| Objective:A retrospective study was conducted to evaluate the effect of two-phase orthodontic treatment on the structural characteristics of the hard and soft tissues of the maxillofacial region,the width of the sagittal upper airway and the position of the tongue between skeletal class III patients with unilateral complete cleft lip and palate(UCLP)and skeletal class III patients with nonclef.To explore the similarities and differences of two-phase orthodontic treatment effects between with UCLP patients and the skeletal class III patients with nonclef,in order to provide reference for the selection of clinical treatment options and prediction of treatment results in patients with UCLP.Methods:Fourteen UCLP patients(age 11.07±2.13 years old)with skeletal class III who completed two-phase orthodontic treatment were selected,named as the UCLP group.Sixteen non-cleft patients with skeletal class III patients(age 11.44±1.32 years old)who completed two-phase orthodontic treatment were included,named as SⅢ group.All the study subjects obtained good occlusal relationship and facial aesthetics through two-phase orthodontic treatment which included orthopedic treatment during mixed dentition(maxillary expansion and protraction)and fixed orthodontic treatment during permanent dentition(straight-wire orthodontic appliance).A cartesian coordinate system was established on the lateral cephalometric radiographs,with the anterior skull base plane(SN)rotating 7° clockwise as X-axis,and the X-axis perpendicular across the sella point(S)as Y-axis.Eighteen soft and hard tissue measurement items,six upper airway measurement items and four tongue measurement items were selected for cephalometric analysis.Using SPSS 26.0 statistical software,independent samples t test or independent sample Mann-Whitney U test were used to compare and analyze the between-group analysis of before and after two-phase orthodontic treatment,differences of changes;and paired t test or Wilcoxon signed rank test were used to compare the intra-group analysis before and after treatment.Results:1.Comparison of results between UCLP group and SⅢ group before two-phase orthodontic treatmentBefore two-phase orthodontic treatment,in hard tissue measurement results,SNA,A-Pt,SNB,B-Y,U1-SN and OJ in the UCLP group were lower than those in the SⅢgroup(P<0.05).In soft tissue measurement results,LL-Sm-Pos in the UCLP group was lower than that in the SⅢ group(P<0.01),while LLP was greater than that in the SⅢgroup(P<0.05).In sagittal upper airway measurement results,PNS-ad1 and PNS-ad2 in the nasopharyngeal segment of the upper airway in the UCLP group were significantly lower than those in the SⅢ group(P<0.01).In tongue measurement results,TGH and HY in UCLP group were smaller than that in SⅢ group(P<0.05).There was no significant difference in the other measurements between the two groups(P>0.05).2.Comparison of results before and after two-phase orthodontic treatment in each groupAfter two-phase orthodontic treatment in UCLP group,in hard tissue measurement results,SNA,A-Pt,B-Y,Co-Po,ANB,U1-SN and OJ were significantly increased(P<0.01),while PP-SN,SNB and OB were decreased(P<0.05).In soft tissue measurement results,G-Prn-Pos was significantly decreased(P<0.01),and ULP was significantly increased(P<0.01).In sagittal upper airway measurement results,PNS-ad1,PNS-ad2,Ve-Pve and eb-Peb increased(P<0.05).In tongue measurement results,TGL,TGH and H-X were significantly increased(P<0.01).There was no significant difference in other measurement values within the UCLP group(P>0.05).After two-phase orthodontic treatment in SⅢ group,in hard tissue measurement results,SNA,A-Pt,B-Y,Co-Po,ANB,U1-SN and OJ were significantly increased(P<0.01),OB was decreased significantly(P<0.01).In soft tissue measurement results,G-Prn-Pos was decreased significantly(P<0.01),while G-Sn-Pos and ULP increased significantly(P<0.01).In sagittal upper airway measurement results,all segments of the upper airway were significantly enlarged after treatment(P<0.001).In tongue measurement results,TGL,TGH and H-X were increased(P<0.05).There was no significant difference in other measurement values within the SⅢ group(P>0.05).3.Comparison of results between UCLP group and SⅢ group after two-phase orthodontic treatmentAfter two-phase orthodontic treatment,in hard tissue measurement results,SNA,APt,SNB,B-Y,U1-SN in UCLP group were lower than that in SⅢ group(P<0.05).In sagittal upper airway measurement results,PNS-ad1 in UCLP group was lower than that in SⅢ group(P<0.05).There was no significant difference in the other measurements between the two groups(P>0.05).4.Comparison of the differences of changes between UCLP group and SⅢ groupThere was no significant difference between the two groups in the amount of change before and after two-phase orthodontic treatment(P>0.05).Conclusions:1.Before the two-phase orthodontic treatment,the patients in the UCLP group had more retraction of the maxilla.After two-phase orthodontic treatment,the relationship between the jaws in both groups was improved,the length of the maxilla increased,and the position was moved forward.2.Before two-phase orthodontic treatment,the lower lip of the UCLP group was more protruding,and the geniolabial angle was smaller.The profiles of both groups were improved after two-phase orthodontic treatment.3.Before two-phase orthodontic treatment,the upper airway nasopharyngeal segment in UCLP group was narrower than that in SⅢ.After two-phase orthodontic treatment,the sagittal upper airway width in the SⅢ group increased as a whole.In UCLP group,except for the upper airway widths corresponding to the tip of the soft palate and the narrowest airway width in the lower oropharynx,the upper airway width of the rest of the patients also increased significantly.However,the upper airway width corresponding to basion in the UCLP group was still narrower than that in the SⅢ group after two-phase orthodontic treatment.4.Before two-phase orthodontic treatment,the height of the tongue in the UCLP group was lower than that in the SⅢ group,and the level of the hyoid bone was more posterior.After two-phase orthodontic treatment,the height and length of the tongue increased,and the hyoid bone moved down in both groups.There was no significant difference in the positions of the tongue and hyoid bone between the two groups after two-phase orthodontic treatment.5.Two-phase orthodontic treatment promotes maxillary development in UCLP and SⅢ patients,corrects the relationship between the jaws,improves soft tissue profile,and increases the width of the upper airway.which is beneficial to the maxillofacial appearance and respiratory function.The response of UCLP patients to two-phase orthodontic treatment was not significantly different from that of patients in SⅢ group,but the former was more difficult to correct than non-cleft patients,and the treatment process was longer. |
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