莫朝伦,张军梅,付雪飞,宋明慧
MO Chaolun,ZHANG Junmei,FU Xuefei,SONG Minghui

• 1:贵州医科大学附属口腔医院正畸二科

摘要(Abstract)：

目的 研究成人骨性Ⅲ类偏颌畸形的牙齿三维位置特征。方法 收集骨性Ⅲ类错(牙合)畸形患者锥形束CT(CBCT)资料、导入Invivo 5.2图像处理软件，以头影测量ANB角(上-下牙槽座角，由上齿槽座点A.subspinale、鼻根点N.nasion和下齿槽座点B.supramental构成的角)小于0°、上下第一磨牙至少一侧呈近中关系以及颏下点至正中矢状面的距离﹥2 mm作为骨性Ⅲ类偏颌畸形标准筛选出偏颌患者38例，偏颌牙弓的左右两侧以颏下点偏向的一侧为偏斜侧(作为偏斜侧组，S组),另一侧为非偏斜侧(作为非偏斜侧组，NS组),筛选非偏颌患者34例作为对照组(N组)。测量各组被检者的牙齿颊舌向、近远中向倾斜角以及牙冠垂直向高度。结果 S组上颌第一前磨牙、第一磨牙较N组颊倾(P<0.05),下颌尖牙、第一前磨牙、第一磨牙较N组舌倾(P<0.05),上颌的尖牙、第一前磨牙、第一磨牙较NS组颊倾(P<0.05),下颌较NS组舌倾(P<0.01);S组上颌第一磨牙近远中向倾斜角小于N组(P<0.05)、大于NS组(P<0.05);S组上下颌第一前磨牙、上颌第一磨牙牙冠垂直高度小于N组(P<0.05),上颌的尖牙、第一前磨牙、第一磨牙牙冠垂直高度小于NS组(P<0.05)。结论 骨性Ⅲ类偏颌畸形患者偏斜侧牙齿在三维方向上都发生了代偿，偏斜侧上颌牙相对颊向倾斜、下颌牙相对舌向倾斜、上颌磨牙相对直立、上颌牙冠垂直高度相对偏低。
Objective To study three-dimensional positional characteristics of teeth in adults with skeletal Class Ⅲ mandibular deviation. Methods Data were collected from cone-beam computed tomography(CBCT) of patients with skeletal class Ⅲ malocclusion and imported into Invivo 5.2 image software. A total of 38 patients with mandibular deviation were selected based on ANB angle(between the subspinale point A, nasion point N,and supramentale point B) <0 ° by cephalometric measurement, at least one side of the upper and lower first molars in a mesial relationship and the distance from the submental point to the mid sagittal plane >2 mm. The side to which the pogonion was biased towards was considered the tilted side(S group), and the opposite side was the non-titled side(NS group). A control group(N group) of 34 patients with non-tilted pogonion was selected. Buccolingual and mesiodistal inclinations as well as the vertical crown heights of the teeth were measured in each group. Results The buccolingual inclinations of maxillary first premolar and the first molar in S group were higher than those in N group(P<0.05), and the lingual inclinations of mandibular canines, the first premolar and the first molar in S group were higher than those in NS group(P<0.05). The mesial and distal inclination angles of the maxillary first molar in S group were smaller than those in N group(P<0.05),but larger than those in NS group. The vertical heights of the first premolar and maxillary first molar crown in S group were lower than those in N group(P<0.05), and the vertical heights of maxillary canine, first premolar and first molar crown in S group were lower than those in NS group(P<0.05). Conclusions Teeth in the tilted side of skeletal ClassⅢpatients with facial asymmetry have compensation in the three-dimensional directions. On the tilted side, the maxillary teeth are inclined to the buccal direction, and the mandibular teeth are inclined to the lingual direction, with relatively upright maxillary molars and small vertical height of the maxillary crown.

关键词(KeyWords)： 锥形束CT;骨性Ⅲ类错(牙合)畸形;偏颌;牙齿倾斜度
cone-beam computed tomography;skeletal class Ⅲ malocclusion;facial symmetry;dental inclination

Abstract:

Keywords:

基金项目(Foundation): 贵州省卫生健康委科学技术基金项目(gzwkj2024-448)

作者(Author): 莫朝伦,张军梅,付雪飞,宋明慧
MO Chaolun,ZHANG Junmei,FU Xuefei,SONG Minghui

DOI: 10.19367/j.cnki.2096-8388.2024.08.014

参考文献(References)：

• [1] SEVERT T R,PROFFIT W R.The prevalence of facial asymmetry in the dentofacial defor-mities population at the University of North Carolina[J].Int J Adult Orthodon Orthognath Surg,1997,12(3):171-176.
• [2] SIMONE M,ROSALIA L,KHALED A,et al.Evaluation of structural skeletal asymmetry of the glenoid fossa in adult patients with unilateral posterior crossbite using surface-to-surface matching on CBCT images[J].The Angle Orthodontist,2020,90(3):376-382.
• [3] ALSHOAIBI L H,ALAREQI M M,AL-SOMAIRI M A A,et al.Three-dimensional phenotype characteristics of skeletal class Ⅲ malocclusion in adult Chinese:a principal component analysis-based cluster analysis[J].Clinical Oral Investigations,2023 ,27(8):4173-4189.
• [4] DIéGUEZ-PéREZ M,DE NOVA-GARCíA M J,MOURELLE-MARTíNEZ M R,et al.The influence of crossbite in early development of mandibular bone asymmetries in paediatric patients[J].Journal of Clinical and Experimental Dentistry,2017,9(9):e1115-e1120.
• [5] TULIKA T,SHILPA K,PRIYANK R.Management of skeletal Class Ⅲ with facial asymmetry using skeletal anchorage:4-year follow-up[J].Dental Press Journal of Orthodontics,2020,25(2):e1-e9.
• [6] CAO H L,KANG M H,LEE J Y,et al.Quantification of three-dimensional facial asymmetry for diagnosis and postoperative evaluation of orthognathic surgery[J].Maxillofacial Plastic and Reconstructive Surgery,2020,42(1):17.
• [7] JOU L L ,TUNG C Y ,TING C H ,et al.Automatic assessment of 3-dimensional facial soft tissue symmetry before and after orthognathic surgery using a machine learning model:a preliminary experience[J].Annals of Plastic Surgery,2021,86(S3):S224-S228.
• [8] PENG J,JIANG Y R,SHANG F X,et al.Changes in masseter muscle morphology after surgical-orthodontic treatment in patients with skeletal class Ⅲ malocclusion with mandibular asymmetry:the automatic masseter muscle segmentation model[J].Am J Orthod Dentofacial Orthop,2024,165(6):638-651.
• [9] KIM H J,NOH H K,PARK H S.Mandibular asymmetry types and differen-ces in dental compensations of Class Ⅲ patients analyzed with cone-beam computed tomography[J].Angle Orthod,2023,93:695-705.
• [10]TAM T M,GUO R,LIU H,et al.Hard and soft tissue asymmetry in patients with skeletal class Ⅲ malocclusion:a cone-beam computed tomography study[J].Diagnostics,2023,13(5):869-869.
• [11]MING Y,HU Y,WANG T,et al.Three-dimensional evaluation of skeletal and dental changes in patients with skeletal class Ⅲ malocclusion and facial asymmetry after surgical-orthodontic treatment[J].Journal of X-ray Science and Technology,2020,28(4):783-798.
• [12]LI J,LIU Y,GE X,et al.A cross-sectional study on three-dimensional compensatory characteristics of maxillary teeth in patients with different types of skeletal Class Ⅲ malocclusion with mandibular asymmetry[J].Clinical Oral Investigations,2023,27(9):4973-4985.
• [13]HU X ,HUANG X ,GU Y.Assessment of buccal and lingual alveolar bone thickness and buccolingual inclination of maxillary posterior teeth in patients with severe skeletal Class Ⅲ malocclusion with mandibular asymmetry[J].American Journal of Orthodontics & Dentofacial Orthopedics,2020,157(4):503-515.
• [14]SATO M,MOTOYOSHI M,HIRABAYASHI M,et al.Inclination of the occlusal plane is associated with the direction of the masticatory movement path[J].European Journal of Orthodontics,2007,29(1):21-25.
• [15]TYAN S,PARK H S,JANCHIVDORJ M,et al.Three-dimensional analysis of molar compensation in patients with facial asymmetry and mandibular prognathism[J].The Angle Orthodontist,2016,86(3):421-430.
• [16]曲冠霖，张丹，杨鸣良，等.骨性Ⅲ类偏颌患者下颌骨髁突位置三维评估研究 [J].中国实用口腔科杂志，2018,11(03):167-171.
• [17]KIM H J,HONG M,PARK H S.Analysis of dental compensation in patients with facial asymmetry using cone-beam computed tomography[J].Am J Orthod Dentofacial Orthop,2019,156:493-501.
• [18]张烁，孙婷婷，赵红艳，等.偏颌畸形患者颅颌面部组织不对称的CBCT研究 [J].口腔医学，2017,37(12):1090-1094.
• [19]CHEN Y J,YAO C C,CHANG Z C,et al.Characterization of facial asymmetry in skeletal Class Ⅲ malocclusion and its implications for treatment[J].Int J Oral Maxillofac Surg,2019,48(12):1533-1541.
• [20]KAMATA H,HIGASHIHORI N,FUKUOKA H,et al.Comprehending the three-dimensional mandibular morphology of facial asymmetry patients with mandibular prognathism[J].Progress in Orthodontics,2017,18(1):1-7.
• [21]惠元.成人骨性下颌偏斜患者牙槽骨形态学特点的CBCT观察分析[D].西安：第四军医大学，2013.
• [22]喻金凤.成年骨性Ⅲ类颜面不对称患者骨性及牙性特征的三维研究[D].重庆：重庆医科大学，2018.

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