上颌前牵引联合快速扩弓矫治儿童骨性Ⅲ类错(牙合)前后软硬组织变化

摘要

AIM: To examing the skeletal and soft tissue changes in the correction of skeletal class Ⅲ malocclusion by maxillary protraction combined with rapid maxillary expansion (RME). METHODS; 28 children of 7 -10 years old with skeletal class Ⅲ malocclusion were treated with maxillary protraction combined with RME in this study. Before and after treatment, cephalometric radiographs were taken and analyzed. RESULTS; After maxillary protraction, the anterior crossbite were corrected and obvious profile changes were observed. The maxilla moved fore-ward, the length increased but followed with PP-SN plane rotated anticlockwise. The mandible moved backward and downward, the N-Me, ANS-Me/N-Me increased. The upper incisors inclined labially and the lower incisors inclined lingually with the jaw. Profile changes was achieved with FCA, H angle increased. Upper lip moved forward and protrusion increased. Correspondingly lower lip moved backward. CONCLUSION; Maxillary protraction combined with RME is effective in the treatment of Class III malocclusion with maxillary deficiency.%目的:探讨上颌前牵引联合快速扩弓对儿童骨性Ⅲ类错(牙合)的矫治效果.方法:对28例儿童骨性Ⅲ类错(牙合)病人(7 ～10岁)进行上颌前牵引治疗,在前牵引前快速扩弓1周.分别在治疗开始(T0)和结束(T1)时拍摄头颅定位侧位片,进行定点测量分析.结果:①硬组织变化:ANB角增加5.37°(P＜0.05),Wit's值增加5.74 mm(P ＜0.05),Ptm-A增加2.49 mm(P ＜0.05),Yaxis增加1.82°(P＜0.05)；SNB角减小0.75°(P＞0.05),Go-Me、Co- Gn分别增加0.64 mm、2.21 mm,但P＞0.05,SN- PP减小0.61°(P＞0.05),PP-MP增加5.54°(P＜0.05),下面高、下面高/全面高分别增加3.98(P ＜0.05)、1.61(P＞0.05)；U1-NA角增加3.10°(P＜0.05),L1 - NB角减小1.23°(P＜0.05),Ms6-PP距增加1.13 mm(P ＜0.05)；②软组织测量项目变化:面型角增大5.98°,颏唇角减小2.45°、H角增大5.2°,上唇-E线距增大1.42 mm,下唇-E线距减小1.18 mm(P ＜0.05).结论:前牵引联合快速扩弓矫治儿童骨性Ⅲ类错(牙合),可产生显著治疗效果,能促进上颌骨的生长,使面型改善,但下颌出现顺时针旋转,高角病人慎用.