微种植钉辅助上颌快速扩弓在Ⅲ类错𬌗畸形患者中的临床效果

doi:10.13591/j.cnki.kqyx.2025.10.006

摘要/Abstract

摘要：

目的分析微种植钉辅助上颌快速扩弓在Ⅲ类错𬌗畸形患者中的临床效果。方法选取邯郸市口腔医院2022年1月至2023年4月诊治的58例Ⅲ类错𬌗畸形患者作为对照组,采用手术辅助上颌快速扩弓治疗,选取邯郸市口腔医院2023年6月至2024年5月收治的58例Ⅲ类错𬌗畸形患者作为观察组,微种植钉辅助上颌快速扩弓治疗,在治疗3个月后拍摄锥形束CT,比较两组患者治疗前后骨性结构、软组织测量结果、咬合功能、扩弓效果及术后并发症发生情况。结果与术前比较,两组治疗后骨性宽度、上颌牙支抗牙倾斜度均增加(P<0.05);而与对照组比较,观察组鼻腔宽度增加明显,支抗牙倾斜度均减低明显(P<0.05)。治疗后观察组ANB、LI-MP高于对照组,SNB、MP-SN低于对照组,面凸角、鼻唇角高于对照组,颏唇角低于对照组,咬合功能高于对照组(P<0.05)。观察组术后并发症发生率(1.72%)低于对照组(13.79%),差异明显(P<0.05)。结论微种植钉辅助上颌快速扩弓可取得明显的骨性扩宽效应,促进患者骨性结构改善,改善其面貌形态,提高其咬合功能,可推广应用。

关键词: 微种植钉, 上颌快速扩弓, Ⅲ类错𬌗畸形

Abstract:

Objective To analyze the clinical outcome of microimplant screw-assisted maxillary rapid arch expansion in patients with Class Ⅲ malocclusion. Methods A total of 58 patients with Class Ⅲ malocclusion treated at Handan Stomatological Hospital from January 2022 to April 2023 were selected as the control group, and surgically assisted rapid maxillary arch expansion treatment was used. A total of 58 patients with Class Ⅲ malocclusion treated at Handan Stomatological Hospital from June 2023 to May 2024 were selected as the observation group, and micro-implant assisted rapid maxillary arch expansion treatment was performed. After 3 months of treatment, cone beam CT was taken to compare the bone structure, soft tissue measurement results, occlusal function, arch expansion effect, and postoperative complications between the two groups of patients before and after treatment. Results The bony width and the tilt of the supported teeth of the maxillary teeth increased in both groups after treatment, compared with the preoperative period(P<0.05). The nasal width of the maxillary first molar in the observation group increased significantly, and the tilt of the supported teeth were all reduced significantly compared with the control group(P<0.05). After treatment, ANB and LI-MP of the observation group were higher than those of the control group; SNB and MP-SN were lower than those of the control group. Facial convexity angle and nasolabial angle were higher than those of the control group; chin-labial angle was lower than those of the control group, and occlusal function was higher than those of the control group(P<0.05). The postoperative complication rate of 1.72% in the observation group was lower than that of 13.79% in the control group, with a significant difference(P<0.05). Conclusion Micro-implant-assisted rapid maxillary arch expansion can achieve obvious bony expansion effect, promote the improvement of the patient’s bony structure, improve their facial morphology, and enhance their occlusal function, which can be promoted and applied.

Key words: micro-implant, maxillary rapid arch expansion, Class Ⅲ malocclusion

中图分类号:

R783.5

朱琳, 尚张丽, 薛晶. 微种植钉辅助上颌快速扩弓在Ⅲ类错𬌗畸形患者中的临床效果[J]. 口腔医学, 2025, 45(10): 754-759.

ZHU Lin, SHANG Zhangli, XUE Jing. Clinical outcomes of micro-implant-assisted maxillary rapid arch expansion in patients with Class Ⅲ malocclusion[J]. Stomatology, 2025, 45(10): 754-759.

图/表 9

表1

图1

图2

图3

表2

表3

表4

表5

表6

参考文献 20

[1]	宋明慧,莫朝伦,张军梅.不同垂直骨面型骨性Ⅲ类错𬌗畸形患者牙弓及牙槽弓宽度的特征[J]. 贵州医科大学学报,2022(3): 313-317.
[2]	张琳琳,刘东旭.骨性Ⅲ类偏颌畸形牙骨特征、分类及治疗相关研究进展[J]. 口腔医学,2024,44(9): 710-714.
[3]	周静文,闫麒安,米丛波.正颌手术治疗骨性Ⅲ类错𬌗畸形对颞下颌关节髁突影响的研究现状[J]. 中国美容医学,2024,33(5): 185-187.
[4]	杨任,马巧玲,林爽,等.采用两种不同功能矫治器治疗骨性Ⅲ类错𬌗畸形的临床研究[J]. 口腔医学,2023,43(5): 460-464,475.
[5]	汤彧婧,贺红,刘志坚.种植体支抗辅助上颌快速扩弓后Ⅲ类错𬌗上颌骨及上气道的即刻变化[J]. 中华口腔医学杂志,2023,58(9): 906-912.
[6]	任超超,于文琪,王凡.利用SBL线评价上颌前方牵引治疗骨性Ⅲ类错𬌗畸形的疗效[J]. 北京口腔医学,2023,31(4): 255-259.
[7]	Brunetto DP, Moschik CE, Dominguez-Mompell R, et al.Mini-implant assisted rapid palatal expansion(MARPE)effects on adult obstructive sleep apnea(OSA)and quality of life: A multi-center prospective controlled trial[J]. Prog Orthod, 2022, 23(1): 3.
[8]	周彦恒,柳大为主译.口腔正畸技术精粹[M]. 北京:人民军医出版社,2015: 36.
[9]	史红丽,孙秀梅,肖艳菊,等.骨性Ⅲ类错𬌗畸形下颌偏斜患者正颌手术前后髁突形态变化的研究[J]. 口腔颌面外科杂志,2024,34(4): 282-288.
[10]	蔡蕾,王荣,胡颖超,等.腭中缝骨皮质切开联合快速扩弓法治疗上颌横向宽度不足患者的临床体会[J]. 浙江创伤外科,2023,28(1): 81-84.
[11]	刘博慧,魏福兰.上颌快速扩弓腭中缝骨改建效果及其辅助方法研究进展[J]. 中华口腔正畸学杂志,2022,29(2): 95-98.
[12]	丁玲敏,纪雅宁,钱素婷,等.微种植钉辅助上颌快速扩弓治疗成人阻塞性睡眠呼吸暂停综合征的研究进展[J]. 口腔医学,2022,42(2): 160-164.
[13]	窦尉尉,岳从雷,张家坤,等.骨皮质切开术上颌快速扩弓辅助正畸-正颌联合治疗骨性Ⅲ类错𬌗畸形效果分析[J]. 上海口腔医学,2022,31(6): 643-647.
[14]	刘佳君,熊晖.种植钉辅助上颌快速扩弓对上颌骨三维位置的影响[J]. 口腔医学研究,2024,40(4): 330-336.
[15]	高明,陶永炜,毕思思,等.双侧下颌升支矢状劈开截骨术后近心骨段横向宽度变化的临床观察[J]. 口腔颌面外科杂志,2023,33(1): 20-25.
[16]	韩磊,李佳岭,李保超,等.两种快速扩弓方式联合前方牵引治疗骨性Ⅲ类错𬌗的疗效差异分析[J]. 中华口腔医学杂志,2023,58(4): 318-328.
[17]	赵天然,刘东旭.上颌快速扩弓联合前方牵引对替牙期骨性Ⅲ类错𬌗畸形的矫治疗效[J]. 山东大学学报(医学版),2024,62(3): 77-86.
[18]	雷巧玲,何文丹,雷期音,等.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.
[19]	孙滕,鲁明星,李文健.直丝弓滑动矫治技术联合微螺钉种植体支抗对安氏Ⅱ类错𬌗畸形患者的疗效及美学效果观察[J]. 中国医疗美容,2024,14(5): 68-72.
[20]	王雯文,胡一帆.微螺钉种植体支抗应用于错𬌗畸形的临床效果[J]. 医学美学美容,2024,33(9): 82-85.

测量指标	时间	观察组(n=58)	对照组(n=58)	t	P
腭中缝宽度/mm	治疗前	0	0
腭中缝宽度/mm	治疗后	3.52±1.01^a	3.49±1.01^a	0.160	0.873
颧上颌缝间距/mm	治疗前	74.28±4.15	75.10±4.26	1.050	0.296
颧上颌缝间距/mm	治疗后	79.58±4.52^a	78.82±4.63^a	0.895	0.373
鼻腔宽度/mm	治疗前	29.84±2.16	30.01±2.20	0.420	0.675
鼻腔宽度/mm	治疗后	34.58±1.68^a	36.04±1.72^a	4.625	<0.001
鼻底宽度/mm	治疗前	24.48±3.28	25.01±3.36	0.860	0.392
鼻底宽度/mm	治疗后	28.40±3.82^a	28.75±3.96^a	0.484	0.629
支抗牙倾斜度/(°)	治疗前	87.49±4.15	88.01±4.30	0.663	0.629
支抗牙倾斜度/(°)	治疗后	95.58±5.16^a	99.82±5.38^a	4.332	<0.001

测量指标	时间	观察组/(°) (n=58)	对照组/(°) (n=58)	t	P
SNA	治疗前	81.92±2.05	82.02±2.14	0.257	0.798
	治疗后	82.20±2.16	81.82±2.03	0.976	0.331
SNB	治疗前	85.10±3.15	84.97±3.28	0.218	0.828
	治疗后	80.04±2.04^a	82.43±2.19^a	6.082	<0.001
ANB	治疗前	-4.90±1.58	-4.89±1.60	0.034	0.973
	治疗后	2.16±0.58^a	1.71±0.40^a	4.864	<0.001
MP-SN	治疗前	38.04±2.48	37.92±2.50	0.260	0.796
	治疗后	31.15±2.04^a	33.09±2.74^a	4.325	<0.001
LI-MP	治疗前	74.50±6.29	75.16±6.37	0.561	0.576
	治疗后	92.60±5.15^a	86.23±5.07^a	6.713	<0.001

测量指标	时间	观察组/(°) (n=58)	对照组/(°) (n=58)	t	P
面凸角	治疗前	5.28±2.07	5.36±2.13	0.205	0.838
	治疗后	14.30±2.49^a	12.01±2.08^a	5.365	<0.001
鼻唇角	治疗前	80.14±13.36	79.62±15.04	0.197	0.844
	治疗后	89.27±12.74^a	84.06±10.93^a	2.364	0.020
颏唇角	治疗前	154.87±13.64	152.74±15.51	0.785	0.434
	治疗后	132.67±6.17^a	141.20±7.39^a	6.748	<0.001

测量指标	时间	观察组(n=58)	对照组(n=58)	t	P
TOF/raw	治疗前	4 824.16±848.20	4 904.75±862.69	0.507	0.613
	治疗后	6 278.82±916.43^a	5 671.14±884.39^a	3.634	<0.001
AOF/%	治疗前	18.24±6.31	17.97±6.57	0.226	0.822
	治疗后	10.28±3.35^a	12.74±3.16^a	4.068	<0.001
COF/cm	治疗前	1.61±0.78	1.58±0.81	0.203	0.839
	治疗后	1.06±0.46^a	1.28±0.58^a	2.263	0.026
OT/s	治疗前	1.07±0.52	1.03±0.55	0.402	0.688
	治疗后	0.62±0.39^a	0.83±0.43^a	2.755	0.007
DT/s	治疗前	1.71±0.52	1.69±0.55	0.201	0.841
	治疗后	0.92±0.43^a	1.27±0.50^a	4.042	<0.001

指标	观察组(n=58)	对照组(n=58)
感染	0	1(1.72)
出血	1(1.72)	2(3.43)
严重疼痛	0	3(5.17)
牙龈退缩	0	1(1.72)
牙根吸收	0	0
鼻窦感染	0	1(1.72)
总计	1(1.72)	8(13.79)