骨性Ⅲ类错合的双期矫治
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摘要
目的:观察并评价骨性Ⅲ类错合双期矫治的临床效果。
方法:选取大连医科大学附属第一医院口腔门诊2008年收治的骨性Ⅲ类错合男性患者一例为研究对象,年龄10岁9个月。临床检查上颌发育不足,下颌轻度发育过度,双侧磨牙关系近中,前牙反覆盖2mm,下中线右偏2mm,侧貌为凹面型,下颌可后退至前牙对刃。对该患者进行双期矫治:Ⅰ期前方牵引联合快速扩弓矫形治疗;Ⅱ期直丝弓矫治。对治疗前、Ⅰ期结束、治疗后头颅侧位片及模型进行对比分析。
结果:矫治疗程34个月。对该患者治疗前后进行比较:Ⅰ期治疗后患者磨牙关系由Ⅲ类变为Ⅰ类,前牙反合解除,上颌牙弓宽度扩大,侧貌凹面型改善。SNA角增加4°,Naperp.-A由-5增加到1.5,SNB角没有明显改变,ANB角由-5增加到-2.5,上牙轴(U1/SN)由115°增加到125°。Ⅱ期治疗稳定Ⅰ期矫治疗效,SNA角增加了3°,ANB角增加了5.5°,而U1/SN角减小到22°,上下牙轴接近正常值。关于颌骨垂直向的分析:MP/SN角增加了1°,前后面高比没有改变。软组织侧貌改善,病人和家长对治疗结果很满意。
结论:前方牵引联合扩弓与直丝弓矫治器治疗早期骨性Ⅲ类错合可达到良好的临床效果。
Object:This study was designed to observe and evaluate the clinic effect of the dual-phase treatment in skeletal ClassⅢmalocclusion.
Methods:A male case with skeletal ClassⅢmalocclusion.was selected from The first Affiliated Hospital of Dalian Medical University ortho clinic in 2008,who was 10 years and 9 months.Clinical examination display maxillary deficiency with a lightly protruded mandible,bilateral molars ClassⅢrelationship, 2-mm negative overjet,2-mm deviation of the mandibular midline to the right,a concave profile appearance. His mandible could move into edge-to-edge anterior occlusion.Treat the patient with 2 phases:phaseⅠof the orthopedic therapy with a rapid palatal expander and a maxillary protraction;phaseⅡusing the straightwire appliance.Compared and analysed the lateral cephalometric radiograph and plaster modle among the pre-treatment,the end of therapy phaseⅠand after treatment.
Result:The course of orthodontical treatment needs 32 months. Compare the changes between pre-treatment and protreatment:After the phaseⅠtreatment,the first molar relationship changed from ClassⅢinto l,the anterior crossbite had been corrected and the maxillary dental arch was expanded,skeletal facial profile was improved.SNA angle increased 4o,Naperp.-A increased from -5 to 1.5,SNB did not significantly ANB increased from -5 to -2.5,U1/SN increased from 115o to 125o.phasesⅡstrengthen the effect of phasesⅠ.compared with phasesⅠ,SNA angle increased 3°,ANB angle increased 5.5o,while U1/SN angle decreased to 22o,L1/MP increased 3°,the values are close to normal.The vertical analysis indicates that,MP/SN angle increased 1°,face height ration did not increase.maxillary soft tissue profile improved,the patiention and his parents were satisfied with the result of ortho therapy after treatment.
Conclude:maxillary protraction therapy can provides effective correction in early class III malocclusion,with the straight wire appliance,the treatment could achieve a better clinical result.
方法:选取大连医科大学附属第一医院口腔门诊2008年收治的骨性Ⅲ类错合男性患者一例为研究对象,年龄10岁9个月。临床检查上颌发育不足,下颌轻度发育过度,双侧磨牙关系近中,前牙反覆盖2mm,下中线右偏2mm,侧貌为凹面型,下颌可后退至前牙对刃。对该患者进行双期矫治:Ⅰ期前方牵引联合快速扩弓矫形治疗;Ⅱ期直丝弓矫治。对治疗前、Ⅰ期结束、治疗后头颅侧位片及模型进行对比分析。
结果:矫治疗程34个月。对该患者治疗前后进行比较:Ⅰ期治疗后患者磨牙关系由Ⅲ类变为Ⅰ类,前牙反合解除,上颌牙弓宽度扩大,侧貌凹面型改善。SNA角增加4°,Naperp.-A由-5增加到1.5,SNB角没有明显改变,ANB角由-5增加到-2.5,上牙轴(U1/SN)由115°增加到125°。Ⅱ期治疗稳定Ⅰ期矫治疗效,SNA角增加了3°,ANB角增加了5.5°,而U1/SN角减小到22°,上下牙轴接近正常值。关于颌骨垂直向的分析:MP/SN角增加了1°,前后面高比没有改变。软组织侧貌改善,病人和家长对治疗结果很满意。
结论:前方牵引联合扩弓与直丝弓矫治器治疗早期骨性Ⅲ类错合可达到良好的临床效果。
Object:This study was designed to observe and evaluate the clinic effect of the dual-phase treatment in skeletal ClassⅢmalocclusion.
Methods:A male case with skeletal ClassⅢmalocclusion.was selected from The first Affiliated Hospital of Dalian Medical University ortho clinic in 2008,who was 10 years and 9 months.Clinical examination display maxillary deficiency with a lightly protruded mandible,bilateral molars ClassⅢrelationship, 2-mm negative overjet,2-mm deviation of the mandibular midline to the right,a concave profile appearance. His mandible could move into edge-to-edge anterior occlusion.Treat the patient with 2 phases:phaseⅠof the orthopedic therapy with a rapid palatal expander and a maxillary protraction;phaseⅡusing the straightwire appliance.Compared and analysed the lateral cephalometric radiograph and plaster modle among the pre-treatment,the end of therapy phaseⅠand after treatment.
Result:The course of orthodontical treatment needs 32 months. Compare the changes between pre-treatment and protreatment:After the phaseⅠtreatment,the first molar relationship changed from ClassⅢinto l,the anterior crossbite had been corrected and the maxillary dental arch was expanded,skeletal facial profile was improved.SNA angle increased 4o,Naperp.-A increased from -5 to 1.5,SNB did not significantly ANB increased from -5 to -2.5,U1/SN increased from 115o to 125o.phasesⅡstrengthen the effect of phasesⅠ.compared with phasesⅠ,SNA angle increased 3°,ANB angle increased 5.5o,while U1/SN angle decreased to 22o,L1/MP increased 3°,the values are close to normal.The vertical analysis indicates that,MP/SN angle increased 1°,face height ration did not increase.maxillary soft tissue profile improved,the patiention and his parents were satisfied with the result of ortho therapy after treatment.
Conclude:maxillary protraction therapy can provides effective correction in early class III malocclusion,with the straight wire appliance,the treatment could achieve a better clinical result.
引文
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2.曾祥龙.现代口腔正畸学诊疗手册[M].北京:北京大学医学出版社,2000:441.
3.傅民魁,主编口腔正畸学第4版。人民卫生出版社,2003:213
4.Guyer EC。Ellis EE 3rd,McNamara JA,et a1.Components of class 111 malocclusion in juveniles and adoleseents.Angle Orthod,1986,56:7-30.
5.Franchi L, Baccetti T, McNamara JA. Postpubertal assessment of treatment timing for maxillary expansion and protraction therapy followed by fixed appliances. Am J Orthod Dentofacial Orthop 2004;126:555-68
6.Kajiyama K, Murakami T, Suzuki A. Comparison of ortho-dontic and orthopedic effects of a modified maxillary pro-tractor between deciduous and early mixed dentitions. Am J Orthod Dentofacial Orthop. 2004;126:23–32
7.Jinhui Jiang,Jiuxiang Lin,and Changrong Ji.Two-stage early permanent dentition[J].American Journal of Orthodontics and Dentofacial Orthopedics 2005, 128(4)520-527
8.宋立辉、张明辉、高宏。前方牵引配合方丝弓矫治技术矫治恒牙早期安氏Ⅲ类错颌16例报告[J]现代口腔医学杂志,2004,18(5):395.
9.Vladimir Leo n-Salazar,Guiherme Janson,Marcos Roberto de Freitas,Rentao Rodrigues de Almeida,Rube n Leo n-Salazard.Nonextraction treatment of a skeletal ClassⅢmalocclusion[J].American Journal of Orthodontics and Dentofacial Orthopedics m,2009,136(5):736-745.
10.辛洪哲.青少年骨性安氏III类错合畸形的双期治疗.口腔正畸学,2006,13:197-199
11.傅民魁,罗卫红。面部侧貌美学特征的调查分析与研究(第一部分)。实用医学口腔杂志。1998;14(3):202
12.傅民魁,林久祥主编。口腔正畸学第一版。北京大学医学出版社,2005:237-238
13.周彦恒。安格尔Ⅲ类错合畸形的诊断和治疗[J]。口腔正畸学,2000,7(1):40-43。
14.徐宝华。骨性前牙反合的前方牵引治疗[J]。口腔正畸学,2001,8(3):133-135
15.邹冰爽。反复扩缩式上颌快速扩弓矫治器配合前方牵引的初步临床应用[J]。口腔正畸学,2008,15(4)173-179
16.曾祥龙,主编.现代口腔正畸学诊疗手册.第一舨.北京:北京医科大学出版社,2000,495—498.
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