Marşan Gülnaz
Department of Orthodontics, Faculty of Dentistry, Istanbul University, Capa, Istanbul, Turkey.
Eur J Orthod. 2007 Apr;29(2):140-8. doi: 10.1093/ejo/cjm003.
The aim of this study was to evaluate skeletal, dentoalveolar, and soft tissue profile changes with activator and high-pull headgear combination therapy in patients with Class II malocclusions caused by maxillary prognathism and mandibular retrognathism. The subjects, all in the mixed dentition, were selected from a single centre and were divided into two groups: 28 patients were treated with an incisor double capping activator and a high-pull headgear combination appliance (13 girls, 15 boys mean chronological age 11.7 +/- 1.2 years, skeletal age 12.1 +/- 1.4 years) and an untreated group of 28 subjects (14 girls, 14 boys mean chronological mean age 11.9 +/- 1.1 years, skeletal age 12.3 +/- 1.3 years). The skeletal, dentoalveolar, and soft tissue profile changes that occurred were compared on lateral cephalograms taken before treatment (T0) and after 1.1 +/- 0.3 years when the combination appliance was removed (T1). In the control group, the radiographs were obtained at the start (T0) and after an observation period 1.2 +/- 0.4 years (T1). Statistical analysis was undertaken with Wilcoxon's ranked-sum test for intra-group comparisons and differences between groups with t-test and Bonferroni's test at a level of significance of P < 0.05. Activator and high-pull headgear combination treatment in these growing patients resulted in a correction of the skeletal Class II relationship (ANB -3.4 degrees), a restriction of maxillary growth (SNA -2.0 degrees, OLp-A -2.3 mm), an advancement of the mandibular structures (SNB +2.6 degrees, FH-NPg +2.3 degrees, OLp-B +2.7 mm, OLp-Pg +2.2 mm), an increase in lower face height (ANS-Me +3.9 mm), a correction of the overjet (-5.4 mm), an improvement in overbite (-2.2 mm), uprighting of the maxillary incisors (U1-FH -5.3 degrees, OLp-U1 -2.5 mm), protrusion of the mandibular incisors (IMPA +2.0 degrees, OLp-L1 +2.7 mm), and a correction of the dental Class II malocclusion (OLp-L6 +3.5 mm). The soft tissue profile changes were a correction of facial convexity (G'-Sn-Pg' angle 2.3 degrees, Mlf-Li-x-axis angle 9.1 degrees), and an increase in lower antero-posterior (Mlf-y-axis 5.6 mm, Pg'-y-axis 5.3 mm), and lower vertical (Sls-x-axis 3.8 mm, Pg'-x-axis 3.8 mm, Me'-x-axis 5.1 mm) soft tissue dimensions. The mentolabial fold depth (Mlf-E line) also significantly decreased, -0.8 mm in the treated group. The activator and high-pull headgear combination appliance was effective in treating growing patients with maxillary prognathism, mandibular deficiency, and facial convexity by a combination of skeletal and dentoalveolar changes and improvement in the soft tissue facial profile.
本研究的目的是评估使用肌激动器和高位牵引矫治器联合治疗上颌前突和下颌后缩导致的安氏II类错牙合患者时，骨骼、牙牙槽和软组织侧貌的变化。研究对象均处于混合牙列期，从单一中心选取并分为两组：28例患者采用切牙双帽肌激动器和高位牵引矫治器联合装置进行治疗（13名女孩，15名男孩，平均实际年龄11.7±1.2岁，骨骼年龄12.1±1.4岁），以及28名未治疗的受试者组成的对照组（14名女孩，14名男孩，平均实际年龄11.9±1.1岁，骨骼年龄12.3±1.3岁）。比较治疗前（T0）和去除联合装置后1.1±0.3年（T1）拍摄的头颅侧位片上发生的骨骼、牙牙槽和软组织侧貌变化。在对照组中，在开始时（T0）和观察期1.2±0.4年（T1）后获取X线片。采用Wilcoxon秩和检验进行组内比较，采用t检验和Bonferroni检验比较组间差异，显著性水平为P<0.05。对这些生长发育期患者采用肌激动器和高位牵引矫治器联合治疗，可矫正骨骼性安氏II类关系（ANB -3.4°），限制上颌生长（SNA -2.0°，OLp-A -2.3 mm），促进下颌结构向前生长（SNB +2.6°，FH-NPg +2.3°，OLp-B +2.7 mm，OLp-Pg +2.2 mm），增加面下高（ANS-Me +3.9 mm），矫正覆盖（-5.4 mm），改善覆牙合（-2.2 mm），使上颌切牙直立（U1-FH -5.3°，OLp-U1 -2.5 mm），下颌切牙前突（IMPA +2.0°，OLp-L1 +2.7 mm），并矫正牙性安氏II类错牙合（OLp-L6 +3.5 mm）。软组织侧貌变化包括面部凸度的矫正（G'-Sn-Pg'角2.3°，Mlf-Li-x轴角9.1°），以及面下前后（Mlf-y轴5.6 mm，Pg'-y轴5.3 mm）和垂直（Sls-x轴3.8 mm，Pg'-x轴3.8 mm，Me'-x轴5.1 mm）软组织尺寸的增加。颏唇沟深度（Mlf-E线）在治疗组也显著减小，为-0.8 mm。肌激动器和高位牵引矫治器联合装置通过骨骼和牙牙槽变化以及软组织面部侧貌的改善，有效治疗了上颌前突、下颌后缩和面部凸度的生长发育期患者。
