发育期上颌发育不足的骨性Ⅲ类错[牙合]畸形患者中的牙周健康和临床疗效。方法:选取20例生长发育期上颌发育不足的骨性Ⅲ类错[牙合]患者,随机分配为MSE组和RME组,各10例。于治疗前、治疗3个月检查对比两组患者牙龈指数(GI)、牙周探诊深度(PD)和菌斑指数(PLI)。对比两组患者治疗前后咀嚼效率、患者美观度和满意度及X线头影测量情况。结果:在治疗3个月,GI、PD和PLI在RME组中显著增加,且高于MSE组(P<0.05)。两组在治疗后均取得了良好临床效果,上下颌骨矢状向不调得到显著改善,软组织协调。两组患者治疗后咀嚼效率、患者美观度和满意度均比治疗前显著增加(P<0.05),但两组之间无统计学差异(P>0.05)。头影测量指标中,两组之间治疗前后变化量有6项具有统计学差异(P<0.05)。在MSE组中:下颌骨顺时针旋转和前面高增加相对较少。在RME组中:上颌前牙出现了更多唇倾和前移,上颌磨牙更多伸长和前移。结论:对于生长发育期上颌发育不足的骨性Ⅲ类错[牙合]患者,通过Alt-RAMEC后,MSE结合FM前牵引可以有效维护牙周健康,且疗效确切。

Objective:Comparing periodontal health and the clinical therapeutic efficacy of the maxillary skeletal expander(MSE) and the traditional rapid maxillary expander(RME), through the alternate rapid maxillary expansion and constriction(Alt-RAMEC) and then protraction facemask(FM)to correct the skeletal class Ⅲ malocclusion with maxillary deficiency in growing patients.Methods:20 patients with skeletal class Ⅲ malocclusion with maxillary deficiency in growing were selected, and 10 patients were randomly assigned to the MSE group and 10 patients were the RME group.The gingival index(GI), periodontal probing depth(PD) and plaque index(PLI) before the treatment and treatment for three months in two groups were compared. Before and after the treatment, the masticatory efficiency, the degree of patient aesthetic and satisfaction, the cephalometric variables were compared between the two groups.Results:GI,PD and PLI of treatment for three months in the RME group were significantly increased, and the RME group was higher than the MSE group(P<0.05). Both groups achieved good clinical results after treatment, and the sagittal irregularity of the mandible and mandible was significantly improved, and the soft tissues was coordinated. The masticatory efficiency, the degree of patient aesthetic and satisfaction in the two groups after treatment were significantly higher than that before treatment(P<0.05), however, there was no significant difference between the two groups(P>0.05).Among the cephalometric indexes, 6 items of changes before and after treatment were different between the two groups, which were statistically significant(P<0.05).In the MSE group: the mandible rotated relatively less clockwise and the anterior height increased less. In the RME group: the maxillary anterior teeth showed more proclination and advancement, and the maxillary molars showed more downward movement and mesialization.Conclusion:For patients with the skeletal class Ⅲ malocclusion with maxillary deficiency in growing, through the Alt-RAMEC, MSE combined with FM protraction can effectively maintains periodontal health, and the clinical effect is definite.