醫(yī)學(xué)-wagner orthodontics article2016cn en口腔正畸學(xué)和頜面研究

Orthodntics&CraniofacialResearchORIGINALARTICLER.Heinrich-R.Heinrich-

Effectofathin-neckpacifieronprimarydentition:arandomizedcontrolledtrialAuthors'Y.Wagner,R.Heinrich-Weltzien,DepartmentofPreventiveDentistryandPediatricDentistry,JenaUniversityHospital,Jena,Germany德國(guó)耶拿大學(xué)附屬醫(yī)院口腔預(yù)防

WagnerY.,Heinrich-WeltzienR.Effectofathin-neckpacifieronprimarydentition:arandomizedcontrolledOrthodCraniofacRes2016.?2016JohnWiley&SonsA/S.PublishedbyOrthodCraniofacRes2016.?2016JohnWiley&SonsA/S.JohnWiley&由JohnWiley& DepartmentofPreventiveDentistryandPediatricDentistryJenaUniversity德國(guó)耶拿大學(xué)附屬醫(yī)院口腔預(yù)防Bachstr.18Jena,Germany.:Yvonne.Wagner@med.uni-jena.de

Objectives–Toevaluatechangesinocclusalcharacteristicsintheprimarydentitionthatoccurafterintroducingathin-neckpacifier(TNP)tochildrenwithpreviouslydiagnosedpacifier-associatedanterioropenbite(AOB)andincreasedoverjet.目標(biāo)–評(píng)估（SettingandSamplePopulation–DepartmentofPreventiveandPediatricDentistry,JenaUniversityHospital,Germany.Subjectswere86children(meanage20.3months)withapacifier-associatedopenbiteoroverjet≥2mm.試驗(yàn)環(huán)境和樣本群體–相關(guān)開牙合或超牙合（≥2mm）86名兒童，平均為20.3個(gè)月。Material&Methods–Randomizedtrial.Subjectswererandomlyassigned:groupI(n=28),interventiongroupusingaTNP;groupII(n=30),controlgroup,usingaconventionalorphysiologicalpacifier;andgroupIII(n=28),interventiongroup,Goldstandard,weanedoffpacifier.Participantswerere-examinedafter3,6,9and12monthsbyanoperator,blindedforthe材料與方法–I組(n=28)TNP的干預(yù)組；II組(n=30)，對(duì)照組，使用傳統(tǒng)或生理安撫戒掉安撫奶嘴。一名不了解治療的在第3、6、912個(gè)月時(shí)對(duì)參與者進(jìn)行重新檢驗(yàn)。Results–After12monthsdatafor63children(meanage33.1months)wereyzed(I:n=24;II:n=22;III:n=17).Therewasasignificantdifferencebetweenthegroupsregardingmeanoverjet(groupI:2.7_0.5mm,groupII:3.2_0.7mm,groupIII:2.4_0.5mm,Kruskal–Wallis,p0.002)andAOB(groupI:_1.2_0.3mm,group_2.2_0.3mm,groupIII:_0.8_0.8mm,Kruskal–Wallis,p<0.001).ThedifferencesbetweengroupIandIIregardingincreasedoverjet(3.1_0.2mmvs.3.6_0.3mm,Mann–Whitney,<0.001)andextentofAOB(_1.2_0.3mm_2.2_0.3mm,Mann–Whitney,p<0.001)werestatisticallysignificant.–63（In24;IIn22;III=17）12個(gè)月數(shù)據(jù)后得出如下結(jié)論：組之間II組：3.2_0.7mmIII組：2.4_0.5mm，=_0.8mm，Kruskal–Wallis，p0.001）的顯著_0.2mm3.6_0.3mm，Mann–Whitney，p<0.001）和AOB（_1.2_0.3mm與_2.2_0.3mm，Mann–Whitney，p0.001）程度的差異具有統(tǒng)計(jì)Conclusion–UseofTNPresultedinbetterclinicalmeasurementsforinoverjetandoverbitecomparedwiththecontinuinguseofconventionalorphysiologicalpacifiers.結(jié)論–與繼續(xù)使用傳統(tǒng)或生理安撫奶嘴相比，TNP產(chǎn)生了更好的超牙合與覆牙合臨床測(cè)Accepted3April接受日期：201643::?2016JohnWiley&Sons?2016JohnWiley&SonsA/S.PublishedbyJohnWiley&SonsJohnWiley&Sons

:child;malocclusion;openbite;overbite;pacifiers;preschoolNonnutritivesucking(NNS)iscommonandtheprevalenceofNNSinchildrenvariesfrom60tomorethan80%(1,2).Apacifierisusedforcomforting;asasleeaid;andtoamelioratefortable,stressfulorpainfulepisodes(3–5).Useofapacifierisconsideredsociallynormalinmostcultures,andweaningmaybedifficult(1,5).Ideally,NNShabitsshouldbediscontinuedby24–36monthsofagetoreducetheriskofdevelomalocclusion(4,6).Nevertheless,morethantwentypercentofchildrenthatare3yearsandoldercontinuethisbehavior(1).非營(yíng)養(yǎng)性吸吮（NNS）行為極為常見，NNS60%80%以上（1、2（3–5大多數(shù)文化中使用安撫奶嘴被視為是一種社會(huì)正?，F(xiàn)象戒掉安撫奶嘴可能較為1、5理想情況下兒童應(yīng)在24–36個(gè)月大時(shí)改掉NNS以降低咬合不正的風(fēng)（4,、6（1NumerousstudieshaveexaminedtheeffectsofNNShabitsonocclusalcharacteristicsandfoundthatNNSbeyondage3mayhavedetrimentalconsequencesfordento-andmaxillofacialdevelopment(1–15).Anterioropenbite(AOB),increasedoverjet,posteriorcrossbite,narrowintercuspidwidthofthemaxillaryarchandahighnarrolatearethemostnotablechangesinthedevelodentition(5–15).StudieshavealsoshownwhenNNShabitsarestoppedspontaneousresolutionmayoccur(1,12,14–18).AOBtendstoresolve,whileposteriorcrossbiteandincreasedoverjettendtopersistafterthecessationofthepacifierhabit(1,12,14–18).Themajorityofchildrenwhouseapacifierbeyondage3haveamalocclusion(18,19).Seventy-sevenpercentofchildrenwithpacifierhabitsduring48monthsormorehadamalocclusion(19).有大量研究過NNS對(duì)咬合特征的影響結(jié)果發(fā)現(xiàn)超過3歲以上仍有NNS（1–15（AOB（5–1514–1814–18歲以上仍使用安撫奶嘴的大多數(shù)兒童都患有咬合不正（18、19。在安撫奶嘴持續(xù)48（19Twotypesofpacifiersarecommerciallyavailable:physiological(alsoknownasorthodontic)pacifiersandconventionalones.Withtheexceptionofonestudy(20),comparisonsbetweenthesepacifiershaveshownnosignificantadvantagesofphysiologicaloverconventionalpacifierswithrespecttodevelopmentofAOB,increasedoverjetorreducedmaxillaryarchwidth(19–27).Longitudinalstudiesexaminingimpactondentaldevelopmentofthesepacifiersarelacking.Todate,onlyonelongitudinalstudyhasreportedonthedevelopmentofAOBwithuseofanewlydesignedphysiologicalpacifier;thestudypopulationwasagroupof121childrenaged16(20).Thephysiologicalpacifierexhibitedadvantagesovertheconventionalmodel;theuseofthepacifierresultedinalowerincidenceofopenbites(20).（20（19–27（20（20In2009,apacifierwasdevelopedwithauniquedesign:anextrathinandsoftneck(MAMPerfect,BamedAG,Wollerau,Switzerland)(Fig.1).Todate,therehasbeennolongitudinalinvivostudyinvestigatingtheeffectsofaTNPondentaldevelopment.Therefore,theaimofthisstudywastocomparechangesinocclusalcharacteristicsintheprimarydentitionthatoccurafterintroducingaTNPtochildrenwithpreviouslydiagnosedAOBandincreasedoverjetandthoseusingaconventionalorphysiologicalpacifierorthoseweanedoffapacifier.TheworkinghypothesiswasthatchangingtoaTNPwouldreducepacifier-associatedmalocclusionsintheprimarydentition.沃勒勞（圖1。迄今為止，尚無縱向體內(nèi)研究旨在TNP對(duì)牙齒發(fā)育的影響。因此本研究的目的是對(duì)比先前確診患有AOB和增大超牙合的兒童使用TNP后使用普改變TNP會(huì)降低安撫奶嘴的乳牙列中咬合不正。MaterialsandThiswasaprospective,parallel-assigned,randomizedcontrolledtrialwithanequalallocationratio(GermanClinicalTrialsRegisterDRKS00003533).TheEthicsCommitteeofJenaUniversityHospitalapprovedthisstudy(3441-05/12).ThestudywasconductedwithinformedconsentofallparentsandinfullaccordancewiththeethicalrequirementsoftheWorldMedicalAssociationDeclarationofHelsinki(2008).ThestudyalsofollowedtheprinciplesoftheCONSORTstatement.0000353305/12年）的道德要求。該研究還遵從CONSORT原則。Allnetients(n=106)attendingtheDepartmentofPreventiveandPaediatricDentistryatJenaUniversityHospitalinGermanyforroutinedentalexaminationsbetweenMay2012andJanuary2014wereassessedforeligibility.Theinclusioncriteriawereprovisionofwrittenconsentbytheparents,age16–24monthswithpreviouslydiagnosedpacifier-associatedAOBorincreasedoverjet(AOB≤0mmand/oroverjet≥2mm),currentuseofapacifier,availabilityofdatarelatedtodentalexaminationsandcompletedpacifier-usagequestionnaire.AccordingtothecriteriaofFosteretHamilton(28)ameasurementof≥2mmwasconsideredasincreasedoverjetExclusioncriteriawerelackofwrittenconsent;ageaboveorbelowtheacceptablerange;congenital,geneticortrauma-relatedmaldevelopment;pretermbirth;dentalcariesorfillings;mouthbreathing;thumborfingersucking;useofababybottleforlongerthan15monthsandpletedata.Eighty-sixchildrenwithameanageof20.3monthsmettheinclusioncriteria.Theywererandomlyassignedtothreegroups:groupI(intervention)switchedtoaTNP(n=28),groupII(control)(n=30)continuedtousetheirinitialpacifier(conventionalorphysiological)andgroupIII(intervention,Goldstandard)weretobeweanedoffthepacifierduringthestudyperiod(n=28).Noincentiveswereoffered.我們對(duì)在2012年5月至2014年1月參加德國(guó)耶拿大學(xué)附屬醫(yī)院預(yù)防牙科進(jìn)行常規(guī)齒檢查的所有新患者（n=106）進(jìn)行了資格評(píng)審。入選標(biāo)準(zhǔn)為父母提供同意書；16–24AOB或增大超牙合（AOB≤0mm和/或超F(xiàn)osteretHamilton標(biāo)準(zhǔn)(28)，測(cè)量值≥2mm視為增大超牙合(28)。排除標(biāo)準(zhǔn)包括未簽訂書面同意書；超過或不滿可接受的范圍；性、遺傳性或性發(fā)育不良；早產(chǎn)；15個(gè)月以及數(shù)據(jù)不完整。八十六名平均為20.3個(gè)月的兒童符合入選標(biāo)準(zhǔn)。這些兒童被隨機(jī)分配至三個(gè)組：第I組（干預(yù)）TNP(n=28)II組（對(duì)照）(n=30)III組（干預(yù)，黃金標(biāo)準(zhǔn)）是將在研究期間戒掉安撫奶嘴的兒童（n=28。不提供任何。Fig.1.Frontviewandsideviewofthethin-neckpacifier(MAMGroupallocationwasperformedbyaresearchassistantnotinvolvedinthestudyusingprepared,sequentiallynumbered,opaquesealedenvelopescontaininggroupnumbers.The9.2computerprogram(SASSoftwareInstitute,Cary,NC,USA)wasusedtogeneratearandomallocationsequence(parallelassignment,equalallocationratio,blockrandomization:blocklength6,randomseed5834935).RandomizationandstatisticalysisofthestudywerecarriedoutincollaborationwiththeInstituteofMedicalStatistics,Informaticsandation,JenaUniversityHospital.分組工作由不參與研究的研究助理使用準(zhǔn)備好的按順序的不透明的密封信（包含組號(hào)）執(zhí)行。使用SAS9.2計(jì)算機(jī)程序（北卡羅萊納州凱里市SAS軟件學(xué)院）生成隨機(jī)分配序（并行分配均等分配比例區(qū)組隨機(jī)化區(qū)組長(zhǎng)度6隨機(jī)數(shù)5834935Childrenwereexcludedfromthefinalysisiftheydidnotfollowthestudyregimen(e.g.,iftheyswitchedtoanotherpacifierorstartedsuckingtheirthumb).IngroupIII,onlychildrenwhoweresuccessfullyweanedofftheirpacifierduringthestudyperiodwereincludedinthefinalysis.Cessationofpacifieruseforatleast3monthswasconsideredsuccessfulIII組的最終分析中僅包含在研究期間成功戒掉安撫奶嘴的兒童。戒掉3個(gè)月方可視為成功戒掉安撫奶嘴。Allparentsreceivedstudyinstructions.ToensurethatlostpacifiersingroupIcouldbereplacedimmediay,parentsreceivedsufficientreplacementsoftheexperimentalpacifier.Parentswereinstructedoncompletionofadiaryofpacifierusagetimetorecordtheapproximatehoursofpacifierusebythechild.ParentsingroupIIIweregivenguidanceonhowtoweantheirchildoffthepacifier.Forexample,aslow,gentleweaningprocessvs.stopimmediay;restrictingthepacifiertocertaintimesorcertainplaces;takeorgiveitawayorloseit;orleaveitforthebinkyfairy.Ithastobementionedthatallparentsreceivedthesameguidancetoassisttheirchildinceasingthehabitindependentlyoftheirgroupallocation.對(duì)所有患者進(jìn)行研究指導(dǎo)。為確保第I組中失去的安撫奶嘴立即得到代替，我們?yōu)楦改競(jìng)僆IIbinkyfairy。必須提到的是，我們向所有父母都提供了關(guān)于如何協(xié)助其After3,6,9and12months,thechildrenwerere-examinedbytwocalibrateddentists,oneofthemwasblindedforthetreatment.Participants,parentsandonecalibrateddentistwereawareofthetreatmentintervention.Dataysiswasconductedbytheblindeddentist.ThedentistshadbeentrainedandcalibratedfollowingWHOguidelines(29).Eachexaminerfirstpractisedtheexaminationonagroupoftensubjects.Afterwards,everyexaminerindependentlyexaminedthesamegroupof20pre-selectedsubjectstoassesstheconsistency.Allmeasurementswererecheckedforaccuracy.Theintraclasscorrelationcoefficientsforintraobserveragreementregardingthemeasurementsofoverbiteandoverjetwere0.87–0.89.Theintraclasscorrelationcoefficientsforinterobserverreliabilitywithregardtothemeasurementsofoverbiteandoverjetwere0.86–0.88.Theaveragemeasuringdifferencebetweenthedentistswas0.1mm.（290.1mm。Examinationswereconductedusingadentallight,mirrorandsterilegauzeforremovingdebrisanddryingtheteeth,andwiththechildsittingontheirparent’slapinanuprightpositioninadentalchairsothattheFrankforthorizontalplanewasparalleltothefloor.Noradiographsweretaken.Sagittalandverticalmeasurementsweremadewithaverniercaliper(M€unchnerModell042-751-00,Germany)withanaccuracyof0.1mm.RegistrationoftheocclusalcharacteristicswascarriedoutaccordingtotheprinciplesdevelopedbytheFederationDentaire(30).Allmeasurementswererecheckedforaccuracy.ThefollowingocclusalparameterswereOverjetinmillimetersbetweentwoantagonisticanteriorteeth(lateralorcentralincisor)measuredfromthebuccalsurfaceofthemostlingualmandibulartoothtothemiddleoftheincisaledgeofamorebuccallypositionedmaxillarytooth.Overbite,measuredinmillimetersandrecordedasoverlapofmandibularanteriorteethbymaxillaryanteriorteeth.Apencilmarkonthetooth(centralmandibularincisor)indicatingtheextentoftheoverlapfacilitatedthemeasurement.Overbitewasrecordedasdegreeofoverbite,recordedaspercentoverlapofthemandibularincisorscrown:鉛筆記號(hào)表示程度相關(guān)的測(cè)量值覆牙合按照下頜切牙牙冠百分比記錄為覆牙≤?one-thirdcoveringoflower?to?betweenone-thirdandtwo-thirds>?morethantwo-thirds>?Openbite,whenpresent,measuredinmillimetersbetweentheincisaledgesofmaxillaryandmandibularanteriorteeth. SampleThesamplesizecalculationwasbasedonapreliminarystudywith17patientsusingthesamemethodsasinthemainstudy.Primary emeasureAOB/increasedoverjetwas_1.0_0.2mm/2.8_0.4mmingroupIand_2.3_0.2mm/3.1_0.4mmingroupII.Todetecttheobserveddifferencebetweengroupswithatwo-tailedsignificancetest,a5%criticallevelandapowerof90%,asampleofthreechildrenpergroupwererequiredfortheprimary eAOBand21childrenpergroupwasrequiredfortheprimary eincreasedoverjet(calculatedwiththenQueryAdvisor7.0computerprogram,StatisticalSolutions,Cork,Ireland).Thecalculatedsamplesizewasadaptedtoatleast28childrenpergrouptoallowfordropout.AOB/增大超牙合的主要結(jié)果測(cè)量值分別為_1.0_0.2mm/2.8_0.4mm和_2.3_0.221名兒童（nQueryAdvisor7.0StatisticalSolutions28名兒童，以保證在中途有參與者退出仍有 DatawererecordedinExcelfilesandtransferredtotheStatisticalPackageforSocialSciences(SPSSversion20,IBMCorporation,Armonk,NY,USA).ThedatawereyzedusingtheMann–WhitneyU-test(forcomparisonoftwogroups),Kruskal–Wallis(forcomparisonofthreegroups)andBonferroniintervals(forthedifferencebetweenmeanvaluesoftativevariables).Ap-value≤0.05wasusedtoindicatestatisticallysignificantdifferences.數(shù)據(jù)記錄在Excel文件中并傳輸至社會(huì)科學(xué)統(tǒng)計(jì)軟件包（20SPSS，IBMCorporation，美國(guó)紐約州克市。數(shù)據(jù)采用曼-U檢驗(yàn)（用于比較兩個(gè)組、Kruskal–Wallis（用于Atotalof106childrenmettheinclusioncriteriaand86(81.1%)ofthemparticipatedinthestudy(Fig.2).Figure2ispresentingtheparticipantflowdiagramfortheentirestudypopulation.Eighty-sixpatients(meanage20.3_2.4months,48males)wererandomlyassignedtothreegroups:28childreningroupI(TNP,interventiongroup),30ingroupII(initialpacifier,controlgroup)and28ingroupIII(weaningoff,interventiongroup,Goldstandard).Twelvechildrenwerelosttofollowupduetorelocation,nonappearanceorstartofthumbsucking.Seventyfourchildrenwereinvitedforthefinalexamination.Elevenchildrenwereexcludedfromthefinalysisduetodentaltrauma,mouthbreathing,andnoweaningoff.Ultimay,63subjects(meanage33.1_5.0months,40males)mettheinclusioncriteria(groupI:n=24;groupII:n=22;groupIII:n=17).NoneofthechildreningroupsIandIIhadceasedthehabitforlongerthan3months.%)2究群體的參與流程圖。八十名患者（平均為20.3_2.4個(gè)月，48名為）被隨機(jī)分配I28（TNP，干預(yù)組II30（，III28名（戒掉安撫奶嘴，干預(yù)組，黃金標(biāo)準(zhǔn)。十二名兒童因搬遷、未到場(chǎng)或開始吸吮拇指而失去隨訪。我們邀請(qǐng)了七十四名兒童進(jìn)行最終檢驗(yàn)。十一名兒童因牙、口呼吸或未戒掉安撫奶嘴而被排除之外。最終，63名對(duì)象（平均為33.1_5.0個(gè)月，40名）符合入選標(biāo)準(zhǔn)（第I組：n=24；第II組：n=22；第III組：n=17。第I組和第II組中無一兒童改掉該并保持超過3個(gè)月BaselinepatientDescriptionsofallchildrenaccordingtogroupatbaselinearepresentedinTable1.Allweredrawnfromthesamepopulation.Therewerenobaselinedifferencesbetweengroupsregardingage,numberofteeth,diet,pacifiertype,durationandfrequencyofpacifieruse,orocclusalcharacteristics(Kruskal–Wallistest,p>0.05).Mostofthechildren(82.0%)startedtheuseofthepacifierintheirfirstmonthoflife.Allchildrenhadanintensepacifierusethroughoutthedayandnightandengagedinthehabitformorethan8haday.關(guān)于、牙齒數(shù)、飲食、安撫奶嘴類型、安撫奶嘴使用持續(xù)時(shí)間和頻率或咬合特（.Kruskal-Wallis檢驗(yàn)，p>0.05）的基線差異。大多數(shù)兒童(82.0%)在出生后第一個(gè)月就開8小時(shí)。 隨機(jī)對(duì)照分配分配至第I 分配至第II 分配至第III（薄頸安撫奶嘴，干預(yù)組）（最初安撫奶嘴，對(duì)照組）（ 金標(biāo)準(zhǔn)隨訪·搬遷·搬遷··搬遷·未出現(xiàn)·分析分析分析（ （ 分析IIFig.2.Participantflowdiagramfortheentirestudy2.Dentalmeasurementsatfollow-Therewerenodifferencesbetweengroupsregardingage,gender,andnumberofteeth(Kruskal–Wallistest,p>0.05).ThetotaldurationofpacifierusewasloweringroupIII,whohadceasedthehabit(Kruskal–Wallis,p=0.010).ThedifferencesbetweengroupIandIIregardingdurationofpacifieruseandaveragepacifierusetimewerenotstatisticallysignificant(Mann–WhitneyU-test,pDuration=0.712,pTime=0.613).Therewasastatisticallysignificantdifferencebetweenthethreegroupsregardingmeanoverjet(Kruskal–Wallis,p=0.002)andmeanoverbite(Kruskal–Wallis,p=0.031).Bonferronirelianceintervalsdemonstratedastatisticallysignificantdifference(overjetandoverbite)betweenthosewhousedaconventionalorphysiologicalpacifier(groupII)andthosewhohadbeenweanedofftheirpacifierorusedTNP.ThedifferencebetweenthethreegroupsregardingtheprevalenceofAOB,theprevalenceofoverjet≥2mm,ortheprevalenceofoverjet≥3mmwasnotstatisticallysignificant(Kruskal–Wallistest,p>0.05).表2中提供最終檢查時(shí)的所有兒童情況說明（按組。組之間不存在關(guān)于、和牙數(shù)（Kruskal–Wallis測(cè)試，p>0.05）的差異。第III組兒童已改掉安撫奶嘴使用，因此0.010間和平均安撫奶嘴使用時(shí)間的差異不具有統(tǒng)計(jì)意義（曼-U檢驗(yàn)，pDuration=0.712,pTime=0.613。三個(gè)組之間關(guān)于平均超牙合（Kruskal–Wallis,p=0.002）（Kruskal–Wallis,p=0.031）的差異具有統(tǒng)計(jì)意義。Bonferroni依賴間隔證明，使用普通或具有統(tǒng)計(jì)意義（Kruskal–Wallis測(cè)試，p>0.05ChangeindentalTable3presentsacomparisonofthebaselineandfinal edataofallgroupsregardingAOB,overjet≥2mmandoverjet≥3mm.IngroupI,theonlysignificantchangeinmeasurementbetweenbaselineandfollow-upwasthemeanoverjet≥2mm(Mann–WhitneyU-test,p=0.001).IngroupII,therewasstrongevidencetoindicateachangeinallmeasurementsfrombaselinetofinalfollow-up,withexceptionofAOBprevalence.IngroupIII,therewasstrongevidenceforachangefrombaselinetofinalfollow-upinmeanoverjet≥3mm(Mann–WhitneyU-test,p=0.002),butlittleevidenceofachangeforothermeasurements.3AOB、超牙合≥2mm和超牙合≥3mmI組中，基線和隨訪之間唯一重要的測(cè)量值變化是平均超牙合≥2mm（曼-U檢驗(yàn)0.001病率除外。第III組中存在超牙合≥3mm從基線到最終隨訪期間變化的有力（曼-惠特尼U檢驗(yàn)，p=0.002，但其他測(cè)量值的變化缺乏。Table1.DescriptionofallparticipatingchildrenaccordingtogroupatGroupI(TNP)GroupII(initialpacifier,control interventiongroup,Goldstandard)lisp-valueNMaleN141717 20.8±20.1±20.1±Meannumberof±15.2±14.9±15.0±DietN 192620Uptoage0.8±0.8±0.8±Bottlefeeding747Uptoage0.9±1.0±1.0±Drinklearncup181412Fromage0.7±0.6±0.8±CupN283028Fromage1.0±1.0±0.9±PacifiertypeN2220206108Durationpacifier19.5±19.0±19.1±Meanoverjet±2.2±2.1±2.1±Meanoverbite±0.3±0.4±0.4±≤?overlapN131213?to?overlapN243Anterioropenbite131412Meanoverbite±_1.0±_1.0±_1.0±Overjet≥2mmN222221Meanoverjet±2.3±2.4±2.4±Overjet≥3mmN564Meanoverjet±3.1±3.2±3.2±1.第I組 第II組（最I(lǐng)II組（戒掉（薄頸安撫奶安撫奶嘴，對(duì)安撫奶嘴，干p 照組預(yù)組，黃金標(biāo)準(zhǔn)N 男N14 1717 平均±SD（月數(shù) 20.8± 20.1± 20.1± 平均牙齒數(shù)平均牙齒數(shù)N15.2±14.9±15.0±喂養(yǎng)N192620最高（歲0.8±0.8±0.8±奶瓶喂養(yǎng)N747最高（歲0.9±1.0±1.0±N181412最低（歲0.7±0.6±0.8±N283028最低（歲1.0±1.0±0.9±N2220206108安撫奶嘴使用持續(xù)19.5±19.0±19.1±±2.2±2.1±2.1±±0.3±0.4±0.4±N131213?toN243前牙開牙合N 131412±_1.0±_1.0±_1.0±超牙合≥2mmN 222221±2.3±2.4±2.4±超牙合≥3mmN 564±3.1±3.2±3.2±ComparisoninfinaldentalmeasurementsbetweenTable4showsacomparisonofgroupsregardingmalocclusionatfinalexamination.ThedifferencebetweenthegroupsregardingtheprevalenceofAOB,theprevalenceofoverjet≥2mm,ortheprevalenceofoverjet≥3mmwasnotstatisticallysignificant(Mann–WhitneyU-test,p>0.05).DifferencesbetweengroupsIandIIregardingtheextentofmalocclusionwerestatisticallysignificantforthechildrenwithanAOB(Mann–WhitneyU-test,p<0.001),overjet≥2mm(Mann–WhitneyU-test,p=0.015),andoverjet≥3mm(Mann–WhitneyU-test,p<0.001).ThedifferencebetweengroupIandIIIwasonlystatisticallysignificantforthechildrenwithanoverjet≥2mm(Mann–WhitneyU-test,p=0.012)butnotforthechildrenwithanoverjet≥3mm(Mann–WhitneyU-test,p=0.277)orAOB(Mann–WhitneyU-test,p=0.185).DifferencesbetweengroupsIIandIIIregardingtheextentofmalocclusionwerestatisticallysignificantforthechildrenwithanAOB(Mann–WhitneyU-test,p<0.001),overjet≥2mm(Mann–WhitneyU-test,p<0.001),andoverjet≥3mm(Mann–WhitneyU-test,p<0.001).病率或超牙合≥3mm的差異不具有統(tǒng)計(jì)意義（曼-U檢驗(yàn)，p值>0.05。第I0.001，m（p=0.015m（p的兒童具有統(tǒng)計(jì)意義第I組和第III組之間的差異僅對(duì)超牙合≥2mm（曼-U檢驗(yàn)，p值=0.012）的兒童具有統(tǒng)計(jì)意義，但對(duì)超牙合≥3mm（曼-U檢驗(yàn)，p值=0.277）或AOB（曼-U檢驗(yàn)，p值=0.185）的兒童不具有統(tǒng)計(jì)意義。第II組和第III組之間關(guān)于咬合不正程度的差異對(duì)AOB（曼-U檢驗(yàn)，p值<0.001，超牙合≥2mm（曼-惠特0.001，Table2.DescriptionofallchildrenaccordingtogroupatfinalGroupI(TNP)GroupII(initialpacifier,control interventiongroup,Goldstandard)lisp-valueNMale141313 32.9±32.4±34.6±Meannumberof±19.6±19.6±19.8±Durationpacifier31.8±31.3±28.0± useNForslee16–during6– and00– (hoursper2.2±2.2±–Meanoverjet±2.7±3.2±2.4±Meanoverbite±0.2±-0.8±0.5±≤?overlapN1387?to?overlap113Anterioropenbite10137Overjet≥2mmN212115Overjet≥3mmN10146第I組（薄頸安撫奶II組（安撫奶嘴，對(duì)安撫奶嘴，干p照組第I組（薄頸安撫奶II組（安撫奶嘴，對(duì)安撫奶嘴，干p照組預(yù)組，黃金標(biāo)準(zhǔn)N男14131332.9±32.4±34.6±平均牙齒數(shù)± 19.6±19.6±19.8±安撫奶嘴使用持續(xù)安撫奶嘴使用頻率N16–6–00–2.2±2.2±2.2±–2.7±3.2±2.4±0.2±-0.8±0.5±±SD±SD≤?N1387?至?N113前牙開牙合N10137超牙合≥2mmN212115超牙合≥3mmN10146Boldvaluesindicatestatisticallysignificant,*ComparisongroupIvs.II,Mann–WhitneyU-test,pDuration=0.712,pTime=*第I組與第II組對(duì)比，曼-U檢驗(yàn)，pDuration=0.712,pTime=0.613ThisstudyevaluatedtheimpactofanewlydesignedTNPonpacifier-associatedmalocclusion. ewasthatuseoftheTNPresultedinbetterclinicalmeasurementsregardinerjetandoverbitecomparedtocontinuinguseofconventionalorphysiologicalpacifiersbutnotincomparisontocessationofhabit.TheseobservationsweresupportedbyaclinicalcasereportshowingthatchangingfromaconventionalpacifiertoaTNPcloseda6-mmAOBwithin6monthsina3-year-oldchild(31).Thereareveryfewcontemporarystudiescomparingocclusionsinchildrenwhousedphysiologicalvs.conventionalpacifiers.Withtheexceptionofonestudy(20),noclinicallysignificantdifferenceswerefoundregardingmeanoverjet,meanoverbite,occurrenceofAOBorposteriorcrossbitebetweenphysiologicalandconventionalpacifiers(20–23).ThisstudyisthefirsttoshowadvantagesoftheuseofaTNPoverapreviouslyusedphysiologicalorconventionalpacifierwithrespecttooverjetandoverbite.Ithastobeemphasizedthateventhoughtheobserveddifferencesaresmalltheyarestatisticallysignificant.Inadditionthedifferenceswerenotedafteronlyarelativelyshorttimeofintervention.Howevertheclinicalrelevanceforthepermanentdentitionisyetunprovenandrequiresfurtherresearch.Discrepanciesinocclusalcharacteristicsoftheprimarydentitioncouldleadtosimilarocclusalproblemsinpermanentdentition(4–6,32–34).本研究評(píng)估了新設(shè)計(jì)的TNP對(duì)安撫奶嘴的咬合不正產(chǎn)生的影響。結(jié)果顯示，與繼續(xù)使用普通或生理性安撫奶嘴相比（但并非與改掉此相比，使用TNP產(chǎn)生了關(guān)于超牙合3TNPAOB66-mm（31。極少現(xiàn)代研發(fā)生率或后牙反合的顯著臨床差異（20–23TNP在超牙合和覆牙咬合問題（4–6,32–34Thisstudywasuniqueinthatchildrenwhoalreadyhadapacifier-associatedmalocclusionwererecruited.Itisimportanttonotethateventhoughtheobservationperiodwasshort,children,whowereweanedofftheirpacifier,hadsignificantlyfewerandlesssevereocclusalalterationsthanthoseintheothertwogroups.TheseresultsconfirmrecentfindingsthatifNNSisstoppedbyagetwotothree,spontaneousremissionmayoccur(1,12,14–18,35–38).Therefore,pediatriciansandpediatricdentists mendstoppacifierusebyagetwotothree(1,4–6).Thepresentstudyshowedthatweaningoffapacifieristhebesttreatmentoption.However,itwasalsothemostdifficultoption,consistentwithfindingsofotherstudies(1,4–7,16,23,24,38–40).Parentsworrythatthechildwillstartusingtheirthumborfingerinstead.Inourstudy,sixchildreningroupIIIcouldnotbesuccessfullyweanedofftheirpacifierwithintheexaminationperiod,andthreechildrenstartedthumbsucking.SwitchingfromthepreviouslyusedpacifiertoaTouldbeacompromise.35–38638–40使用的安撫奶嘴變?yōu)門NP可能是一種折衷辦法。Table3.Comparisonofbaselineandfinaldataforall95%p-GroupI(TNP)(thin-neckpacifier,interventionAnterioropenbiteN1310-0.24toMeanoverbite±SD-1.0±-1.2±-0.07toOverjet≥2mmN(%)2221-0.30toMeanoverjet±SD2.3±2.8±-0.76to-Overjet≥3mmN(%)510-0.49toMeanoverjet±SD3.1±3.1±-0.11toGroupII(initialpacifier,controlAnterioropenbiteN1413-0.41toMeanoverbite±SD-1.0±-2.2±0.92toOverjet≥2mmN2221-0.43to-Meanoverjet±SD2.4±3.2±-1.11to-Overjet≥3mmN614-0.69to-Meanoverjet±SD3.2±3.6±-0.52to-GroupIII(weaningoff,interventiongroup,GoldAnterioropenbiteN127-0.30toMeanoverbite±SD-1.0±-0.8±-0.62toOverjet≥2mmN2115-0.39toMeanoverjet±SD2.4±2.4±-0.27toOverjet≥3mmN46-0.47toMeanoverjet±SD3.2±3.1±0.04to95%曼-PI(TNP)（薄頸安撫奶嘴，干預(yù)組前牙開牙合N 1310-0.24平均超牙合±SD -1.0±-1.2±-0.07超牙合≥2mmN(%) 2221-0.30平均超牙合±SD 2.3±2.8±-0.76至-超牙合≥3mmN(%) 510-0.49平均超牙合±SD 3.1±3.1±-0.11前牙開牙合N1413-0.41平均超牙合SD-1.0±-2.2±0.92超牙合≥2mmN2221-0.43至-平均超牙合SD2.4±3.2±-1.11至-超牙合≥3mmN614-0.69至-平均超牙合SD3.2±3.6±-0.52至-前牙開牙合N127-0.30平均超牙合SD-1.0±-0.8±-0.62超牙合≥2mmN2115-0.39平均超牙合SD2.4±2.4±-0.27≥3mmN46-0.47平均超牙合SD3.2±3.1±0.04Boldvaluesindicatestatisticallysignificant,Therearesomelimitationsofthisstudy.Thefirstlimitationwastheprocedureforrecordingpacifier-usetime.Earlierstudieshadshownthat,inretrospect,itisdifficultforparentstogiveapreciseestimationofhoursperdayornight(20–23).Inourstudyparentswereaskedtokeepadiaryofusagetimestoapproximatethechildren’spacifierusetimes.Anotherlimitationofthestudypertainstointra-oralmeasurementsintoddlers<3yearsofageduetotheirstageofdevelopmentandthepossiblelimitedcooperation.Toensurecomparablemeasurementsandstabilizethetoddler,aparentsatinthedentalchairwiththechildinhisorherlap.Iftherewerecooperationproblemsthedentalappointmentwasusedtopracticeandanewdatefortheexaminationwasset.Toreducesourcesofbias,allmeasurementswererecheckedforaccuracy,andfollow-upexaminationswereverifiedbyanoperator,blindedforthegroupthepatientbelongedto.Nonetheless,themeasurementsmighthavebeenmoreaccurateifwehadimpressionsandphotographs.23作好使用時(shí)間，以粗略估計(jì)兒童的安撫奶嘴使用時(shí)間。本研究的另一個(gè)局限是關(guān)于3名不知道相關(guān)患者所屬小組的核實(shí)隨訪檢查。然而，如果我們有和，測(cè)量ThisstudyevaluatedchangesinocclusalcharacteristicsintheprimarydentitionthatmayoccurafterintroducingaTNPtochildrenwithpreviouslydiagnosedAOBandincreasedoverjet.ItwasdemonstratedthatchangingtoaTNPcanreducepacifier-associatedmalocclusionintheprimarydentitioncomparedtoconven