Clinical effect of Invisible MA Appliance and Twin-block Appliance in Treatment of Early Skeletal Class II Mandibular Retrusion Malocclusion
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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（°）。 
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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。
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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。
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