正畸优先模式与手术优先模式对骨性Ⅲ类患者疗效的差异性研究

doi:10.13591/j.cnki.kqyx.2023.04.006

摘要/Abstract

摘要：

目的比较手术优先与正畸优先对骨性Ⅲ类错牙合患者疗效的影响。方法选择正畸-正颌联合治疗的骨性Ⅲ类错牙合患者24例,其中正畸优先组13例,手术优先组11例。收集患者治疗前后的锥形束CT(CBCT)影像学资料,并导入Dolphin Imaging软件,进行软硬组织头影测量分析。结果正畸优先组与手术优先组都能够成功改善患者的覆盖及软组织侧貌,治疗前后软硬组织变化具有统计学差异(P<0.05)。两组治疗前后各项指标差值比较无统计学意义(P>0.05)。此外手术优先组平均治疗时间为(18.86±3.61)个月,显著小于正畸优先组(27.15±5.16)个月,具有统计学差异(P<0.001)。结论手术优先组与正畸优先组治疗前后软硬组织变化值差异无统计学意义,治疗时间差异有统计学意义。

关键词: 骨性Ⅲ类错牙合, 手术优先, 正畸-正颌联合治疗

Abstract:

Objective To compare the impact between a surgery-first strategy and an orthodontics-first approach on the result and course of therapy in patients with skeletal Class Ⅲ malocclusion. Methods The sample consisted of 24 patients with severe skeletal Class Ⅲ malocclusion, who needed orthognathic surgery. Eleven patients were treated with the surgery-first approach, and 13 patients were treated with the traditional orthodontic-surgical approach. Dolphin Imaging software was used to perform cephalometric analysis on the cone beam computed tomography(CBCT)data that were collected before and after treatment. Results In skeletal Class Ⅲ patients, the overjet and soft-tissue profile were successfully normalized in both of the two groups at high rates. Before and after the treatment, there was no statistically significant difference in indexes between the two groups(P>0.05). In terms of soft and hard tissue changes before and after treatment, there was a statistically significant difference between the orthodontic-first group and the surgery-first group(P<0.05). In addition, the overall treatment duration was much shorter in the surgery-first group((18.86±3.61) months) than in the orthodontic-first group((27.15±5.16)months), with a statistical difference(P<0.001). Conclusion There is no statistically significant difference in soft and hard tissue changes between the surgery-first group and the orthodontic-first group, but there is a significant difference in treatment duration between two groups.

Key words: skeletal Class Ⅲ malocclusion, surgery-first approach, orthodontic-surgical approach

中图分类号:

R783.5

蔡观慧,管兆兰,李根,王华,张卫兵. 正畸优先模式与手术优先模式对骨性Ⅲ类患者疗效的差异性研究[J]. 口腔医学, 2023, 43(4): 317-321.

CAI Guanhui,GUAN Zhaolan,LI Gen,WANG Hua,ZHANG Weibing. Differences in efficacy between orthodontic-first and surgery-first models for skeletal Class Ⅲ patients[J]. Stomatology, 2023, 43(4): 317-321.

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项目	正畸优先组	手术优先组	P
覆盖	2.27±2.06	3.47±1.88	0.169
覆牙合	0.54±1.28	1.36±2.71	0.359
拥挤度	0.38±0.49	0.27±0.45	0.582
咬合关系	3.23±1.97	3.82±1.40	0.436
ANB	6.92±2.27	5.63±2.70	0.234
锁牙合	0.08±0.27	0.00	0.369
SN-GoGN	1.18±2.18	2.08±2.86	0.413
缺牙	0.15±0.53	0.18±0.57	0.907
DI总分	14.76±6.98	16.82±7.08	0.510

测量项目	正畸优先组			手术优先组
测量项目	术前	术后6个月	P	术前	术后6个月	P
SNA/(°)	82.25±2.63	84.32±3.20	0.062	83.75±4.61	84.05±4.65	0.726
SNB/(°)	86.20±2.21	84.34±3.30	0.044^*	87.85±4.27	85.17±4.62	<0.001^***
ANB/(°)	-3.89±2.07	-0.12±2.27	<0.001^***	-4.09±2.78	-1.13±3.64	<0.001^***
Co-A/mm	83.40±4.07	86.24±3.19	0.002^**	85.00±4.61	86.89±5.45	0.214
Co-Gn/mm	135.41±8.52	133.35±7.63	0.001^**	137.22±8.56	137.40±9.89	0.945
Go-Gn/mm	88.58±6.02	84.24±4.60	<0.001^***	86.91±7.66	85.54±7.82	0.450
覆盖/mm	-4.25±1.32	4.12±1.68	<0.001^***	-3.41±1.90	3.65±1.40	<0.001^***
Y轴角/(°)	57.80±3.18	58.53±3.31	0.338	57.44±3.24	58.70±3.53	0.279
FMA/(°)	23.34±5.20	21.84±4.08	0.104	23.41±5.09	23.10±5.15	0.767
FMIA/(°)	71.60±9.56	72.82±7.41	0.525	76.63±8.20	78.02±6.74	0.390
IMPA/(°)	85.82±8.36	85.36±8.73	0.773	79.97±5.17	78.87±6.73	0.524

测量项目	正畸优先组			手术优先组
测量项目	术前	术后6个月	P	术前	术后6个月	P
Lower lip-H线/mm	2.48±1.85	-1.03±1.54	<0.001^***	3.10±1.90	-0.65±1.63	<0.001^***
Subnasale-H线/mm	-1.82±2.60	0.20±1.94	0.001^**	-0.46±1.77	0.45±2.50	0.360
Lower lip-E线/mm	-1.30±2.58	-4.48±2.17	0.002^**	-1.43±2.40	-3.96±2.76	0.002^**
Upper lip-E线/mm	-9.23±2.68	-7.45±1.91	0.082	-7.83±5.99	-4.76±6.05	0.338
H角/(°)	2.81±1.90	7.05±2.04	<0.001^***	2.97±3.11	7.62±3.68	<0.001^***
Inferior Sulcus-H线/mm	-0.18±1.59	3.13±1.47	<0.001^***	-0.26±1.56	2.35±0.85	<0.001^***

测量项目	正畸优先组	手术优先组	P
SNA/(°)	2.07±3.49	0.30±2.63	0.199
SNB/(°)	-1.75±2.69	-2.67±1.61	0.348
ANB/(°)	3.78±2.80	2.96±1.82	0.437
Co-A/mm	2.84±2.48	1.89±4.51	0.540
Co-Gn/mm	-2.06±1.71	0.18±8.08	0.360
Go-Gn/mm	-4.35±2.82	-1.37±5.53	0.119
覆盖/mm	8.36±2.26	7.05±1.69	0.145
Y轴角/(°)	0.73±2.54	1.26±3.49	0.693
FMA/(°)	-1.50±2.96	-0.31±3.22	0.376
FMIA/(°)	1.22±6.59	1.39±4.89	0.945
IMPA/(°)	-0.46±5.42	-1.10±5.27	0.783
Lower lip-H线/mm	-3.52±1.25	-3.75±2.12	0.747
Subnasale-H线/mm	2.02±1.66	0.91±2.99	0.282
Lower lip-E线 /mm	-3.18±2.72	-2.54±3.13	0.609
Upper lip-E线 /mm	1.78±3.25	3.06±9.63	0.669
H角 /(°)	4.24±2.59	4.65±2.40	0.708
Inferior Sulcus-H线/mm	3.31±1.70	2.61±1.36	0.305
治疗时间/月	27.15±5.16	18.86±3.61	<0.001^***