Clinical effect of Invisible MA Appliance and Twin-block Appliance in Treatment of Early Skeletal Class II Mandibular Retrusion Malocclusion
-
摘要:
目的 对比评价隐形MA矫治器与双板矫治器治疗骨性Ⅱ类错畸形儿童患者的临床疗效。 方法 选取骨性Ⅱ类下颌后缩儿童患者30例,平均年龄10.5岁,分为隐形MA矫治器组(A组)、双板矫治器组(B组)各15例,测量分析治疗前(T0)后(T1)颌骨及牙变化差异。 结果 骨性指标:两组矫治后SNB角增加,ANB角减小,Wits值减小,下颌骨位置Pg/OLP增大,差异均有统计学意义(P < 0.05),两组间差异无统计学意义(P > 0.05);两组矫治后前面高比S-Go/N-Me减小,下颌平面角SN/MP、前下面高与前面高比ANS-Me/N-Me增大(P < 0.05),两组间差异有统计学意义(P < 0.05);牙性指标:两组矫治后上切牙角U1-SN减小、下切牙角L1-MP增加,覆盖减小,磨牙关系改善,差异有统计学意义(P < 0.05),两组仅在L1-MP角间有显著差异(P < 0.05)。Pancherz分析法结果A组骨性效应大于B组。 结论 两种矫治器均有效促进下颌骨的发育,改善颌骨间矢状不调;矫治后下颌骨出现顺时针旋转,隐形MA矫治器相较于双板矫治器旋转较小;隐形MA矫治器对前牙轴倾度的控制较好,前牙支抗的丢失较少,隐形MA矫治器矫治可获得更多骨性效应。 Abstract:Objective To comapre the clinical effect of invisible MA and double plate appliance in the treatment of children with early skeletal Class II mandibular retrusion malocclusion. Methods We selected 30 children with skeletal Class II mandibular retrusion malocclusion, with an average age of 10.5 years, divided them into invisible MA appliance correction group (group A) and twin-block correction group (group B), 15 cases in each group. The changes of jaw and teeth before (T0) and after (T1) treatment were measured and analyzed. Results Bone indexes: after treatment, there were statistically significant increases in SNB Angle, decrease in ANB Angle, decrease in Wits value, and increase in Pg/OLP of mandibular position in both groups (P < 0.05), while there was no statistically significant difference between the two groups (P > 0.05). After correction, the anterior height ratio of s-Go/N-ME in both groups decreased, while the mandibular plane Angle SN/MP, the anterior lower height ratio and the anterior lower height ratio of ANS/N-ME in both groups increased (P < 0.05), and the differences between the two groups were statistically significant (P < 0.05). Dental properties: U1-SN of the upper incisor decreased, l1-MP of the lower incisor increased, coverage improved, and molar relationship improved after treatment in both groups, all of which were statistically significant (P < 0.05). Only l1-MP Angle was significantly different between the two groups (P < 0.05). Pancherz analysis was used to conclude that the bone effect of group A was greater than that of group B. Conclusions The two kinds of orthodontics can effectively promote the development of mandible and improve the intersagittal deformity of mandible. After the orthodontics, the mandible will rotate clockwise, but the invisible orthodontics rotate less than the double plate orthodontics. The invisible orthodontic device MA can control the axial inclination of the anterior teeth better, and the loss of the anterior anchorage is less, so the orthodontic treatment can obtain better bone effect. -
表 1 侧位片测量项目
Table 1. Measurement items of lateral radiograph
测量项目 定义 牙性指标 is/OLP 上中切牙位置,is点到OLP的距离 ii/OLP 下中切牙位置,ii点到OLP的距离 ms/OLP 上颌第一恒磨牙位置,ms点到OLP的距离 mi/OLP 下颌第一恒磨牙位置,mi点到OLP的距离 U1-NA 上中切牙的倾斜度与突度 U1-SN 上中切牙角 L1-MP 下中切牙角 L1-NB 下中切牙的倾斜度与突度 is/OLP-ii/OLP 覆盖,is点到OLP的距离减去ii点到OLP的距离 ms/OLP-mi/OLP 磨牙关系,ms点到OLP的距离减去mi点到OLP的距离 is/OLP-ss/OLP 上中切牙相对于上颌骨的位置变化,is点到OLP的距离减去ss点到OLP的距离 ii/OLP-pg/OLP 下中切牙相对于下颌骨的位置变化,ii点到OLP的距离减去Pg点到OLP的垂直距离 ms/OLP-ss/OLP 上颌第一恒磨牙相对于上颌骨的位置变化,ms点到OLP的距离减去ss点到OLP的距离 mi/OLP-pg/OLP 下颌第一恒磨牙相对于下颌骨的位置变化,mi点到OLP的距离减去Pg点到OLP的距离 骨性指标 ss/OLP 上颌骨位置,ss点到OLP的垂直距离 Pg/OLP 下颌骨位置,Pg点到OLP的垂直距离 Pg/OLP+Co/OLP 下颌体长度,Pg点到OLP的距离加上Co点到OLP的距离 SNA 上颌前部相对于前颅底的位置关系 SNB 下颌前部相对于前颅底的位置关系 ANB 上下颌之间前后位置关系 Wits 上、下牙槽座点相对于平面距 SN/MP 下颌平面角 S-Go/N-Me 后、前面高比 ANS-Me/N-Me 前下面高与前面高比 注:正值表示远中关系,负值表示近中关系;距离单位为毫米(mm),角度单位为度(°)。 表 2 两组矫治前后牙性变化比较(
$\bar x \pm s $ )Table 2. Comparison of dental changes between two groups before and after treatment (
$\bar x \pm s $ )测量项目 A组 B组 A、B组 差值T1-T0 t P 差值T1-T0 t P t P ss/OLP 0.67 ± 0.55 −0.392 0.349 0.37 ± 1.19 −0.259 0.399 −0.904 0.373 Pg/OLP 3.23 ± 0.26 −1.773 0.044* 3.58 ± 0.74 −1.060 0.030* 1.745 0.092 Pg/OLP+Co/OLP 5.17 ± 0.63 −2.711 0.006** 5.03 ± 1.59 −3.222 0.000** −0.317 0.753 SNA −0.17 ± 0.88 0.257 0.400 −0.10 ± 1.40 0.067 0.474 0.131 0.898 SNB 2.57 ± 0.86 −3.797 0.000** 3.30 ± 1.10 −2.407 0.014* 1.715 0.105 ANB −2.73 ± 0.38 13.669 0.000** −3.40 ± 0.68 8.849 0.000** −1.801 0.095 Wits −4.66 ± 1.18 10.579 0.000** −4.63 ± 0.90 6.969 0.000** 0.045 0.965 SN/MP 1.87 ± 1.25 −1.799 0.041* 2.81 ± 0.93 −3.264 0.001** −2.331 0.028* S-Go/N-Me −2.06 ± 0.78 1.809 0.041* −3.01 ± 0.80 3.547 0.001** 3.295 0.003** ANS-Me/N-Me 1.40 ± 0.84 −1.896 0.036* 2.93 ± 0.82 −3.624 0.001** 4.346 0.000** 注:*P < 0.05,**P < 0.01。 表 3 两组矫治前后骨性变化比较(
$\bar x \pm s $ )Table 3. Bone changes before and after treatment were compared between the two groups (
$\bar x \pm s $ )测量项目 A组 B组 A、B组 差值T1-T0 t P 差值T1-T0 t P t P is/OLP −1.42 ± 1.11 0.851 0.201 −2.70 ± 0.82 1.765 0.044* −3.618 0.001** ii/OLP 2.55 ± 0.87 −1.539 0.067 3.61 ± 0.71 −2.353 0.013* 3.643 0.001** ms/OLP −1.39 ± 0.46 0.973 0.170 −0.88 ± 0.49 0.663 0.256 2.970 0.006** mi/OLP 2.16 ± 0.40 −1.470 0.076 3.31 ± 0.82 −2.900 0.004** 4.913 0.000** U1-NA −5.16 ± 2.63 2.354 0.015* −5.20 ± 6.12 2.654 0.007** 0.020 0.984 U1-SN −5.73 ± 1.97 3.178 0.003** −6.56 ± 4.58 4.531 0.000** 0.531 0.601 L1-MP 2.79 ± 0.80 −4.465 0.000** 5.46 ± 1.60 −2.203 0.020* 5.079 0.000** L1-NB 4.60 ± 1.72 −2.08 0.024* 6.03 ± 2.38 −2.848 0.004* −1.89 0.069 is/OLP-ii/OLP −3.97 ± 0.84 18.55 0.000** −6.31 ± 0.70 21.723 0.000** −8.319 0.000** ms/OLP-mi/OLP −3.56 ± 0.50 8.69 0.000** −4.19 ± 1.06 4.180 0.000** −2.117 0.043* is/OLP-ss/OLP −2.09 ± 0.95 2.32 0.014* −3.07 ± 1.73 6.661 0.000** −1.922 0.068 ii/OLP-pg/OLP −0.67 ± 0.94 0.75 0.229 0.03 ± 0.57 −0.041 0.484 2.486 0.021* ms/OLP-ss/OLP −2.07 ± 0.77 −29.997 0.000** −1.25 ± 1.27 1.041 0.153 2.139 0.043* mi/OLP-pg/OLP −1.07 ± 0.35 1.45 0.079 −0.27 ± 0.54 0.247 0.403 4.795 0.000** 注:*P < 0.05,**P < 0.01。 -
[1] 傅民魁,张丁,王邦康,等. 中国25392名儿童与青少年错牙合畸形患病率的调查[J]. 中华口腔医学杂志,2000,37(5):371-373. doi: 10.3760/j.issn:1002-0098.2000.05.016 [2] 孙燕,姜潮. 错畸形对青少年自尊发展影响的多因素分析[J]. 中华口腔医学杂志,2004,2004(1):69-71. [3] 呼明燕. 安氏Ⅱ类2分类患者对自身畸形的认知度及客观正畸治疗需要的评价[D]. 山东: 山东大学硕士学位论文, 2012. [4] 赵迪,曹军,李小燕,等. 骨性II类错患者上下颌骨矢状向结构病因机制分析[J]. 口腔医学研究,2007,23(1):95-97. [5] Ehsani S,Nebbe B,Normando D,et al. Short-term treatment effects produced by the Twin-block appliance:a systematic review and meta-analysis[J]. Eur J Orthod,2015,37(2):170-176. doi: 10.1093/ejo/cju030 [6] Almaqrami Bushra-Sufyan,Alhammadi Maged-Sultan,Bao Chang C. Three dimensional reliability analyses of currently used methods for assessment of sagittal jaw discrepancy.[J]. J Clin Exp Dent,2018,10(4):e352-e360. [7] Giuseppe P,Luca C,Attilio C,et al. Diagnostic reliability of the cervical vertebral maturation method and standing height in the identification of the mandibular growth spurt[J]. Angle Orthod,2016,86(4):599-609. doi: 10.2319/072415-499.1 [8] Wu J Y C,Hägg U,Pancherz H,et al. Sagittal and vertical occlusal cephalometric analyses of Pancherz:Norms for Chinese children[J]. American Journal of Orthodontics & Dentofacial Orthopedics,2010,137(6):816-824. [9] 陈荣敬,沈刚. Pancherz 分析法在咬合前导型功能性矫正器疗效评价中的应用[J]. 上海口腔医学,2003,12(4):256-259. doi: 10.3969/j.issn.1006-7248.2003.04.006 [10] 于艳玲,宋宇,董刚,等. Pancherz分析法评估Twin-block矫治器矫治骨性Ⅱ类错的骨牙效果[J]. 临床口腔医学杂志,2011,27(3):174-176. doi: 10.3969/j.issn.1003-1634.2011.03.019 [11] O’ brien K,Wright J,Conboy F,et al. Effectiveness of early orthodontic treatment with the twin-block appliance:A multicenter,randomized,controlled trial.[J]. Part 1:Dental and Skeletal Effects,2003,124(3):234-243. [12] 沈刚. SGTB 矫形诱发髁突改建的生物机制及临床意义[J]. 上海口腔医学,2018,27(3):225-229. [13] Giuntini V,Vangelisti A,Masucci C,et al. Treatment effects produced by the Twin-block appliance vs the Forsus Fatigue Resistant Device in growing Class II patients[J]. Angle Orthod,2015,85(5):784-789. doi: 10.2319/090514-624.1 [14] Koretsi V,Zymperdikas V F,Papageorgiou S N,et al. Treatment effects of removable functional appliances in patients with Class II malocclusion:a systematic review and meta-analysis[J]. Eur J Orthod,2015,37(4):418-434. doi: 10.1093/ejo/cju071 [15] Ahmadian-Babaki F,Araghbidi-Kashani S M,Mokhtari S. A cephalometric comparison of twin block and bionator appliances in treatment of class II malocclusion[J]. J Clin Exp Dent,2017,9(1):e107-e111. [16] 赵长铭,徐璐璐. Twin-block功能矫治器在安氏Ⅱ类错畸形矫治的临床研究进展[J]. 临床口腔医学杂志,2019,35(9):569-571. doi: 10.3969/j.issn.1003-1634.2019.09.018 [17] ClarK W, Clark W J. Twin block functional therapy[M]. JP Medical Ltd: Oversea Publishing House, 2002: 125-126. [18] Mack S,Bonilla T,English J D,et al. Accuracy of 3-dimensional curvilinear measurements on digital models with intraoral scanners[J]. Am J Orthod Dentofacial Orthop,2017,152(3):420-425. doi: 10.1016/j.ajodo.2017.05.011 [19] Fl ü gge T V,Schlager S,Nelson K,et al. Precision of intraoral digital dental impressions with iTero and extraoral digitization with the iTero and a model scanner[J]. Am J Orthod Dentofacial Orthop,2013,144(3):471-478. doi: 10.1016/j.ajodo.2013.04.017 [20] Scheffler N R,Proffit W R,Phillips C. Outcomes and stability in patients with anterior open bite and long anterior face height treated with temporary anchorage devices and a maxillary intrusion splint.[J]. Am J Orthod Dentofacial Orthop,2014,146(5):594-602. doi: 10.1016/j.ajodo.2014.07.020 [21] Shin K. The invisalign appliance could be an effective modality for treating overbite malocclusions within a mild to moderate range[J]. Journal of Evidence Based Dental Practice,2017,17(3):278-280. doi: 10.1016/j.jebdp.2017.06.010 [22] Bucci R,Franchi L,Rongo R,et al. Class II functional orthopaedic treatment:a systematic review of systematic reviews[J]. J Oral Rehabil,2015,42(8):624-642. doi: 10.1111/joor.12295 [23] 杨斌,白玉兴. 两种矫治技术治疗牙周病患者牙周组织应力的对比分析[J]. 现代口腔医学杂志,2009,23(3):232-234. doi: 10.3969/j.issn.1003-7632.2009.03.003 [24] Papadimitriou A,Mousoulea S,Gkantidis N,et al. Clinical effectiveness of Invisalign® orthodontic treatment:a systematic review[J]. Progress in Orthodontics,2018,19(1):37. doi: 10.1186/s40510-018-0235-z [25] Simon M,Keilig L,Schwarze J,et al. Treatment outcome and efficacy of an aligner technique--regarding incisor torque,premolar derotation and molar distalization[J]. BMC Oral Health,2014,14(1):68. doi: 10.1186/1472-6831-14-68 [26] Kravitz N D,Kusnoto B,Begole E,et al. How well does Invisalign work? A prospective clinical study evaluating the efficacy of tooth movement with Invisalign[J]. Am J Orthod Dentofacial Orthop,2009,135(1):27-35. doi: 10.1016/j.ajodo.2007.05.018 [27] Rossini G,Parrini S,Castroflorio T,et al. Efficacy of clear aligners in controlling orthodontic tooth movement:A systematic review.[J]. Angle Orthod,2015,85(5):881-889. doi: 10.2319/061614-436.1