Robertson Christopher, Herbison Peter, Harkness Michael
Department of Oral Sciences and Orthodontics, School of Dentistry, University of Otago, Dunedin, New Zealand.
Eur J Orthod. 2003 Aug;25(4):371-6. doi: 10.1093/ejo/25.4.371.
The aims of this longitudinal, observational study were two-fold: first, to determine in adults with sleep disorders the extent of dental and occlusal changes following the use of a mandibular advancement splint (MAS) and, second, to determine the time course of these changes. One hundred adult subjects (87 males, 13 females) diagnosed with obstructive sleep apnoea (OSA) and/or asymptomatic snoring were treated with non-adjustable MAS. At the outset each subject was randomly assigned to a group and reviewed 6, 12, 18, 24 or 30 months after placement of a splint. There were 20 subjects in each group. Craniofacial changes were measured on lateral cephalometric radiographs taken at the initial and review appointments. When the changes in all subjects were examined, the SNA, ANB angles, ANS-PNS length and face height increased, and the mandibular first molars and the maxillary first premolars significantly overerupted. Significant retroclination of the maxillary incisors and proclination of the mandibular incisors were accompanied by reductions in maxillary arch length, overbite and overjet. When the changes over time were determined, the mandibular symphysis was significantly lower at all review periods. An increase in face height and reductions in overbite and overjet were evident at 6 months, and over-eruption of the maxillary first premolars and mandibular first molars, and proclination of the lower incisors were found at 24 months. Significant positive correlations were also found between the amount of anterior opening by the appliances and changes in overbite at 24 and 30 months. The appliance used produced small, unpredictable changes in the occlusion that tended to occur after 24 months' wear. It is postulated that the changes in overbite might be lessened by keeping the bite opening to a minimum.
第一，确定睡眠障碍成人使用下颌前移矫治器（MAS）后牙齿和咬合变化的程度；第二，确定这些变化的时间进程。100名被诊断为阻塞性睡眠呼吸暂停（OSA）和/或无症状打鼾的成年受试者（87名男性，13名女性）接受了不可调节的MAS治疗。一开始，每个受试者被随机分组，并在佩戴矫治器后的6、12、18、24或30个月进行复查。每组有20名受试者。在初始和复查时拍摄的头颅侧位片上测量颅面变化。检查所有受试者的变化时，SNA、ANB角、前鼻棘-后鼻棘长度和面部高度增加，下颌第一磨牙和上颌第一前磨牙明显过度萌出。上颌切牙明显后倾和下颌切牙前倾，同时上颌牙弓长度、覆合和覆盖减小。确定随时间的变化时，在所有复查期下颌联合明显更低。6个月时面部高度增加，覆合和覆盖减小明显，24个月时发现上颌第一前磨牙和下颌第一磨牙过度萌出，以及下颌切牙前倾。在24和30个月时，矫治器的前开口量与覆合变化之间也发现显著正相关。所使用的矫治器在咬合方面产生小的、不可预测的变化，这些变化往往在佩戴24个月后出现。据推测，通过将咬合开口保持在最小程度，覆合的变化可能会减轻。
