正畸优先模式与手术优先模式对骨性Ⅲ类患者疗效的差异性研究

Differences in efficacy between orthodontic-first and surgery-first models for skeletal Class Ⅲ patients

目的 比较手术优先与正畸优先对骨性Ⅲ类错牙合患者疗效的影响。方法 选择正畸-正颌联合治疗的骨性Ⅲ类错牙合患者24例,其中正畸优先组13例,手术优先组11例。收集患者治疗前后的锥形束CT(CBCT)影像学资料,并导入Dolphin Imaging软件,进行软硬组织头影测量分析。结果 正畸优先组与手术优先组都能够成功改善患者的覆盖及软组织侧貌,治疗前后软硬组织变化具有统计学差异(P<0.05)。两组治疗前后各项指标差值比较无统计学意义(P>0.05)。此外手术优先组平均治疗时间为(18.86±3.61)个月,显著小于正畸优先组(27.15±5.16)个月,具有统计学差异(P<0.001)。结论 手术优先组与正畸优先组治疗前后软硬组织变化值差异无统计学意义,治疗时间差异有统计学意义。

Objective To compare the impact between a surgery-first strategy and an orthodontics-first approach on the result and course of therapy in patients with skeletal Class Ⅲ malocclusion.Methods The sample consisted of 24 patients with severe skeletal Class Ⅲ malocclusion,who needed orthognathic surgery.Eleven patients were treated with the surgery-first approach,and 13 patients were treated with the traditional orthodontic-surgical approach.Dolphin Imaging software was used to perform cephalometric analysis on the cone beam computed tomography(CBCT)data that were collected before and after treatment.Results In skeletal Class Ⅲ patients,the overjet and soft-tissue profile were successfully normalized in both of the two groups at high rates.Before and after the treatment,there was no statistically significant difference in indexes between the two groups(P>0.05).In terms of soft and hard tissue changes before and after treatment,there was a statistically significant difference between the orthodontic-first group and the surgery-first group(P<0.05).In addition,the overall treatment duration was much shorter in the surgery-first group((18.86±3.61)months)than in the orthodontic-first group((27.15±5.16)months),with a statistical difference(P<0.001).Conclusion There is no statisti-cally significant difference in soft and hard tissue changes between the surgery-first group and the orthodontic-first group,but there is a significant difference in treatment duration between two groups.