微型骨钉辅助上颌快速扩弓对下颌位置的影响

doi:10.13591/j.cnki.kqyx.2023.02.008

摘要/Abstract

摘要：

目的探索微型骨钉辅助上颌快速扩弓(miniscrew-assisted rapid palatal expansion,MARPE)在治疗成人骨性Ⅰ类上颌宽度不足错牙合畸形时对下颌位置的影响。方法本回顾性研究选取2019年7月—2022年3月,本院收治的20例采用MARPE治疗的成人骨性Ⅰ类上颌宽度不足错牙合畸形患者为研究对象,收集治疗前(T0)、扩弓结束即刻(T1)及维持6个月后(T2)三个时间点的锥形束CT(cone beam computed tomography,CBCT)资料,利用Dolphin软件将头位进行标准化校准,测量下颌骨标记点(左/右侧髁顶点,左/右侧下颌角点及颏下点),相对于冠状面、横断面、矢状面三个参考平面的线距变化,分别代表下颌骨矢状向、垂直向及水平向的位移,采用重复测量方差分析及最小显著性差异法多重比较评估各标记点的位置变化。结果颏下点及右侧下颌角点在结束即刻(T1)发生顺时针旋转,维持6个月后(T2)复发到治疗前(T0)位置;颏下点未发现水平向移位变化。结论 MARPE在治疗骨性Ⅰ类上颌宽度不足错牙合畸形时,引起下颌位置发生短暂的顺时针旋转,长期效果评估未显示矢状向、垂直向和水平向位置变化。

关键词: 微型骨钉辅助上颌快速扩弓, 上颌宽度不足, 下颌位置, CBCT

Abstract:

Objective To explore the effect of miniscrew-assisted rapid palatal expansion (MARPE) on mandible position in the treatment of adult skeletal Class Ⅰ malocclusion with maxillary transverse deficiency. Methods In this retrospective study, 20 cases of adult skeletal Class Ⅰ malocclusion with maxillary transverse deficiency treated with MARPE in our hospital from July 2019 to March 2022 were selected as research objects. CBCT data of three time points before treatment (T0), immediately after expansion (T1) and six months after retention (T2) were collected. The head position was standardized and calibrated by Dolphin software, and then mandible landmarks (left and right Condylion, left and right Gonion, Menton) were positioned. The linear distance changes of each landmark relative to the reference plane of coronal plane, axial plane and sagittal plane were measured, which represented the sagittal, vertical and horizontal displacement of mandible respectively. Repeated measurement ANOVA and LSD multiple comparison were used to evaluate the position change of each landmark. Results The Menton and right Gonion rotated clockwise at T1, and relapsed to the initial position at T2. No lateral displacement of Menton was found. Conclusion When MARPE is used to treat skeletal Class Ⅰ malocclusion with maxillary transverse deficiency, it causes a transient clockwise rotation of the mandiblar. The mandible does not show sagittal, vertical and horizontal position changes in long-term evaluation.

Key words: miniscrew-assisted rapid palatal expansion, maxillary transverse deficiency, mandibular position, cone beam computed tomography

中图分类号:

R783.5

雷巧玲,何文丹,雷期音,熊培颖,王忠东. 微型骨钉辅助上颌快速扩弓对下颌位置的影响[J]. 口腔医学, 2023, 43(2): 135-140.

LEI Qiaoling,HE Wendan,LEI Qiyin,XIONG Peiying,WANG Zhongdong. Effect of miniscrew-assisted rapid palatal expansion on mandibular position[J]. Stomatology, 2023, 43(2): 135-140.

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测量项目	T0	T1	T2	P
rCo-CoP	8.32±3.12	8.46±3.71	8.14±2.38	0.60
lCo-CoP	8.65±3.52	8.92±4.23	8.18±3.34	0.13
rGo-CoP	18.51±4.31	17.61±3.98	18.56±4.70	0.04^*
lGo-CoP	20.35±4.03	19.16±3.20	20.01±3.22	0.06
Me-CoP	78.32±8.29	76.67±7.09	78.06±7.86	0.02^*
rCo-AxP	2.92±2.11	3.15±1.80	3.03±2.23	0.37
lCo-AxP	2.37±1.71	2.61±1.41	2.33±1.63	0.20
rGo-AxP	50.70±3.92	51.55±3.44	50.90±3.67	0.00^**
lGo-AxP	51.15±4.08	51.81±3.91	51.32±4.40	0.09
Me-AxP	77.57±5.55	79.03±6.00	78.10±4.54	0.00^**
Me-SaP	2.65±1.81	2.42±1.83	2.78±2.13	0.71

测量项目	时间	线距变化	P
rGo-CoP	T0-T1	0.90±0.41	0.04^*
	T1-T2	-0.95±0.49	0.07
	T0-T2	-0.05±0.30	0.88
rGo-AxP	T0-T1	-0.86±0.23	0.00^**
	T1-T2	0.66±0.28	0.03^*
	T0-T2	-0.20±0.19	0.30
Me-CoP	T0-T1	1.65±0.66	0.02^*
	T1-T2	-1.39±0.64	0.04^*
	T0-T2	0.26±0.37	0.49
Me-AxP	T0-T1	-1.46±0.15	0.00^**
	T1-T2	0.94±0.42	0.04^*
	T0-T2	-0.52±0.34	0.15