拔牙與不拔牙治療Angle Class Ⅱ division 2咬合不正顱面結構變化的初步研究

Craniofacial Changes Associated with Extraction and Non-extraction of Angle Class Ⅱ Division 2 Malocclusion

陳鐘漢(Chung-Han Chen)

《中華民國齒顎矯正學雜誌》 20卷2期 (2008/06) Pp. 32-41

https://doi.org/10.30036/TJO.200806.0004

摘要

由於上前牙獨特的形態學特徵，造成相對直立的側貌以及生長受限制的下顎骨，因此安格氏Ⅱ/2級咬合不正的治療方案也較為複雜。相較於數目眾多的非拔牙治療安格氏Ⅱ/2級咬合不正的文獻及病例報告，目前評價拔牙矯治安格氏Ⅱ/2級咬合不正的研究卻很少。本研究通過測顱分析，對11例安格氏Ⅱ/2級咬合不正拔牙治療患者，32例安格氏Ⅱ/2級咬合不正不拔牙治療患者進行比較，研究其治療前、後的顱顎面軟硬組織的形態學特徵以及兩組治療前後變化的差異。本文主要得到以下結論：相對於不拔牙組，拔牙組在治療前的下顎平面角較大、下顎較為後縮、下前牙較為唇傾。軟組織側貌較為前突。不拔牙組在治療後，上下前牙唇向開展幅度較大。在經過治療後，拔牙組的下顎呈現逆時針旋轉，而不拔牙組則呈現順時針旋轉。本研究提示：存在嚴重擁擠、下顎平面角較大的安格氏Ⅱ/2級咬合不正患者，臨床比較傾向拔牙治療。

關鍵字

安格氏Ⅱ/2級咬合不正 ； 拔牙治療 ； 不拔牙治療 ； 測顱分析

並列摘要

Orthodontic treatment of class Ⅱ division 2 malocclusion is known to be complicated. Many researches had been launched to study non-extraction treatment of Angle Class Ⅱ division 2, but there is hardly few research about extraction of Angle Class Ⅱ division 2 malocclusion. This study was undertaken to compare craniofacial changes of skeletal, dental, and soft-tissue variables, and to assess Class Ⅱ division 2 malocclusions treated with either 4 premolars extraction or non-extraction therapy by means of lateral cephalograms. The sample consisted of 43 Chinese adolescents (11 extraction, 32 non-extraction).
Through comparing the results with extraction group and non-extraction group, we concluded that:
1. Compared with non-extraction group, extraction group presents steep mandibular plane, sagittal posterior mandible position, proclined lower incisors at the pre-treatment stage. Besides, the soft tissue profile of extraction group is more convex than non-extraction group.
2. During active treatment:
(1) The upper and lower incisors are more protrusive in non-extraction group.
(2) Having taken into account the effects of growth, duration of treatment, choice of treatment, and treatment mechanics, we find that non-extraction treatment is associated with a downward and backward rotation of the mandible, but extraction treatment presents a forward and upward rotation of the mandible.
3. This study suggests: we should take extraction treatment when the Angle Class Ⅱ division 2 malocclusion patient has steep mandibular plane and severe crowding, however, if an Angle Class Ⅱ division 2 malocclusion patient has flat mandibular plane and mild crowding, non-extraction should be taken into consideration.

並列關鍵字

Extraction ； Non-extraction ； Angle Class Ⅱ division 2 ； Cephalometric Analysis