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目的探讨拔除下颌第二磨牙联合固定矫正技术矫治恒牙期骨性Ⅲ类错畸形的效果,为此类患者寻找更好的治疗方案。方法选择2008年1月～2010年1月入我科治疗的恒牙期骨性Ⅲ类错畸形患者18例,其中男8例、女10例。年龄14.1～18.2岁,平均(16.2±1.5)岁。治疗方法为所有患者拔除下颌第二磨牙后,用矫治器矫正畸形。对治疗前后以头颅X线侧位片为基础的头影方法测得的评价矫正治疗效果的指标如角度、线距、比例进行比较分析。结果与矫治畸形前比较,18例患者矫治后上颌第一磨牙至腭平面的垂直距离、下颌平面角、前上面高无明显改变,前后差异无统计学意义(P>0.05);但平面角、腭平面角、前下面高、前面高与治疗前比较差异有统计学意义(P<0.05)。结论恒牙期骨性Ⅲ类畸形在拔除下颌第二磨牙并用矫形器矫正后因上颌第一磨牙位置保持不变而使上下磨牙的关系得到基本改善,但下颌第一磨牙移动距离较大,且平面逆时针旋转移位,腭平面顺时针旋转移位从而说明治疗效果有限。因此,在矫治恒牙期骨性Ⅲ类错畸形时应遵循的原则是尽量使上磨牙高度稳定、避免前面高的增加,增加矫正的美观程度。
Objective To investigate the effect of removing mandibular second molars combined with fixed orthognathic technique in the treatment of permanent skeletal Class Ⅲ malocclusion and to find a better treatment for such patients. Methods 18 patients with permanent type skeletal Class Ⅲ malocclusion treated in our department from January 2008 to January 2010 were selected, including 8 males and 10 females. Age 14.1 ~ 18.2 years, mean (16.2 ± 1.5) years. Treatment for all patients with mandibular second molar removal, orthodontics with orthodontics. Before and after treatment of skull X-ray films based on the cephalometric method to measure the evaluation of the therapeutic effect of the indicators such as angle, line spacing, the ratio of comparative analysis. Results Before treatment, the vertical distances between maxillary first molar and palatal plane and mandibular plane angle in 18 patients had no significant difference after correction. There was no significant difference between before and after treatment (P> 0.05) Palatal plane angle, before the next high, before the high and before treatment were statistically significant differences (P <0.05). CONCLUSIONS: The relationship between the upper and lower molars is basically improved after permanent mandibular second molars are removed and orthopedic orthodontics is used. However, the movement of the first molars in the mandible is larger, And the plane is rotated counterclockwise, the palatal plane clockwise rotation shift to illustrate the limited treatment. Therefore, the treatment of orthodontic skeletal Class III malocclusion should follow the principle is to make the molar as high as possible, to avoid the previous increase in height, increase the aesthetic level of correction.