乳牙末期、混合牙列初期前牙反牙合前方牵引矫治疗效研究(1)
[摘要]目的：研究对乳牙末期、混合牙列初期前牙反牙合的儿童早期施行前方牵引矫形治疗效果。方法：选取经前方牵引矫形治疗的29例前牙反牙合患者(5～8岁)作为治疗组的研究对象，通过在X线头颅侧位定位片上对这些患者在治疗前(T0)和治疗结束时(T1)状况的比较，及这些患者治疗结束时与同龄的、未采取任何正畸治疗的前牙反牙合患者的状况比较，分析前方牵引矫治的疗效。结果：①治疗组的患者矫治后在前牙反牙合得到矫正的同时，T1期较T0期上颌骨有明显地长度增加、位置前移改变，下颌骨有明显的向后、向下旋转。②治疗组患者在T1期相对于未经矫治的同龄前牙反牙合患者，上颌骨有明显增长、前移的特点，下颌骨的生长方向则没有明显的差异性。结论：对乳牙末期、混合牙列初期前牙反牙合的儿童早期施行前方牵引矫形治疗，能起到改善面中部凹陷骨型的作用，是一种值得提倡的矫治方法。
[关键词]前牙反牙合；骨性Ⅲ类；早期治疗；前方牵引；头影测量分析
[中图分类号]R783.5[文献标识码]A [文章编号]1008-6455(2008)05-03
, 百拇医药
Study on the effect of face-mask for the cross-bite at late stage of primary dentition or early stage of mixed dentition
XU Jing,CAO Jun,YANG Qi-guo
(Department of Orthodontics, College of Stomatology, Fourth Military Medical University,Xi'an 710032,Shaanxi,China)
Abstract:ObjectiveTo study on the effect of face-mask for the cross-bite at late stage of primary dentition or early stage of mixed dentition. Methods29 anterior cross-bite patients treated with face-mask were included in the treatment group. The therapeutic effect was analyzed by comparing the cephalometric state before treatment (T0) to the state after treatment (T1). The effect was also analyzed by comparing the cephalometric state of the patients after treatment with the state of the anterior cross-bite patients at the same age without orthodontic treatment.ResultsIn the treatment group, the cross-bite was corrected. Compared with T0 stage, the patients in T1 stage were significantly different in that the length of upper jaw increased, the position of the jaw proceed, as well as the lower jaw rotated down and backwards. Compared with the untreated patients, upper jaw length of the the patients in T1 stage was larger with more forward position. There was no significant difference at the growth direction of mandiblein such comparison.ConclusionFor the cross-bite at late stage of primary dentition or early stage of mixed dentition, the effect of improving the middle face deficiency could be obtained by the face mask treatment. It is suggested that the face mask should be recommended for such patients.
, 百拇医药
Key words: anterior crossbite;skeletal Class III;early treatment; maxillary protraction; cephalometric analysis
前牙反牙合是临床常见的一种错牙合畸形，它对口腔功能，颜面美观和心理健康均有较严重的影响，反牙合的存在不仅改变了牙合、颌、面正常生长发育的轨迹，且随着年龄的增长进行性加重，因此对前牙反牙合应尽早矫治[1]。前方牵引矫治是一种常用于快速生长发育期的前方牵引的矫形方法，这种方法在矫治反牙合的同时，能起到改善患者存在的面中1/3凹陷面型的效果[2]。而对于乳牙末期、混合牙列初期前牙反牙合是否适合进行这种前方牵引矫形治疗，目前无论从临床应用、还是理论研究方面都还存在一定的争议。本研究中我们应用矫治前后疗效比较及矫治后与未经矫治的同龄反牙合的状况比较的方法，对这一类患者的前方牵引疗效进行研究探讨。
1材料和方法
, 百拇医药
1.1研究对象
1.1.1治疗组：选择1999年6月～2007年6月第四军医大学口腔医学院正畸科就诊的29例安氏骨性III类错牙合畸形伴上颌骨发育不足的患者，均无矫治史。病例纳入标准：①临床诊断为前牙反牙合，反牙合范围包括有两侧上颌中切牙在内的4个前牙；②患者处于乳牙末期、混合牙列初期，年龄5～8岁；③无先天性唇腭裂及呼吸道疾病(如腺样体增生)。
1.1.2对照组：随机选择1999年6月～2007年6月来第四军医大学口腔医学院正畸科就诊的未经正畸治疗的前牙反牙合患者，病例纳入标准与治疗组相同，再从中按照与治疗组前方牵引矫治结束后性别一致、年龄相差2个月以内的原则，为治疗结束的病例分别选择配比研究病例，与治疗组矫治结束的病例进行配比对照研究，通过这种方法去除生长发育对矫治效果的影响，分析前方牵引矫治的疗效。
1.2治疗方法：制作下颌牙合垫，将下颌牙合垫戴入口内，调磨牙合垫，解除前牙反牙合咬合锁结；以双侧上颌第一磨牙或第二乳磨牙上的带环为支抗，连接唇、舌弓固定牵引支架，在侧切牙和尖牙或乳侧切牙和乳尖牙之间的支架上焊接牵引钩，供前方牵引使用；选用合适的弹力橡皮圈，从口内固定装置到面具进行前方牵引，每侧牵引力为400～500g，每天牵引时间不少于14h。前方牵引治疗周期平均为5.2个月，矫治标准为反牙合牙全部解除，达到正常覆牙合、覆盖关系[3]。, http://www.100md.com(徐 静 曹 军 杨其国)
[关键词]前牙反牙合；骨性Ⅲ类；早期治疗；前方牵引；头影测量分析
[中图分类号]R783.5[文献标识码]A [文章编号]1008-6455(2008)05-03
, 百拇医药
Study on the effect of face-mask for the cross-bite at late stage of primary dentition or early stage of mixed dentition
XU Jing,CAO Jun,YANG Qi-guo
(Department of Orthodontics, College of Stomatology, Fourth Military Medical University,Xi'an 710032,Shaanxi,China)
Abstract:ObjectiveTo study on the effect of face-mask for the cross-bite at late stage of primary dentition or early stage of mixed dentition. Methods29 anterior cross-bite patients treated with face-mask were included in the treatment group. The therapeutic effect was analyzed by comparing the cephalometric state before treatment (T0) to the state after treatment (T1). The effect was also analyzed by comparing the cephalometric state of the patients after treatment with the state of the anterior cross-bite patients at the same age without orthodontic treatment.ResultsIn the treatment group, the cross-bite was corrected. Compared with T0 stage, the patients in T1 stage were significantly different in that the length of upper jaw increased, the position of the jaw proceed, as well as the lower jaw rotated down and backwards. Compared with the untreated patients, upper jaw length of the the patients in T1 stage was larger with more forward position. There was no significant difference at the growth direction of mandiblein such comparison.ConclusionFor the cross-bite at late stage of primary dentition or early stage of mixed dentition, the effect of improving the middle face deficiency could be obtained by the face mask treatment. It is suggested that the face mask should be recommended for such patients.
, 百拇医药
Key words: anterior crossbite;skeletal Class III;early treatment; maxillary protraction; cephalometric analysis
前牙反牙合是临床常见的一种错牙合畸形，它对口腔功能，颜面美观和心理健康均有较严重的影响，反牙合的存在不仅改变了牙合、颌、面正常生长发育的轨迹，且随着年龄的增长进行性加重，因此对前牙反牙合应尽早矫治[1]。前方牵引矫治是一种常用于快速生长发育期的前方牵引的矫形方法，这种方法在矫治反牙合的同时，能起到改善患者存在的面中1/3凹陷面型的效果[2]。而对于乳牙末期、混合牙列初期前牙反牙合是否适合进行这种前方牵引矫形治疗，目前无论从临床应用、还是理论研究方面都还存在一定的争议。本研究中我们应用矫治前后疗效比较及矫治后与未经矫治的同龄反牙合的状况比较的方法，对这一类患者的前方牵引疗效进行研究探讨。
1材料和方法
, 百拇医药
1.1研究对象
1.1.1治疗组：选择1999年6月～2007年6月第四军医大学口腔医学院正畸科就诊的29例安氏骨性III类错牙合畸形伴上颌骨发育不足的患者，均无矫治史。病例纳入标准：①临床诊断为前牙反牙合，反牙合范围包括有两侧上颌中切牙在内的4个前牙；②患者处于乳牙末期、混合牙列初期，年龄5～8岁；③无先天性唇腭裂及呼吸道疾病(如腺样体增生)。
1.1.2对照组：随机选择1999年6月～2007年6月来第四军医大学口腔医学院正畸科就诊的未经正畸治疗的前牙反牙合患者，病例纳入标准与治疗组相同，再从中按照与治疗组前方牵引矫治结束后性别一致、年龄相差2个月以内的原则，为治疗结束的病例分别选择配比研究病例，与治疗组矫治结束的病例进行配比对照研究，通过这种方法去除生长发育对矫治效果的影响，分析前方牵引矫治的疗效。
1.2治疗方法：制作下颌牙合垫，将下颌牙合垫戴入口内，调磨牙合垫，解除前牙反牙合咬合锁结；以双侧上颌第一磨牙或第二乳磨牙上的带环为支抗，连接唇、舌弓固定牵引支架，在侧切牙和尖牙或乳侧切牙和乳尖牙之间的支架上焊接牵引钩，供前方牵引使用；选用合适的弹力橡皮圈，从口内固定装置到面具进行前方牵引，每侧牵引力为400～500g，每天牵引时间不少于14h。前方牵引治疗周期平均为5.2个月，矫治标准为反牙合牙全部解除，达到正常覆牙合、覆盖关系[3]。, http://www.100md.com(徐 静 曹 军 杨其国)