中国实用口腔科杂志

中国实用口腔科杂志 ›› 2011, Vol. 4 ›› Issue (04): 228-230.

• 论著 • 上一篇    下一篇

替牙期不同类型骨性安氏Ⅲ类错牙合矫治设计研究

  

  1. 大连大学附属口腔医院·大连市口腔医院正畸科，辽宁  大连  116021
  • 收稿日期:2011-01-08 修回日期:2011-02-12 出版日期:2011-04-15 发布日期:2011-05-10

  • Received:2011-01-08 Revised:2011-02-12 Online:2011-04-15 Published:2011-05-10

摘要：

目的    探讨替牙期不同类型骨性安氏Ⅲ类错牙合的矫治设计要点。方法    选择2001年1月至2008年12月于大连市口腔医院正畸科就诊的上颌骨后缩为主的骨性安氏Ⅲ类错牙合畸形患者20例，根据患者的下颌平面角度及下颌能否进行部分功能后退分成2组。第1组12例，下颌平面角为均角或略偏高角，下颌不能进行部分功能后退，采用前方牵引刺激上颌骨发育、恒牙期综合治疗调整牙合关系的方法；第2组8例，下颌平面角为均角或低角，下颌能够部分功能后退，此类患者多存在不良口腔习惯或咬合干扰、替牙障碍，治疗中采取纠正不良习惯，使用牙合垫配合颌间牵引改变下颌矢状向位置、去除牙合干扰，适当扩大上牙弓，矫治替牙障碍，诱导上颌骨正常发育的方法。两组患者均由同一医生对矫治前后头颅侧位定位片进行测量分析。结果    以上两种不同类型的病例治疗后均取得较满意疗效。第1组治疗后SNA角（蝶鞍点-鼻根点-上齿槽座点角）增大，表明上颌骨获得了更明显的生长；第2组治疗后SNB角（蝶鞍点-鼻根点-下齿槽座点角）减小，表明下颌矢状向位置后移。两组治疗后下颌平面角均增大，表明治疗后下颌骨均发生顺时针旋转。结论    结合病因采取不同的设计方案是正确治疗替牙期不同骨性安氏Ⅲ类错牙合的关键。合理的早期矫治，可降低恒牙期综合治疗的难度。

关键词: 骨性安氏Ⅲ类错牙合, 混合牙列期, 上颌后缩

Abstract:

Objective    To discuss the key point of treatment option for different skeletal class Ⅲ malocclusion in mixed dentition，by comparing clinical effects and skeletal changes. Methods    Twenty skeletal class Ⅲ cases with retro maxilla were selected. Two groups were divided according to the mandibular plane angle and the degree of retruding. Group one consisted of 12 cases，with average/high angle and without functional retrusion；group two consisted of 8 cases，with average/ low angle and somewhat functional retrusion. Face mask was used in group one to stimulate forward growth of the maxilla；in group two partial edgewise appliance was used on upper incisors and first molars，cooperated with splint on lower arch. Cephalograms were taken before and after active treatment. All the radiographs were traced by the first author，and the measurements were calculated with cephalometric analysis program. Results    Anterior crossbites were corrected in both groups，and facial balance improved greatly. Significant sagittal changes were found between them：SNA increased in group 1，suggesting the forward movement of the maxilla，while SNB decreased in group 2，suggesting the backward displacement of the mandible. The increase in the mandibular plane angle in both groups indicated the clock-wise rotation of the mandible. Conclusion    The key point of treatment option for different skeletal class Ⅲ malocclusion in mixed dentition is based on the correct diagnosis for etiology and mechanism. Proper early treatment helps guiding the jaws to a more balanced position.

Key words: skeletal class Ⅲ malocclusion；mixed dentition；maxillary protraction