- 學位論文
骨性三級異常咬合者頦帽治療之生物力學效應-整合分析
Biomechanical Effects of Chin Cap On Skeletal Class III Patients: a Meta analysis
摘要
本篇研究的目的，針對提到骨性三級異常咬合病患使用頦帽裝置的文章作完整性的回顧，並使用整合分析的方法，評估頦帽裝置在骨性三級異常咬合病患的生物力學效應。初始透過電腦化的資料庫、參考書目和文獻中的參考資料，搜尋到129篇與頦帽裝置相關的文獻，其中有24篇符合作敘述性回顧的標準，但只有12篇文章所給的測顱分析數據資料符合整合分析統計的運算所需。不同測顱分析測量值的結果用固定作用模式及隨機作用模式來計算其整合估計值和信賴區間，也有作同質性檢定。 從敘述性回顧的結果可以知道，用頦帽裝置治療骨性三級異常咬合病人在亞洲（如日本）比較常見，歐美的學者比較偏好用上顎前拉裝置來治療骨性三級異常咬合的患者；經過整合分析的統計運算後，可知頦帽裝置在骨性三級異常咬合病患的生物力學效應為：減少SNB角，增加ANB角，改善水平顎間關係；抑制下顎骨體長度、垂直的下顎枝高度和下顎骨總長度；然而頦帽裝置對上顎骨的前後向生長以及對顱底角(N-S-Ar)和下顎平面角(Mandibular plane angle) 沒有影響。頦帽裝置對下顎角(Gonial angle)的影響會因施力方向而不同，如果頦帽的施力方向為從頦部到髁頭，會使下顎角減少，如果頦帽裝置的施力方向是從頦部到Sella點，比其他的研究的施力方向還高，反而會使下顎角隨著時間增加。結果也顯示，年齡較小（小於九歲）的三級異常咬合患者對頦帽裝置的反應比較大，雖然治療效果的差異並沒有很大。 關於頦帽治療的穩定性，整體來說，頦帽治療組在治療結束後，與下顎骨有關的測量值，如SNB角和ANB角的確會有復發的情形發生，但復發的量比治療效果得到改善的量還小，所以頦帽治療仍然是有意義的。
並列摘要
The aim of this study was a systemic review of the literatures concerning the chin cap appliance on patients with skeletal Class III malocclusion and to evaluate the biomechanical effects of chin cap on skeletal Class III patients using the meta-analysis method. An initial search from the computerized database, bibliographies, and references of literatures identified 129 articles relating to chin cap appliance. Of these, 24 studies remained for descriptive overview based on the pre-defined criteria. But only 12 studies presenting results of cephalometric measurements were selected for further statistical analysis. The results of different cephalometric measurements were reviewed with fixed and random effect models in order to calculate their effect sizes and confidence intervals. The homogeneity of the variables was also computed. The results of descriptive overview showed that chin cap appliance on skeletal Class III patients was more popular in Asia. The western scholars preferred to treat the skeletal Class III patients with maxillary protraction appliance. The statistical analysis showed that the biomechanical effects of chin cap appliance on skeletal Class III patients were reduction of SNB angle, increase of ANB angle, improvement of horizontal jaw relation, and inhibition of mandibular body length, vertical ramus height and total mandibular length. However, chin cap appliance had no influence on cranial base angle (N-S-Ar), mandibular plane angle, and horizontal growth of maxilla. The changes of gonial angle were effected by the direction of force of chin cap. The gonial angle decreased if the line of force were from chin to condyle. Reversely, the gonial angle would increase because of the more vertical line of force directed from chin to sella. Examination of the effects of age revealed greater treatment changes in the younger group who were younger than 9 years of age. Although, the magnitude of the difference was not substantial. Speaking of the stability of chin cap therapy, the cephalometric measurements relating to mandible of treated groups such as SNB and ANB angles did have some relapse during follow up period. But the magnitude of relapse was lesser than the changes gained from chin cap therapy. The chin cap therapy was still effective to skeletal Class III patients.
參考文獻
延伸閱讀
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