Twin-Block双期矫治与单纯直丝弓矫正技术在早期下颌后缩矫正患儿中的疗效对比.pdf

中国医疗美容第14卷 第1期（总第125期）2024年1月中国医疗美容第14卷 第1期（总第125期）2024年1月中国医疗美容中国医疗美容第14卷 第1期（总第125期）2024第14卷 第1期（总第125期）2024年1月年1月China Medical Cosmetology China Medical Cosmetology Vol.14 No.1(Total No.125Vol.14 No.1(Total No.125)JanJan.20242024China Medical Cosmetology China Medical Cosmetology Vol.14 No.1(Total No.125Vol.14 No.1(Total No.125)JanJan.2024202410 Habets L,Bezuur J N,Naeiji M,et al.The Orthopantomogram,an aid in diagnosis of temporomandibular joint problems.II.The vertical symmetryJ.Journal of oral rehabilitation,1988,15(5):465-471.11 Vitral R W F,de Souza Telles C.Computed tomography evaluation of temporomandibular joint alterations in class II Division 1 subdivision patients:condylar symmetryJ.American journal of orthodontics and dentofacial orthopedics,2002,121(4):369-375.12 Hansson T,Nordstrm B.Thickness of the soft tissue layers and articular disk in temporomandibular joints with deviations in formJ.Acta Odontologica Scandinavica,1977,35(6):281-288.13 Rodrigues A F,Fraga M R,Vitral R W F.Computed tomography evaluation of the temporomandibular joint in Class II Division 1 and Class III malocclusion patients:condylar symmetry and condyle-fossa relationshipJ.American Journal of Orthodontics and Dentofacial Orthopedics,2009,136(2):199-206.14 Miller V J.The effect of age on condylar asymmetry in patients with craniomandibular disorders of arthrogenous originJ.The Journal of Prosthetic Dentistry,1992,67(6):845-846.15 Yez-Vico R M,Iglesias-Linares A,Torres-Lagares D,et al.Three-dimensional evaluation of craniofacial asymmetry:an analysis using computed tomographyJ.Clinical oral investigations,2011,15(5):729-736.16 李文艳,郑雷,陈文静.髁突不对称性研究概述 J.口腔医学,2013,33(05):348-350.DOI:10.13591/ki.kqyx.2013.05.011.17 Mao W,Lei J,Lim L Z,et al.Comparison of radiographical characteristics and diagnostic accuracy of intraosseous jaw lesions on panoramic radiographs and CBCTJ.Dentomaxillofacial Radiology,2021,50(2):20200165.18 庞亚倩,张凯,刘亮,冯大军,刘畅,王晶,杜悦,郭振飞.下颌骨囊性病变的三维有限元模型生物力学分析 J.南方医科大学学报,2020,40(06):911-915.19 王美青,杨鸿旭,张虹云等.颞下颌关节软骨对咬合力刺激响应特征的动物实验启示J.口腔颌面外科杂志,2020,30(02):61-66.20 李俊慧,黄银莉.长期偏侧咀嚼对青少年颞下颌关节形态 的 影 响 J.宁 夏 医 科 大 学 学 报,2020,42(12):1240-1243.DOI:10.16050/ki.issn1674-6309.2020.12.011.21 Polat M,Odabas O.Can cystic lesions of the jaws be considered as the cause of mandibular asymmetry?J.Medicina Oral,Patologa Oral y Ciruga Bucal,2022,27(2):e159.22 Alam M K,Ganji K K,Munisekhar M S,et al.A 3D cone beam computed tomography(CBCT)investigation of mandibular condyle morphometry:Gender determination,disparities,asymmetry assessment and relationship with mandibular sizeJ.The Saudi dental journal,2021,33(7):687-692.23 Roque-Torres G D,Peyneau P D,da Costa E D,et al.Correlation between midline deviation and condylar position in patients with Class II malocclusion:A cone-beam computed tomography evaluationJ.American Journal of Orthodontics and Dentofacial Orthopedics,2018,154(1):99-107.24 Rodrigues A F,Fraga M R,Vitral R W F.Computed tomography evaluation of the temporomandibular joint in Class I malocclusion patients:condylar symmetry and condyle-fossa relationshipJ.American journal of orthodontics and dentofacial orthopedics,2009,136(2):192-198.25 Lemes C R,Tozzi C F,Gribel S,et al.Mandibular ramus height and condyle distance asymmetries in individuals with different facial growth patterns:a cone-beam computed tomography studyJ.Surgical and Radiologic Anatomy,2021,43:267-274.第一作者：第一作者：田华（田华（1987-1987-）女，硕士研究生，主治医师，）女，硕士研究生，主治医师，E-mailE-mail：。口腔美容Twin-BlockTwin-Block 双期矫治与单纯直丝弓矫正技术在早期下颌后缩矫双期矫治与单纯直丝弓矫正技术在早期下颌后缩矫正患儿中的疗效对比正患儿中的疗效对比田 华，邓 刚，郝天喜田 华，邓 刚，郝天喜（焦作市人民医院口腔科，河南（焦作市人民医院口腔科，河南 焦作，焦作，454000454000）【摘【摘 要】要】目的目的 探讨 Twin-Block 双期矫治与单纯直丝弓矫正技术在替牙及恒牙早期错 探讨 Twin-Block 双期矫治与单纯直丝弓矫正技术在替牙及恒牙早期错牙合牙合畸形矫正患儿中的疗效对比。畸形矫正患儿中的疗效对比。方法方法 选 选取我院 2020 年 9 月到 2023 年 9 月收治的 60 例恒牙早期错取我院 2020 年 9 月到 2023 年 9 月收治的 60 例恒牙早期错牙合牙合畸形患儿作为研究对象，按照治疗方法不同分为观察组与对照畸形患儿作为研究对象，按照治疗方法不同分为观察组与对照组，各组均为 30 例。所有患儿均采取矫正治疗，对照组患儿采取直丝弓矫正技术进行治疗，观察组患儿采取 Twin-Block 矫组，各组均为 30 例。所有患儿均采取矫正治疗，对照组患儿采取直丝弓矫正技术进行治疗，观察组患儿采取 Twin-Block 矫治器及直丝弓矫治技术进行双期治疗。对比两组患儿临床疗效，及矫治时间，治疗前头影测量及关节改建情况，采用口腔锥治器及直丝弓矫治技术进行双期治疗。对比两组患儿临床疗效，及矫治时间，治疗前头影测量及关节改建情况，采用口腔锥形束扫描成像进行检测两组患儿关节窝宽径、关节前间隙、关节后间隙、关节上间隙、髁突前后径、髁突高度相关参数表达形束扫描成像进行检测两组患儿关节窝宽径、关节前间隙、关节后间隙、关节上间隙、髁突前后径、髁突高度相关参数表达水平，最后对比两组患儿治疗前后上下齿槽座（ANB）角、下齿槽座（SNB）角、上齿槽座（SNA）角、下颌平面角（Mp-水平，最后对比两组患儿治疗前后上下齿槽座（ANB）角、下齿槽座（SNB）角、上齿槽座（SNA）角、下颌平面角（Mp-SN）、下颌综合长度（Ar-Po）、下颌升支高度（Ar-Go）、下颌体长（Go-Gn）、上中切牙-SN 平面角（U1-SN）、下中SN）、下颌综合长度（Ar-Po）、下颌升支高度（Ar-Go）、下颌体长（Go-Gn）、上中切牙-SN 平面角（U1-SN）、下中切牙-下颌平面角（L1-Mp）、上唇审美平面距（Ls-E）、下唇审美平面距（Li-E）、鼻唇角。切牙-下颌平面角（L1-Mp）、上唇审美平面距（Ls-E）、下唇审美平面距（Li-E）、鼻唇角。结果结果 观察组治疗总有效率 观察组治疗总有效率96.67%明显高于对照组 76.67%（96.67%明显高于对照组 76.67%（P P 0.05）；治疗后，观察组矫治时间长于对照组（0.05）；治疗后，观察组矫治时间长于对照组（P P 0.05）；治疗前，两组患儿关节窝 0.05）；治疗前，两组患儿关节窝宽径、关节前间隙、关节后间隙、关节上间隙、髁突前后径、髁突高度对比无明显差异（宽径、关节前间隙、关节后间隙、关节上间隙、髁突前后径、髁突高度对比无明显差异（P P 0.05），治疗后，两组患儿关 0.05），治疗后，两组患儿关节窝宽径对比无明显差异，关节前间隙减小，观察组（1.210.28）mm 高于对照组，关节后间隙、关节上间隙、髁突前后节窝宽径对比无明显差异，关节前间隙减小，观察组（1.210.28）mm 高于对照组，关节后间隙、关节上间隙、髁突前后径、髁突高度均增加，且观察组高于对照组（径、髁突高度均增加，且观察组高于对照组（P P 0.05）；治疗前，两组患儿 ANB 角、SNB 角、SNA 角、Mp-SN、Ar-Po、0.05）；治疗前，两组患儿 ANB 角、SNB 角、SNA 角、Mp-SN、Ar-Po、Ar-Go、Go-Gn、U1-SN、L1-Mp、Ls-E、Li-E、鼻唇角对比无明显差异（Ar-Go、Go-Gn、U1-SN、L1-Mp、Ls-E、Li-E、鼻唇角对比无明显差异（P P 0.05），治疗后，两组患儿 SNB、Mp-SN、Ar-0.05），治疗后，两组患儿 SNB、Mp-SN、Ar-Po、Ar-Go、Go-Gn、鼻唇角均增大，ANB、U1-SN、L1-Mp、Li-E、Ls-E 减小，且观察组变化大于对照组（Po、Ar-Go、Go-Gn、鼻唇角均增大，ANB、U1-SN、L1-Mp、Li-E、Ls-E 减小，且观察组变化大于对照组（P P 0.05）。0.05）。结结中国医疗美容第14卷 第1期（总第125期）2024年1月中国医疗美容第14卷 第1期（总第125期）2024年1月中国医疗美容中国医疗美容第14卷 第1期（总第125期）2024第14卷 第1期（总第125期）2024年1月年1月China Medical Cosmetology China Medical Cosmetology Vol.14 No.1(Total No.125Vol.14 No.1(Total No.125)JanJan.20242024China Medical Cosmetology China Medical Cosmetology Vol.14 No.1(Total No.125Vol.14 No.1(Total No.125)JanJan.20242024论论 Twin-Block 矫治器配合直丝弓矫治技术双期矫治器与单纯直丝弓矫正技术相比治疗替牙及恒牙早期错 Twin-Block 矫治器配合直丝弓矫治技术双期矫治器与单纯直丝弓矫正技术相比治疗替牙及恒牙早期错牙合牙合畸形疗效显著，可畸形疗效显著，可作为儿童恒牙早期错作为儿童恒牙早期错牙合牙合畸形的首选治疗方案。畸形的首选治疗方案。【关键词】【关键词】Twin-Block 矫治器；直丝弓矫正；恒牙早期；错Twin-Block 矫治器；直丝弓矫正；恒牙早期；错牙合牙合畸形；咀嚼功能畸形；咀嚼功能DOI:DOI:10.19593/j.issn.2095-0721.2024.01.01710.19593/j.issn.2095-0721.2024.01.017Comparison of the efficacy and periodontal aesthetic effects of Twin Block appliance and Comparison of the efficacy and periodontal aesthetic effects of Twin Block appliance and straight wire arch correction technology in correcting malocclusion in children during mixed straight wire arch correction technology in correcting malocclusion in children during mixed dentition perioddentition periodTIAN Hua,DENG Gang,HAO Tian-xiTIAN Hua,DENG Gang,HAO Tian-xi（Department of Stomatology,Jiaozuo Peoples Hospital,Henan Province,454000,ChinaDepartment of Stomatology,Jiaozuo Peoples Hospital,Henan Province,454000,China）ABSTRACT ABSTRACT ObjectiveObjective To compare the efficacy and periodontal aesthetic effects of Twin Block appliance and straight wire arch To compare the efficacy and periodontal aesthetic effects of Twin Block appliance and straight wire arch correction technology in correcting malocclusion in children during mixed dentition period.correction technology in correcting malocclusion in children during mixed dentition period.MethodMethod:Sixty children with early:Sixty children with early permanent tooth malocclusion admitted to our hospital from September 2020 to September 2023 were selected as the research permanent tooth malocclusion admitted to our hospital from September 2020 to September 2023 were selected as the research objects,and were divided into observation group and control group according to different treatment methods,with 30 cases in each objects,and were divided into observation group and control group according to different treatment methods,with 30 cases in each group.All the children were treated with correction,the control group was treated with straight wire arch correction technology,and group.All the children were treated with correction,the control group was treated with straight wire arch correction technology,and the observation group received Twin-Block appliance and straight wire arch correction technology for double-stage treatment.The the observation group received Twin-Block appliance and straight wire arch correction technology for double-stage treatment.The observation group received two-stage treatment using Twin Block appliances and straight wire arch correction technology.Compare the observation group received two-stage treatment using Twin Block appliances and straight wire arch correction technology.Compare the clinical efficacy,aesthetic score,correction time,cephalometric measurement and joint remodeling before treatment between the two clinical efficacy,aesthetic score,correction time,cephalometric measurement and joint remodeling before treatment between the two groups of children.Use oral cone beam scanning imaging to detect the expression levels of parameters related to the width of the joint groups of children.Use oral cone beam scanning imaging to detect the expression levels of parameters related to the width of the joint fossa,anterior and posterior joint spaces,supraarticular spaces,anterior and posterior condylar diameter,and condylar height of the fossa,anterior and posterior joint spaces,supraarticular spaces,anterior and posterior condylar diameter,and condylar height of the two groups of children.Finally,compare the angles of the upper and lower alveolar base(ANB)and lower alveolar base(SNB)before two groups of children.Finally,compare the angles of the upper and lower alveolar base(ANB)and lower alveolar base(SNB)before and after treatment between the two groups of children Upper teeth socket angle(SNA),mandibular plane angle(Mp-SN),mandibular and after treatment between the two groups of children Upper teeth socket angle(SNA),mandibular plane angle(Mp-SN),mandibular comprehensive length(Ar Po),mandibular ramus height(Ar Go),mandibular body length(Go Gn),upper central incisor SN plane comprehensive length(Ar Po),mandibular ramus height(Ar Go),mandibular body length(Go Gn),upper central incisor SN plane angle(U1-SN),lower central incisor mandibular plane angle(L1-Mp),upper lip aesthetic plane distance(Ls-E),lower lip aesthetic angle(U1-SN),lower central incisor mandibular plane angle(L1-Mp),upper lip aesthetic plane distance(Ls-E),lower lip aesthetic plane distance(Li-E),nasolabial angle.plane distance(Li-E),nasolabial angle.ResultResult:The total effective rate of 96.67%in the observation group was significantly higher than:The total effective rate of 96.67%in the observation group was significantly higher than 76.67%in the control group(76.67%in the control group(P P0.05);After treatment,the correction time in the observation group was longer than that in the control 0.05);After treatment,the correction time in the observation group was longer than that in the control group(group(P P0.05);Before treatment,there was no significant difference(0.05)in the width and diameter of the joint fossa,anterior 0.05)in the width and diameter of the joint fossa,anterior and posterior joint spaces,suprajoint spaces,anterior and posterior condylar diameters,and condylar heights between the two groups and posterior joint spaces,suprajoint spaces,anterior and posterior condylar diameters,and condylar heights between the two groups of children.However,after treatment,there was no significant difference in the width and diameter of the joint fossa between the two of children.However,after treatment,there was no significant difference in the width and diameter of the joint fossa between the two groups.The anterior joint space decreased,and the observation group(1.21 0.28)mm was higher than the control group.The posterior groups.The anterior joint space decreased,and the observation group(1.21 0.28)mm was higher than the control group.The posterior joint space,superior joint space,anterior and posterior condylar diameter,and condylar height all increased,and the observation group joint space,superior joint space,anterior and posterior condylar diameter,and condylar height all increased,and the observation group was higher than the control group(was higher than the control group(P P0.05);Before treatment,there was no significant difference between the two groups of children in 0.05).0.05).After treatment,SNB,Mp-SN,Ar Po,Ar Go,Go Gn,and nasolabial angle increased in both groups,while ANB,U1-SN,L1 Mp,Li-E,After treatment,SNB,Mp-SN,Ar Po,Ar Go,Go Gn,and nasolabial angle increased in both groups,while ANB,U1-SN,L1 Mp,Li-E,and Ls-E decreased,and the observation group showed greater changes than the control group(and Ls-E decreased,and the observation group showed greater changes than the control group(P P0.05).0.05).ConclusionConclusion:The Twin Block:The Twin Block appliance combined with straight wire arch correction technology has a significant therapeutic effect on early malocclusion of mixed appliance combined with straight wire arch correction technology has a significant therapeutic effect on early malocclusion of mixed teeth and permanent teeth compared to simple straight wire arch correction technology.During the correction period,it can improve the teeth and permanent teeth compared to simple straight wire arch correction technology.During the correction period,it can improve the patients profile and can be used as the preferred treatment plan for early malocclusion of permanent teeth in children.patients profile and can be used as the preferred treatment plan for early malocclusion of permanent teeth in children.KEY WORDSKEY WORDS Twin Block appliance;Straight wire arch correction;Teeth replacement period;Malocclusion;Periodontal aesthetics;Twin Block appliance;Straight wire arch correction;Teeth replacement period;Malocclusion;Periodontal aesthetics;Chewing functionChewing function错错牙合牙合畸形是指人体在生长发育过程中，受后天畸形是指人体在生长发育过程中，受后天环境因素、先天遗传因素影响，引发颌骨、颅面、环境因素、先天遗传因素影响，引发颌骨、颅面、牙齿畸形的相关疾病牙齿畸形的相关疾病11。下颌后缩是比较常见的一种。下颌后缩是比较常见的一种错错牙合牙合畸形，下颌骨较上颌骨位置靠后，可伴或不伴畸形，下颌骨较上颌骨位置靠后，可伴或不伴上颌前突，外观主要表现下颌短小，侧貌不协调。上颌前突，外观主要表现下颌短小，侧貌不协调。该病多始发于替牙期及恒牙早期，若未及时干预，该病多始发于替牙期及恒牙早期，若未及时干预，影响患儿生长发育，同时也会影响面部美观及心理影响患儿生长发育，同时也会影响面部美观及心理健康健康22。当前临床上多采取正畸治疗，纠正上下颌。当前临床上多采取正畸治疗，纠正上下颌不调的关系，改善侧貌和口腔功能，但针对下颌后不调的关系，改善侧貌和口腔功能，但针对下颌后缩是否早期采用功能性矫治器进行双期矫治存在争缩是否早期采用功能性矫治器进行双期矫治存在争议。议。Twin-BlockTwin-Block矫治器是导下颌向前的功能性矫治矫治器是导下颌向前的功能性矫治器的代表，其因可以全天佩戴、不影响进食、舒适器的代表，其因可以全天佩戴、不影响进食、舒适性高、制作方便而被许多正畸医生推崇性高、制作方便而被许多正畸医生推崇3-43-4。但一些。但一些研究发现研究发现55，儿童替牙期及恒牙早期错，儿童替牙期及恒牙早期错牙合牙合畸形矫正方畸形矫正方面应用单纯直丝弓矫正技术效果也较好，且操作简面应用单纯直丝弓矫正技术效果也较好，且操作简单，美观度高。所以单，美观度高。所以Twin-BlockTwin-Block矫治器双期矫治与矫治器双期矫治与单纯直丝弓矫正技术对于错单纯直丝弓矫正技术对于错牙合牙合畸形的治疗效果相对畸形的治疗效果相对比，哪种矫正方法效果更好尚无确切定论。因此，比，哪种矫正方法效果更好尚无确切定论。因此，本研究选取我院本研究选取我院2020 2020 年年9 9 月到月到2023 2023 年年9 9 月收治的月收治的60 60 例替牙期及恒牙早期错例替牙期及恒牙早期错牙合牙合畸形患儿作为研究对象，畸形患儿作为研究对象，中国医疗美容第14卷 第1期（总第125期）2024年1月中国医疗美容第14卷 第1期（总第125期）2024年1月中国医疗美容中国医疗美容第14卷 第1期（总第125期）2024第14卷 第1期（总第125期）2024年1月年1月China Medical Cosmetology China Medical Cosmetology Vol.14 No.1(Total No.125Vol.14 No.1(Total No.125)JanJan.20242024China Medical Cosmetology China Medical Cosmetology Vol.14 No.1(Total No.125Vol.14 No.1(Total N