Assistant professor, Department of Orthodontics, Başkent University, Faculty of Dentistry, Ankara, Turkey.
Postdoctoral fellow, Department of Orthodontics, Başkent University, Faculty of Dentistry, Ankara, Turkey.
Am J Orthod Dentofacial Orthop. 2014 Jan;145(1):41-54. doi: 10.1016/j.ajodo.2013.09.009.
The aim of this clinical study was to investigate the skeletal, dentoalveolar, and soft-tissue effects of 2 skeletal anchorage rationales for Class III treatment compared with an untreated Class III control group.
Fifty-one subjects who were in the prepubertal or pubertal growth period were included in the study. In group 1 (n = 17), facemasks were applied from miniplates placed in the lateral nasal walls of the maxilla, and intermaxillary Class III elastics were applied from symphyseal miniplates to a bonded appliance on the maxilla in group 2 (n = 17). These skeletal anchored groups were compared with an untreated control group (n = 17). Lateral cephalometric radiographs were obtained at the beginning and the end of the observation periods in all groups and analyzed according to the structural superimposition method. Differences between the groups were assessed with the Wilcoxon signed rank test or the paired-samples t test.
The treatment periods were 7.4 and 7.6 months in groups 1 and 2, respectively, and the untreated control group was observed for 7.5 months. The maxilla moved forward by 3.11 mm in group 1 and by 3.82 mm in group 2. The counterclockwise rotation of the maxilla was significantly less in group 1 compared with group 2 (P <0.01). The mandible showed clockwise rotation and was positioned downward and backward in the treatment groups, and it was significantly greater in group 2 compared with group 1 (P <0.01). Changes in the maxillary incisor measurements were negligible in group 1 compared with group 2. A significant amount of mandibular incisor retroclination was seen in group 1, and a significant proclination was seen in group 2. The maxillomandibular relationships and the soft-tissue profiles were improved remarkably in both treatment groups.
The protocols of miniplates with facemasks and miniplates with Class III elastics offer valid alternatives to conventional methods in severe skeletal Class III patients. However, the 2 maxillary protraction protocols demonstrated significant skeletal and dentoalveolar effects. The miniplate with facemask protocol is preferred for patients with severe maxillary retrusion and a high-angle vertical pattern, whereas in patients with a decreased or normal vertical pattern and retroclined mandibular incisors, miniplates with Class III elastics can be the intraoral treatment option. Therefore, the exact indication of the procedure should be considered carefully.
本临床研究旨在比较两种用于 III 类错颌治疗的骨骼锚定原理与未治疗的 III 类错颌对照组之间的骨骼、牙颌和软组织效果。
本研究纳入了 51 名处于青春前期或青春期生长阶段的受试者。在第 1 组（n=17）中，从放置在上颌侧鼻壁的迷你板上应用面弓，在第 2 组（n=17）中，从颏部迷你板上应用颌间 III 类弹性体至上颌粘结的矫治器。将这两个骨骼锚定组与未治疗的对照组（n=17）进行比较。所有组均在观察期开始和结束时获得侧位头颅侧位片，并根据结构叠加法进行分析。使用 Wilcoxon 符号秩检验或配对样本 t 检验评估组间差异。
第 1 组和第 2 组的治疗期分别为 7.4 和 7.6 个月，未治疗的对照组观察期为 7.5 个月。上颌向前移动 3.11mm ，第 2 组向前移动 3.82mm 。与第 2 组相比，第 1 组上颌的逆时针旋转明显减少（P<0.01）。下颌呈现顺时针旋转，在治疗组中向下和向后定位，与第 1 组相比，第 2 组明显更大（P<0.01）。第 1 组上颌切牙的测量值变化可忽略不计，与第 2 组相比，第 1 组下颌切牙显著后倾，第 2 组显著前倾。两组均显著改善了上颌下颌关系和软组织轮廓。
微型板结合面弓和微型板结合 III 类弹性体的方案为严重骨骼 III 类患者提供了与传统方法有效的替代方法。然而，两种上颌前牵引方案显示出明显的骨骼和牙颌效果。对于上颌严重后缩和高角垂直模式的患者，建议使用微型板结合面弓方案，而对于垂直模式降低或正常、下颌切牙后倾的患者，微型板结合 III 类弹性体可以作为口腔内治疗选择。因此，应仔细考虑该手术的确切适应证。
