Kinzinger Gero, Fritz Ulrike, Diedrich Peter
Deaprtment of Orthodontics, University of Aachen, Germany.
J Orofac Orthop. 2003 May;64(3):201-13. doi: 10.1007/s00056-003-0244-4.
In 20 patients with arch length deficiency and anterior crowding, pendulum and lingual arch appliances were inserted simultaneously in the upper and in the lower arch respectively to gain space. The patients were divided into two groups according to their dental eruption stage: ten children (six boys, four girls; mean age: 9 years, 6 months) were in the early mixed dentition, while an adolescent comparison group of the same size (three boys, seven girls; mean age: 12 years, 3 months) were in the permanent dentition at the beginning of treatment.
The main purpose of the study was to investigate whether simultaneous therapy with pendulum and lingual arch appliances is to be recommended, i.e. whether this therapy should take place as interceptive treatment in the early mixed dentition or only in the permanent dentition in adolescence. Parameters were the extent and quality of dentoalveolar effects and the side effects (mesial movement of the incisors, protrusion of the incisors, tipping of molars).
The treatment course was documented by means of study casts and lateral cephalograms. Assessment of the diagnostic records yielded the following findings: In the early treatment group the maxillary molars were distalized by the pendulum appliance by a mean distance of 4.0 +/- 1.46 mm, resulting in distal tipping by 6.1 +/- 2.18 degrees. The incisors were moved reciprocally by 1.08 +/- 1.06 mm to anterior and protruded by 7.65 +/- 4.84 degrees. In the comparison group molar distalization and molar tipping were less pronounced (2.86 +/- 1.54 mm/4.25 +/- 3.78 degrees ), while mesial movement of the incisors was comparably high at 1.62 +/- 0.99 mm. At only 3.8 +/- 2.9 degrees, incisor protrusion was significantly less pronounced than in the early treatment group (p = 0.045). The proportion of molar distalization in the total movement was higher in patients in the early mixed dentition: 79.83 +/- 15.38% vs 60.71 +/- 26.64%. During the early therapy with the lingual arch appliance in the lower arch, the molars were uprighted to the distal by 2.4 +/- 0.97 degrees and the incisors were tipped to labial by 5.0 +/- 1.83 degrees. In the adolescent control group, molar uprighting was less pronounced and the degree of incisor protrusion was significantly lower (2.75 +/- 1.11 degrees, p = 0.004).
With the appropriate indication, the combined therapy with the two compliance-independent appliances described can be recommended for gaining sagittal arch length in the early mixed dentition.
20例存在牙弓长度不足和前牙拥挤的患者，分别在上、下牙弓同时佩戴摆锤矫治器和舌弓矫治器以获得间隙。根据牙齿萌出阶段将患者分为两组：10名儿童（6名男孩，4名女孩；平均年龄：9岁6个月）处于混合牙列早期，而另一组同规模的青少年对照组（3名男孩，7名女孩；平均年龄：12岁3个月）在治疗开始时处于恒牙列期。
本研究的主要目的是探讨是否推荐同时使用摆锤矫治器和舌弓矫治器进行治疗，即这种治疗应作为混合牙列早期的阻断性治疗，还是仅在青少年恒牙列期进行。观察指标为牙槽骨效应的程度和质量以及副作用（切牙近中移动、切牙前突、磨牙倾斜）。
通过研究模型和头颅侧位片记录治疗过程。对诊断记录的评估得出以下结果：在早期治疗组中，摆锤矫治器使上颌磨牙远中移动，平均距离为4.0±1.46mm，远中倾斜6.1±2.18度。切牙相对向前移动1.08±1.06mm，前突7.65±4.84度。在对照组中，磨牙远中移动和磨牙倾斜程度较轻（2.86±1.54mm/4.25±3.78度），而切牙近中移动程度较高，为1.62±0.99mm。切牙前突仅为3.8±2.9度，明显低于早期治疗组（p = 0.045）。混合牙列早期患者磨牙远中移动在总移动量中的比例更高：79.83±15.38% 对比 60.71±26.64%。在下牙弓使用舌弓矫治器进行早期治疗期间，磨牙向远中直立2.4±0.97度，切牙向唇侧倾斜5.0±1.83度。在青少年对照组中，磨牙直立程度较轻，切牙前突程度明显较低（2.75±1.11度，p = 0.004）。
在有适当适应证的情况下，对于在混合牙列早期获得矢状牙弓长度，推荐使用上述两种不依赖患者配合的矫治器联合治疗。
