不同测量方法分析上下颌宽度关系的一致性研究

Study on the consistency of using different methods to analyze the relationship between the mandibular and maxillary width

目的 应用石膏模型牙槽嵴中心点(center of the alveolar crest,CAC)测量法、头颅正位片Ricketts测量法和宾夕法尼亚大学锥形束CT(University of Pennsylvania cone beam CT,Penn CBCT)测量法对上下颌宽度关系进行分析诊断及一致性评价。方法 选择2017—2021年于中国医科大学附属口腔医院拟行正畸治疗的恒牙期初诊患者93例,应用石膏模型CAC测量法、头颅正位片Ricketts测量法和Penn CBCT测量法分别测量患者上下颌宽度并得出宽度差值,再与理论上的理想参考值比较得出宽度不调量。宽度不调量> 0诊断为上颌宽度不足,≤0诊断为无上颌宽度不足,并对3种方法的测量结果进行一致性评价。结果 在上下颌宽度关系分析诊断方面,3种方法的一致性中等(Kappa值为0.445),石膏模型CAC测量法和Penn CBCT测量法的一致性较高(Kappa值为0.710),头颅正位片Ricketts测量法和Penn CBCT测量法的一致性一般(Kappa值为0.353),石膏模型CAC测量法和头颅正位片Ricketts测量法的一致性一般(Kappa值为0.289)。结论 对于无CBCT资料的患者,应用石膏模型CAC测量法进行上下颌宽度关系的分析诊断具有较高的准确性,且临床中不建议单独使用头颅正位片进行上下颌宽度关系的分析。

Objective Center of the alveolar crest(CAC),Ricketts posteroanterior(PA)analysis,and University of Pennsylvania cone beam CT(Penn CBCT)analysis are used to analyze and diagnose the relationship between maxillary and mandibular width and to evaluate consistency.Methods The data of 93 patients newly diagnosed with permanent dentition who were expected to undergo orthodontic treatment at the Affiliated Stomatological Hospital of China Medical University from 2017 to 2021 were selected.Maxillary and mandibular width were measured by the CAC,Ricketts PA analysis,and Penn CBCT to calculate width differences.The width discrepancy was calculated by comparing the width differences with the theoretical standard deviation.We defined a discrepancy>0 as maxillary transverse deficiency,and a discrepancy≤0 as no maxillary transverse deficiency.The results were tested by Kappa consistency.Results In the diagnosis and analysis of maxillary and mandibular width,the agreement of the three methods was average(Kappa value was 0.445);the agreement between CAC and Penn CBCT was high(Kappa value was 0.710);the agreement between Ricketts PA analysis and Penn CBCT was fair(Kappa value was 0.353);the agreement between CAC and Ricketts PA analysis was fair(Kappa value was 0.289).Conclusion The CAC is an accurate method in analyzing and diagnosing the relationship between maxillary and mandibular width in cases without CBCT data,Ricketts PA analysis alone is not recommended in this analysis.