Treatment strategies for patients with hyperdivergent Class II Division 1 malocclusion: Is vertical dimension affected?
Treatment strategies for patients with hyperdivergent Class II Division 1 malocclusion: Is vertical dimension affected?
复制标题
DOI：
10.1016/j.ajodo.2011.05.015
复制
发表时间：
2011-09-01
影响因子：
3
通讯作者：
Haralabakis, Nikos B.
中科院分区：
文献类型：
--
作者：
Gkantidis, Nikolaos;Halazonetis, Demetrios J.;Haralabakis, Nikos B.
简介：拔牙与非拔牙治疗的困境，以及正畸治疗控制垂直尺寸的不确定潜力，仍然是正畸学中最具争议的问题之一。本研究的目的是评估 2 种相互矛盾的治疗方案，用于治疗超发散型 II 类 1 错牙合畸形，了解其在控制垂直尺寸方面的有效性。方法：受试者是从 2 个使用对比治疗方案的正畸诊所中回顾性选出的。这些患者具有相似的高度分化骨骼模式、咬合不正模式、骨骼年龄和性别。 A 组（29 名患者）接受 4 次第一前磨牙拔除和“侵入”机械治疗（例如，高拉头带），而 B 组（28 名患者）接受不拔牙治疗，不考虑垂直控制（例如，颈部头带、II 类松紧带）。治疗前后的侧位头影测量片上的 27 个标志被数字化，并评估了 14 项测量结果。还采用几何形态测量方法来评估尺寸和形状差异。结果：正如预期的那样，A 组上颌和下颌磨牙近中平移，下颌切牙直立，但 B 组基本保持不变。治疗前后，各组间磨牙和切牙的垂直位置相似，尽管它们因治疗或生长而改变。两组之间的治疗后骨骼测量没有观察到显着差异，包括垂直变量，其保持不变。对骨骼形状之间的 Procrustes 距离进行排列测试证实了这些结果。结论：这项研究证明了传统正畸在显着改变骨骼垂直尺寸方面的局限性。更重要的因素可能负责垂直骨骼模式的发育和建立，例如神经肌肉平衡和功能。 (Am J Orthod Dentofacial Orthop 2011;140:346-55)
Introduction: The dilemma of extraction vs nonextraction treatment, along with the uncertain potential of orthodontic treatment to control vertical dimensions, still remains among the most controversial issues in orthodontics. The aim of this study was to evaluate 2 contradictory treatment protocols for hyperdivergent Class II Division 1 malocclusion regarding their effectiveness in controlling vertical dimensions. Methods: The subjects were retrospectively selected from 2 orthodontic offices that used contrasting treatment protocols. The patients had similar hyperdivergent skeletal patterns, malocclusion patterns, skeletal ages, and sexes. Group A (29 patients) was treated with 4 first premolar extractions and "intrusive" mechanics (eg, high-pull headgear), whereas group B (28 patients) was treated nonextraction with no regard to vertical control (eg, cervical headgear, Class II elastics). Twenty-seven landmarks were digitized on lateral cephalometric radiographs before and after treatment, and 14 measurements were assessed. Geometric morphometric methods were also implemented to evaluate size and shape differences. Results: As expected, the maxillary and mandibular molars translated mesially and the mandibular incisors uprighted in group A but remained approximately unchanged in group B. The vertical positions of the molars and the incisors were similar between groups before and after treatment, although they were altered by treatment or growth. No significant differences were observed in the posttreatment skeletal measurements between the 2 groups, including vertical variables, which remained unaltered. Permutation tests on Procrustes distances between skeletal shapes confirmed these results. Conclusions: This study demonstrated the limitations of conventional orthodontics to significantly alter skeletal vertical dimensions. More important factors are probably responsible for the development and establishment of the vertical skeletal pattern, such as neuromuscular balance and function. (Am J Orthod Dentofacial Orthop 2011;140:346-55)