骨性Ⅲ类畸形上颌前方牵引治疗的三维测量分析

上海口腔医学 ›› 2014, Vol. 23 ›› Issue (6): 699-703.

骨性Ⅲ类畸形上颌前方牵引治疗的三维测量分析

秦燕军¹, 沈云娟¹, 谷妍², 王珊², 刘可³, 赵春洋²

1.常州市口腔医院口腔正畸科,江苏常州 213003; 2.南京医科大学口腔医学研究所·南京医科大学附属口腔医院口腔正畸科,江苏南京 210029; 3.南京军区南京总医院口腔科,江苏南京 210002

收稿日期:2014-01-24 修回日期:2014-03-13 出版日期:2014-12-20 发布日期:2015-01-08
通讯作者: 赵春洋,Tel: 025-85031846, E-mail: zhaochunyang_orth@163.com E-mail:184749876@qq.com
作者简介:秦燕军（1974-）,女,学士,副主任医师
基金资助:
江苏省高校优势学科建设工程资助项目

Three dimensional measurement and analysis of maxillary protraction treatment in skeletal Class Ⅲ malocclusion

QIN Yan-jun, SHEN Yun-juan, GU Yan, WANG Shan, LIU Ke, ZHAO Chun-yang

1.Department of Orthodontics, Changzhou Stomatological Hospital. Changzhou 213003;
2. Department of Orthodontics, Institute of Stomatology. Nanjing Medical University. Nanjing 210029;
3. Department of Stomatology, Nanjing General Hospital of Nanjing Military Area Command. Nanjing 210002, Jiangsu Province, China

Received:2014-01-24 Revised:2014-03-13 Online:2014-12-20 Published:2015-01-08
Supported by:
University Leading Discipline Construction Projects of Jiangsu Province

摘要/Abstract

摘要： 目的：通过锥形束CT（cone-beam computed tomography, CBCT）研究骨性Ⅲ类错颌畸形患者上颌前方牵引治疗前后的变化,从三维方向上探讨上颌前方牵引治疗的机制。方法：选取14例恒牙列早期骨性Ⅲ类错颌畸形患者,男6例,女8例,年龄10~12岁,平均10.9岁,采用上颌前方牵引治疗。牵引治疗前、后,进行CBCT三维扫描,采用Dolphin 11.0对骨组织及牙进行三维重建、建立三维坐标体系,选择23个标志点进行测量、分析。测量结果使用SPSS 17.0软件包进行统计学分析。结果：上颌前方牵引后,A-冠状面的距离、SNA、ANB均显著增大 (P<0.01);A-水平面的距离显著增大 (P<0.05),ANS-PNS增大,有显著差异 (P<0.05),上颌骨向前、向下生长。Po-S-N显著增大(P<0.01),SNB显著减小 (P<0.05),提示颏部向下、向后旋转,下颌生长得到抑制。U1j-冠状面的距离显著增大(P<0.01),提示上切牙前移;U1牙长轴-SN交角显著增大 (P<0.05),提示上切牙唇倾。U6j-水平面的距离、U6j-冠状面的距离均显著增大（P<0.05）,提示上颌磨牙近中移动、伸长。额颌缝等4条骨缝三维方向上均有变化,但无显著差异（P>0.05）。结论：上颌前方牵引后,经CBCT三维测量,证实翼腭缝等骨缝的生长改建在上颌骨生长过程中发挥了重要作用,上颌骨及上颌牙明显向前、向下生长;下颌骨生长得到抑制。

关键词: 骨性Ⅲ, 类错颌, 前方牵引, 骨缝, 锥形束CT, 三维测量

Abstract: PURPOSE: To study the three-dimensional mechanism of maxillary protraction in skeletal Class Ⅲ malocclusion by cone-beam CT (CBCT). METHODS: Fourteen patients (6 males and 8 females with a mean age of 10.9 years) of early permanent dentition with skeletal Class Ⅲ malocclusion were treated with maxillary protraction. CBCT was used to obtain the Dicom data both before and after treatment, and then digitized with the software Dolphin 11.0 was used to reconstruct and establish the tridimensional coordinate system. 23 landmarks were chosen for measurement and analysis. The data was analyzed using SPSS 17.0 software package. RESULTS: After maxillary protraction, A- coronal plane distance, SNA and ANB increased significantly (P<0.01); A- horizontal plane distance, ANS-PNS increased significantly (P<0.05), suggest maxillary growth was forward and downward. Po-S-N increased significantly (P<0.01), while SNB decreased significantly (P<0.05), suggesting that the chin was rotated downward and backward, and mandibular growth was inhibited. U1j - the coronal plane distance increased significantly (P<0.01), suggesting that the upper incisor moved forward; U1-SN angle increased significantly (P<0.05), suggesting anterior teeth inclined labially. The distance between U6j- horizontal plane and U6j- the coronal plane increased significantly (P<0.05), suggesting that maxillary molar elongated and moved mesially. Frontomaxillary suture changed on the three-dimensional direction, but without significant difference (P>0.05). CONCLUSIONS: Three-dimensional measurements confirm that growth and remodeling of bone suture (such as pterygopalatine suture) play an important role in maxilla development. The maxilla and maxillary teeth move forward and downward, while the mandibular growth is inhibited after maxillary protraction.

Key words: Skeletal Class III malocclusion, Maxillary protraction, Bone suture, CBCT, Three-dimensional measurement

中图分类号:

R783.5

秦燕军, 沈云娟, 谷妍, 王珊, 刘可, 赵春洋. 骨性Ⅲ类畸形上颌前方牵引治疗的三维测量分析[J]. 上海口腔医学, 2014, 23(6): 699-703.

QIN Yan-jun¹, SHEN Yun-juan¹, GU Yan², WANG Shan², LIU Ke³, ZHAO Chun-yang². Three dimensional measurement and analysis of maxillary protraction treatment in skeletal Class Ⅲ malocclusion[J]. Shanghai Journal of Stomatology, 2014, 23(6): 699-703.

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