背景:市场上已经出现了各种用于纠正口腔习惯和训练口面肌肉的预制早期正畸矫治器。然而,关于这些矫治器用于口面肌功能训练的有效性的报道很少。
方法:本研究回顾性分析2016-2018年上海市第九人民医院小儿牙科科收治的唇功能不全和混合牙列患儿。共有109名儿童(54名男性,55名女性;年龄范围:7-10岁,平均年龄:8.2岁)从870例患者的总体样本中选择。在第一次访问中,所有患者被指示每天在家进行积极的唇舌训练,并根据佩戴的器具种类分为两组。第一组由56名受试者(30名女性;26名男性)组成,平均年龄为8.1岁(SD为1.1岁),用预制器具处理。第二组由53名受试者(25名女性;28名男性)组成,平均年龄8.2岁(SD1.0岁),用常规早期正畸矫治器治疗(牙弓扩张装置以及“2*4”局部固定矫治器)。对于两组中的每个受试者,初始(预处理,T1)和最终(后处理,T2)口腔内和外部照片,牙模,外侧脑电图,并拍摄了正位图,并测量了唇强度。SNA,SNB,ANB,APDI,FMA,U1SN,采用Dolphin影像头影分析软件对治疗前后的IMPA进行测定。还记录了舌骨位置。组间差异采用独立样本t检验(P<0.05)。
结果:在第一组中,通过SNB增加-1.06度(P<0.01)和APDI增加-2.23度(P<0.01)检测到下颌骨有统计学意义的向前运动。IMPA的增加(-3.21度,P<0.01)表明下切牙有统计学意义的突出。唇力明显增加(-2.44,P<0.01)。HC3的增加(-1毫米,P<0.01)和HFH(-2.95mm,P<0.01)暗示舌骨向前和向下运动。在第二组中,通过APDI增加-1.96度(P<0.01),下颌骨的前向运动也具有统计学意义。唇力也显著增加(-1.24,P<0.01)。HFH的增加(-2.55mm,P<0.01)暗示舌骨向下运动。与第二组治疗相比,口面肌功能疗法结合预成型矫治器可使唇力增加有统计学意义(-2.30,P<0.05)。两组SNB和IMPA比较差异有统计学意义(P<0.05)。
结论:颜面肌功能疗法有效地改善了患者的唇力,对于患有唇功能不全的混合性牙列患者是一个很好的选择。预制矫治器可以增强口面肌功能治疗效果,并显着改善下颌骨的嘴唇力量和向前运动,这可以优化下巴关系。
Various preformed early orthodontic appliances for correcting oral habits and training orofacial muscles have emerged on the market. However, there are few reports on the effectiveness of these appliances for orofacial myofunctional training.
This retrospective study evaluated children with lip incompetence and mixed dentition treated at the Pediatric Dentistry Department of Shanghai Ninth People\'s Hospital from 2016 to 2018. A total of 109 children (54 males, 55 females; age range: 7-10 years, mean age: 8.2 years) were selected from an overall sample of 870 patients. During the first visit, all patients were instructed to perform active lip and tongue training at home daily and were divided into two groups according to the kind of appliances worn. The first group consisted of 56 subjects (30 females; 26 males), with a mean age of 8.1 years (SD 1.1 years), treated with preformed appliances. The second group consisted of 53 subjects (25 females; 28 males), with a mean age of 8.2 years (SD 1.0 years), treated with conventional early orthodontic appliances (arch expansion devices along with \"2*4\" local fixed appliances). For each subject in the two groups, initial (pretreatment, T1) and final (posttreatment, T2) intraoral and external photos, dental casts, lateral cephalograms, and orthopantograms were taken, and lip strength was measured. SNA, SNB, ANB, APDI, FMA, U1SN, and IMPA before and after treatment were measured by The Dolphin Imaging Cephalometric Analysis Software. The hyoid bone position was also recorded. Differences between groups were identified with an independent sample t-test (P < 0.05).
In the first group, a statistically significant forward movement of the mandible was detected by an increase in SNB of - 1.06 degrees (P < 0.01) and an increase in APDI of - 2.23 degrees (P < 0.01). The increase in IMPA (- 3.21 degrees, P < 0.01) demonstrated a statistically significant protrusion of the lower incisors. Lip strength significantly increased (- 2.44, P < 0.01). The increase in HC3 (- 1 mm, P < 0.01) and HFH (- 2.95 mm, P < 0.01) implied a forward and downward movement of the hyoid bone. In the second group, a statistically significant forward movement of the mandible was also detected by an increase in APDI of -1.96 degrees (P < 0.01). Lip strength also significantly increased (- 1.24, P < 0.01). The increase in HFH (- 2.55 mm, P < 0.01) implied a downward movement of the hyoid bone. Compared with the treatment in the second group, orofacial myofunctional therapy combined with the preformed appliances led to a statistically significant lip strength increase (- 2.30, P < 0.05). Significant differences were observed in SNB and IMPA between the two groups (P < 0.05).
Orofacial myofunctional therapy effectively improved patient lip strength and was a good option for mixed dentition patients with lip incompetence. Preformed appliances could enhance the orofacial myofunctional therapy effect and result in significant improvements in lip strength and forward movement of the mandible, which can optimize the jaw relationship.