雙顎前突患者治療前後齒顎顏面變化之分析：
傳統錨定、骨性錨定、前根尖下截骨術治療效果比較

研究背景及目的：本回溯性研究的目的是比較各種治療方式用於雙顎前突病患的治療效果。同時也探討在治療前的顱顏特徵。方法：本研究樣本為75位無成長發育變化之成年女性，均接受拔牙矯正治療的第一級異常咬合且雙顎前突的患者。依治療方式將其分為五組：一. 19位使用傳統錨定，未使用頭套。二.10位使用高拉式頭套傳統錨定。三. 19位使用上顎雙側後方骨釘。四. 9位使用上顎雙側後方骨釘外，及下顎雙側後方骨釘。五.18 位使用上下顎前根尖下截骨術合併頦部成型術。以One-way ANOVA比較五組在各項線段及角度測量值在治療前的特徵及治療變化的差異，及進一步以Tukey HSD進行post-hoc comparison。並以ANCOVA調整前測值後再比較各組分析數值改變量的差異。結果治療前之測顱分析比較： 1.在所有治療組別都呈現前牙前傾且前突的現象，在第五組上顎前牙前傾角度較其他組別更為直立(uprighted) 治療前後變化量之測顱分析比較 1.第五組對下頦後縮的改善量明顯優於其他組別 2.第五組對骨骼水平差距的改善量大於其他一、二、三、四組3.第五組上鼻唇角有減少的傾向4.第一、二、三、四組在骨骼垂直方向變化無明顯差異5.第二、三、四組上顎前牙切端達到大量的後退量，第二、三、四組間無明顯差異6.第四組上顎前牙切端退後量顯著大於第一組，調整前測值後，一、四組不呈顯著差異。7.第三、四組上顎前牙前傾角度縮小量最大，明顯多於第五組8.第二組治療時間明顯多於其它四組結論 1.改良式上下顎前根尖下截骨術合併頦部成型術的患者組別，在治療前上顎前牙角度明顯較為直立，上下顎前牙齒軸角有偏大的傾向。 2.承上，此術式較有效改善頦部不足的情況，與骨骼水平方向的差距。 3.承上，此術式比較傳統術式，造成鼻孔上仰的副作用較低。但仍需進一步的研究證明。 4.比較骨性錨定或高拉式頭套做為錨定對於骨骼垂直關係的影響無顯著差異。 5.以骨性錨定或高拉式頭套做為錨定均可達到相當大量的前牙後退量，但以高拉式頭套做為錨定需患者良好的配合度與較長的治療時間。 6.骨性錨定為一簡單方便的加強錨定的方式，但退後前牙的同時也會大量縮小前牙前傾的角度，須特別注意在上、下顎前牙的扭矩控制。 7.以骨性錨定或高拉式頭套做為錨定對於改善上下顎前牙前傾且前突的效果較好，但軟組織的反應卻不一定優於使用不包含高拉式頭套的傳統錨定，影響軟組織的因子，則還須更進一步的研究來解釋與證明。

關鍵字

雙顎前突；骨性錨定；前根尖下截骨術

並列摘要

Introduction: The aim of this retrospective study was to compare the effects of various anchorage setups, and also compare the treatment outcomes of orthodontic treatment and anterior segmental osteotomy for correction of bimaxillary protrusion. The difference of pre-treatment cephalomatric characteristics was also investigated. Methods: The sample consisted of 75 non-growing patients with Angle Class I bimaxillary protrusion who received extraction treatment and were divide into 5 groups. Group 1 (n=19) received traditional anchorage preparation without headgear ; Group 2 (n=10) received traditional anchorage preparation with high pull headgear; Group 3 (n=19) received upper bilateral posterior skeletal anchorage; Group 4 (n=9) received upper and lower bilateral posterior skeletal anchorage; Group 5 (n=18) received upper and lower modified anterior segmental osteotomy(ASO) plus genioplasty. Pretreatment and posttreatment lateral cephalograms were superimposed. One-way ANOVA and Tukey HSD tests were utilized to compare the pretreatment morphological characteristics and treatment changes among the 5 groups. ANCOVA was used to compare the treatment changes among the 5 groups after pre-treatment value adjusted. Results: Comparison of cephalometric variables before treatment 1. Before treatment, the incisors were protrued and proclined among the 5 groups, but in group 5, the incisors showed more uprighted than in the other groups. Comparison of treatment changes in cephalometric variables 1.After treatment, group 5 showed largest advancement of the retrued chin among the 5 groups. 2.The improvement of skeletal horizontal discrepancy was greatest in group 5. 3.Group 5 showed a decreased upper nasolabial angle. 4.The change in facial divergence had no significant difference among group 1, 2, 3, and 4. 5.Group 2, 3 and 4 had maximal retraction of upper incisors, and there was no significant difference among group 2, 3, and 4. 6.There was greater retraction of upper incisors in group 4 than in group 1, but after pre-treatment value adjusted, the result presented no significant difference. 7.The improvement of anterior teeth proclination was greater in group 3 and group 4 than in group 5. 8.The treatment duration of group 2 was longer than group1, 3, 4, and 5. Conclusions: 1.The group treated with modified Wunderer’s technique of anterior segmental osteotomy presented more uprighted incisors before treatment. 2.Anterior segmental osteotomy combined with genioplasty apparently improved retrued chin and skeletal horizontal discrepancy. 3.The modified technique may decrease the upper nasolabial angle but further investigations were needed to prove it. 4.There was no significant different change in the facial divergence between skeletal anchorage groups and traditional anchorage groups. 5.Anterior teeth had maximal retraction both in the group with skeletal anchorage and with high pull headgear, but treatment duration was longer in the group with high-pull headgear. 6.When using skeletal anchorage for anterior teeth retraction, we must control anterior torque carefully. 7.The retraction of upper and lower lips was not significant different among the skeletal anchorage groups and the traditional anchorage groups. Lip structure seemed to have an influence on lip response to incisor retraction and it is necessary to find the reason in future studies.

並列關鍵字

bimaxillary protrusion ； skeletal anchorage ； anterior segmental osteotomy

參考文獻

1.Proffit WR, Fields HW. Jr., Sarver DM. Orthodontic diagnosis: the development of a problem list.” Contemporary Orthodontics. 4th ed. St. Louis:Mosby Co. 2007.p.181-4.