传统Twin block与无托槽隐形矫治器在安氏二类下颌后缩中的临床对比

Clinical comparison of traditional twin block and invisible appliance without bracket in the second class mandibular retraction

目的:比较传统双合垫(Twin block)矫治器与无托槽隐形矫治器矫治安氏二类下颌后缩的效果。方法:收集2020年1月至2023年7月本院93例安氏二类下颌后缩患者临床资料,按矫治器的不同分为传统TB(Twin block)组(n=48)和无托槽隐形组(n=45)。传统TB采用传统Twin block矫治器矫治,无托槽隐形组采用无托槽隐形矫治器矫治,矫治前、矫治6 m后采用数字化口腔全景X射线机测定两组蝶鞍中心、鼻根点、下牙槽座点形成的交角(Sella nasion B point angle,SNB)、蝶鞍中心、鼻根点、上牙槽座点形成的交角(Sella nasion A point angle,SNA)、上牙槽座点、鼻根点、下牙槽座点形成的交角(ANB angle,ANB)、下中切牙长轴与鼻根点-下牙槽座点连线的交角(L1-NB角)、上中切牙长轴与鼻根点和上齿槽座点连线的上交角(U1-NA角)、上中切牙切缘到鼻根点和上齿槽座点连线的垂直距离(U1-NA距)、下中切牙切缘到鼻根点-下牙槽座点连线的距离(L1-NB距)、下颌角点至下颌颏顶点的距离(Go-Gn距)水平;采用卧式口腔锥形束CT机测定上气道的总体积(V总)、最小横截面积(Smin)、最小矢状径(Lmin矢)、最小冠状径(Lmin冠)水平;同时采用中文版儿童口腔健康影响程度量表(Child perception questionnaire,CPQ11-14)评估口腔健康情况,并于矫治期间统计不良反应。结果:矫治后,两组SNB角、SNA角、ANB角、L1-NB角、U1-NA角、U1-NA距、L1-NB距、Go-Gn距均优于矫治前,组间无显著差异(P>0.05);矫治后,两组V总、Smin、Lmin矢、Lmin冠、CPQ11-14评分均高于矫治前,且传统TB组均高于无托槽隐形组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:传统Twin block与无托槽隐形矫治器矫治安氏二类下颌后缩均有良好效果,但前者改善气道效果更佳,而后者更能维持口腔健康。

Objective:To compare the clinical effect of traditional twin block appliances and invisible appliances without brackets in the correction of two types of mandibular retraction.Methods:The clinical data of 93 patients with Type II mandibular retraction treated in our hospital from January 2020 to July 2023 were retrospectively collected.According to the different appliances,they were divided into the traditional TB(Twin block)group(n=48)and the non-bracket invisible group(n=45).The traditional TB group was treated with a traditional twin-block appliance,and the non-bracket invisible group was treated with a non-bracket invisible appliance.Before treatment and 6 months after treatment,the digital oral panoramic X-ray machine was used to measure the intersection angle(SNB)formed by sella nasion center,nasal root point and lower alveolar seat point,the intersection angle(SNA)formed by sella nasion center,nasal root point and upper alveolar seat point,the intersection angle(ANB angle,ANB)formed by upper alveolar seat point,nasal root point and lower alveolar seat point,the intersection angle(L1-NB angle)between the long axis of lower central incisor and the connection line of nasal root point and lower alveolar seat point,and the upper intersection angle(U1-NA angle)between the long axis of upper central incisor and the connection line of nasal root point and upper alveolar seat point,the vertical distance from the incisal margin of the upper central incisor to the line between the nasal root point and the upper alveolar socket point(U1-NA distance),the distance from the incisal margin of the lower central incisor to the line between the nasal root point and the lower alveolar socket point(L1-NB distance),and the distance from the mandibular angle point to the mandibular chin point(Go-Gn distance)level.The total volume(V total),minimum cross-sectional area(Smin),minimum sagittal diameter(Lmin vector),and minimum coronal diameter(Lmin crown)of the upper airway were measured by horizontal mouth conical beam CT.At the same time,the Chinese version of the Child perception questionnaire(CPQ11-14)was used to assess oral health status,and adverse reactions were counted during treatment.Results:At correction,the sella nasion B point angle,sella nasion A point angle,ANB angle,L1-NB angle,U1-NA angle,U1-NA distance,L1-NB distance,and Go-Gn distance between the two groups were all better than before correction,and there was no significant difference between the groups(P>0.05).After treatment,the V total,Smin,Lmin vector,Lmin crown,and CPQ11-14 scores in the two groups were higher than before treatment,and the traditional TB group was higher than the non-bracket invisible group(P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion:Both the traditional twin block and the invisible appliance without brackets have good effects in correcting the second type of mandibular retraction,but the former is more effective in improving the airway,while the latter is more effective in maintaining the oral health of patients.