本文選題：安氏Ⅱ1類錯(cuò)牙合　切入點(diǎn)：拔牙矯治　出處：《第四軍醫(yī)大學(xué)》2014年碩士論文

【摘要】：安氏Ⅱ1類錯(cuò)牙合在我國(guó)恒牙期青少年錯(cuò)牙合畸形中約占23.8％，臨床主要表現(xiàn)為上頜前突、下頜后縮，前牙區(qū)深覆牙合、深覆蓋。對(duì)于這種錯(cuò)牙合畸形，拔牙矯治是一種常用的矯治方法，其目的在于利用上頜拔牙間隙解除擁擠，內(nèi)收上前牙，緩解深覆蓋；利用下頜拔牙間隙整平Spee曲線，矯治深覆牙合，同時(shí)前移下后牙，改善磨牙遠(yuǎn)中關(guān)系。拔牙矯治一般會(huì)帶來(lái)牙弓形態(tài)的改變，而牙弓形態(tài)的這些變化主要體現(xiàn)在牙弓寬度、長(zhǎng)度以及牙弓曲線的改變上。 安氏Ⅱ1類錯(cuò)牙合畸形在拔牙矯治后牙弓形態(tài)變化的程度，與矯治作用機(jī)制密切相關(guān)，直接關(guān)系到正畸臨床矯治效果的穩(wěn)定性。本研究通過(guò)選擇拔除4個(gè)第一前磨牙的安氏Ⅱ1類錯(cuò)牙合患者，分析比較患者在矯治前后牙弓不同部位牙弓寬度、長(zhǎng)度及整體牙弓曲線的變化規(guī)律，從而分析其矯治作用機(jī)制，為臨床治療該類畸形確定治療方案、同時(shí)也為進(jìn)一步研究該類型錯(cuò)牙合畸形矯治效果的穩(wěn)定性提供參考。 論文由兩部分組成： 第一部分：牙弓形態(tài)計(jì)算機(jī)輔助分析方法的建立。 本部分研究的目的是針對(duì)安氏Ⅱ1類錯(cuò)牙合拔牙矯治后牙弓形態(tài)變化研究的需要，建立一種能夠進(jìn)行牙弓寬度、長(zhǎng)度測(cè)量及牙弓曲線形態(tài)特征分析的計(jì)算機(jī)輔助分析方法。具體研究?jī)?nèi)容、測(cè)量實(shí)現(xiàn)途徑如下： 1．獲取三維數(shù)字化牙頜模型：利用Zenotec Scan S100三維激光掃描儀對(duì)患者矯治前、后的石膏模型進(jìn)行掃描，得到以*.stl格式（三角網(wǎng)格形式）存貯的三維表面點(diǎn)云文件，通過(guò)Geomagic Studio逆轉(zhuǎn)錄軟件進(jìn)行去除噪點(diǎn)、平滑補(bǔ)洞、拼合減點(diǎn)等處理，獲得精細(xì)的三維數(shù)字化牙頜模型。 2．牙弓曲線形態(tài)參數(shù)的提�。翰捎媚嫦蚬こ�(Reverse Engineering)原理，使用Visual Studio2005和視覺(jué)化工具函式庫(kù)(VTK，Visualization Toolkit)等平臺(tái)作為開(kāi)發(fā)工具，建立牙弓曲線計(jì)算機(jī)擬合系統(tǒng)。利用該系統(tǒng)，首先確定牙弓形態(tài)測(cè)量平面，然后確定三維數(shù)字化牙頜模型表面牙弓曲線擬合用標(biāo)志點(diǎn)及其在測(cè)量平面生成牙弓曲線擬合用點(diǎn)，最后實(shí)現(xiàn)牙弓曲線的擬合及擬合用點(diǎn)坐標(biāo)的導(dǎo)出等功能，完成牙弓曲線形態(tài)參數(shù)的提取。 3．牙弓形態(tài)計(jì)算機(jī)輔助分析方法的功能實(shí)現(xiàn)：將牙弓曲線形態(tài)參數(shù)導(dǎo)入MATLAB軟件，進(jìn)行相應(yīng)的數(shù)學(xué)運(yùn)算任務(wù)編程，實(shí)現(xiàn)牙弓曲線上不同部位牙弓寬度、長(zhǎng)度的測(cè)量及牙弓曲線形態(tài)特征分析等功能。 第二部分：安氏Ⅱ1類錯(cuò)牙合拔牙矯治后牙弓形態(tài)變化的研究。 目的：分析安氏Ⅱ1類錯(cuò)牙合患者拔牙矯治后牙弓形態(tài)各個(gè)方面的變化規(guī)律，為正畸臨床中治療方案的確定提供參考。 方法：選取30例安氏Ⅱ1類錯(cuò)牙合病例，分別取拔牙矯治前、后的石膏模型進(jìn)行三維（3D，Three dimensional）激光掃描，獲取數(shù)字化牙頜模型，利用本研究中所建立的牙弓曲線計(jì)算機(jī)擬合系統(tǒng)擬合出相應(yīng)牙弓曲線并提取擬合用點(diǎn)的三維坐標(biāo)，導(dǎo)入MATLAB軟件進(jìn)行數(shù)學(xué)運(yùn)算任務(wù)編程，計(jì)算上下牙弓治療前后不同部位牙弓寬度、長(zhǎng)度的數(shù)值。通過(guò)配對(duì)t檢驗(yàn)方法對(duì)矯治前后不同部位牙弓寬度、長(zhǎng)度的變化進(jìn)行統(tǒng)計(jì)學(xué)分析；通過(guò)生成治療前、后牙弓形態(tài)測(cè)量分析平面上牙弓曲線擬合用點(diǎn)的平均牙弓曲線，比較分析安氏Ⅱ1類錯(cuò)牙合拔牙矯治后牙弓形態(tài)的變化。 結(jié)果：（1）牙弓寬度變化：安氏Ⅱ1類錯(cuò)牙合患者經(jīng)矯治后，上頜前部牙弓寬度側(cè)切牙區(qū)、尖牙區(qū)雖有增加，但增加的量較小，側(cè)切牙區(qū)寬度增加了1.74±1.48mm(P＜0.01)，尖牙區(qū)寬度增加了0.90±1.20mm(P＜0.05)。上頜后部牙弓寬度在各個(gè)牙位均明顯減小，第二前磨牙及第一磨牙間的寬度相對(duì)于前牙區(qū)的變化量較大，分別減小了4.08±1.32mm（P＜0.001)、3.19±1.35mm（P＜0.001)，而第二磨牙間的寬度減小量下降為1.89±0.96mm（P＜0.001)。下頜牙弓的寬度變化與上頜基本是一致的，前部牙弓寬度僅在中切牙區(qū)有少量增加治療前后增加了0.26±0.30mm（P＜0.05)，側(cè)切牙及尖牙區(qū)則未見(jiàn)明顯改變。下頜后部牙弓寬度呈現(xiàn)出與上頜后部牙弓相適應(yīng)的減小性變化，第二前磨牙區(qū)牙弓平均寬度治療后減小了4.47±3.06mm（P＜0.001)，第一磨牙區(qū)牙弓寬度減小了2.48±1.80mm（P＜0.001)，而第二磨牙區(qū)牙弓寬度治療前后未見(jiàn)明顯變化。 （2）牙弓長(zhǎng)度變化：安氏Ⅱ1類錯(cuò)牙合患者經(jīng)矯治后，上頜尖牙區(qū)牙弓長(zhǎng)度增加1.18±1.19mm（P＜0.05)，，增加量比較小，而上頜后部第二前磨牙、第一磨牙及第二磨牙區(qū)牙弓長(zhǎng)度分別減少了5.96±3.14mm（P＜0.001)，6.53±2.04mm（P＜0.001)及6.35±1.79mm（P＜0.001)，其長(zhǎng)度的變化量要大于前部牙弓。下頜牙弓前部及后部長(zhǎng)度的變化與上頜是一致的。 （3）牙弓弓形形態(tài)的變化：根據(jù)30例患者治療前后所有的牙弓曲線擬合用點(diǎn)計(jì)算出上下頜矯治前后的平均點(diǎn)分布圖，從分布圖展現(xiàn)出來(lái)的牙弓弓形形態(tài)看，治療前后上、下頜牙弓的弓形形態(tài)基本是一致的，沒(méi)有發(fā)生明顯的變化。 結(jié)論：本研究的上述結(jié)果提示，對(duì)于安氏Ⅱ1類錯(cuò)牙合拔牙矯治來(lái)說(shuō)，其矯治后牙弓形態(tài)沒(méi)有發(fā)生明顯的改變。對(duì)于這些安氏Ⅱ1類錯(cuò)牙合拔牙矯治前后牙齒位置在矢狀向上存在明顯位移的患者，左右兩側(cè)同名牙間的寬度變化并不能準(zhǔn)確地反映牙弓弓形寬度的變化。結(jié)合本研究關(guān)于矯治后牙弓長(zhǎng)度在前、后部均有減低的結(jié)果進(jìn)行分析，安氏Ⅱ1類錯(cuò)牙合拔牙矯治后，上述左右同名牙間寬度的變化的一個(gè)重要機(jī)制為矢狀向上牙齒位置的前后移動(dòng)，造成了其在水平橫向上寬度及長(zhǎng)度的變化。本研究的結(jié)果說(shuō)明，牙弓形態(tài)的擬合提取在分析拔牙患者的牙弓形態(tài)的變化中的重要作用，本研究中建立的牙弓形態(tài)計(jì)算機(jī)輔助分析方法，可作為牙弓形態(tài)的擬合提取工具，有一定的推廣應(yīng)用價(jià)值。
[Abstract]:Class II Division 1 malocclusion in permanent dentition malocclusion teenagers in China accounted for about 23.8% anomalies, the main clinical manifestations of maxillary protrusion, mandibular retrusion, anterior deep overbite, deep overjet. For this kind of malocclusion, orthodontic extraction is a commonly used treatment method, its purpose in the extraction of tooth space lift congestion, adduction of upper anterior teeth, alleviate the deep overburden; using mandibular extraction space leveling Spee curve, correction of deep overbite, and forward under the posterior teeth, improve the relationship between the molars. Extraction treatment typically leads to the change in arch form, and these changes mainly reflected the state of dental arch width in the dental arch, and the length of the dental arch curve changes.
Class II Division 1 malocclusion after extraction treatment of dental arch shape change degree is closely related with the treatment mechanism, directly related to the stability of orthodontic clinical treatment effect. This study through the selection of extraction of 4 first premolar of the class II Division 1 malocclusion patients, compared with the width of the teeth before and after treatment different parts of the dental arch arch, and the whole length changes of dental arch curve, then analyzes its treatment mechanism, this kind of deformity to determine treatment options for clinical treatment, but also provide a reference for the malocclusion treatment effect the stability of further research of this type of fault.
The paper consists of two parts:
The first part: the establishment of computer aided analysis of dental arch.
The objective of this study is to meet the needs of class II Division 1 malocclusion tooth changes of posterior arch shape correction, can establish a dental arch width, analysis method of computer aided measurement and analysis of the length of the dental arch curve morphological characteristics. The specific research contents, measurement ways are as follows:
1. to obtain the 3D digital dental model: using Zenotec Scan S100 three-dimensional laser scanner in patients before treatment, after the plaster models were scanned with *.stl format (triangular form) 3D surface point cloud file storage, remove the noise by Geomagic Studio reverse transcription software for smooth hole filling, split point subtraction processing. Get the 3D digital dental model with fine.
Extraction of 2. morphological parameters of the dental arch curve by Reverse Engineering (Reverse Engineering) principle, using Visual Studio2005 and Visualization Toolkit (VTK Visualization Toolkit) platform as a development tool, the establishment of the dental arch curve fitting system. By using the computer system, first determine the arch form measuring plane, and then determine the three-dimensional the digital tooth surface of dental arch curve fitting combined point model and in the measurement plane generation dental arch curve fitting, and finally realize the fitting and fitting of dental arch curve by point coordinate export functions, complete the extraction of dental arch curve parameters.
3. methods of analysis of the arch form of computer aided functions: the dental arch curve shape parameter into MATLAB software, mathematical programming tasks corresponding to the implementation of the dental arch curve on different parts of the arch width, measurement and morphological characteristics of dental arch curve analysis function of length.
The second part: the study of class II Division 1 malocclusion tooth dental arch morphology treatment.
Objective: to analyze the changes of class II Division 1 malocclusion patients of posterior arch shape extraction treatment in various aspects, and provide some reference for orthodontic clinical treatment programs.
Methods: 30 cases of class II Division 1 malocclusion cases were taken before extraction treatment, the 3D model of gypsum (3D, Three dimensional) laser scanning, acquisition of digital dental model established in this study, using dental arch curve fitting computer system fitting the dental arch curve and extracted by fitting the three-dimensional coordinates of points, import MATLAB software for mathematical programming tasks, calculated before and after treatment in different parts of the dental arch width and length value. Through paired t test before and after treatment in different parts of the arch width and length changes were statistically analyzed; through the generation before treatment, analysis of posterior arch form measurement plane the dental arch curve fitting with the average dental arch curve points, comparative analysis of class H Division 1 malocclusion with extraction treatment changes of posterior arch form.
Results: (1) the changes of dental arch width: Class II Division 1 malocclusion patients after treatment, anterior maxillary lateral incisor width, canine area had increased, but the increase was smaller, the width of the lateral incisor area increased 1.74 + 1.48mm (P < 0.01), intercanine width increased by 0.90 + 1.20MM (P < 0.05). Posterior maxillary dental arch width were significantly decreased in all teeth, second premolars and first molar width variation with respect to the anterior region of the larger amounts were reduced by 4.08 (P < 0.001) + 1.32mm, 3.19 + 1.35mm (P < 0.001), and the second molar the width reduction decreased to 1.89 + 0.96mm (P < 0.001). The width changes with the maxillary mandibular arch is basically the same, the front arch width in only a small increase in the incisor region before and after treatment increased 0.26 + 0.30mm (P < 0.05), lateral incisor and canine posterior area did not change significantly. The dental arch width and showing The maxillary posterior arch adaptation decreased. The average width of dental arch in second premolar area decreased by 4.47 + 3.06mm after treatment (P < 0.001). The width of the first molar area decreased by 2.48 + 1.80mm (P < 0.001), while the second molar area arch width did not change significantly before and after treatment.
(2) changes the length of dental arch: Class II Division 1 malocclusion patients after treatment, the maxillary canine area arch length increased 1.18 + 1.19mm (P < 0.05), increase the amount is relatively small, and the posterior maxillary second premolar, first molar and two molar tooth arch length decreased respectively (5.96 + 3.14mm P < 0.001), 6.53 + 2.04mm (P < 0.001) and 6.35 + 1.79mm (P < 0.001). The variation of its length is greater than the anterior arch and the maxillary mandibular arch. Changes of the front and back length is the same.
(3) the changes of dental arch form: according to the dental arch curve fitting of all patients before and after treatment in 30 cases with the calculated average point before and after the treatment of mandibular distribution, from the distribution map show the dental arch form, before and after the treatment, the dental arch arch shape is basically the same, no significant changes.
Conclusion: the results of this study suggest that for class II Division 1 malocclusion extraction treatment, the treatment of dental arch form was not changed obviously. For these class II Division 1 malocclusion after extraction in tooth position in the sagittal direction has obvious displacement with the right and left sides of the teeth width the room does not accurately reflect the changes of dental arch width. Combined with the research on treatment of posterior arch length in front and rear were reduced by analyzing the results of the class II Division 1 malocclusion after extraction treatment, one of the important mechanisms of the change of width of the left and right teeth between the sagittal to move on the position of the teeth, resulting in the horizontal lateral width and length changes. The results of this study show that the fitting extraction of dental arch form an important role in the changes of dental arch form tooth extraction in this study. The computer aided analysis method of dental arch form established in this paper can be used as a fitting extraction tool for dental arch shape, and has certain popularization and application value.

【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R783.5

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