成人三級異常咬合單純矯正治療或合併正顎手術患者治療前側面測顱分析之比較

Cephalometric Study of Adult Class 111 Malocclusions Treated with Orthodontic Therapy or Orthognathic Surgery

三級異常咬合患者顏面外貌的不美觀，以及較差的咬合功能，常會對患者造成心理上的問題，擬定適合三級異常咬合患者的治療計畫，幫助病人恢復妓好面容和理想咬合功能，是臨床上重要課題。本研究目的在於探討三級異常咬合成人病患採用單純矯正治療和矯正合儕手術治療兩種不同治療計畫，在治療前齒頭顱顏形態的特徵與差異，進而幫助三級異常咬合患者的臨床診斷與治療。選取安格氏骨性三級異常咬合患者，分單純矯正治療組，以及矯正合併手術治療組男女各20人，共的人。分別描繪其治療前之側面測顱X光片，利用傳統測顱分析方法，共採用45 個標記點及37 個測量項目，測量項目結果進行雙樣本t檢定分析。結果顯示骨性三級異常咬合經由矯正合併手術治療組，治療前的下額骨較前突，臉型更開展，上下頓骨前後徑差異較大，下額前牙角度更往舌側傾斜，水平覆咬及垂直覆咬值較小，下頓骨聯合寬度較小;在軟組織外貌方面凹臉形更為明顯，下臉部長度偏長，H角度偏小。結論：骨性三級異常咬合單純矯正治療組與矯正合併手術治療組在齒額顱顏上的確存在許多差異，這些顯著差異可提供臨床治療計畫擬定的參考。然而，顏面外貌的自我感受可能是影響患者決定選擇手術治療的重要因素。The Class Ⅲ malocclusion is the most difficult anomalies to understand. The purpose of this study was to investigate the differences in morphological characteristics of Class Ⅲ malocclusion patient who can properly treated by orthodontic treatment only or combined orthognathic surgery. To find the most important morphological factors those influence the treatment planning and predict probability of orthognathic surgery. The pre-treatment lateral cephalograms of two groups of 80 subjects (40 orthodontic and 40 surgical) with Class Ⅲ malocclusion were analyzed. Thirty-seven linear, proportional, angular and soft tissue measurements were made. Two sample t test was applied to identify the dentoskeletal variables that best separate the two groups. The findings of the study indicated that Class Ⅲ malocclusion patients with orthognathic surgery present with significantly larger linear dimensions of the mandible, higher vertical dimension, larger gonial angle and the mandibular incisor more retroclined. However, self-perception of profile may be important factors affecting the patient's decision to opt for surgical correction.