骨性三級異常咬合者面罩治療 之生物力學效應-整合分析

Biomechanical Effects of Face Mask on Skeletal Class III Patients: a Meta-analysis

蔡鎰隆(Yi-Lung Tsai)

指導教授 ： 張宏博

高雄醫學大學/口腔醫學院/牙醫學研究所/碩士(2003年)

摘要

摘要
本研究目的主要是檢視骨性三級異常咬合者，面罩治療的臨床效
果。利用整合分析的方法，定量回顧與面罩治療相關的文獻結果，希
望找到一些常受爭議問題的答案。
1966 年到2003 年共有154 篇文獻與面罩治療相關，符合整合分
析嚴格篩選原則的共有25 篇，利用這些文獻的測顱分析結果進行進
一步的運算，結果資料依據年齡與裝置等項目進行分類與整合分析運
算。
實驗結果顯示，面罩治療確實有顯著的骨性治療效果(SNA 增加
1.39°( FIXED T )與1.55°( RND T ); SNB 減少1.09°( FIXED T )與1.08°( RND T ); ANB
增加2.56°( FIXED T ) 與2.60°( RND T ); SN-PP 減少0.63°( FIXED T ) 與
0.67°( RND T ); SN-MP 增加1.32°( FIXED T )與1.36°( RND T ))。牙齒方面一樣
有顯著的變化(U1-SN 增加3.26°( FIXED T )與2.73°( RND T ); L1-MP 減少
3.79°( FIXED T )與3.74°( RND T ))，與控制組相比則顎骨矯治效果更顯著，
對牙齒的影響顯得較不明顯。
長期追蹤結果，上顎雖然有些微後縮但無明顯復發情形，整體顎
骨矯治結果還算穩定，但仍需進一步長期追蹤。測顱標界的變化在各
分組間並無顯著差異，除了不合併上顎擴張組的上顎門牙角度增加量
比合併上顎擴張組的大，快速顎骨擴張組的骨性變化量與慢速顎骨擴
張組的大，年輕組的治療效果都比年長組大，除了上腭平面角之外，
合併頦帽組的下顎平面順時針旋轉量、上顎前牙唇側傾斜量、下顎前
牙舌側傾斜量，皆比不合併頦帽組大。
面罩治療確實可在短期間內改善骨性三級異常咬合，上下顎間不
協調的狀態，尤其是面罩合併上顎快速擴張的年輕患者。因此，面罩
治療特別適用於上顎後縮合併下顎正常或前突的患者，另外，它也提
供嚴重骨性三級異常咬合患者另一種早期顎骨矯治的選擇。

關鍵字

整合分析 ； 面罩 ； 三級異常咬合

並列摘要

Abstract:
The aim of this study was examined the clinical effectiveness of
facemask therapy in patients with skeletal Class III malocclusion. A
quantitative review of the study results concerning the treatment effects
of facemask therapy using the meta-analysis.
There are 154 articles about face mask therapy between 1966 and
2003. Of these, 25 studies fitted in with strict criteria for meta-analysis.
The result of these cephalometric measurements were selected for further
analysis. Data from the selected studies were categorized by age and
appliances for meta-analysis.
Our result showed a significantly orthopedic effect of face mask
therapy(SNA: 1.39°( FIXED T ) and 1.55°( RND T ); SNB: -1.09°( FIXED T )and
-1.08°( RND T ); ANB: 2.56°( FIXED T ) and 2.60°( RND T ); SN-PP: -0.63°( FIXED T )
and -0.67°( RND T ); SN-MP: 1.32°( FIXED T ) and 1.36°( RND T ))as well as on
the dental components of the face (U1-SN: 3.26°( FIXED T ) and 2.73°( RND T );
L1-MP: -3.79°( FIXED T ) and -3.74°( RND T )), the result showed more
significant orthopedic effect and less dental effect when compared with
control group.
The result showed slightly released of maxilla in post-treatment
follow-up, but entire result of orthopedic treatment was stable, it needed
further evaluation for treatment effect. The change of cephalometric
landmarks showed no distinct difference between all subgroups, but the
non-expansion group showed more increasing in degree of upper incisor
angulation than in the palatal expansion group. Rapid palatal expansion
group showed more orthopedic effect than slow palatal expansion group.
Younger group showed more treatment effect than older group, except the
palatal plane angle. Combined with chincup group showed more labial
inclination of upper incisor, clockwise rotation of mandible and lingually
tipping of lower incisor than non-compinated with chincup group.
Face mask could corrected the maxillary discrepancy in skeletal
Class III malocclusion patients in a short period factually, especially in
young children who received face mask therapy compined with rapid
palatal expansion appliance. So, it is suited for patient with maxillary
retrusion and normal mandible or mandibular prognathism, and provided
an other choice for young children with severe skeletal Class III
malocclusion.

並列關鍵字

meta-analysis ； facemask ； Class III malocclusion

參考文獻

參考文獻

1. Akkaya S, Lorenzon S, Ucem TT. A comparison of sagittal and vertical effects

between bonded rapid and slow maxillary expansion procedures. Eur J Orthod 21:

175-80, 1999.

2. Alex J. Sutton, Keith R. Abrams, David R. Jones, Trevor A. Sheldon, Fujian Song.