双颌垫功能性矫治器对安氏Ⅱ类错[牙合]畸形青少年上气道及舌骨位置变化的影响

Effect of twin block functional appliance on upper airway and hyoid position changes in adolescents with ClassⅡmalocclusion

目的分析安氏Ⅱ类错[牙合]畸形青少年应用双颌垫功能性矫治器的效果。方法采用回顾性分析,将在开封市口腔医院救治的62例安氏Ⅱ类错[牙合]畸形患者作为研究对象,病例收集时间为2019年1月—2024年1月,根据治疗方法不同将其分为两组,即观察组(31例,采用TB功能性矫治器)和对照组(31例,采用标准方丝弓矫治器)。比较两组上气道形态功能[上齿槽座角(sella-nasion-A point,SNA)、下齿槽座角(sella-nasion-B point,SNB)、上下齿槽座角(angle's A-point over B-point,ANB)、软腭后气道矢状径(maxillary pharyngeal segment,MPS)、咽后壁与软腭之间的距离(soft palate to posterior pharyngeal space distance,SPPS)、第二颈椎最下点与上气道后壁矢状径(inter-pedicular space,IPS)、后鼻腔高度(posterior nasal passage heigh,S-PNS)、鼻咽全长(base to posterior nasal spine,BA-PNS)、舌骨到颈椎的矢状向距离(hyoid-vertebral level,H-VL)、舌骨到蝶鞍中心点的矢状向距离(hyoid point-sella,H-S)、舌骨到眶耳平面的垂直距离(hyoid point-frankfort horizontal,H-FH)、舌骨到下颌面的垂直距离(hyoid point-mandibular plane,H-MP)、氧减指数(oxygen desaturation index,ODI)、平均血氧饱和度(mean blood oxygen saturation,MSaO_(2))、最低血氧饱和度(lowest oxygen saturation,LSaO_(2))]、侧貌变化(下唇基角、颊唇沟角、软组织颊凸角、下唇凸点-H线距离)、正畸效果。结果正畸12周后,观察组SNB、下唇基角、颊唇沟角均相比对照组较大;MPS、IPS、S-PNS、Ba-PNS均相比对照组较长;SNA、ANB、软组织颊凸角均相比对照组较小;SPPS、下唇凸点-H线距离均相比对照组较短;H-S、H-FH、H-MP、MSaO_(2)、LSaO_(2)均相比对照组较高;H-VL、ODI均相比对照组较低;差异有统计学意义(P<0.05)。观察组总有效率(93.55%)相比对照组总有效率(74.19%)较高,差异有统计学意义(χ^(2)=4.292,P<0.05)。结论安氏Ⅱ类错[牙合]畸形青少年应用TB功能性矫治器,效果明确,不仅能有效改善上气道形态功能,调节舌骨位置,降低对侧貌的影响,还能优化睡眠情况。

Objective Analyzing the results of applying a bimaxillary pad functional orthodontic appliance in adolescents with an Ann's Class II malocclusion.Methods A retrospective analysis was conducted on 62 patients with classⅡmalocclusion treated at Kaifeng Stomatological Hospital.The case collection period was from January 2019 to January 2024,and they were divided into two groups based on different treatment methods:the observation group(31 cases,using TB functional appliances)and the control group(31 cases,using standard square wire appliances).Comparison of upper airway morphology and function between the two groups[sella-nasion-A point,SNA、sella nasion B point,SNB、Angle's A-point over B-point,ANB、Maxillary Pharyngeal Segment,MPS、Soft Palate to Posterior Pharyngeal Space Distance,SPPS、inter-pedicular space,IPS、Posterior Nasal Passage Heigh,S-PNS、base to posterior nasal spine,Ba-PNS],hyoid position[hyoid-vertebral level,H-VL、hyoid point-Sella,H-S、hyoid point-Frankfort horizontal,H-FH、hyoid point-mandibular plane,H-MP],sleep condition[oxygen desaturation index(ODI),mean oxygen saturation(MSaO_(2)),minimum oxygen saturation(LSaO_(2))],lateral appearance changes(angle of lower lip base,angle of buccolabial sulcus,angle of soft tissuebuccolabial convexity angle,lower lip convexity-H-line distance),and orthodontic outcome.Vertical distance(H-FH),vertical distance from the hyoid bone to the submandibular surface(H-MP),sleep status(Oxygen Deficiency Index(ODI),mean blood oxygen saturation(MSaO_(2)),minimum blood oxygen saturation(LSaO_(2)),changes in profile(lower lip base angle,buccal sulcus angle,soft tissue buccal convexity angle,lower lip convexity H-line distance),orthodontic effect.Results After 12 weeks of orthodontic treatment,the SNB,lower lip base angle,and buccal labial sulcus angle in the observation group were larger than those in the control group;MPS,IPS,S-PNS,and Ba PNS were all longer than those in the control group;SNA,ANB,and soft tissue buccal protrusion angle were all smaller compared to the control group;the SPPS and the distance between the lower lip protrusion and the H line were shorter compared to the control group;H-S,H-FH,H-MP,MSaO_(2),and LSaO_(2)were all higher than those in the control group;H-VL and ODI were lower compared to the control group;the difference was statistically significant(P<0.05).The total effective rate of the observation group was 93.55%,which was higher than that of the control group,which was 74.19%,and the difference was statistically significant(χ^(2)=4.292,P<0.05).Conclusion The application of TB functional appliance in teenagers with classⅡmalocclusion has a clear effect,which can not only effectively improve the morphology and function of upper airway,adjust the position of hyoid bone,reduce the impact on the profile,but also optimize the sleep condition.