- 學位論文
成人三級異常咬合治療計畫之判定: 單純矯正治療或合併正顎手術
Treatment Decision in Adult Patients with Class III Malocclusion:Orthodonitc Therapy or Orthognathic Surgery
摘要
研究目的： 三級異常咬合患者顏面外貌的不美觀，以及較差的咬合功能，常會對患者造成心理上的問題，擬定適合三級異常咬合患者的治療計畫，幫助病人恢復姣好面容和理想咬合，是臨床上重要課題。本研究目的在於探討三級異常咬合成人病患採用單純矯正治療和矯正合併手術治療兩種不同治療計畫，在治療前齒顎顱顏結構的特徵與差異，進而幫助三級異常咬合患者臨床診斷與治療。 研究方法： 選取骨性安格氏三級異常咬合患者，分單純矯正治療組男女各20人，以及矯正合併手術治療組男女各20人，共80人。分別描繪其治療前之側面測顱X光片，利用傳統測顱分析方法，共採用45個標記點及45個測量項目，範圍涵蓋軟硬組織，測量項目結果進行雙樣本t 檢定分析及two-way ANOVA，更進一步利用ROC分析，找出判定兩種治療計畫的鑑別因子。 研究結果 研究發現：骨性安格氏三級異常咬合經由矯正合併手術治療組，下顎骨較前突，臉型更開展，上下顎骨前後徑差異較大，下顎前牙角度更往舌側傾斜，水平覆咬及垂直覆咬值較小，下顎骨聯合寬度較小；在軟組織外貌方面凹臉形更為明顯，下臉部長度偏長，H angle小。經ROC分析，在判定手術或非手術治療之間，最具臨床意義的測量項目依序為水平覆咬關係 ( overjet )，Wits appraisal，下顎前牙與下顎平面交角(∠L1-MP )，上下顎長度比例 ( M/M ratio )，下顎角點角 ( gonial angle )，以及垂直覆咬關係 ( overbite )，而軟組織方面具判定意義者為頦唇溝 ( mentolabial sulcus ) 的深度以及中臉部與下臉部之比例關係 ( G-Sn/Sn-Me’ )。 結論 骨性安格氏三級異常咬合患者，單純矯正治療組與矯正合併手術治療組，在齒顎顱顏上的確存在許多差異，這些顯著差異可提供臨床治療計畫擬定的參考。若overjet ≦ - 4.73 mm，Wits appraisal ≦ -11.18 mm，∠L1-MP ≦ 80.8度，M/M ratio ≦ 65.9%，gonial angle ≧ 120.8度，overbite ≦ -0.18 mm，符合以上條件，是屬於須尋求正顎手術治療的病患，若只符合四項，需以手術治療之可能性已達80.56%
並列摘要
Objective： The Class III malocclusion is the most difficult anomalies to understand and treat. The purpose of this study was to investigate the differences in morphological characteristics of Class III malocclusion patient who can treated by orthodontic treatment only or orthognathic surgery. To find the most important morphological factors that influence the treatment planning and predict probability of orthognathic surgery. Material and Method： The pre-treatment lateral cephalograms of two groups of 80 subjects (40 orthodontic and 40 surgical) with Class III malocclusion were analyzed. Fourty-five linear, proportional, angular and soft tissue measurements were made. Two sample t test and receiver operating curve (ROC) analysis were applied to identify the dentoskeletal variables that best separate the two groups. Result： The findings of the study indicated that Class III malocclusion patients with orthognathic surgery present with significantly larger linear dimensions of the mandible, higher vertical dimension, larger gonial angle and the mandibular incisor more retroclined. The following variables were extracted by ROC curves : overjet, Wits appraisal, ∠L1-MP, maxillary/mandibular (M/M) ratio, gonial angle and overbite. Conclusion: Overjet≦ -4.73 mm, Wits appraisal≦ -11.18 mm, ∠L1-MP≦80.8°, M/M ratio≦65.9%, gonial angle≧120.8° and overbite≦-0.18 mm can be the guideline in determining the treatment modalities for Class III malocclusion patients. But the patient’s opinion and functional factors should also be considered.