数字化三维打印前方牵引联合快速扩缩矫治替牙期骨性Ⅲ类的临床效果研究

doi:10.13591/j.cnki.kqyx.2025.01.008

Abstract

Abstract:

Objective To evaluate the skeletal effect, dental effect, soft tissue and airway changes of a digital 3D printed maxillary protraction combined with alternate maxillary rapid expansion and constriction in the treatment of skeletal Class Ⅲ patients during mixed dentition. Methods Twenty-two mixed dentition patients(mean age of (11.33±0.88) years, 9 males and 13 females) of skeletal Class Ⅲ malocclusion with maxillary hypoplasia were collected from 2018 to 2023. Treatment was performed using a digital 3D printed protraction device combined with maxillary rapid expansion and constriction. Cone-beam CT were obtained before and after treatment to assess the orthopedic treatment of hard tissue, dentition, soft tissue and airway in three dimensional direction. Results After treatment, hard tissue measurements of SNA, ANB, Wits, Co-A, and Co-Gn distance increased significantly with a statistical difference, whereas there were no statistically significant changes in SNB, FMA, Occ plane to FH and Y-axis angle. There was a statistically significant increase in U1-SN, whereas there was no significant change in U1-NA. Soft tissue measurements of upper lip distance from the E line improved with a statistically significant difference while no significant changes in nasolabial angle were detected. The volume of the posterior palatal region of the upper airway increased significantly. Conclusion The digital 3D printed maxillary protraction combined with alternate rapid maxillary expansion and constriction promotes maxillary development, inhibits mandibular development, essentially maintains vertical dimension and improves skeletal Class Ⅲ patients’ deformity and profile. The volume of the posterior palatal region of the upper airway is also significantly improved.

Key words: digital 3D printed maxillary protraction, alternate rapid maxillary expansion and constriction, skeletal Class Ⅲ malocclusion, cone-beam computed tomography

CLC Number:

R783.5

LI Gen, WANG Hua, GU Yan. Clinical effect of digital 3D printed maxillary protraction combined with alternate rapid maxillary expansion and constriction in the treatment of patients with skeletal Class Ⅲ malocclusion during mixed dentition[J]. Stomatology, 2025, 45(1): 51-57.

Figures/Tables 6

Fig.1

Tab.1

Definition of measurement items"

测量项目	定义
1骨性测量项目
矢状向
SNA/(°)	上颌相对于颅部的前后位置关系
SNB/(°)	下颌相对于颅部的前后位置关系
ANB/(°)	上下颌骨对颅部的相互位置关系
Wits值/mm	分别由A点、B点向牙合平面作垂线之间的距离
Co-A/mm	上颌综合长度,髁顶点到上齿槽座点的距离
Co-Gn/mm	下颌综合长度,髁顶点到颏顶点的距离
NA-AP/(°)	代表上颌部分相对于整个侧面的关系
垂直向
FMA/(°)	眶耳平面与下颌平面的交角,代表下颌体的陡度
Occ plane to FH角/(°)	牙合平面与眶耳平面之交角
Y轴角/(°)	蝶鞍中心点和颏顶点连线与眶耳平面的前下交角
Co-Go-Me/(°)	髁顶点到下颌角点连线与下颌角点与颏下点连线的交角
2牙性测量项目
U1-SN/(°)	上颌中切牙长轴与SN平面相交的下内角
U1-NA/(°)	上中切牙切缘至鼻根点-上牙槽座点连线的交角
U1-PP/mm	上中切牙切缘距上颌腭平面的垂直距离
IMPA(L1-MP)/(°)	下颌中切牙长轴与下颌平面的交角
L1-NB/(°)	下中切牙长轴与鼻根点-下牙槽座点连线的交角;
L1-NB/mm	下中切牙切缘至鼻根点-下牙槽座点连线的垂直距离;
U1-L1/(°)	上、下中切牙牙长轴所形成的夹角
U6-PP/mm	上颌第一磨牙至腭平面的垂直距离
L6-MP/mm	下颌第一磨牙至下颌平面的垂直距离
覆牙合/mm	上前牙切端至下前牙唇面的垂直距离
覆盖/mm	上前牙切端至下前牙唇面的水平距离
3软组织测量项目
Ls-E/mm	上唇至审美平面距离;Ls点至E线的垂直距离
Li-E/mm	下唇至审美平面距离;Li点至E线的垂直距离
FCA/(°)	面凸角,软组织鼻根点-鼻下点连线与鼻下点-颏前点连线延长线的交角
NLA/(°)	鼻唇角,鼻小柱点-鼻下点-上唇突点连线的交角
4上气道测量项目
口咽区气道容积/mm³	口咽区气道的容积,上边界平面过后鼻棘平行于FH平面,下边界过会厌骨底平行于FH平面
口咽区气道正中纵截面积/mm²	口咽区气道在正中矢状面上的纵截面积,上、下边界同上
口咽区最小横截面积/mm²	口咽区气道的最小横截面积,上、下边界同上
腭后区气道容积/mm³	腭后区气道的容积,上边界过后鼻棘平行于FH平面,下边界过软腭尖平行于FH平面
腭后区气道正中纵截面积/mm²	腭后区气道在正中矢状面上的纵截面积,上、下边界同上
腭后区最小横截面积/mm²	腭后区气道的最小横截面积,上、下边界同上
舌后区气道容积/mm³	舌后区气道的容积,上边界过软腭尖平行于FH平面,下边界过会厌骨底平行于FH平面
舌后区气道正中纵截面积/mm²	舌后区气道在正中矢状面上的纵截面积,上、下边界同上
舌后区最小横截面积/mm²	舌后区气道的最小横截面积,上、下边界同上

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

References 23

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测量项目	术前		术后		改变量		P
测量项目	均值	标准差	均值	标准差	均值	标准差	P
SNA/(°)	78.81	3.18	81.16	3.76	2.35	1.67	0.000^*
SNB/(°)	79.24	3.47	79.02	3.87	-0.22	1.21	0.406
ANB/(°)	-0.40	1.86	2.17	1.63	2.57	1.18	0.000^*
Wits值/mm	-6.27	3.04	-2.83	2.97	3.44	2.34	0.000^*
NA-AP/(°)	1.46	5.82	4.96	5.21	3.49	3.63	0.000^*
Co-A/mm	81.61	7.95	83.83	8.06	2.22	1.57	0.000^*
Co-Gn/mm	120.43	12.50	122.39	13.35	1.96	3.11	0.008^*
FMA/(°)	29.86	4.43	31.10	4.91	1.24	3.44	0.106
Occ plane to FH角/(°)	-9.98	3.26	-8.68	4.65	1.30	3.57	0.104
Y轴角/(°)	61.87	2.74	62.97	3.17	1.10	3.24	0.127
Co-Go-Me/(°)	127.65	7.16	128.26	6.32	0.61	4.88	0.562

测量项目	术前		术后		改变量		P
测量项目	均值	标准差	均值	标准差	均值	标准差	P
U1-SN/(°)	103.95	6.65	105.90	7.46	1.95	4.14	0.038^*
U1-NA/(°)	24.87	5.28	26.07	6.01	1.20	5.35	0.305
U1-PP/mm	28.77	3.77	29.18	3.91	0.41	1.54	0.228
IMPA/(°)	85.24	4.99	82.11	6.55	-3.14	4.91	0.007^*
L1-NB/(°)	24.47	5.10	21.83	4.58	-2.64	4.29	0.009^*
L1-NB/mm	5.97	2.20	4.80	1.75	-1.17	1.72	0.004^*
U1-L1/(°)	130.53	7.96	130.28	8.06	-0.25	6.68	0.862
U6-PP/mm	19.23	3.03	20.21	3.80	0.97	2.77	0.115
L6-MP/mm	30.66	3.98	31.69	4.01	1.02	2.37	0.056
覆牙合/mm	1.43	2.53	0.71	1.27	-0.73	2.65	0.212
覆盖/mm	-0.33	2.57	4.12	1.29	4.45	2.63	0.000^*

测量项目	术前		术后		改变量		P
测量项目	均值	标准差	均值	标准差	均值	标准差	P
Ls-E/mm	-2.31	1.87	-1.33	2.00	0.98	1.63	0.007^*
Li-E/mm	1.76	2.25	1.77	2.74	0.01	1.76	0.912
FCA/(°)	-8.75	5.38	-11.23	5.45	-2.48	4.17	0.004^*
NLA/(°)	145.95	5.68	145.13	5.06	-0.82	3.98	0.346

测量项目	术前		术后		变化量		P
测量项目	均值	标准差	均值	标准差	均值	标准差	P
口咽区
气道容积/mm³	8 329.07	3 402.21	10 959.40	3 242.33	2 630.33	4 468.99	0.039^*
气道正中纵截面积/mm²	493.47	104.82	559.07	116.96	65.60	148.13	0.108
气道最小截面积/mm²	78.20	45.95	92.87	33.09	14.67	47.77	0.254
腭后区
气道容积/mm³	3 791.07	1 499.65	4 858.00	1 346.49	1 066.93	1 831.91	0.041^*
气道正中纵截面积/mm²	264.20	71.81	284.13	88.21	19.93	75.59	0.324
气道最小截面积/mm²	78.80	43.86	94.07	38.11	15.27	48.79	0.246
舌后区
气道容积/mm³	4 557.67	2 128.02	6 188.73	2 613.86	1 631.07	2 985.49	0.053
气道正中纵截面积/mm²	252.73	68.46	305.87	98.73	53.13	100.78	0.060
气道最小截面积/mm²	130.54	55.26	132.86	38.56	7.75	69.12	0.705

Clinical effect of digital 3D printed maxillary protraction combined with alternate rapid maxillary expansion and constriction in the treatment of patients with skeletal Class Ⅲ malocclusion during mixed dentition

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