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研究生:周靖國
研究生(外文):CHOU, CHING-KUO
論文名稱:隱適美兒童及青少年牙套用於治療成長期患者 二級異常咬合之臨床療效評估
論文名稱(外文):Evaluation of Invisalign First and Teen Treatment Effectiveness of Class II Malocclusion in Growing Patients
指導教授:李忠興李忠興引用關係
指導教授(外文):LI,CHUNG-HSING
口試委員:李忠興莊傳宗賴智信
口試委員(外文):LI, CHUNG-HSINGCHUANG, CHUAN-CHUNGLAI, CHIH-HSIN
口試日期:2022-05-12
學位類別:碩士
校院名稱:國防醫學院
系所名稱:牙醫科學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2022
畢業學年度:110
語文別:中文
論文頁數:151
中文關鍵詞:二級異常咬合成長期患者隱適美兒童及青少年牙套
外文關鍵詞:Class II malocclusionGrowing patientsInvisalign FirstInvisalign Teen
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研究背景與動機:
台灣二級異常咬合孩童在同年齡中的比例約在17-29%之間,這個問題除了會對患者的美觀、心理和社會狀態產生顯著的負面影響外,也會影響呼吸、吞嚥等其他功能,因此接受適當的治療是必要的。固定式矯正裝置會有明顯的不適感,且其不討好的外型往往讓患者感到排斥;而傳統活動式裝置相較於隱適美牙套,在外型及配戴的方便程度皆無優勢,又存在裝置斷裂需額外回診的情況。因此,當隱適美公司推出新型的產品能改善上述問題時,其療效便是我們想了解的。本研究收集6-18歲骨性二級異常咬合及齒列不正並接受隱適美兒童或青少年牙套矯正之患者,並分析矯正裝置對成長期患者顏面骨骼及齒列的影響,進而找尋最適合介入治療的時機。
研究方法:
收集美日牙醫診所6-18歲骨性二級咬合伴隨齒列不正並接受隱適美兒童或青少年牙套治療之患者,收案人數共16人。受試者之術前、術中及術後測顱X光片利用數位軟體描繪28個標記點後,取得線段、角度之測量值達20項,進行顱顏形態分析。另取得隱適美療程設計程式ClinCheck檔案內上、下顎牙弓寬度共8組之數值,進行牙弓寬度變化分析。
結果與討論:
在測顱影像上所見治療後之骨骼及齒列變化,SNB角度增加、ANB角度減少,可能代表下顎有較前位的生長。在外觀及軟組織的部分,本研究在三個不同階段變化中皆可以觀察到Overjet減少,且達顯著差異(p=0.007, p=0.000, p=0.039)。合併在長期及短期變化中皆可以觀察到達顯著差異之 U1-SN縮減(p=0.000, p=0.013)及Interincisal angle增加(p=0.001, p=0.002);顯示患者上顎門齒向內後縮至正常角度,因此在外型上得到改善。在生長發育的部分,Length of mandible及length of maxilla在治療後長度皆增加並達顯著差異,且下顎長度經治療後的變化量大於上顎。在下顎角度的部份,依結果可發現,短期變化中TGA及UGA各自有1.81度和1.91度的微幅增加;長期變化中LGA減少1.21度且達顯著差異;調整期變化中UGA減少1.73度且達顯著差異。依上述結果可知,配戴隱適美牙套在長期變化中可以看到下顎昇支的改變及下顎有朝向逆時針方向旋轉的趨勢。分析ClinCheck軟體則可看到上、下顎牙弓寬度變化,在短期及長期變化中,除13-23外,其餘位置在治療後距離全部皆為增加且達顯著差異。
本研究針對成長期不同階段患者治療前後的短期變化之數據可以發現,骨骼的反應相對小,且FMA、SN-MP及Y-axis to SN變化都不大,推測隱適美牙套對生長發育影響較為微小。從長期及調整期變化則可以觀察到,治療時間若是橫跨生長高峰期的CS3-4,則骨骼的反應相對比較好,且牙齒的反應相對小。綜合上述所說,本研究認為,在CS1, 2, 3時開始治療可以得到較大的骨骼反應。
針對不同垂直骨面型成長期患者治療前後的變化可以發現,變化相對明顯並沒有集中於某一組別的趨勢,且會隨著分析之時間變化不同,所呈現之結果亦會不同。各組間的差異性因受試者數量不足,無法做統計分析之緣故,結果分析僅呈現各組間數據之相對關係,實質差異應不明顯。
本研究在隱適美牙套治療達成率的部分可以發現,無論上下顎的牙弓寬度變化皆只能達成治療計畫中設定結果之60-70%。因此,未來若有使用隱適美牙套進行擴弓的需求,都需要考慮做過度矯正。
結論:
本研究的可貴之處在於同時將隱適美兒童及青少年牙套做多方面分析,且是台灣進行相關研究之前驅。依據結果可以確認隱適美兒童及青少年牙套確實能改善成長期二級異常咬合患者的顏面骨骼、齒列及外觀,且較大幅度的改善可以在成長高峰期看見。然而,目前尚無法分析出治療結果究竟有多少部分是來自於生長,有多少部分是來自於牙套提供之療效,仍須進一步的研究做分析。也期望未來可聯合台灣各地區之專業人員,共同收集接受隱適美兒童及青少年牙套的患者,整理並建立出一套適用於台灣臨床醫師參考的指引。

Background:
The prevalence rate of Class II malocclusion in Taiwanese children is about 17-29% of their same age. This problem will not only have a significant negative impact on the patient's aesthetic, psychological and social status, but also affects other functions such as breathing and swallowing, thus, appropriate treatment is necessary. Traditional fixed orthodontic devices have distinct discomfort, and their unflattering appearance often make patients feel repulsive; while traditional removable devices have no advantages in appearance and convenience of wearing, and there are higher chances of extra appointments required for breakages compared to Invisalign. So, when Align Technology® comes out with a new product that can improve those problems, we are interested in its clinical effectiveness. This study collected patients aged 6-18 with Class II malocclusion who received Invisalign first or teen treatment, and the impact of the orthodontic device on the facial bones and dentition of patients in the growing period were analyzed, so as to find the most suitable timing of interventional therapy.

Material and Methods:
Patients aged 6-18 with Class II malocclusion who received Invisalign first or teen treatment in AJ dental clinic were collected. The study group included 16 subjects. The subjects' preoperative and postoperative cephalometric X-ray films are depicted with 28 marked points using digital software, and 20 measured values of line segments and angles were then obtained for craniofacial morphology analysis. In addition, 8 pairs of interdental widths, overjet, and overbite values are retrieved from the ClinCheck software for analyzing the dental effect changes.
Results and Discussion:
Changes in skeletal and dentition after treatment found on cephalometric images were as follow. The SNB angle increased with decreased ANB angle, indicating that the mandible grew more anteriorly. In the part of appearance and soft tissue changes, the reduction of overjet was observed in all three different stages in this study (p=0.007, p=0.000, p=0.039). In both long-term and short-term changes, significant differences in U1-SN reduction (p=0.000, p=0.013) and interincisal angle increase (p=0.001, p=0.002) could be observed. Above results showed that patients' upper incisors are retracted to normal angulation, and their esthetic are improved. For growth changes, both length of mandible and length of maxilla increased after treatment, and the changes in the length of the lower jaw was greater than that of the upper jaw. In the part of the jaw angle, according to the results, TGA and UGA have a slight increase of 1.81 degrees and 1.91 degrees, respectively, in the short-term; in the long-term, the LGA decreased by 1.21 degrees; in the adjustment period, UGA was reduced by 1.73 degrees. All changes above showed statistically significant change (p<0.05). According to the above results, changes of the ascending ramus of the mandible and the tendency of the mandible to rotate in the counterclockwise direction can be seen in the long-term changes with Invisalign braces. Analysis of the ClinCheck software showed in both short-term and long-term changes, 8 pairs of arch widths except for 13-23 have increased after treatment and showed statistically significant change (p<0.05).
In the study of changes in different cervical maturation stages can be found that the response of bones is relatively small, and the changes in FMA, SN-MP and Y-axis to SN are not that significant. It is speculated that the ability of Invisalign braces affecting growth and development, is relatively small. From the long-term and adjustment period, it can be observed that if the treatment time spans CS3-4, the growth peak, the response of the bones is relatively good, and the response of the teeth is relatively small. Based on the above, this study believes that the treatment at CS1, 2, and 3 can obtain a greater skeletal response.
In the study of changes in patients with different vertical skeletal patterns one can found that the changes which are relatively obvious do not focus on a certain group, and the long-term and short-term results may be different with the variant time period of the analysis. Moreover, due to the insufficient number of subjects for statistical analysis, the above result shows only the relative relationship between the data of each group, and the substantive difference should not be obvious.
In the study of Invisalign treatment achievement rate, changes in the width of the dental arches of both upper and lower jaws can only achieve 60-70% of the goals set in the treatment plan. Therefore, if there is a need for arch expansion using Invisalign braces in the future, overcorrection needs to be considered.
Conclusion:
The valuable aspect of this study is that we not only conducted a multi-faceted analysis of Invisalign First and Teen, and we are also a precursor to relevant research in Taiwan. According to the results, it can be confirmed that Invisalign First and Teen can indeed improve the facial bones, dental and appearance of growing patients with Class II malocclusion, and the substantial improvement can be seen in the peak growth period. However, it is not yet possible to analyze how much of the treatment results are from growth and how much is from the curative effect provided by Invisalign appliance, which still needs further research and analysis. We are looking forward that in the future, professionals from all regions in Taiwan can jointly collect Class II malocclusion patients receiving Invisalign first and teen, then establish guidelines suitable for reference by clinicians in Taiwan.

目錄 I
圖目錄 IV
表目錄 V
附件目錄 VII
中文摘要 VIII
英文摘要 XI
第一章、緒論 1
第一節、背景與動機 1
第二節、研究目的 3
第二章、文獻探討 4
第一節、骨性二級異常咬合 4
第二節、二級異常咬合的治療方式 6
第三節、成長期患者 7
第四節、接受二級咬合治療的最佳時機 9
第五節、隱適美系統 10
第六節、隱適美兒童牙套 12
第七節、隱適美青少年牙套 13
第三章、材料與方法 14
第一節、研究對象 14
第二節、研究設計與架構 15
第三節、研究工具 16
第四節、研究方法與步驟 18
第五節、資料統計與分析 19
第四章、結果 20
第一節、基本人口學 20
第二節、受試者各變項治療前(T0)、中(T1)、後(T2)之數值 21
第三節、受試者各變項短期變化(T1-T0) 30
第四節、受試者各變項長期變化(T2-T0) 33
第六節、隱適美牙套對成長期患者顏面骨骼及齒列的影響 39
第七節、隱適美牙套對成長期不同階段患者顏面骨及齒列的影響 44
第八節、隱適美牙套對不同垂直顏面型成長期患者顏面骨及齒列影響 69
第八節、隱適美兒童及青少年牙套之治療達成率 88
第五章、討論 89
第一節、隱適美牙套對成長期患者顏面骨及齒列的影響 89
第二節、隱適美牙套對成長期不同階段患者顏面骨及齒列的影響 92
第三節、隱適美牙套對不同垂直顏面型成長期患者顏面骨及齒列影響 93
第四節、隱適美兒童及青少年牙套之治療達成率 95
第五節、研究限制 96
第六章、結論與建議 97
參考文獻 98
附圖目錄 104
附表目錄 115
附件目錄 150

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