【作者】 李杰；

【导师】 马文盛；

【作者基本信息】 河北医科大学 ， 口腔医学（专业学位）， 2021， 硕士

【摘要】 目的:通过锥形束CT影像结合三维重建测量技术,研究成人骨性Ⅲ类偏斜患者牙齿在三维方向上的代偿特征,以期为正颌手术的术前正畸提供临床指导和借鉴。方法:1.选取成人骨性Ⅲ类偏斜患者29例以及个别正常成人28例,进行锥形束CT扫描,通过INVIVO 5软件对颅面骨骼牙齿结构进行三维重建,测量相应骨性与牙性测量指标。2.运用SPSS 21.0统计分析软件,对测量指标中骨性Ⅲ类偏斜组及个别正常组的两侧差值进行完全随机设计的检验,对偏斜组的双侧测量项目进行配对设计的检验,牙性测量指标与骨性测量指标进行双变量相关分析。结果:1.骨性Ⅲ类偏斜组两侧下颌升支长度、下颌体部长度以及下颌角大小差异有统计学意义(P<0.05),个别正常组两侧差异无统计学意义;2.牙性的垂直向测量指标中,骨性Ⅲ类偏斜组在AOP、OP、U5Mx P、U6Mx P、U7Mx P、L3Mn P指标中两侧差异有统计学意义(P<0.05),其中U5Mx P、U6Mx P、U7Mx P偏斜侧较偏斜对侧更小,AOP、OP偏斜侧较偏斜对侧更大;3.牙性的横向测量指标中,骨性Ⅲ类偏斜组的Width U3、Width U4、Width U6、Width L3、Width L4、Width L6、Torque U3、Torque U5、Torque U6、Torque U7、Torque L3、Torque L5、Torque L6、Torque L7两侧差异均有统计学意义(P<0.05),Width U3、Width U4、Width U6在偏斜侧更大,在偏斜对侧更小;Width L3、Width L4、Width L6偏斜侧小于偏斜对侧;Torque U3、Torque U5、Torque U6、Torque U7偏斜侧大于偏斜对侧;Torque L3、Torque L5、Torque L6、Torque L7偏斜侧小于偏斜对侧;4.在牙性的矢状向测量指标中,骨性Ⅲ类偏斜组中U6dev、U7dev、L3dev、Inclination U6、Inclination L7,两侧差异有统计学意义(P<0.05);5.偏斜侧的L3Mn P与Me-dev有显著相关性,呈正相关关系;偏斜侧Width U4、Width U6与Me-dev有显著相关性,均呈正相关关系,而偏斜对侧Width U4、Width U6与Me-dev有显著相关性,均呈负相关关系;偏斜侧Width L3、Width L4、Width L6与Me-dev有显著相关性,呈负相关关系,偏斜对侧Width L3、Width L4、Width L6与Me-dev有显著相关性,呈正相关关系;偏斜侧Torque U5、Torque U6与Me-dev有显著相关性,呈正相关关系,偏斜对侧Torque U3、Torque U6与Me-dev有显著相关性,呈负相关关系。结论:通过对成人骨性Ⅲ类偏斜组与个别正常组的CBCT的测量分析,得到如下结论:1.与个别正常组相比,骨性Ⅲ类偏斜患者偏斜侧下颌升支长度、下颌体部长度、下颌角小于偏斜对侧。2.与个别正常组相比,骨性Ⅲ类偏斜组偏斜侧上颌第二前磨牙、第一磨牙、第二磨牙垂直高度小于偏侧对侧,偏斜侧前部平面以及上颌平面更陡;3.与个别正常相比,骨性Ⅲ类偏斜组两侧的牙齿距中线距离以及牙齿的转矩存在明显差异,其中偏斜侧上颌牙齿较对侧同名牙齿更偏唇颊侧位,偏斜侧下颌牙齿较对侧同名牙齿更偏舌侧位;与偏斜对侧相比,偏斜侧上颌牙齿更颊倾,下颌牙齿更舌倾;4.在矢状方向上,骨性Ⅲ类偏斜患者的两侧牙齿位置存在差异,偏斜侧上颌第一磨牙和下颌第二磨牙较偏斜对侧同名牙更向近中倾斜,偏斜侧上颌第一、二磨牙牙冠的位置较偏侧对侧更偏近中;5.下颌偏斜程度越大,偏斜侧上颌后牙距中线距离越大,下颌后牙距中线距离越小,上颌第一磨牙越颊倾,偏侧对侧相反。更多还原

【Abstract】 Objective: The purpose of this study was to analyze three-dimensional dental compensation in reference to the maxillary and mandibular basal bones using cone-beam computed tomography(CBCT)and three-dimensional reconstruction measurement technology and to evaluate the correlations between dental compensation and skeletal asymmetry variables in patients with skeletal Class III malocclusion and mandibular asymmetry,in order to provide clinical guidance and reference for the preoperative orthodontics of orthognathic surgery.Methods:1.Twenty-nine patients with skeletal Class III malocclusion and mandibular asymmetry(asymmetry group)and twenty-eight subjects with individual normal occlusion(control group)were included.Skeletal and dental measurements were acquired from reconstructed CBCT images using INVIVO 5 software.2.All measurements were compared between groups and between the deviated and non-deviated sides of the asymmetry group using SPSS 21.0statistical analysis software.Correlation analyses for the association between skeletal and dental variables were performed.Results:1.There were statistically significant differences between the two sides in the ramus length,the mandibular body length,and the gonial angle in asymmetry group(P<0.05),and the differences between the two sides of the control group were not statistically significant;2.In the vertical dental measurement variables,there were statistically significant differences between the two sides in AOP,OP,U5 Mx P,U6 Mx P,U7 Mx P,and L3 Mn P in asymmetry group(P<0.05).In the asymmetry group,U5 Mx P,U6 Mx P,U7 Mx P on the deviated side were smaller than those on the non-deviated side and the AOP and OP on the deviated side were greater.3.In the transverse dental measurement variables,there were statistical differences between the two sides in Width U3,Width U4,Width U6,Width L3,Width L4,Width L6,Torque U3,Torque U5,Torque U6,Torque U7,Torque L3,Torque L5,Torque L6,Torque L7 in asymmetry group(P<0.05).In the asymmetry group,Width U3,Width U4,Width U6 on the deviated side were larger than those on the non-deviated side.Width L3,Width L4,Width L6 on the deviated side were smaller;Torque U3,Torque U5,Torque U6,Torque U7 on the deviated side were larger;Torque L3,Torque L5,Torque L6,Torque L7 on the deviated side were smaller.4.In the sagittal dental measurement variables,there were statistically significant differences between the two sides in U6 dev,U7dev,L3 dev,Inclination U6,Inclination L7 in asymmetry group(P<0.05).5.The L3 Mn P,Width U4 and Width U6 on deviated side were positively correlated with the Me-dev;the Width U4,Width U6 on the non-deviated side were negatively correlated with the Me-dev;Width L3,Width L4,Width L6 on the deviated side were negatively correlated with the Me-dev,and Width L3,Width L4,Width L6 on the non-deviated side were positively correlated with the Me-dev;Torque U5 and Torque U6 on the deviated side were positively correlated with the Me-dev;while Torque U3,Torque U6 on the non-deviated side were negatively correlated with Me-dev.Conclusions:1.Compared with subjects with individual normal occlusion,there were significant differences between two sides of patients with skeletal Class III malocclusion and mandibular asymmetry in the ramus length,the mandibular body length,and the gonial angle.The ramus length,the mandibular body length and the gonial angle on the deviated side were smaller in patients with skeletal Class III malocclusion and mandibular asymmetry.2.Compared with subjects with individual normal occlusion,there were significant differences between two sides of patients with skeletal Class III malocclusion and mandibular asymmetry in the vertical height of the maxillary second premolar,maxillary first molar,maxillary second molar,and anterior occlusal plane and maxillary occlusal plane.The vertical height of the maxillary second premolar,maxillary first molar,and maxillary second molar were smaller on the deviated side.And the anterior occlusal plane and maxillary occlusal plane of the deviated side were steeper.3.There were significant differences between two sides in the distance from the teeth to the midline and the torque in patients with skeletal Class III malocclusion and mandibular asymmetry.Among them,the maxillary teeth on the deviated side were more baccal and further from the midline.The mandibular teeth on the deviated side were more more lingual and closer to the midline.4.In the sagittal direction,there may be differences in the positions of the teeth on both sides of the patients with skeletal Class III malocclusion and mandibular asymmetry.The maxillary first molar and the mandibular second molar on the deviated side were more mesially inclined,and the positions of the crown of the maxillary first and second molar were more mesial;5.In patients with skeletal Class III malocclusion and mandibular asymmetry,on the deviated side,the greater the degree of menton deviation,the greater the distance from the maxillary premolars and molars to the midline,the smaller the distance from the mandibular canines,premolars and molars to the midline,and the more buccal inclined of the maxillary first molar.更多还原