医学-wagner orthodontics article2016cn en口腔正畸学和颌面研究

Orthodntics&CraniofacialResearchORIGINALARTICLER.Heinrich-R.Heinrich-

Effectofathin-neckpacifieronprimarydentition:arandomizedcontrolledtrialAuthors'Y.Wagner,R.Heinrich-Weltzien,DepartmentofPreventiveDentistryandPediatricDentistry,JenaUniversityHospital,Jena,Germany德国耶拿大学附属医院口腔预防

WagnerY.,Heinrich-WeltzienR.Effectofathin-neckpacifieronprimarydentition:arandomizedcontrolledOrthodCraniofacRes2016.©2016JohnWiley&SonsA/S.PublishedbyOrthodCraniofacRes2016.©2016JohnWiley&SonsA/S.JohnWiley&由JohnWiley& DepartmentofPreventiveDentistryandPediatricDentistryJenaUniversity德国耶拿大学附属医院口腔预防Bachstr.18Jena,Germany.:Yvonne.Wagner@med.uni-jena.de

Objectives–Toevaluatechangesinocclusalcharacteristicsintheprimarydentitionthatoccurafterintroducingathin-neckpacifier(TNP)tochildrenwithpreviouslydiagnosedpacifier-associatedanterioropenbite(AOB)andincreasedoverjet.目标–评估（SettingandSamplePopulation–DepartmentofPreventiveandPediatricDentistry,JenaUniversityHospital,Germany.Subjectswere86children(meanage20.3months)withapacifier-associatedopenbiteoroverjet≥2mm.试验环境和样本群体–相关开牙合或超牙合（≥2mm）86名儿童，平均为20.3个月。Material&Methods–Randomizedtrial.Subjectswererandomlyassigned:groupI(n=28),interventiongroupusingaTNP;groupII(n=30),controlgroup,usingaconventionalorphysiologicalpacifier;andgroupIII(n=28),interventiongroup,Goldstandard,weanedoffpacifier.Participantswerere-examinedafter3,6,9and12monthsbyanoperator,blindedforthe材料与方法–I组(n=28)TNP的干预组；II组(n=30)，对照组，使用传统或生理安抚戒掉安抚奶嘴。一名不了解治疗的在第3、6、912个月时对参与者进行重新检验。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个月数据后得出如下结论：组之间II组：3.2_0.7mmIII组：2.4_0.5mm，=_0.8mm，Kruskal–Wallis，p0.001）的显著_0.2mm3.6_0.3mm，Mann–Whitney，p<0.001）和AOB（_1.2_0.3mm与_2.2_0.3mm，Mann–Whitney，p0.001）程度的差异具有统计Conclusion–UseofTNPresultedinbetterclinicalmeasurementsforinoverjetandoverbitecomparedwiththecontinuinguseofconventionalorphysiologicalpacifiers.结论–与继续使用传统或生理安抚奶嘴相比，TNP产生了更好的超牙合与覆牙合临床测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).非营养性吸吮（NNS）行为极为常见，NNS60%80%以上（1、2（3–5大多数文化中使用安抚奶嘴被视为是一种社会正常现象戒掉安抚奶嘴可能较为1、5理想情况下儿童应在24–36个月大时改掉NNS以降低咬合不正的风（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).有大量研究过NNS对咬合特征的影响结果发现超过3岁以上仍有NNS（1–15（AOB（5–1514–1814–18岁以上仍使用安抚奶嘴的大多数儿童都患有咬合不正（18、19。在安抚奶嘴持续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.沃勒劳（图1。迄今为止，尚无纵向体内研究旨在TNP对牙齿发育的影响。因此本研究的目的是对比先前确诊患有AOB和增大超牙合的儿童使用TNP后使用普改变TNP会降低安抚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。该研究还遵从CONSORT原则。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.我们对在2012年5月至2014年1月参加德国耶拿大学附属医院预防牙科进行常规齿检查的所有新患者（n=106）进行了资格评审。入选标准为父母提供同意书；16–24AOB或增大超牙合（AOB≤0mm和/或超FosteretHamilton标准(28)，测量值≥2mm视为增大超牙合(28)。排除标准包括未签订书面同意书；超过或不满可接受的范围；性、遗传性或性发育不良；早产；15个月以及数据不完整。八十六名平均为20.3个月的儿童符合入选标准。这些儿童被随机分配至三个组：第I组（干预）TNP(n=28)II组（对照）(n=30)III组（干预，黄金标准）是将在研究期间戒掉安抚奶嘴的儿童（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.分组工作由不参与研究的研究助理使用准备好的按顺序的不透明的密封信（包含组号）执行。使用SAS9.2计算机程序（北卡罗莱纳州凯里市SAS软件学院）生成随机分配序（并行分配均等分配比例区组随机化区组长度6随机数5834935Childrenwereexcludedfromthefinalysisiftheydidnotfollowthestudyregimen(e.g.,iftheyswitchedtoanotherpacifierorstartedsuckingtheirthumb).IngroupIII,onlychildrenwhoweresuccessfullyweanedofftheirpacifierduringthestudyperiodwereincludedinthefinalysis.Cessationofpacifieruseforatleast3monthswasconsideredsuccessfulIII组的最终分析中仅包含在研究期间成功戒掉安抚奶嘴的儿童。戒掉3个月方可视为成功戒掉安抚奶嘴。Allparentsreceivedstudyinstructions.ToensurethatlostpacifiersingroupIcouldbereplacedimmediay,parentsreceivedsufficientreplacementsoftheexperimentalpacifier.Parentswereinstructedoncompletionofadiaryofpacifierusagetimetorecordtheapproximatehoursofpacifierusebythechild.ParentsingroupIIIweregivenguidanceonhowtoweantheirchildoffthepacifier.Forexample,aslow,gentleweaningprocessvs.stopimmediay;restrictingthepacifiertocertaintimesorcertainplaces;takeorgiveitawayorloseit;orleaveitforthebinkyfairy.Ithastobementionedthatallparentsreceivedthesameguidancetoassisttheirchildinceasingthehabitindependentlyoftheirgroupallocation.对所有患者进行研究指导。为确保第I组中失去的安抚奶嘴立即得到代替，我们为父母们IIIbinkyfairy。必须提到的是，我们向所有父母都提供了关于如何协助其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:铅笔记号表示程度相关的测量值覆牙合按照下颌切牙牙冠百分比记录为覆牙≤⅓one-thirdcoveringoflower⅓to⅔betweenone-thirdandtwo-thirds>⅔morethantwo-thirds>⅔Openbite,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/增大超牙合的主要结果测量值分别为_1.0_0.2mm/2.8_0.4mm和_2.3_0.221名儿童（nQueryAdvisor7.0StatisticalSolutions28名儿童，以保证在中途有参与者退出仍有 DatawererecordedinExcelfilesandtransferredtotheStatisticalPackageforSocialSciences(SPSSversion20,IBMCorporation,Armonk,NY,USA).ThedatawereyzedusingtheMann–WhitneyU-test(forcomparisonoftwogroups),Kruskal–Wallis(forcomparisonofthreegroups)andBonferroniintervals(forthedifferencebetweenmeanvaluesoftativevariables).Ap-value≤0.05wasusedtoindicatestatisticallysignificantdifferences.数据记录在Excel文件中并传输至社会科学统计软件包（20SPSS，IBMCorporation，美国纽约州克市。数据采用曼-U检验（用于比较两个组、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究群体的参与流程图。八十名患者（平均为20.3_2.4个月，48名为）被随机分配I28（TNP，干预组II30（，III28名（戒掉安抚奶嘴，干预组，黄金标准。十二名儿童因搬迁、未到场或开始吸吮拇指而失去随访。我们邀请了七十四名儿童进行最终检验。十一名儿童因牙、口呼吸或未戒掉安抚奶嘴而被排除之外。最终，63名对象（平均为33.1_5.0个月，40名）符合入选标准（第I组：n=24；第II组：n=22；第III组：n=17。第I组和第II组中无一儿童改掉该并保持超过3个月BaselinepatientDescriptionsofallchildrenaccordingtogroupatbaselinearepresentedinTable1.Allweredrawnfromthesamepopulation.Therewerenobaselinedifferencesbetweengroupsregardingage,numberofteeth,diet,pacifiertype,durationandfrequencyofpacifieruse,orocclusalcharacteristics(Kruskal–Wallistest,p>0.05).Mostofthechildren(82.0%)startedtheuseofthepacifierintheirfirstmonthoflife.Allchildrenhadanintensepacifierusethroughoutthedayandnightandengagedinthehabitformorethan8haday.关于、牙齿数、饮食、安抚奶嘴类型、安抚奶嘴使用持续时间和频率或咬合特（.Kruskal-Wallis检验，p>0.05）的基线差异。大多数儿童(82.0%)在出生后第一个月就开8小时。 随机对照分配分配至第I 分配至第II 分配至第III（薄颈安抚奶嘴，干预组）（最初安抚奶嘴，对照组）（ 金标准随访·搬迁·搬迁··搬迁·未出现·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中提供最终检查时的所有儿童情况说明（按组。组之间不存在关于、和牙数（Kruskal–Wallis测试，p>0.05）的差异。第III组儿童已改掉安抚奶嘴使用，因此0.010间和平均安抚奶嘴使用时间的差异不具有统计意义（曼-U检验，pDuration=0.712,pTime=0.613。三个组之间关于平均超牙合（Kruskal–Wallis,p=0.002）（Kruskal–Wallis,p=0.031）的差异具有统计意义。Bonferroni依赖间隔证明，使用普通或具有统计意义（Kruskal–Wallis测试，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组中，基线和随访之间唯一重要的测量值变化是平均超牙合≥2mm（曼-U检验0.001病率除外。第III组中存在超牙合≥3mm从基线到最终随访期间变化的有力（曼-惠特尼U检验，p=0.002，但其他测量值的变化缺乏。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±≤⅓overlapN131213⅓to⅔overlapN243Anterioropenbite131412Meanoverbite±_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组 第II组（最III组（戒掉（薄颈安抚奶安抚奶嘴，对安抚奶嘴，干p 照组预组，黄金标准N 男N14 1717 平均±SD（月数 20.8± 20.1± 20.1± 平均牙齿数平均牙齿数N15.2±14.9±15.0±喂养N192620最高（岁0.8±0.8±0.8±奶瓶喂养N747最高（岁0.9±1.0±1.0±N181412最低（岁0.7±0.6±0.8±N283028最低（岁1.0±1.0±0.9±N2220206108安抚奶嘴使用持续19.5±19.0±19.1±±2.2±2.1±2.1±±0.3±0.4±0.4±N131213⅓toN243前牙开牙合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的差异不具有统计意义（曼-U检验，p值>0.05。第I0.001，m（p=0.015m（p的儿童具有统计意义第I组和第III组之间的差异仅对超牙合≥2mm（曼-U检验，p值=0.012）的儿童具有统计意义，但对超牙合≥3mm（曼-U检验，p值=0.277）或AOB（曼-U检验，p值=0.185）的儿童不具有统计意义。第II组和第III组之间关于咬合不正程度的差异对AOB（曼-U检验，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±≤⅓overlapN1387⅓to⅔overlap113Anterioropenbite10137Overjet≥2mmN212115Overjet≥3mmN10146第I组（薄颈安抚奶II组（安抚奶嘴，对安抚奶嘴，干p照组第I组（薄颈安抚奶II组（安抚奶嘴，对安抚奶嘴，干p照组预组，黄金标准N男14131332.9±32.4±34.6±平均牙齿数± 19.6±19.6±19.8±安抚奶嘴使用持续安抚奶嘴使用频率N16–6–00–2.2±2.2±2.2±–2.7±3.2±2.4±0.2±-0.8±0.5±±SD±SD≤⅓N1387⅓至⅔N113前牙开牙合N10137超牙合≥2mmN212115超牙合≥3mmN10146Boldvaluesindicatestatisticallysignificant,*ComparisongroupIvs.II,Mann–WhitneyU-test,pDuration=0.712,pTime=*第I组与第II组对比，曼-U检验，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).本研究评估了新设计的TNP对安抚奶嘴的咬合不正产生的影响。结果显示，与继续使用普通或生理性安抚奶嘴相比（但并非与改掉此相比，使用TNP产生了关于超牙合3TNPAOB66-mm（31。极少现代研发生率或后牙反合的显著临床差异（20–23TNP在超牙合和覆牙咬合问题（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使用的安抚奶嘴变为TNP可能是一种折衷办法。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)（薄颈安抚奶嘴，干预组前牙开牙合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前牙开牙合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-前牙开牙合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作好使用时间，以粗略估计儿童的安抚奶嘴使用时间。本研究的另一个局限是关于3名不知道相关患者所属小组的核实随访检查。然而，如果我们有和，测量ThisstudyevaluatedchangesinocclusalcharacteristicsintheprimarydentitionthatmayoccurafterintroducingaTNPtochildrenwithpreviouslydiagnosedAOBandincreasedoverjet.ItwasdemonstratedthatchangingtoaTNPcanreducepacifier-associatedmalocclusionintheprimarydentitioncomparedtoconven