安氏Ⅰ类早期恒牙拔牙矫治对上气道形态和舌骨位置影响的研究

安氏Ⅰ类早期恒牙 拔牙矫治对上气道形态和舌骨位置影响的研究

【摘要】

目的：通过X线头影测量方法评估比较安氏Ⅰ类错畸形早期恒牙正畸治疗前后拔牙矫治与非拔牙矫治方式对上气道形态及舌骨位置的影响，探讨安氏Ⅰ类年轻恒牙正畸拔牙矫治方式对上气道形态和舌骨位置影响的相关关系，进而对正畸临床矫治的实施进行指导。

方法：选择从2015年到2018年的就诊于宁夏人民医院口腔正畸科就诊的正畸患者的选取60名早期恒牙安氏I类错畸形矫正治疗的患者，收集和分析所有治疗患者的良好病程记录。根据矫治方案设计分为两组：第一组正畸矫治方案设计未减数拔牙的30例患者（男性13例，女性17例）的X线头颅定位侧位片。第二组为正畸矫治方案设计经典拔除四个第一前磨牙的患者30例（男性14例，女性16例），所有受试者年龄10～13岁，平均年龄（11.2±0.7）岁。对其治疗前后上气道形态及舌骨位置进行X线头影测量，测量、对比安氏Ⅰ类早期恒牙正畸治疗前后拔牙与否对上气道形态及舌骨位置的影响。

结果：

1.非拔牙组上气道形态治疗前后测量项目进行组内比较：仅反映腭咽段的指标PNS-UPW增大及反映口咽段的指标U-MPW减小，治疗前后差异有统计学意义（P＜0.05）；其余反映非拔牙组上气道形态的指标治疗前后差异无统计学差异（P＞0.05）。

2.非拔牙组舌骨位置治疗前后测量项目进行组内比较：反映舌骨垂直向的指标H-FH增大及反映矢状向的指标H-VL减小，治疗前后差异有统计学意义（P＜0.05）；其余反映非拔牙组舌骨位置的指标治疗前后差异无统计学差异（P＞0.05）。

3.拔牙组上气道形态治疗前后测量项目进行组内比较：反映腭咽段的指标PNS-UPW增大，SPP-SPPW治疗后减小，反映口咽段的指标U-MPW减小，治疗前后差异有统计学意义（P＜0.05）；其余反映拔牙组上气道形态的指标治疗前后差异无统计学差异（P＞0.05）。

4.拔牙组舌骨位置治疗前后测量项目进行组内比较：仅反映舌骨垂直向的指标：H-MP治疗后增大，差异有统计学意义（P＜0.05）；其余反映拔牙组舌骨位置的指标治疗前后差异均无统计学意义（P＞0.05）。

5.非拔牙组与拔牙组治疗前后上气道形态测量项目进行组间比较：治疗前各测量项目进行两组间比较仅反映口咽段的指标TB-TPPW差异有统计学意义（P＜0.05），其余反映鼻咽段、腭咽段、喉咽段的指标差异均无统计学意义（P＞0.05）；治疗后各测量项目进行两组间比较仅反映腭咽段的指标PNS-UPW差异有统计学意义（P＜0.05），其余反映鼻咽段、腭咽段、喉咽段的指标差异均无统计学意义（P＞0.05）。

6.非拔牙组与拔牙组治疗前后舌骨位置测量进行组间比较：治疗前、治疗后拔牙组与非拔牙组两组反映舌骨位置的数据对比，反映舌骨垂直向及矢状向的指标均无统计学差异（P＞0.05）。

结论：

1.对于安氏I类错颌畸形早期恒牙患者而言，进行减数四颗第一前磨牙的正畸治疗方式，拔牙矫治不会对上气道矢状径大小较短时间内产生明显变化；

2.拔牙矫治对舌骨位置无明显影响，但使舌骨位置在矢状方向上有产生向后向下移动的趋势。

【关键词】上气道形态；舌骨位置；安氏I类错畸形；早期恒牙；拔牙矫治(https://www.daowen.com)

The influence about premolar extraction of the effects on upper airway morphology and hyoid position in Angle ClassⅠwith premature permanent occlusion

ABSTRACT

Objective：This research was designed to observe the effects of premolar extraction or non-premolar extraction treatments on upper airway morphology and hyoid position in the Angle ClassⅠwith premature permanent occlusion by cephalometrics comparing the pretreatment and postreatment upper airway morphology and hyoid position.Discussing Angle ClassⅠwith premature permanent occlusion and tooth extraction or not on the correlation between airway morphology and hyoid position，In order to offer a more reliable theoretical basis for making the clinical orthodontic treatment plan.

Methods：Choosing from 2015 to 2018 the sufferings of Ningxia People’s Hospital of orthodontics division of early selection of orthodontic patients 60 Angle ClassⅠwith premature permanent occlusion abnormalities，collect and analyze all good course record for the treatment of patients.According to the orthodontic program design，the patients were divided into two groups：the first group included 30 patients（13 males and 17 females）whose orthodontic program design did not premolar extraction treatment;The second group of 30 patients with four first premolar extraction treatment（14 males and 16 females），all the participants aged from 10 to 13 years old（average age 11.2±0.7 years old）.To measure the shape of upper airway morphology and the position of hyoid bone were by cephalometrics before and after treatment orthodontic and measurement，compareAngle ClassⅠwith premature permanent occlusion or not before and after orthodontic treatment of upper airway morphology and hyoid position.

Results：

1.The measurement items of upper airway morphology in non-extraction group were compared before and after treatment：The increase of PNS-UPW in palatopharyngeal segment and the decrease of U-MPW in oropharyngeal segment showed significant difference before and after treatment（P<0.05），while there was no significant difference in upper airway morphology before and after treatment in other non-extraction groups（P>0.05）.

2.The hyoid position measurement items in non-extraction group were compared before and after treatment：The increase of H-FH and the decrease of H-VL in the sagittal direction showed significant difference before and after treatment（P<0.05），while there was no significant difference in the other indicators of hyoid position before and after treatment in the non-extraction group（P>0.05）.

3.The measurement items of upper airway morphology in extraction group were compared before and after treatment：the index PNS-UPW of the palatopharyngeal segment increased，the index U-MPW of the palatopharyngeal segment decreased after SPP-SPPW treatment，and the index U-MPW of the oropharyngeal segment decreased.There was significant difference before and after treatment（P<0.05）.There was no significant difference in the index of upper airway morphology between the other groups before and after treatment（P>0.05）.

4.The hyoid position measurement items in extraction group were compared before and after treatment：indicators reflecting hyoid vertical orientation only H-MP increased after treatment，with statistical significance（P<0.05）;the other indicators reflecting hyoid position in the extraction group had no significant difference before and after treatment（P>0.05）.

5.The upper airway morphology measurement items before and after treatment in the non-extraction group and the extraction group were compared before treatment：there was significant difference in TB-TPPW between the two groups（P<0.05），while there was no significant difference in other indexes of nasopharyngeal，palatopharyngeal and laryngopharyngeal segments（P>0.05）.The difference of PNS-UPW was significant only in the palatopharyngeal segment（P<0.05），but there was no significant difference in the other indexes in the nasopharyngeal，palatopharyngeal and laryngopharyngeal segments（P>0.05）.

6.The hyoid position was measured before and after treatment in the non-extraction group and the extraction group：there was no significant difference in the hyoid vertical and sagittal indexes between the two groups before and after treatment（P>0.05）.

Conclusion：

1.For the early permanent occlusion with Angle class I malocclusion，the orthodontic treatment of the first premolar with the reduction of four teeth will not change the sagittal diameter of upper airway in a short time，but will affect it.

2.Tooth extraction treatment has no significant effect on hyoid position，but the hyoid position has a tendency to move backward and downward in sagittal direction.

Key words：Upper airway morphology；Hyoid position；Angle class I malocclusion；Early permanent occlusion；Extraction