不同镍钛弓丝对拔牙和非拔牙矫治患者正畸排齐效率和疼痛感知程度的影响

doi:10.13481/j.1671-587X.20240522

摘要/Abstract

摘要：

目的探讨应用低摩擦自锁托槽的拔牙和非拔牙矫治患者中超弹性镍钛弓丝（SENT）与热激活镍钛弓丝（HANT）对下前牙初期排齐效率和患者疼痛程度的影响，为正畸临床中最适弓丝的选择提供依据。方法将80例接受固定正畸治疗并应用自锁托槽的40例拨牙矫治患者（拔牙矫治组）和40例非拨牙矫治患者（非矫治拔牙组）随机分配到SENT亚组和HANT亚组，由同一名操作者将0.014英寸平直弓丝完全入槽。患者、操作者和数据测量人员均实行盲法。观察各组患者初始弓丝的临床排齐效率并计算患者Little’s指数，记录各组患者在初粘矫治器4 h后及矫治第1周的每天早饭前视觉模拟量表（VAS）评分和疼痛感知情况，对患者初始Little’s指数、性别和年龄进行多元回归分析，分析影响患者疼痛的影响因素。结果拔牙矫治组和非拔牙矫治组患者年龄、性别和初始Little’s指数比较差异无统计学意义（P>0.05）。治疗4周后，非拔牙矫治组中HANT和SENT亚组患者的Little’s指数均较治疗前降低，但组间比较差异无统计学意义（P>0.05）；与非拔牙矫治组中SENT亚组比较，非拔牙矫治组中HANT亚组患者Little’s指数降低（P<0.05）；拔牙矫治组中HANT和SENT亚组患者治疗前后的Little’s指数比较差异无统计学意义（P>0.05）。患者初粘矫治器后的疼痛感在第 1 天达到峰值，随后逐渐降低至基础水平；在拔牙矫治组和非拔牙矫治组患者中，SENT和HANT亚组患者表现出相同的疼痛变化模式；SENT和HANT亚组患者各时间点VAS评分平均值和最高疼痛强度评分比较差异均无统计学意义（P>0.05）。弓丝类型对疼痛程度无明显影响，时间明显影响患者的疼痛程度。多元回归分析，拔牙矫治组患者初始Little’s指数与VAS最高评分间有明显相关性（b=0.359，P=0.033），性别和年龄均不会对2组患者疼痛程度产生影响。结论应用低摩擦自锁托槽正畸治疗时，非拔牙矫治组患者使用0.014英寸HANT弓丝的初始排齐效率优于0.014英寸SENT弓丝；SENT弓丝和HANT弓丝对正畸患者初始疼痛程度无影响。

关键词: 镍钛弓丝, 排齐效率, 正畸疼痛, 自锁托槽, Little’s指数

Abstract:

Objective To discuss the effects of superelastic nickel-titanium archwires （SENT） and heat-activated nickel-titanium archwires （HANT） on the initial alignment efficiency of mandibular anterior teeth and pain levels of the patients with extraction orthodontic treatment and non-extraction orthodontic treatment by using low-friction self-ligating brackets， and to provide the basis for the selection of the most suitable archwire in orthodontic clinical practice. Methods Eighty patients underwent fixed orthodontic treatment with self-ligating brackets were randomly assigned to SENT or HANT subgroups， and there were 40 patients in extraction orthodontic treatment group and 40 patients in non-extraction orthodontic treatment group. A single operator fully engaged a 0.014-inch straight archwire into the brackets.The patients， operators， and data measurers were all blinded；the initial clinical alignment efficiency of the archwires of the patients in various groups was observed， and the Little’s index was calculated； the visual analog scale （VAS） scores and pain perception of the patients in various groups were recorded 4 h after initial bonding of the appliances and every day before breakfast during the first week of orthodontic treatment； multivariate regression analysis was performed for the initial Little’s index， gender， and age， and the influence factors of pain in the patients was analyzed. Results There were no significant differences in age， gender， and initial Little’s index among the patients in extraction group and non-extraction group （P>0.05）. Compared with before treatment， the Little’s indexes of the patients in both HANT and SENT subgroups in non-extraction orthedontic treatment group were decreased 4 weeks after treatment，but the difference between groups was not significant （P>0.05）. Compared with SENT subgroup in non-extraction orthodontic treatment group， the Little’s index of the patients in HANT subgroup was decreased （P<0.05）. In extraction orthodontic treatment group， there were no significant differences in Little’s indexes of the patients between the HANT and SENT subgroups before and after treatment （P>0.05）. The pain perception peaked on the first day after initial bonding and gradually decreased to baseline levels.The patients in SENT and HANT subgroups in both extraction and non-extraction orthodontic treatment groups showed the similar patterns of pain change. There were no significant differences in the average VAS scores and maximum pain intensity scores between the patients in SENT and HANT subgroups at different time points （P>0.05）. The type of archwire had no significant effect on the degree of pain， while time significantly affected the degree of pain. The multivariate regression analysis results showed a significant correlation between initial Little’s index and maximum VAS scores of the patients in extraction orthodontic treatment group （b=0.359， P=0.033）. Gender and age did not affect the degree of pain of the patients in either group. Conclusion When applying low-friction self-ligating brackets for orthodontic treatment， the initial alignment efficiency with 0.014-inch HANT archwires is superior to 0.014-inch SENT archwires in non-extraction treatment group， while both archwires show the same efficiency in extraction patients. SENT and HANT archwires do not affect the initial degrees of pain of the orthodontic patients.

Key words: NiTi archwires, Alignment efficiency, Orthodontic pain, Self-ligating brackets, Little’s index

中图分类号:

R783.5

宋吉玉,张祎,任庆源,聂瑾涵,胡敏,齐慧川. 不同镍钛弓丝对拔牙和非拔牙矫治患者正畸排齐效率和疼痛感知程度的影响[J]. 吉林大学学报(医学版), 2024, 50(5): 1372-1380.

Jiyu SONG,Yi ZHANG,Qingyuan REN,Jinhan NIE,Min HU,Huichuan QI. Effects of different nickel-titanium archwires on orthodontic alignment efficiency and pain perception of patients with extraction orthodontic treatment and non-extraction orthodontic treatment[J]. Journal of Jilin University(Medicine Edition), 2024, 50(5): 1372-1380.

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Group	n	Age（year）	Male/Female	Little’s index (l/mm)
Extraction orthodontic treatment
SENT	19	17.47±5.66	3/16	4.31±1.11
HANT	18	15.17±4.37	2/16	4.36±0.97
Non-extraction orthodontic treatment
SENT	17	14.12±1.45	5/12	4.06±0.87
HANT	17	13.47±1.70	8/9	4.26±1.14

Group	n	Little’s index
Group	n	Before treatment	4 weeks after treatment
Extraction orthodontic treatment
SENT	19	4.31±1.11	1.84±0.57
HANT	18	4.36±0.97	1.80±0.87
Non-extraction orthodontic treatment
SENT	17	4.06±0.87	1.99±0.88
HANT	17	4.26±1.14	1.84±0.79^*

Group	n	VAS score								VAS_max score
Group	n	4 h	1 d	2 d	3 d	4 d	5 d	6 d	7 d	VAS_max score
Extraction orthodontic treatment
SENT	19	4.11±2.69	4.21±2.72	3.58±2.29	2.78±2.15	2.47±2.22	1.74±2.18	1.47±1.95	1.21±1.62	5.11±2.62
HANT	18	3.33±2.33	3.66±2.11	2.39±1.75	2.11±1.68	1.22±1.59	0.56±1.09	0.33±0.77	0.22±0.65	4.56±2.01
Non-extraction orthodontic treatment
SENT	17	3.00±2.26	4.06±2.49	2.94±2.04	2.47±1.74	1.65±1.77	1.17±1.43	0.76±0.90	0.47±0.72	4.88+1.87
HANT	17	3.35±2.26	3.82±1.91	2.47±1.66	1.59±1.54	1.18±1.42	0.94±1.25	0.71±1.26	0.53±1.07	4.82±1.67

Group	Source	Type Ⅲ sum of squares	df	Mean square	F	P
Extraction orthodontic treatment	Time	411.258	2.570	160.014	33.778	<0.001
	Archwires type	69.318	1.000	69.318	3.712	0.062
	Time vs archwires type	4.691	2.570	1.825	0.385	0.733
Non-extraction orthodontic treatment	Time	364.085	7.000	52.012	26.279	<0.001
	Archwires type	4.004	1.000	4.004	0.467	0.499
	Time vs archwires type	8.437	2.882	12.928	0.609	0.604

Group	b	t	SE	P
Extraction orthodontic treatment
Little’s index (mm)	0.359	2.230	0.364	0.033
Age	-1.770	-1.093	0.074	0.282
Gender	0.019	0.113	1.100	0.911
Non-extraction orthodontic treatment
Little’s index (mm)	0.253	1.362	0.324	0.183
Age	0.010	0.056	0.197	0.956
Gender	0.173	0.947	0.646	0.351