安氏Ⅲ类错(牙合)伴有下颌偏斜患者髁突位置的研究

目的 比较安氏III类错(牙合)伴下颌偏斜患者髁突的位置与安氏I类患者髁突位置的差异.方法 选择安氏Ⅲ类错(牙合)伴下颌偏斜患者与安氏Ⅲ类患者各20名,在薛氏位X线片上测量正中(牙合)位时,两组髁突在关节窝中位置,并进行比较.结果 偏颌组颏点偏斜侧与I类对照组髁突在关节窝中的位置无显著差异,颏点偏斜侧的对侧髁突前间隙减小、髁突相对位置比值增大,有显著性差异,该侧髁突位置相对前移;偏颌组两侧髁突在关节窝中的位置无显著性差异.结论 髁突会随咬合的改变发生重建.     

正畸治疗安氏Ⅲ类错伴下颌偏斜的临床研究

目的探讨治疗安氏Ⅲ类错伴有单侧的后牙反、锁和单侧前牙反的牙源性下颌偏斜的有效方法。方法选择安氏Ⅲ类错伴单侧的后牙反、锁和单侧前牙反等牙源性下颌偏斜患者21例,年龄8~25岁,平均15.5岁。单侧后牙反、锁引起的下颌偏斜通过上颌扩弓、上下牙交互牵引纠正宽度不调,促使下颌自行复位;前牙反通过Ⅲ类牵引予以解除。结果 21例患者均取得良好的矫治效果,治疗后颜面对称性和咬合关系恢复正常,颏点偏斜平均减少（2.9±0.6）mm,因长期错导致的下颌骨偏斜亦得到了明显改善。结论牙源性下颌偏斜,经过合理正畸治疗,随着单侧后牙反、锁及单侧前牙反的解除可得到明显的改善。     

Frnkel矫治器对安氏Ⅱ类错患者髁突和下颌位置的影响

目的　了解Fr nkel矫治器治疗安氏Ⅱ类错过程中,髁突和下颌位置的变化情况。方法　选择经Fr nkel矫治器治疗成功的安氏Ⅱ类错患者30例,男女各15例,对其治疗前后的头颅侧位定位片进行X线头影测量重叠分析。结果　①前颅底结构重叠显示治疗后患者的髁突点、下颌角点和颏前点发生明显的下移,同时男性患者颏前点发生明显的前移。②下颌结构重叠显示治疗后患者的髁突点发生明显的上移和后移(移位比约为2∶1) ,下颌角点相对颏部发生后移。结论　Fr nkel矫治器能刺激安氏Ⅱ类错患者髁突的生长,有利于下颌水平向的改建     

安氏Ⅲ类错伴有下颌偏斜者颌面部不对称性研究

目的 :通过头颅正位片的测量 ,揭示安氏Ⅲ类错伴有下颌偏斜者颌面在水平向及垂直向不对称的特点。方法 :早期恒牙 ,安氏Ⅲ类错伴有下颌偏斜患者 4 0名 ,治疗前的正位片与 4 0名正常者进行比较 ,用SPSS统计软件处理数据。结果 :下颌骨及下牙弓宽度增大 ;偏斜侧上颌基骨宽度及上下牙弓宽度大于对侧 ;偏斜侧下颌综合长度及下颌体长度小于对侧 ,差异均有显著性意义。结论 :面部不对称主要表现在面下 1/ 3及牙弓区 ;下颌不对称主要发生于下颌的水平部     

安氏Ⅱ类错关节窝、髁突、关节盘位置及关节盘形态变化的研究

目的 :为探讨安氏Ⅱ1、Ⅱ2 错与颞下颌关节紊乱病之间的关系。方法 :利用矫正薛氏位X线片对Ⅱ1错16人 ,Ⅱ2 错 17人的双侧颞下颌关节的髁突居关节窝的位置进行评价 ,并依据髁突居关节窝中的位置 (前移、居中、后移 ) ,从上述两类错中各选 5人做双侧颞下颌关节矢状位核磁共振扫描 ,观察关节盘的位置及形态变化。结果 :每一类型错髁突居关节窝中的位置并不一致 :Ⅱ1错髁突居关节窝中位 ,但轻度前移 ;Ⅱ2 错髁突居关节窝后位。当髁突居前位及中位时 :关节盘位置在正常范围且形态表现为正常的双凹形 ;髁突居关节窝后位时 :部分关节盘位置明显前移 ,且形态也表现出异常的前带增厚。结论 :大多数Ⅱ1错颞下颌关节结构基本正常 ;而Ⅱ2错部分患者表现出颞下颌关节结构异常 ,提示与颞下颌关节紊乱病关系密切     

安氏Ⅲ类错He伴有下颌偏斜者颌面部不对称性研究

目的：通过头颅正位片的测量，揭示安氏Ⅲ类错He伴有下颌偏斜者颌He面在水平向及垂直向不对称的特点。方法：早期恒牙He，安氏Ⅲ类错He伴有下颌偏斜患者40名。治疗前的正位片与40名正常He者进行比较，用SPSS统计软件处理数据。结果：下颌骨及下牙及宽度增大；偏斜侧上颌基骨宽度及上下牙弓宽度大于对侧；偏斜侧下颌综合长度及下颌体长度小于对侧，差异均有显著性意义。偏斜侧上颌基骨宽度及上下牙弓宽度大于对侧；偏斜侧下颌综合长度及下颌体长度小于对侧，差异均有显著性意义。结论：面部不对称主要表现在面下1/3及牙弓区；下颌不对称主要发生于下颌的水平部。     

替牙晚期安氏Ⅲ类错畸形矫治后的髁突和下颌位置变化

目的探讨矫治替牙晚期安氏Ⅲ类错畸形后髁突和下颌位置的变化。方法选择患有替牙晚期安氏Ⅲ类错畸形的患者32例作为研究对象,均行前方牵引联合直丝弓矫治技术矫正,收集患者治疗前后的X线头颅侧位片进行头影测量分析。结果试验组患者矫治后的鞍角、Y轴角、下颌平面角、上齿槽座点-鼻根点-下齿槽座点角、颌凸角、髁顶点Co到y轴的距离等明显增大,面角、上下齿槽座角、髁顶点Co到x轴的距离、颏前点Pog到y轴的距离等明显减小,且差异具有统计学意义(P<0.05)。结论替牙晚期安氏Ⅲ类错患者通过正畸治疗后,下颌骨的生长可受到一定抑制,有效改善了上下颌骨的矢状不调状况,髁突点向后上移位,下颌的位置会发生明显的后移,并以髁突为中心发生了顺时针旋转。     

Frnkel矫治器对安氏Ⅱ类错患者髁突和下颌位置的影响

目的　了解Frankel矫治器治疗安氏Ⅱ类错过程中,髁突和下颌位置的变化情况。方法　选择经Frankel 矫治器治疗成功的安氏Ⅱ类错患者30例,男女各15例,对其治疗前后的头颅侧位定位片进行X线头影测量重叠分析。结果　①前颅底结构重叠显示治疗后患者的髁突点、下颌角点和颏前点发生明显的下移,同时男性患者颏前点发生明显的前移。②下颌结构重叠显示治疗后患者的髁突点发生明显的上移和后移(移位比约为2∶1),下颌角点相对颏部发生后移。结论　Frankel矫治器能刺激安氏Ⅱ类错患者髁突的生长,有利于下颌水平向的改建。     

安氏Ⅲ类错正畸前后颞下颌关节形态变化的研究

目的　探讨骨性和功能性Ⅲ类错牙合在正畸前、后颞下颌关节形态变化与颞下颌关节紊乱病 (TMD)之间的关系。方法　利用矫正薛氏位X线片在正畸前后对Ⅲ类骨性错牙合正畸前 19例和正畸后 11例、功能性错牙合正畸前 2 0例和正畸后 18例的双侧颞下颌关节的髁突居关节窝中的位置 (前移、居中、后移 ) ,从上述两类错牙合患者中各选 5例做双侧颞下颌关节矢状位核磁共振扫描 ,观察正畸前、后关节盘的位置及形态变化。结果　正畸前Ⅲ类功能性和骨性错牙合髁突居关节窝前位 ;正畸后Ⅲ类功能性错牙合髁突居关节窝中位 ,Ⅲ类骨性错牙合髁突仍居关节窝前位。正畸前、后功能性Ⅲ类错牙合关节盘位置及形态均基本正常 ;Ⅲ类骨性错牙合正畸后有少部分患者髁突明显前移 ,关节盘形态异常。结论　正畸前后功能性Ⅲ类错牙合颞下颌关节结构基本正常 ,与TMD关系不密切 ;骨性Ⅲ类错牙合正畸后关节结构表现出异常 ,提示与TMD有关 ,对于已过生长期的Ⅲ类骨性错牙合不能单纯考虑正畸治疗     

下颌偏斜患者髁突位置的meta分析

目的:系统评价下颌偏斜患者髁突位置与个别正常▉髁突位置的差异。方法:计算机检索Pubmed、Embase、中国知网、万方数据库、维普、中国生物医学文献数据库,纳入所有关于下颌偏斜患者髁突位置的文章。检索时间截至2017年6月。由2名评价员独立进行资料提取和交叉核对后,采用RevMan5.3软件进行统计学分析。结果:共纳入6篇文献,均为下颌偏斜患者与个别正常▉髁突位置对照的研究。其中,下颌偏斜患者122例,个别正常▉110例。Meta分析结果表明,下颌偏斜组偏斜侧关节上间隙[MD=-0.38,95%CI(-0.74,-0.01),P=0.04]、前间隙[MD=-0.72,95%CI(-0.99,-0.04),P<0.00001]均显著大于偏斜对侧;下颌偏斜组偏斜侧关节后间隙[MD=-0.35,95%CI(0.25,0.45),P<0.00001]显著小于偏斜对侧;与个别正常▉相比,偏斜组偏斜侧关节后间隙[MD=-0.58,95%CI(-0.88,-0.28),P=0.0002]偏斜对侧关节后间隙[MD=-0.30,95%CI(-0.59,-0.00),P=0.05]及关节前间隙[MD=-0.85,95%CI(-1.58,-0.13),P=0.02]均显著小于对照组。偏斜组偏斜侧[MD=-0.56,95%CI(-1.14,0.02),P=0.06]及对侧关节上间隙 [MD=-0.58,95%CI(-1.27,0.10),P=0.10],偏斜组偏斜侧关节前间隙[MD=-0.05,95%CI(-0.35,0.46),P=0.80]与对照组相比,差异均无统计学意义。结论:下颌偏斜患者偏斜侧髁突位置较偏斜对侧向后下移位。与个别正常▉相比,下颌偏斜患者偏斜侧髁突位置向后移位。     

Accuracy,confidence and consistency in diagnosing Class III malocclusion with diagnostic records: a two‐center study

The objective of this study was to determine the accuracy, confidence and consistency in diagnosing the Class III malocclusion in children by diagnostic records. Ten orthodontists from the state of West Virginia and 20 from the state of Ohio were asked to classify the dental and skeletal occlusion of eight patients. Six of the cases were patients with Class III malocclusion. Two cases, one with a Class II division 1 malocclusion and one with a Class I malocclusion, were used as distractors. Diagnosis of these cases was established by four published cephalometric analyses, which served as the ‘gold standard’, to determine the number of correct responses from the participants. Four faculty members were employed to confirm the cephalometric and clinical diagnosis of these cases with a full set of records. Participants were asked to diagnose the cases using only study casts and facial profile photographs for the first time. After an interval of 30 days, the procedure was repeated with the addition of lateral cephalograms and tracings. The accuracy in diagnosing malocclusion was determined by the percentage of correct responses. The level of confidence was determined by calculating the median of a 5‐point graded response utilizing the following confidence values: 1=not at all, 2=slightly, 3=moderately, 4=very, 5=absolutely. Differences between ‘with’ and ‘without’ lateral cephalograms were analyzed non‐parametrically using the Wilcoxon matched‐pairs signed‐ranks test. The results from both centers show the accuracy in dental classification of Class III malocclusion was quite good (83%±17.1% in the West Virginia group and 93%±14.1% in the Ohio group). The accuracy in skeletal classification was poor (72%±16.3 in the West Virginia group and 53%±7.03 in the Ohio group). The addition of lateral cephalograms and tracings did not improve the accuracy of dental or skeletal classification. However, clinicians felt more confident in their diagnoses with the information provided by lateral cephalograms and tracings. The consistency in dental and skeletal classification was fair and poor, respectively. These results suggest that clinicians are not consistent in diagnosing the Class III malocclusion and that skeletal classification of Class III malocclusion in children could be difficult. The addition of lateral cephalograms and tracings do not contribute to the accuracy of diagnosis.     

应用改良式Andresen矫治器治疗安氏III类错（牙合）

目的　探讨治疗安氏III类错牙合的有效途径。方法　 36例临床诊断为功能性安氏III类错牙合的患者 ,其中男 2 0例 ,女 16例。应用改良式Andresen矫治器进行治疗。结果　 36例患者反牙合均解除 ,面型得到改善。结论　在适应症范围内 ,改良式Andresen矫治器治疗功能性安氏III类错牙合效果肯定 ,值得推广与应用。     

用扩弓和多曲方丝弓技术矫治反(牙合)伴下颌偏斜畸形

目的探讨扩弓和多曲方丝弓技术在安氏班类错抬伴下领偏斜矫治中的作用机理。方法选择安氏m 类错抬伴下领偏斜患者8例，均采用上领扩弓技术矫治单侧上领后牙反抬，多曲方丝弓技术不同程度地直立后牙，调整后牙在三维方向的位置，并解除前牙的反抬，调整下领中线。结果8例m类错抬伴下领偏斜患者均取得良好的矫治效果，矫治后磨牙为中性关系，前牙覆抬覆盖正常。结论轻度及中度安氏班类错抬伴下领偏斜畸形患者通过上领的扩弓及多曲方丝弓矫治技术可有效地矫正磨牙关系及下领偏斜。     

Midfacial and mandibular morphometry of children with Class II and Class III malocclusions

There is insufficient evidence in conventional cephalometric analysis of the actual sites of putative maxillofacial change in Class II and Class III malocclusions. The purpose of this study was to provide more information about the morphological characteristics of the midfacial complex and mandible in children with Class II or III malocclusions. Seventy children with Class II, division 1 malocclusion and 70 children with Class III malocclusion were compared with 70 children with normal occlusion. This study was conducted to carry out geometric morphometric assessments to localize alterations using Procrustes analysis and thin-plate spline analysis. Procrustes analysis indicated the midfacial and mandibular morphologies differed between normal occlusion subjects and subjects with Class II or Class III malocclusion (P<0.0001). The deformations in subjects with Class II malocclusion may represent a developmental elongation of the palatomaxillary complex and a shortening of the mandible anteroposteriorly, which leads to the appearance of a protruding midface and retruding mandibular profile. In contrast, the deformations in subjects with Class III malocclusion may represent a developmental shortening of the palatomaxillary complex and elongation of the mandible anteroposteriorly, which leads to the appearance of a retrognathic midface and prognathic mandibular profile.     

Modified tandem traction bow appliance compared with facemask therapy in treating Class III malocclusions

Objective:To compare the effects of the modified tandem traction bow appliance (MTTBA) and the facemask in treating patients with Class III malocclusion.Materials and Methods:The material consisted of the pre-post treatment\pre-post observation lateral cephalograms of 65 subjects with skeletal and dental Class III malocclusion. In the first group 21 patients (mean age: 10 years, 6 months) were treated with a Delaire-type facemask (FM). In the second group 22 patients treated (mean age: 10 years) with MTTBA. The remaining 22 children (mean age: 9 years, 7 months) were observed without treatment for 11 months.Results:Increase in SNA, N-FH ⊥ A, and ANB angles were significantly greater in the treatment groups compared to the control group. However, ANB angle showed a significantly greater increase in the FM group (2.8 ± 0.30°) than in the MTTBA group (2.0 ± 0.18°). The overjet and molar relation increased significantly in both treatment groups, but in the FM group (5.2 ± 0.40 mm) increase in overjet was significantly greater than in the MTTBA group (4.0 ± 0.27 mm). Mesial movement of upper molar and incisor were found to be greater in the FM group compared to the modified TTBA group.Conclusions:Both appliances were found to be effective in the treatment of Class III malocclusion. Their skeletal and dental effects showed differences due to their design.     

Short-term effects produced by rapid maxillary expansion and facemask therapy in Class III patients with different vertical skeletal relationships

Objective:To evaluate the dentoskeletal short-term effects of rapid maxillary expansion and facemask therapy (RME/FM) in a sample of Class III patients showing different vertical skeletal relationships.Materials and Methods:Seventy-nine patients (35 females and 44 males) having Class III malocclusion were consecutively treated using RME/FM therapy with application of the protraction force in a downward and forward direction and inclination of about 30° to the occlusal plane. All patients were evaluated at the beginning (T1; mean age, 7.7 years) and at the end (T2; mean age, 9.2 years) of orthopedic therapy and divided into three groups according to their vertical skeletal relationships: normal group (NG), hypodivergent group (HypoG), and hyperdivergent group (HyperG). Statistical comparisons between the three groups were performed on the starting forms (T1), the final forms (T2), and the treatment changes (T1–T2) using the ANOVA with Tukey''s post hoc tests.Results:Favorable modification in terms of maxillary advancement (changes in SNA ranging from 1.4° to 1.8°) and intermaxillary sagittal skeletal relationships (changes in Wits appraisal ranging from 2.5 mm to 3.5 mm) were recorded in all groups. The three groups showed no statistically significant differences in changes in either sagittal or vertical skeletal variables.Conclusions:The various vertical skeletal features do not influence the short-term outcomes of RME/FM therapy.