ACREMAsian Case Reports in Emergency Medicine2328-0409Scientific Research Publishing10.12677/ACREM.2024.121004ACREM-81665ACREM20240100000_26196567.pdf医药卫生 混合牙列期骨性III类错合与骨性I类错合基骨及牙弓对比研究 A Comparative Study of Basal and Dental Arch in the Mixed Dentition of Skeletal Class III Malocclusion and Skeletal Class I Malocclusion 盛丽12刘佳12null新疆医科大学第一附属医院(附属口腔医院)儿童口腔科，新疆 乌鲁木齐；新疆维吾尔自治区口腔医学研究所，新疆 乌鲁木齐0202202412012330© Copyright 2014 by authors and Scientific Research Publishing Inc. 2014This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

目的：通过测量混合牙列期骨性III类错合患者与骨性I类错合患者的锥形束计算机断层扫描(Cone beam computed tomography, CBCT)，对比分析上下颌牙弓、基骨弓长度与宽度差异及协调性，以期为替牙期骨性III类错合畸形治疗提供参考依据。方法：选择替牙列期骨性III类错合与骨性I类错合各30例，通过Dolphin软件处理收集到的DICOM (Digital Imaging and Communications in Medicine)医学图像数据，行三维重建并测量上下颌牙弓、基骨弓的长度与宽度，计算同一牙段牙弓宽度与基骨弓宽度之间的差值，比较骨性III类与骨性I类错牙合畸形牙弓与基骨弓宽度差值的差异。结果：1) 骨性III类错合组上颌牙弓及基骨弓长度均小于骨性I类错合组，下颌基骨弓长度大于骨性I类错合组，且差异有统计学意义(P < 0.05)，下颌牙弓长度两组对比差异无统计学意义(P > 0.05)。2) 骨性III类错合组下颌前段及中段基骨弓宽度大于骨性I类错合组，差异有统计学意义(P < 0.05)；骨性III类错合组上颌前段牙弓及上颌基骨弓宽度小于骨性I类错合组，下颌牙弓宽度及后段基骨弓宽度大于骨性I类错合组，但差异无统计学意义(P > 0.05)。3) 骨性III类错合组上颌牙弓与基骨弓宽度的差值均大于骨性I类错合组，下颌牙弓与基骨弓宽度的差值均小于骨性I类错合组，其中上颌后段牙弓宽度与基骨弓宽度差值差异有统计学意义(P < 0.05)。结论：混合牙列期骨性III类错合存在牙弓、基骨弓不调，上颌可扩大基骨弓，下颌可扩大牙弓，以期改善牙弓与基骨弓的协调性。 Objective: By measuring the cone beam computed tomography (Cone beam computed tomography, CBCT) in patients with mixed dental skeletal Class III malocclusion and Class I malocclusion, and comparatively analyzing the length and width difference and coordination of the maxcillary and mandibular dental arch and basal bone arch, to provide a reference for the treatment of skeletal Class III malocclusion. Methods: Select 30 cases of skeletal Class III malocclusion and Class I malocclusion, process the DICOM (Digital Imaging and Communications in Medicine) medical image data collected by DolPhin software, measure the length and width of the upper and lower jaw dental arch, the width of the dental arch of the same tooth segment is calculated, and the difference between the dental arch and the bony class I malocclusion is compared. Results: 1) The maxillary arch and basal arch lengths in the skeletal Class III malocclusion were lower than Class I malocclusion, the maxillary basal arch lengths were longer than Class I malocclusion, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the mandibular arch lengths between the two groups (P > 0.05). 2) The width of the anterior and middle basal bone arch in the skeletal Class III malocclusion was greater than that in the bone type I misalignment group, and the difference was statistically significant (P < 0.05). The width of maxillary anterior dental arch and maxillary basal bone arch in Class III malocclusion was smaller than Class I malocclusion, and the width of mandibular dental arch and posterior basal bone arch was larger than that in Class I malocclusion, but the difference was not statistically significant (P > 0.05). 3) The difference between maxillary arch width and basal arch width in Class III malocclusion was greater than that in Class I malocclu-sion, and the difference between mandibular arch width and basal arch width was smaller than that in Class I malocclusion, among which the difference between maxillary posterior arch width and basal arch width was statistically significant (P < 0.05). Conclusion: With mixed dental arch and basal bone arch, the upper jaw can expand the basal bone arch, in order to improve the coordination between dental arch and basal bone arch.

混合牙列，骨性III类错合，牙弓，基骨弓, Mixed Dentition Skeletal Class III Malocclusion Dental Arch Basal Bone Arch摘要 - beplay安卓登录

目的：通过测量混合牙列期骨性III类错合患者与骨性I类错合患者的锥形束计算机断层扫描(Cone beam computed tomography, CBCT)，对比分析上下颌牙弓、基骨弓长度与宽度差异及协调性，以期为替牙期骨性III类错合畸形治疗提供参考依据。方法：选择替牙列期骨性III类错合与骨性I类错合各30例，通过Dolphin软件处理收集到的DICOM (Digital Imaging and Communications in Medicine)医学图像数据，行三维重建并测量上下颌牙弓、基骨弓的长度与宽度，计算同一牙段牙弓宽度与基骨弓宽度之间的差值，比较骨性III类与骨性I类错牙合畸形牙弓与基骨弓宽度差值的差异。结果：1) 骨性III类错合组上颌牙弓及基骨弓长度均小于骨性I类错合组，下颌基骨弓长度大于骨性I类错合组，且差异有统计学意义(P < 0.05)，下颌牙弓长度两组对比差异无统计学意义(P > 0.05)。2) 骨性III类错合组下颌前段及中段基骨弓宽度大于骨性I类错合组，差异有统计学意义(P < 0.05)；骨性III类错合组上颌前段牙弓及上颌基骨弓宽度小于骨性I类错合组，下颌牙弓宽度及后段基骨弓宽度大于骨性I类错合组，但差异无统计学意义(P > 0.05)。3) 骨性III类错合组上颌牙弓与基骨弓宽度的差值均大于骨性I类错合组，下颌牙弓与基骨弓宽度的差值均小于骨性I类错合组，其中上颌后段牙弓宽度与基骨弓宽度差值差异有统计学意义(P < 0.05)。结论：混合牙列期骨性III类错合存在牙弓、基骨弓不调，上颌可扩大基骨弓，下颌可扩大牙弓，以期改善牙弓与基骨弓的协调性。

关键词

混合牙列，骨性III类错合，牙弓，基骨弓

A Comparative Study of Basal and Dental Arch in the Mixed Dentition of Skeletal Class III Malocclusion and Skeletal Class I Malocclusion<sup> </sup>

Li Sheng1,2, Jia Liu1,2

1Department of Pediatric and Preventive Dentistry, The First Affiliated Hospital of Xinjiang Medical University (The Affiliated Stomatological Hospital), Urumqi Xinjiang

2The Institute of Oral Medicine in Xinjiang, Urumqi Xinjiang

Received: Jan. 23rd, 2024; accepted: Feb. 22nd, 2024; published: Feb. 29th, 2024

ABSTRACT

Objective: By measuring the cone beam computed tomography (Cone beam computed tomography, CBCT) in patients with mixed dental skeletal Class III malocclusion and Class I malocclusion, and comparatively analyzing the length and width difference and coordination of the maxcillary and mandibular dental arch and basal bone arch, to provide a reference for the treatment of skeletal Class III malocclusion. Methods: Select 30 cases of skeletal Class III malocclusion and Class I malocclusion, process the DICOM (Digital Imaging and Communications in Medicine) medical image data collected by DolPhin software, measure the length and width of the upper and lower jaw dental arch, the width of the dental arch of the same tooth segment is calculated, and the difference between the dental arch and the bony class I malocclusion is compared. Results: 1) The maxillary arch and basal arch lengths in the skeletal Class III malocclusion were lower than Class I malocclusion, the maxillary basal arch lengths were longer than Class I malocclusion, and the difference was statistically significant (P < 0.05). There was no statistically significant difference in the mandibular arch lengths between the two groups (P > 0.05). 2) The width of the anterior and middle basal bone arch in the skeletal Class III malocclusion was greater than that in the bone type I misalignment group, and the difference was statistically significant (P < 0.05). The width of maxillary anterior dental arch and maxillary basal bone arch in Class III malocclusion was smaller than Class I malocclusion, and the width of mandibular dental arch and posterior basal bone arch was larger than that in Class I malocclusion, but the difference was not statistically significant (P > 0.05). 3) The difference between maxillary arch width and basal arch width in Class III malocclusion was greater than that in Class I malocclusion, and the difference between mandibular arch width and basal arch width was smaller than that in Class I malocclusion, among which the difference between maxillary posterior arch width and basal arch width was statistically significant (P < 0.05). Conclusion: With mixed dental arch and basal bone arch, the upper jaw can expand the basal bone arch, in order to improve the coordination between dental arch and basal bone arch.

Keywords:Mixed Dentition, Skeletal Class III Malocclusion, Dental Arch, Basal Bone Arch

Copyright © 2024 by author(s) and beplay安卓登录

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1. 引言

骨性III错合畸形是临床常见的一种错合畸形，其是与生长相关的临床颅合面异常，可能表现为下颌前突、上颌后缩或者两者兼而有之。主要是上颌和下颌基骨发育的不平衡导致了III类错合。这种不平衡出现在发育早期，并随着年龄的增长而加剧 [1] [2] 。

有学者对比研究了恒牙列骨性III类与I类个别正常合基骨及牙弓宽度 [3] [4] ，提示骨性III类错合患者存在上下颌基骨横向发育不调，而对混合牙列期骨性III类与I类的对比研究相对较少。本研究利用骨性III类错合与骨性I类错合患者CBCT数据重建三维影像，测量牙弓及基骨弓长度、宽度相关指标，以期研究骨性III类牙弓与基骨弓协调性，利于骨性III类错合畸形早期干预治疗。

2. 研究对象和方法 2.1. 样本选择

本研究经新疆医科大学第一附属医院医学伦理委员会批准(批准号：20180306-01)。选择2021~2023年期间内就诊于新疆医科大学第一附属医院儿童口腔科，因治疗需要同时拍摄CBCT及头颅侧位片的儿童60例，其中骨性I类错合30例。

1) 纳入标准：替牙列早期阶段，Hellman分期IIIA期(上下颌恒切牙、第一恒磨牙完全萌出，乳尖牙、乳磨牙未替换)；双侧上颌和下颌第一恒磨牙完全达到咬合平面；无明显颅颌面部畸形；回顾病例无正畸治疗史、颅颌面手术史及全身系统性疾病。

2) 排除标准：乳恒牙先天缺失或早失；CBCT及头颅侧位片不合格，影像学资料不完整或不清晰者。龋齿或磨耗致牙齿近远中尺寸减小。

将所有受试者的头颅侧位片导入Uceph4.2.1软件进行测量分析筛选出均角骨面型(MP-FH：28˚ ± 4˚)的受试者，并按矢状骨面型的分组 [5] ；

骨性I类：∠ANB：1˚~4.5˚；骨性III类：∠ANB：<1˚。

2.2. 研究方法

1) 男、女性年龄分布均衡性检验结果显示两组年龄无统计学差异(P > 0.05)，具有可比性(表1)。

Sex-age distribution of skeletal Class I malocclusion and Class III malocclusion group
骨性I类骨性III类P
例数x ¯ ± s例数x ¯ ± s
男性158.63 ± 0.63168.73 ± 0.74>0.05
女性158.22 ± 0.72148.21 ± 0.82>0.05

表1. 骨性I、III错合畸形组性别年龄分布情况

2) 通过DolPhin软件处理收集到的DICOM (Digital Imaging and Communications in Medicine)医学图像数据进行三维重建，并对图像进行校正(图1)冠状面：双侧眶下缘点连线与水平面平行；矢状面：眶下缘点与外耳道上点连线与水平面平行；水平面：双侧颧弓根部连线与水平面平行。

图1. DolPhin处理DICOM数据，进行三维重建并校正

在校正后的图像上测量以下指标(图2，图3)：

(1) 牙弓宽度(上颌记为UW，下颌记为LW)：分别测量双侧乳尖牙牙尖间宽度(前段：UW1，LW1)，双侧第一乳磨牙FA点间宽度(中段：UW2，LW2)，双侧第一磨牙FA点间宽度(后段：UW3，LW3)。

(2) 基骨宽度(上颌记为UBW，下颌记为LBW)：分别测量双侧乳尖牙牙尖(前段：UBW1，LBW1)、双侧第一乳磨牙FA点(中段：UBW2，LBW2)、双侧第一磨牙FA点(后段：UBW3，LBW3)在同一冠状面测量牙槽骨最凹点间距离。

图2. 牙弓宽度、基骨弓宽度测量

(3) 牙弓长度(上颌记为UL，下颌记为LL)：1近中触点到双侧第一恒磨牙远中面的垂距。

(4) 基骨长度(上颌记为UBL，下颌记为LBL) ：上齿槽座点A点及下齿槽座点B点到双侧第一恒磨牙远中面的垂距。

图3. 牙弓、基骨弓长度测量

所有测量项目由同一研究者每隔1周进行1次测量，测量三次，取平均值。

2.3. 统计方法

采用SPSS26.0软件进行统计学分析，用均数 ± 标准差( x ¯ ± s )进行统计描述。对符合正态分布且方差齐的样本，两样本比较采用独立样本t检验，P < 0.05表示差异具有统计学意义。

3. 结果 3.1. 骨性III类错合患者与骨性I类错合患者牙弓与基骨弓长度的比较(见表2)

骨性III类错合组上颌牙弓及基骨弓长度均小于骨性I类错合组，下颌基骨弓长度(LBL)大于骨性I类错合组且差异有统计学意义(P < 0.05)，下颌牙弓长度两组对比差异无统计学意义(P > 0.05)。

The comparison of the length of the dental arch and basal bone arch in patients with skeletal Class III malocclusion and Class I malocclusion ( x ¯ ± s
测量项目骨性I类骨性III类P
UL38.1 ± 2.8734.79 ± 2.960*
UBL33.99 ± 1.7731.57 ± 1.290*
LL35.50 ± 2.2935.25 ± 2.390.686
LBL30.05 ± 2.2931.55 ± 1.960.01**

表2. 骨性III类骨性I类错合畸形患者牙弓与基骨弓长度的比较( x ¯ ± s )

**：P < 0.01；*：P < 0.05。

3.2. 骨性III类骨性I类错合畸形患者牙弓与基骨弓宽度的比较(见表3)

骨性III类错合组下颌前段及中段基骨弓宽度(LBW1，LBW2)大于骨性I类错合组，且差异有统计学意义(P < 0.05)；骨性III类错合组上颌前段牙弓(UW1)及上颌基骨弓宽度(UBW)小于骨性I类错组，下颌牙弓宽度(LW)及后段基骨弓宽度(LBW3)大于骨性I类错合组，但差异无统计学意义(P > 0.05)。

The comparison of the width of the dental arch and basal bone arch in patients with skeletal Class III malocclusion and Class I malocclusion ( x ¯ ± s
测量项目骨性I类骨性III类P
UW136.88 ± 2.4336.46 ± 1.980.768
UW243.66 ± 2.1644.76 ± 2.300.131
UW356.14 ± 2.3657.23 ± 3.020.187
UBW139.18 ± 3.1838.04 ± 3.610.206
UBW248.19 ± 3.3647.46 ± 3.470.396
UBW362.89 ± 2.8961.63 ± 3.150.677
LW128.64 ± 2.4730.09 ± 2.280.105
LW238.02 ± 2.1938.17 ± 2.060.947
LW354.82 ± 2.3855.53 ± 2.580.606
LBW124.81 ± 2.4827.47 ± 2.210**
LBW236.85 ± 3.4439.36 ± 3.020.007**
LBW367.70 ± 4.4369.01 ± 4.120.491

表3. 骨性III类骨性I类错合畸形患者牙弓与基骨弓宽度的比较( x ¯ ± s )

**：P < 0.01；*：P < 0.05。

3.3. 骨性III类骨性I类错合畸形患者牙弓与基骨弓宽度差值的比较

如表4所示，骨性III类错合组上颌牙弓与基骨弓宽度的差值均大于骨性I类错合组，其中后段牙弓宽度与基骨弓宽度差值差异有统计学意义(P < 0.05)。

骨性III类错合组下颌牙弓与基骨弓宽度的差值均小于骨性I类错合组，但差异无统计学意义。

The comparison of the width difference of the dental arch and basal bone arch in patients with skeletal Class III malocclusion and Class I malocclusion ( x ¯ ± s
测量项目骨性I类骨性III类P
UW1-UBW1−2.93 ± 2.98−0.46 ± 2.420.166
UW2-UBW2−5.48 ± 2.74−2.12 ± 2.820.803
UW3-UBW3−6.29 ± 2.34−5.51 ± 0.980.035*
LW1-LBW13.58 ± 2.323.19 ± 2.220.776
LW2-LBW20.35 ± 3.08−0.46 ± 2.710.912
LW3-LBW3−13.45 ± 3.07−14.27 ± 4.100.197

表4. 骨性III类、骨性I类错合畸形患者牙弓与基骨弓宽度差值比较( x ¯ ± s )

*：P < 0.05。

4. 讨论

町田幸雄 [6] 研究牙列、牙槽骨的生长发育时提出，牙龄较年龄更能准确地体现出牙列、牙槽骨的生长变化。因此牙龄选择恒切牙、第一恒磨牙完全萌出，乳尖牙、乳磨牙未替换的混合牙列早期阶段作为研究对象 [7] 。Bishara SE等 [8] 研究6周到45岁牙弓宽度的变化，其中指出此阶段牙弓大小相对稳定，因此样本的选择上一定程度上减小了生长发育对研究结果的影响。

本研究对比研究了骨性III类错合及骨性I类错合牙弓长度及基骨弓长度的差异，其中骨性III类错合组中上颌牙弓及基骨弓长度均小于骨性I类错合组，颌基骨弓长度大于骨性I类错合组，且差异有统计学意义。该结果提示骨性III类错合畸形在长度上可能表现为下颌发育过度，上颌发育不足，这与高丽萍 [9] 、Slaj [10] 等学者的研究类似。骨性III类错合下颌牙弓长度较骨性I类错合稍小，可能表明下前牙有代偿性舌倾 [11] [12] 。提示临床医生，在骨性III类患者发现早期，对上下前牙轴倾度多加关注，在早期诊断骨性III类错合畸形时，就要密切关注这些指标是否异常，这些指标能够帮助临床诊断及后续的疗效分析。

本实验中，骨性III类错合患者下颌基骨弓宽度大于骨性I类错合患者，以往的研究也证明了这一结论 [3] [4] [13] ，提示在牙列早期骨性III类错合就表现出下颌基骨发育过度，研究表明在生长高峰期开始及之后持续的时间里，下颌骨的快速生长量是与持续的时间呈正相关，即生长高峰持续的时间越长，下颌骨发育得越大，最终导致下颌基骨弓越大 [14] 。骨性III类错合患者上颌基骨弓宽度较骨性I类错合患者小，但在本研究中显示差异无统计学意义，而谭晓明 [4] 对恒牙列骨性III类错牙合与I类个别正常牙合患者基骨及牙弓宽度的比较研究中显示骨性III类患者上颌骨宽度不足的量较骨性I类个别正常牙合大，且差异有统计学意义，可能与样本选择有关，本实验选择的样本为混合牙列早期的患儿，有研究指出骨性III类错牙合颌面部的生长发育在早期与正常牙合相差并不是很大，其差异的出现主要是在青春期前、后这段时段内骨性III类错合的异常生长导致的 [9] 。

本研究中骨性III类错合组上颌前段牙弓宽度小于骨性I类错组，而上颌中段及后段牙弓宽度大于骨性I类错合组，但差异无统计学意义。这与先前相关研究结果类似 [3] [4] [15] ，可能是由于牙弓宽度受牙齿代偿的影响，骨性III类错合上颌后牙代偿性颊倾。McNamara [16] 报道，当后牙没有反合，但上颌骨宽度不足时，上颌磨牙的颊部倾角和下颌磨牙的Wilson曲线深度有增加的趋势。Miner等人 [17] 使用CBCT分析混合牙列及恒牙牙列的横向牙弓宽度。他们发现，在临床非后牙反合组中，有相当数量的患者发现骨骼横颌差异，被牙齿补偿所掩盖。

本研究探讨骨性III类错合畸形的牙弓、基骨弓的协调性与骨性I类错合畸形的区别，结果显示骨性III类错合组上颌牙弓与基骨弓宽度的差值均大于骨性I类错合组，下颌牙弓与基骨弓宽度的差值均小于骨性I类错合组，其中上颌后段牙弓宽度与基骨弓宽度差值差异有统计学意义，与前期研究结果类似 [3] 。该结果提示混合牙列期骨性III类错合存在牙弓、基骨弓宽度不调，尤其是上颌后段牙弓、基骨弓。在正畸治疗中，替牙期是进行功能矫治和颌骨矫形治疗的最佳时期，在这一时期，可以利用矫形力大幅度增加发育不良的基骨弓，改善差异明显的牙弓与基骨弓宽度之间的不协调，减轻错合畸形复杂程度，改善骨性III类错合预后。

本研究根据以往的研究使用牙齿根尖位置来定位基骨参考点，测量上颌、下颌基底骨宽度，但牙齿位置可能会影响基底骨宽度测量的结果。当磨牙向内侧移动时，相应的基底骨宽度会变窄。另一方面，当磨牙向远端移动时，基底骨的宽度会更宽。一颗或多颗恒牙缺失，乳牙过早脱落会影响第一磨牙的位置。本研究排除牙齿位置异常的患者，将影响最小化。目前，选用的基骨标志点有牙根根尖水平、上下颌骨向牙槽骨移行处最狭窄的区域、膜龈联合点等 [18] ，这可能是本研究结果与部分研究结果不一致的原因。

本研究对于混合牙列期骨性III类错合畸形的研究选用骨性I类错合来对比，还不够全面。在今后的研究中，为了能够更准确地使骨性III类错牙合畸形患者牙弓与基骨弓的协调性达到正常牙合人群的标准，可选择混合牙列期正常人群作对比，这样才能够更标准地量化骨性III类错牙合畸形牙弓与基骨弓宽度与正常值之间的协调量，为早期矫治骨性III类错牙合畸形提供参考依据。

文章引用

盛 丽,刘 佳. 混合牙列期骨性III类错合与骨性I类错合基骨及牙弓对比研究 A Comparative Study of Basal and Dental Arch in the Mixed Dentition of Skeletal Class III Malocclusion and Skeletal Class I Malocclusion[J]. 亚洲急诊医学病例研究, 2024, 12(01): 23-30. https://doi.org/10.12677/ACREM.2024.121004

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