楊小如，李旭艷，莊福濤，彭　靜

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楊小如1，李旭艷2，莊福濤1，彭靜1

1.100039北京，武警總醫(yī)院口腔科；2.101200，北京平谷區(qū)婦幼保健院口腔科

【摘要】目的比較玻璃離子或樹脂?墊與傳統(tǒng)?墊舌簧矯治器在治療乳牙期和混合牙列早期前牙反?時的效果。方法選取10位能熟練運用這兩種方法治療前牙反?的醫(yī)師，設(shè)計21個調(diào)查項目進行問卷調(diào)查，對調(diào)查結(jié)果進行問卷打分，以評價這兩種方法的效果。結(jié)果玻璃離子或樹脂?墊與傳統(tǒng)?墊舌簧矯治器在21項比較內(nèi)容中，在矯治療程問卷評分分別為3.90±1.88和3.80±2.10，兩者比較無統(tǒng)計學(xué)意義；在口腔印模制取、矯治器制作簡單性、綜合評價等其余20項評價指標，兩種治療方法的評分比較均有統(tǒng)計學(xué)差異(P<0.05)。結(jié)論在治療乳牙期及混合牙列早期的前牙反?時，玻璃離子或樹脂?墊的療效優(yōu)于傳統(tǒng)的?墊舌簧矯治器，值得臨床推廣。

【關(guān)鍵詞】玻璃離子或樹脂墊；墊舌簧矯治器；乳牙期；混合牙列前期；前牙反

1對象與方法

1.1對象選取武警總醫(yī)院和北京市平谷區(qū)婦幼保健院口腔科共10位醫(yī)師，他們能熟練采用玻璃離子或樹脂墊矯治乳牙期和混合牙列早期前牙反，同時也能熟練應(yīng)用墊舌簧矯治器治療前牙反。

1.2調(diào)查方法調(diào)查項目共計21項，即口內(nèi)取印模、矯治器制作簡單性、佩戴初期舒適度、矯治器適應(yīng)期長短、矯治器佩戴時間、矯治器鋼絲折斷、矯治器鋼絲劃傷牙齦或黏膜、治療中前牙松動、治療中牙齒疼痛、復(fù)診間隔時間、口腔衛(wèi)生情況、矯治療程長短、醫(yī)療成本、對下前牙矯治作用、尖窩關(guān)系密合程度、咀嚼效率、發(fā)音、美觀、患兒配合程度、監(jiān)護人接受程度、綜合評價。

1.3評定標準在評定前，對醫(yī)師評定標準進行校準，然后對這21個調(diào)查項目進行問卷打分。每個調(diào)查項目設(shè)6個等級的感受，采用5分制：不能接受(0分)，一般(1分，2分)，良好(3分，4分)，滿意(5分)。

1.4統(tǒng)計學(xué)處理使用SPSS17.0，將10位醫(yī)師對這兩種方法評價的21個指標的感受分數(shù)使用成組t檢驗進行統(tǒng)計學(xué)比較，P<0.05為差異有統(tǒng)計學(xué)意義。

2結(jié)果

兩種矯治方法在矯治療程長短上無統(tǒng)計學(xué)差異，其余項目評分兩種方法比較均有統(tǒng)計學(xué)差異，玻璃或樹脂墊的療效優(yōu)于傳統(tǒng)的墊舌簧矯治器(P<0.05，表1)。

表1　醫(yī)師對兩種矯治方法項目調(diào)查分值比較　(n=10；±s)

3討論

6～12歲孿生子遺傳與環(huán)境作用的研究發(fā)現(xiàn)，下頜前后位置關(guān)系最容易受環(huán)境因素的影響，而面部高度受強遺傳因素的控制，特別是面前部的高度[7,8]。這增加了本研究利用玻璃離子墊矯治混合牙列早期及乳牙期前牙反的信心。

【參考文獻】

[1]傅民魁,張丁,王邦康,等.中國25 392名兒童與青少年錯畸形患病率的調(diào)查[J]. 中華口腔醫(yī)學(xué)雜志, 2002, 37(5): 371-373.

[2]Wiedel A P, Bondemark L. Stability of anterior crossbite correction: a randomized controlled trial with a 2-year follow-up[J]. Angle Orthodontist, 2015, 85(2): 189-195

[3]彭靜,陳琳,王誠煒,等.直絲弓矯治技術(shù)的臨床應(yīng)用分析[J]. 武警醫(yī)學(xué), 1997, 8(1): 27-28.

[4]彭靜,鄧輝,曹采方. 6-12歲女童頭影測量中顱面形態(tài)遺傳作用的縱向分析[J]. 中華口腔醫(yī)學(xué)研究雜志(電子版), 2009, 3(3): 292-299.

[5]James K H, Lorri A M, Liliana M O,etal. Genetics and non-syndromic facial growth[J]. J Pediatric Genetics, 2013, 2(1): 9-20.

[6]Nagahara K. A study of longitudinal changes in the dentition of the deciduous reverse bite using plaster casts[J]. Jpn J Ped Dent, 1989, 48(3): 275-303.

[7]Peng J, Deng H, Cao C F,etal. Craniofacial morphology in Chinese female twins: a semi-longitudinal cephalometric study[J]. Eur J Orthod, 2005, 27(6): 556-561.

[8]彭靜,鄧輝,曹采方. 6～12歲女童頭影測量中上頜形態(tài)遺傳影響的縱向分析[J]. 武警醫(yī)學(xué), 2009, 20(9): 793-796.

[9]孫世閣, 李旭艷, 莊福濤, 等. 玻璃離子墊與傳統(tǒng)墊舌簧矯治器治療兒童前牙反的臨床應(yīng)用比較[J/CD]. 中華口腔醫(yī)學(xué)研究雜志: 電子版, 2015, 9(3): 221-225.

[10]Desouzacosta C A，Dpolidorio D P，Puppin-Rontani R M，etal. Mechanical and biological characterization of resin-modified glass-ionomer cement codoxycycline hyclate[J]. Archives Oral Biol，2012，57(2):131-138.

[11]Seren E, Akan H, Toller M O,etal. An evaluation of the condylar position of the temporomandibular joint by computerized tomography in class iii malocclusions: a preliminary study[J]. Am J Orthod Dentofacial Orthop，1994，105(5): 38-48.

[12]Pedrazzi M E. Treating the open bite[J]. J Gen Orthop，1997, 8(1): 5-16.

[13]Blanksma N C. Electromyogr aphic heterogeneity in the humantemporalis and masseter muscles during static biting, open/close excursions and chewing[J]. J Dent Res, 1995, 74(2): 1318-1327.

[14]Behlfelt K, Linder Aronson S, McWilliam J,etal. Dentition in children with enlarged tonsils compared to control children[J]. Eur J Orthod，1989, 11(4): 416-429.

[15]Meikle M C. Remodeling the dentofacial skeleton: the biological basis of orthodontics and dentofacial orthopedics[J]. J Dental Res，2007,86(1): 12-24.

[16]Cevidanes L H，F(xiàn)ranco A A，Gerig G，etal. Comparison of relative mandibular growth vectors with high-resolution 3-dimensional imaging[J]. Am J Orthod Dentofacial Orthop，2005，128(1): 27-34.

[17]Cevidanes L H，F(xiàn)ranco A A，Gerig G,etal. Assessment of mandibular growth and response to orthopedic treatment with 3-dimensional magnetic resonance images[J]. Am J Orthod Dentofacial Orthop，2005，128(1): 16-26.

[18]Bondemak L，Wiedel A P. Fixed versus removable orthodontic appliances to correct anterior crossbite in the mixed dentition - a randomized controlled trial[J]. Eur J Orthod, 2015, 137(2): 123-127.

(2016-02-20收稿2016-03-20修回)

(責(zé)任編輯尤偉杰)

基金項目：北京市優(yōu)秀人才培養(yǎng)資助項目(2008ID0900900299)

作者簡介：楊小如，碩士研究生，主治醫(yī)師。 通訊作者：彭靜，E-mail：pengjing008@sina.com

【中國圖書分類號】R783.5

An investigating study of correcting anterior crossbite of deciduous and early mixed dentitions with occlusal guidance of glass ionomer cement or resin

YANG Xiaoru1, LI Xuyan2，ZHUANG Futao1，and PENG Jing1.

1.Department of Stomatology, General Hospital of People’s Armed Police Force, Beijing 100039，China；2. Department of Stomatology, Pinggu Maternal and Child Health Hospital，Beijing 101200，China

【Abstract】ObjectiveTo compare the advantage and disadvantage of occlusal guidance of glass ionomer cement or resin with traditional splint and lingual spring in clinical through the questionair for doctor.Methods21 research items were investigated by 10 clinical doctors who can accomplish the therapy with those two methods to correct anterior crossbite skillfully. And the research items were: whether the oral impression, making appliance simplicity, early period comfort when wearing appliance, the length of appliance adaptation, appliance wearing time, wire broken of appliance, appliance wire scratching gingival mucosa, anterior tooth loose in the treatment, dental pain in the treatment, follow-up interval, oral hygiene, treatment duration, medical cost, the lower anterior teeth correction, cusp and fossa relationship close together, masticatory efficiency, pronunciation, appearance, children with the degree, the acceptance of guardian, comprehensive evaluation.ResultsComparing the two treatment methods of 21 research items,the occlusal guidance of glass ionomer cement or resin and the traditional splint lingual spring in the course of orthodontic treatment, the questionnaire scores were 3.90±1.88 and 3.80±2.10, there was no statistically significant difference (P>0.05). However, for the oral impression, making appliance simplicity, comprehensive evaluation and other 20 evaluation items: the scores of the two treatment methods had highly significant difference (P<0.05).ConclusionCompared with the traditional splint and lingual spring to correct anterior crossbite, the occlusal guidance of glass ionomer cement or resin is a fixed functional appliance, which can be easily operated in clinic and has many advantages. This technology is worthy of extensive promotion.

【Key words】occluusal guidance of glass ionomer cement or resin; splint and lingual spring; deciduous dentition; early mixed dentition; anterior crossbite