本文選題：雙側后牙反牙合 + 正畸治療��； 參考：《大連醫(yī)科大學》2014年碩士論文

【摘要】：目的：探討在臨床中正畸治療雙側后牙反牙合的方法，評價使用上頜快速擴弓聯(lián)合自鎖托槽矯治雙側后牙反牙合的治療效果。 方法：選取1例雙側后牙反牙合的錯牙合畸形患者作為研究對象，男性，年齡16歲，漢族；Angle III類，骨性III類，上下頜骨均發(fā)育正常；雙側磨牙近中關系，雙側尖牙中性關系；前牙對刃；上下牙列中線對正；左上側切牙腭向錯位，雙側第一恒磨牙反牙合；上頜牙弓擁擠度通過記存模型測量為9.5mm，下頜牙弓擁擠度通過記存模型測量為4.5mm。對患者進行問診、專科檢查，對其研究模型、面相口內像、頭影測量數(shù)據(jù)等進行診斷分析，征得患者及家長同意，考慮患者主觀要求，選擇采用以下治療方案：先采用上頜快速擴弓拓展上頜牙弓寬度，解除后牙反牙合，再使用SmartClipTM自鎖矯治器排齊整平上下頜牙列，維持上頜寬度并利用頜間牽引調整上下牙列矢狀向不調。治療前后拍攝面像、口內像、曲面斷層片、頭顱側位片，觀察頜面、牙齒、骨骼情況。選取北醫(yī)分析法、Downs分析法、E線等共24項測量項目，對測量項目進行治療前后對比，反映矯治前后軟硬組織數(shù)據(jù)改變及側貌變化。 結果：矯治療程共計31個月。矯治結束后患者上下牙列已排齊整平，上下牙列中線對正，前牙覆牙合覆蓋均在正常范圍內，雙側尖牙、磨牙已達到中性關系；上下頜牙齒無牙合干擾，顳下頜關節(jié)開口型、開口度未見異常，雙側關節(jié)區(qū)無彈響、壓痛；從治療前后記存模型對比可知（1）上牙弓前段長度增加1.5mm，中段長度不變，后段增加1.5mm；下牙弓前段長度增加2mm，中段長度增加1.5mm，后段長度不變；可明顯看出見治療后上下牙弓長度的增加，為解除擁擠和改善矢狀向不調提供了幫助。(2)上頜前段牙弓寬度增加了4.5mm，中段牙弓寬度增加了4.5mm，后段牙弓寬度增加了6.0mm；下頜前段牙弓寬度減少了0.5mm，中段牙弓寬度增加了1.5mm，后段牙弓寬度減少了2.0mm。可見通過上頜擴弓及自鎖矯治器的固定矯治，上頜牙弓寬度的增加非常明顯，對擁擠的解除和后牙反牙合的解除起了關鍵的作用，而下頜牙弓寬度的縮窄是為了與上頜相匹配，達到正常的覆牙合覆蓋關系。從治療前后頭顱側位片對比可知（1）ANB增加2.5°，說明上下頜骨矢狀向不調有所改善；（2）U1-SN增加0.5°、 U1-NA增加1°、L1-MP增加5°、L1-NB增加4.5°、U1-L1減小7.5°，說明上下前牙唇傾度控制良好，下前牙較矯治前更為接近正常數(shù)值，且上下前牙凸度變大。（3）MP-SN增大1.5°、MP-FH增大2.5°，說明矯治后面部垂直關系略微增高。（4）治療后Ls-E、Li-E均增加0.5mm，ULP不變、LLP增加1mm；NLA治療后相比治療前增加了5°，說明通過治療患者獲得了更直的面型，側貌得到改善。 結論：該病例通過上頜快速擴弓與自鎖托槽聯(lián)合使用，取得了良好療效：成功的解除了后牙反牙合和前牙對刃，上下牙列排齊整平，，雙側尖牙磨牙獲得中性關系，后牙尖窩關系良好，覆牙合覆蓋恢復正常。上頜快速擴弓與自鎖托槽的使用解決了上頜牙弓寬度不足以及上下頜牙弓擁擠的問題，且在未拔牙的情況下控制住了前牙的唇傾度，患者軟組織側貌有所改善，可見上頜快速擴弓聯(lián)合自鎖托槽是一種有效的正畸治療雙側后牙反牙合的方法。
[Abstract]:Objective : To evaluate the effect of orthodontic treatment of bilateral posterior teeth on bilateral posterior teeth by using maxillary rapid arch expansion combined with self - locking bracket .

Methods : One patient with bilateral posterior teeth was selected as the study object , male , aged 16 years old , Han nationality ;
Angle III , bone type III , upper mandible all developed normal ;
Keywords bilateral molar near - middle relation , bilateral cuspal sexual relations ;
a pair of anterior teeth ;
the midline of the upper and lower teeth is aligned ;
the left upper jaw palate is malposition , and the bilateral first permanent molar is anti - occlusal ;
The maxillary arch crowding degree was 9.5 mm through the memory model , and the degree of submaxillary arch crowding was 4.5 mm . The patients were diagnosed and analyzed by using the model , the internal image , the cephalometric data and so on . After the treatment , the maxillary arch width was enlarged , the posterior teeth were removed , and the sagittal alignment of the upper and lower teeth was adjusted by the use of the SmartLock TM self - locking appliance .

Results : The treatment course lasted for a total of 31 months . After the treatment , the upper and lower teeth of the patients had been completely flat , the midline of the upper and lower teeth were in the normal range , the bilateral sharp teeth and the molar teeth had reached the middle - sex relationship ;
There were no occlusal interference on the upper and lower jaw teeth , open type of temporo - mandibular joint , no abnormal opening degree , no elastic ring and tenderness in bilateral joint area ;
Compared with the pre - treatment model , the length of the anterior segment of the maxillary arch was 1.5 mm , the length of the middle segment was unchanged , and the posterior segment was increased by 1.5 mm ;
the length of the front section of the lower arch is increased by 2mm , the length of the middle section is increased by 1.5mm , and the length of the rear section is unchanged ;
( 2 ) The arch width of the maxillary anterior segment increased by 4.5 mm , the width of the middle arch was increased by 4.5 mm , and the width of the posterior arch was increased by 6.0 mm ;
The arch width of the maxillary anterior segment decreased by 0.5mm , the width of the middle arch was increased by 1.5mm , the width of the posterior arch was decreased by 2.0 mm . It was found that the width of maxillary arch decreased by 2.0 mm .
( 2 ) U1 - SN increased by 0.5 擄 , U1 - NA increased by 1 擄 , L1 - MP increased by 5 擄 , L1 - NB increased 4.5 擄 , U1 - L1 decreased by 7.5 擄 , and that of upper and lower anterior teeth increased by 1.5 擄 and MP - FH increased by 2.5 擄 .
NLA increased by 5 擄 before treatment , indicating improved profile and side profile improvement by treatment of patients .

Conclusion : This case has been used in combination with self - locking bracket through maxillary rapid arch expansion . It has achieved good curative effect . The relationship between maxillary arch width and maxillary arch is good , and the relationship between maxillary rapid expanding arch and self - locking bracket is normal . The use of maxillary rapid expanding arch and self - locking bracket solves the problem of maxillary arch width deficiency and maxillary arch crowding .
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R783.5

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