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。     

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目的评价上颌前方牵引联合上腭快速扩弓矫治上颌发育不足所致的骨性Ⅲ类错患者面部软组织侧貌的变化。方法选择2007年6月至2009年5月大连医科大学附属第一医院口腔正畸科门诊收治的上颌发育不足所致的骨性Ⅲ类错患者30例(均处于生长发育高峰期或高峰前期),均给予快速扩弓联合前方牵引矫治,测量并比较矫治前后面部软组织侧貌变化。结果前方牵引后,鼻顶点至Y轴距离(Y-Prn)、上唇基角(S-Ns-Sn)、上唇凸距(UL-E)、上唇凸厚(UL-U1)、上唇凹点至Y轴的距离(Y-As)、上唇突点至Y轴的距离(Y-UL)、颏唇角(LL-Bs-Pos)、颏厚度(Pos-Po)、软组织下面高(Sn-Mes)、H角均增大(P<0.01);软组织面角(FH-NsPos)、下唇基角(S-Ns-Bs)、软组织颏前点至Y轴距离(Y-Pos)均减小(P<0.01),鼻唇角(Cm-Sn-UL)亦减小(P<0.05)。结论前方牵引后,上唇显著前移,颏部后下移位,颏唇关系改善,侧貌突度显著增加。     

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目的探讨早期骨性Ⅲ类错患者上腭快速扩弓联合前方牵引矫治后咽腔的改变。方法选择2007年6月至2009年5月大连医科大学附属第一医院口腔正畸门诊收治的早期骨性Ⅲ类错患者30例,行上腭快速扩弓联合前方牵引治疗,并测量矫治前后各指标变化。结果与矫治前比较,矫治后上齿槽座点到Y轴的距离(Y-A)增加,下齿槽座点到Y轴的距离(Y-B)和颏前点到Y轴的距离(Y-Pog)减小,上咽腔宽(UPW)、中咽腔宽(MPW)增加,鼻咽部面积(nasopharynx)和口咽上部面积(oropharynx1)增加(均P<0.01);下咽腔宽(LPW)、口咽下部面积(oropharynx2)及头位角(SN-CVT)变化差异无统计学意义(均P>0.05)。结论上颌前方牵引能改变咽腔大小。     

成人骨性安氏Ⅲ类错患者正畸治疗前后咀嚼效能的变化

目的研究骨性安氏Ⅲ类错患者正畸治疗前后的咀嚼效能的变化,并探讨其影响因素。方法选择骨性安氏Ⅲ类错、已正畸治疗及未治疗的患者各30例,年龄18～25岁。以硬化明胶作咀嚼测试物,利用吸光度法测定咀嚼效能。另选30例正常牙合作为对照。结合临床所见,对测定结果进行多元回归分析。结果⑴3组间咀嚼效能差别有统计学意义(P<0.001)。两两比较发现,正常组与错已治疗组、未治疗组差别有显著性(P<0.05),成人骨性安氏Ⅲ类错已治疗组、未治疗组比较,咀嚼效能差别有显著性(P<0.05)。(2)多元回归分析提示,磨牙反牙合、下颌前突等因素与咀嚼效能有显著相关性。结论正畸治疗能够在改善成人骨性安氏Ⅲ类错患者颜面美观的同时,提高其咀嚼效能。     

安氏Ⅱ类2分类错畸形非拔牙矫治前后颏部形态的变化

目的:利用X线头影测量技术,研究正畸非拔牙治疗对安氏Ⅱ类2分类错畸形颏部形态变化的影响。方法:选择20例恒牙期安氏Ⅱ类2分类错畸形的患者,利用MBT直丝弓矫治器进行矫治。经X线头影测量,对头颅侧位片进行定点、描记后,测量矫治前、后颏部形态、上下颌骨位置、下颌平面角等形态结构,采用PASW statistics18对所得数据进行统计学分析。结果:治疗后,随着上颌切牙舌向倾斜的矫正,下颌骨向前下位移,下面高增加。上、下唇与E线的距离趋于正常。颏点位置前移,颏凹陷度以及颏唇沟的深度变浅,颏曲度增加,与矫治前相比有显著性差异(P<0.05)。结论:安氏Ⅱ类2分类错畸形经正畸治疗后能够改变颏部的位置和形态,使面形更接近理想面形。     

安氏Ⅱ类2分类错畸形非拔牙矫治前后颏部形态的变化

目的:利用X线头影测量技术,研究正畸非拔牙治疗对安氏Ⅱ类2分类错畸形颏部形态变化的影响。方法:选择20例恒牙期安氏Ⅱ类2分类错畸形的患者,利用MBT直丝弓矫治器进行矫治。经X线头影测量,对头颅侧位片进行定点、描记后,测量矫治前、后颏部形态、上下颌骨位置、下颌平面角等形态结构,采用PASW statistics18对所得数据进行统计学分析。结果:治疗后,随着上颌切牙舌向倾斜的矫正,下颌骨向前下位移,下面高增加。上、下唇与E线的距离趋于正常。颏点位置前移,颏凹陷度以及颏唇沟的深度变浅,颏曲度增加,与矫治前相比有显著性差异(P<0.05)。结论:安氏Ⅱ类2分类错畸形经正畸治疗后能够改变颏部的位置和形态,使面形更接近理想面形。     

多曲方丝弓技术矫治骨性安氏Ⅲ类错的临床研究

目的：运用MEAW技术矫治骨性安氏Ⅲ类错,探索骨性安氏Ⅲ类错非手术矫治方法。方法：选择恒牙期骨性安氏Ⅲ类错10例,男4例,女6例,年龄13～22岁,平均16.5岁。用多曲方丝弓技术矫治,矫治结束时至前牙反解除,尖牙磨牙为中性关系。治疗前后拍摄头颅侧位定位片,进行X线头影测量分析。结果：矫治后上前牙唇倾度加大,上后牙近中移动,下前牙代偿性舌向移动,下后牙远中直立。平面变平,颌骨变化较小。结论：多曲方丝弓矫治技术可以通过牙的三维移动矫治骨性前牙反,拓宽了正畸矫治范围。     

正畸正颌联合治疗骨性Ⅲ类错(牙合)畸形侧貌软硬组织变化及相关性分析

目的:测量骨性Ⅲ类错(牙合)畸形正畸正颌联合治疗前后侧貌软硬组织变化及相关性分析,评估正畸正颌联合治疗的美学效果,为更好地预测术后美学性数值提供研究支持。方法:选择32例严重的骨性Ⅲ类错(牙合)畸形患者,并在正畸治疗前、后拍摄CBCT。通过CBCT获得精确的头影侧位片,选择头影测量标记点,测量侧貌相关的角度、厚度、距离。对侧貌相关的角度、软组织厚度进行配对t检验,并对软硬组织的矢状面距离变化进行Pearson相关分析。结果:鼻唇角、颏唇角、下颌平面与SN前下交角、下中切牙长轴与SN后下交角差异显著(P<0.05),上中切牙长轴与SN后下交角差异无统计学意义(P>0.05)。LL’处软组织厚度、Bs处软组织厚度增加,差异有统计学意义(P<0.05),Sn处软组织厚度、UL’处软组织厚度、Pos处软组织厚度差异无统计学意义(P>0.05)。软/硬组织对应点:鼻下点/A点、上唇缘点/上中切牙点、下唇缘点/下中切牙点、颏唇沟点/B点、软组织颏前点/颏前点、软组织颏顶点/颏顶点的矢状向距离变化显著相关,相关系数分别为0.69、0.59、0.73、0.85、0.90、0.97。结论:骨性Ⅲ类错(牙合)畸形患者正畸正颌手术治疗后,侧貌美观明显改善。相关性分析显示,术后颏部位置预测性佳,唇位置预测性差,下颌比上颌更具有可预测性。     

骨性安氏III 类错牙合的家族聚集性研究

目的:通过对先证者一级亲属骨性安氏Ⅲ类错发病的调查,探讨骨性安氏Ⅲ类错分布的家族聚集性特点。方法:采用流行病学横断面研究的方法,对2003～2007年西安交通大学口腔医院收治的125例骨性安氏Ⅲ类错先证者家族中骨性安氏III类错发病情况进行调查,对其家族中病例分布进行二项分布模型拟合,经x2检验进行频数分布拟合优度检验,并用分离分析推断其可能的遗传方式。先证者的诊断标准为:ANB<0°,前牙反,不能后退至前牙对刃,下前牙舌倾。结果:骨性安氏Ⅲ类错先证者家系中的病例分布不服从二项分布。分离分析结果表明该病不属于常染色体隐性遗传。结论:骨性安氏III类错的发病表现出明显的家族聚集性,且具有多基因遗传病的特点。     

双期矫治安氏Ⅱ~1类错的Holdaway软组织头影测量研究

目的研究双期矫治安氏Ⅱ~1类错后患者面部侧貌的改变。方法选择15例双期矫治的替牙期、恒牙早期以下颌后缩为主的安氏Ⅱ~1类错患者,其中男性6例,女性9例,平均年龄11.2岁。Ⅰ期治疗均采用Twin-block矫治器,Ⅱ期采用MBT矫治。应用X线头影测量技术进行Holdaway软组织分析及常规硬组织分析,并对治疗前后测量结果进行配对t检验。结果双期治疗结束后,患者软组织颏部变厚,软组织面角增大,下唇突点-H线距离、H角、颏唇沟深度和骨骼侧面凸度减小,SNB增大,ANB减小,以上结果均有显著性差异;鼻突度、上唇凹深、鼻下点-H线、上唇基部厚、上唇张力测量差异无显著性意义,SNA、U1-SN、U1-NA、L1-MP、L1-NB、U1-L1、Y轴角和下颌平面角在正畸治疗前后无显著改变。结论下颌发育不足的安氏Ⅱ1类错患者在替牙期、恒牙早期采用双期矫治能改善其面部侧貌;Twin-block矫治器有助于改善患者的牙矢状关系。     

Dentocraniofacial morphology of 12 Japanese subjects with unilateral cleft lip and palate with a severe Class III malocclusion: a cephalometric study at the pretreatment stage of surgical orthodontic treatment.

OBJECTIVE: The present study clarifies the dentocraniofacial morphology of patients with cleft lip and palate (CLP) with severe Class III malocclusion prior to surgical orthodontic treatment. METHODS: The sample was 12 Japanese male subjects with repaired complete unilateral CLP (surgical CLP group; 21.2 +/- 1.92 years in mean age). Two sets of patients without CLP Class III malocclusion, consisting of 19 male subjects treated by surgical orthodontic treatment (surgical Class III group; 23.4 +/- 6.35 years in mean age) and 14 male subjects treated by nonsurgical orthodontic treatment (nonsurgical Class III group; 18.7 +/- 3.49 years in mean age) were used as controls. Analyses were performed using lateral and posteroanterior (P-A) cephalograms. RESULTS: (1) The surgical CLP group showed significantly smaller values for overjet, SNA angle, and inclination of the maxillary incisor as compared with those of the surgical and nonsurgical Class III controls. The values of SNB, mandibular effective length, and ramus height in the surgical CLP group were significantly smaller than those of the surgical Class III group but were similar to those of the nonsurgical Class III group. (2) The mandible and the upper and lower dental arches deviated laterally toward the cleft side. The displacement of the mandible was correlated with that of the maxilla. These results show that CLP patients who required surgical orthodontic treatment had a characteristic dentocraniofacial morphology, compared to controls without CLP with Class III malocclusion.     

骨性下颌前突正畸—正颌联合治疗前后髁突位置变化的研究

目的:研究骨性下颌前突正畸-正颌联合治疗前后髁突位置的变化,探讨下颌双侧升支矢状劈开后退术对于治疗骨性下颌前突的可靠性和安全性。方法:15例骨性下颌前突的安氏Ⅲ类错牙合畸形病人,行下颌双侧升支矢状劈开后退术(bilateral sagittal split ramus osteotomy,BSSRO)与正畸矫治联合治疗,分别在术前两周和术后半年拍摄许勒式X线片,测量BSSRO术前、术后双侧髁突在关节窝内前、后、上间隙的距离,进行统计学分析比较术前术后髁突位置的变化情况。结果:15例病例经BSSRO配合正畸治疗后均达到正常的咬合关系,恢复了口腔功能,改善了面部容貌;正颌术前:左侧关节前、后、上间隙均数为1.91、2.30、2.51 mm;右侧前、后、上间隙均数为2.14、2.65、2.98 mm;正颌术后:左侧关节前、后、上间隙均数为1.99、2.38、2.62 mm;右侧前、后、上间隙均数为2.14、2.66、2.60 mm。术后半年双侧髁突在关节窝内的上、前、后间隙与术前两周相比,差异均无统计学意义。结论:下颌双侧升支矢状劈开后退术(BSSRO)配合正畸治疗,能够安全有效的矫治骨性下颌前突,并且未使其出现新的关节症状。     

上颌前牙牙槽骨骨皮质切开辅助治疗轻度骨性Ⅱ类错牙合畸形的临床观察

目的：探讨骨皮质切开术辅助治疗轻度骨性Ⅱ类错(牙合)正畸的效果。方法：对7名骨皮质切开术辅助治疗的轻度骨性Ⅱ类1分类错(牙合)成人患者矫治前后的 CBCT 进行三维测量分析。结果：骨皮质切开的患者前牙内收时间为3．2个月;上中切牙明显内收,上颌牙槽骨也有内收,随着上颌切牙的内收上唇内收明显。结论：骨皮质切开术辅助矫治骨性Ⅱ类错(牙合)成人患者能够加速牙齿移动,并尽可能地实现前牙的整体内收,改善了患者软组织侧貌。     

成人骨性Ⅲ类错牙合患者软组织侧貌形态Holdaway分析

［摘要］ 目的 研究成人骨性Ⅲ类错牙合畸形患者的软组织侧貌形态。方法 选取53例（女32例,男21例）成人骨性Ⅲ类患者及53例成人骨性Ⅰ类患者治疗前的CBCT数据,利用Dolphin imaging 11.0软件重建头颅侧位片,采用Holdaway软组织测量方法进行头影测量分析,测量结果按不同性别及不同矢状向骨面型进行比较,用SPSS 20.0软件进行单因素方差分析。结果 成人骨性Ⅲ类患者与骨性Ⅰ类患者相比,骨性Ⅲ类患者的面中1/3凹陷明显（A点突度、Sn-H线）、上唇前突（上唇沟深度、上唇紧张度）、下唇前突（LL-H线）、颏部前突、颏唇沟变浅（软组织面角、H角、颏唇沟深度、颏部厚度）。成人骨性Ⅲ类患者不同性别间的软组织侧貌形态差异主要集中在软组织面角、上唇沟深度及上唇紧张度,其余指标无明显差异,显示出女性患者具有较好的软组织代偿。结论 由于成人骨性Ⅲ类患者上下颌骨间存在明显的矢状向不协调,因此与骨性I类患者相比,其软组织侧貌有着显著不同的特点。     

成人骨性Ⅱ类高角拔牙病例软组织侧貌变化的研究

目的:研究成人Ⅱ类1分类高角患者拔牙矫治前后软组织侧貌变化情况。方法:选择20例垂直生长型安氏Ⅱ类1分类拔牙病例,矫治前后拍摄头颅侧位片,对12个测量指标进行测量,比较矫治前后软组织变化情况。结果:矫治后TUL-EP、TLL-EP、上下唇位置等减小,而鼻唇角、Z角、颏唇沟倾角等增加,统计学分析结果具有显著差异。结论:成人骨性Ⅱ类高角拔牙病例治疗后侧貌能得到有效改善,随着前牙回收矢状位关系更协调,而垂直向位置关系并未发生明显变化。     

Le FortⅠ型骨切开上颌骨整体后退术矫治骨性Ⅱ类上颌骨前突畸形

目的：探讨Le Fort Ⅰ型骨切开（Le Fort Ⅰ osteotomy）上颌骨整体后退术在矫治骨性Ⅱ类上颌骨前突畸形中的价值。方法：对16例骨性Ⅱ类上颌前突患者（上颌骨前突伴下颌骨后缩14例,其中同时伴颏后缩6例;单纯上颌骨前突2例）进行外科-正畸联合治疗。患者治疗前头影测量∠ANB为7.0°～13.1°,平均9.3°。行Le Fort Ⅰ型骨切开上颌骨整体后退术,其中14例同期行双侧下颌支矢状骨劈开术（bilateral sagittal split ramus osteotomy,BSSRO）前移下颌骨,6例行颏成形术（genioplasty）前移颏部。结果：本组行LeFortⅠ型骨切开上颌骨整体后退4～8mm,14例BSSRO下颌骨前移4～7mm,6例颏成形术颏前移6～8mm。1例一侧腭降动脉术中损伤断裂,经结扎处理,无感染及骨块坏死。16例患者伤口均一期愈合。术后及正畸结束后∠ANB为1.6°～3.5°,平均2.9°。结束治疗后随访6～24个月,牙弓形态及[牙合]曲线正常,牙排列整齐,咬合关系良好,外形明显改善,疗效满意。结论：对于骨性Ⅱ类上颌骨前突畸形患者,Le Fort Ⅰ型骨切开上颌骨整体后退术是一种安全、合理、有效的正颌外科术式。     

双侧下颌骨矢状劈开截骨术矫正骨性Ш类畸形对下颌支及颞下颌关节的影响

目的观察双侧下颌骨矢状劈开截骨术(BSSRO)后移下颌骨对下颌升支及颞下颌关节的影响。方法采用定位头颅后前位片及薛氏关节片,研究16例成人骨性Ш类患者术前及术后下颌升支整体及关节间隙的变化。结果BSSRO术前与术后的下颌升支宽度减小,但无显著性差异。关节间隙在术后1月时有明显改变,6~12月后恢复为原位,且临床表现关节症状多有所缓解。结论BSSRO矫治成人骨性Ш类错畸形对下颌升支及颞下颌关节无显著影响。     

术前正畸对骨性Ⅲ类畸形患者颞下颌关节关节盘和髁突位置影响的MRI研究

目的 探讨术前正畸对骨性Ⅲ类畸形患者颞下颌关节关节盘和髁突位置的影响.方法 选择骨性Ⅲ类畸形患者20例,通过影像科医生的诊断判定关节盘移位类型,通过对颞下颌关节磁共振图像进行关节间隙测量判定髁突位置情况,观察术前正畸治疗前后关节盘和髁突的位置变化.结果 术前正畸治疗不会导致关节盘的位置变化(P＞0.05).术前正畸前后...     

Diagnostic criteria for pseudo-Class III malocclusion.

The aim of this study is to identify the diagnostic criteria for pseudo-Class III malocclusion and compare it with Class I malocclusion in the southern Chinese population. Sixty-seven patients (mean age, 10.9 +/- 1.8 years) were included in this study; 36 patients represented pseudo-Class III malocclusion. Selection criteria included the following: (1) anterior crossbite (at least 2 incisors with negative overjet and overbite); (2) mandibular displacement; (3) all patients were southern Chinese who had been followed after the growth spurt, none had developed a skeletal Class III malocclusion; (4) the patients were treated for an average of 7 months to procline upper incisors and retrocline lower incisors. None of the cases received any treatment that might affect skeletal growth. Thirty-one patients with Class I malocclusion were included in the Class I malocclusion group for the comparison of dentoskeletal characteristics with the pseudo-Class III malocclusion group. Selection criteria included the following: (1) skeletal Class I malocclusion with normal overjet and overbite, (2) mild to moderate crowding with Class I molar relationship, (3) straight facial profile. The following were included in the assessment of pseudo-Class III malocclusion cases: (1) family history, (2) molar and canine relationships at habitual occlusion and centric relation, and (3) dentoskeletal morphology. The results were that 72% of the examined cases in the pseudo-Class III malocclusion group showed no family history and 75% showed Class I molar relationship at habitual occlusion. Compared with the Class I malocclusion group, subjects in the pseudo-Class III malocclusion group showed a significantly decreased midface length, increased maxillary-mandibular difference, more retroclined upper incisors, and a retrusive upper lip. In conclusion, a pseudo-Class III malocclusion is characterized by retroclined upper incisors, retrusive upper lip, decreased midface length, and increased maxillary-mandibular difference. Findings of this study showed that patients with a pseudo-Class III malocclusion exhibit certain morphologic, dental, and skeletal characteristics that should be of aid in the diagnosis of pseudo-Class III malocclusion.     

Morphology of the temporomandibular joint in skeletal class iii symmetrical and asymmetrical cases: a study by cephalometric laminography

The aetiology of asymmetric growth in the mandible is not well understood. Previous studies have indicated that the functional lateral shift of the mandible in the period of prepubertal growth may translate to a true skeletal asymmetry, exclusively in skeletal Class III malocclusion. This asymmetry develops more characteristic features during the pubertal and post-pubertal growth periods. Early correction of a functional lateral shift of the mandible is recommended. The purpose of this study was to examine the relationship between the morphology of the temporomandibular joints and asymmetry in skeletal Class III malocclusion in adult female patients. Cephalometric and laminographic findings in 36 asymmetric skeletal Class III patients with a lateral shift of mandible (group 3) were compared to those of 25 symmetric skeletal Class I patients (group 1) and the same number of symmetric skeletal Class III malocclusions (group 2). All the patients had received no orthodontic treatment. The results showed that the TMJ of the side to which the mandible shifted showed a significantly narrower and shorter shape of the condyle head, smaller superior condylar space, and steeper eminence than those of the unshifted side.