本文選題：青少年 + 臨界病例　； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：通過對(duì)青少年臨界病例進(jìn)行非拔牙矯治，比較其矯治前后頦部位置形態(tài)的變化，分析臨床非拔牙矯治對(duì)頦部變化的作用，同時(shí)探討生長發(fā)育因素對(duì)頦部的影響，以達(dá)到為正畸實(shí)踐工作所借鑒的目的。 方法：選擇沈陽市口腔醫(yī)院二零一零年暑期就診的青少年男性患者一例，為骨性Ⅱ類錯(cuò)牙合，深覆牙合Ⅲ°、深覆蓋Ⅲ°、上牙列存在牙間散隙、下牙列輕度擁擠，磨牙關(guān)系為左側(cè)正常、右側(cè)輕度遠(yuǎn)中錯(cuò)牙合關(guān)系，兩側(cè)尖牙是輕度遠(yuǎn)中錯(cuò)牙合關(guān)系，軟組織側(cè)貌顯示面中部前突，頦唇肌緊張，口唇閉合困難；沈陽市口腔醫(yī)院正畸科室的五位專家一致評(píng)定其為臨界病例，且非拔牙矯治方案得到一致認(rèn)可。上下頜使用直絲弓矯治技術(shù)，上頜牙列序列排齊的同時(shí)配合使用口外弓頸牽引，內(nèi)收上前牙，改善上前牙的傾斜度；使用上頜斜導(dǎo)刺激下頜骨進(jìn)一步生長發(fā)育；關(guān)閉上下頜牙列間散隙，配合使用皮圈牽引，精細(xì)調(diào)整牙齒咬合關(guān)系。矯治前后均拍攝全牙弓曲面斷層片以及頭顱側(cè)位片，并對(duì)矯治前后的頭顱側(cè)位片進(jìn)行頭影描繪并測量，比較分析前后頦部軟硬組織的變化以及軟組織側(cè)貌改善情況。 結(jié)果：經(jīng)過非拔牙矯治后，上下牙列排列整齊；Spee曲線較平直；覆牙合覆蓋在前牙達(dá)到正常，尖牙以及磨牙的關(guān)系恢復(fù)到正常；下牙列中線與上牙列中線均不偏斜且相互對(duì)齊，上下頜牙齒均達(dá)尖窩交錯(cuò)咬合關(guān)系。矯治前后牙弓長度變化為：上牙弓前段、中段的長度減小，后段長度增加。矯治前后牙弓寬度變化為：上牙弓前段、中段的寬度減小，后段寬度增加。頦唇肌緊張得到緩解，無口唇閉合困難，唇突度減少，頦部形態(tài)改變，側(cè)貌有改善，患者對(duì)矯治結(jié)果滿意。對(duì)比矯治前后的牙牙合顱面關(guān)系測量項(xiàng)目：SNA減小，SNB增大， ANB減小，提示上頜骨發(fā)育受限制，下頜骨繼續(xù)發(fā)育，上下頜骨差異減��；下頜平面角及Y-axis基本不變，提示垂直向控制較成功；NP-FH、Po-NB、SL、 Co-Po、ANS-Me、N-Me變大，提示隨下頜骨的生長，頦部突度增大，全面高及下面高增加；UI-SN、 UI-NP、UI-AP、UI-LI減小，提示上切牙內(nèi)收、突度減小，上、下切牙間的突度減小；ULP、LLP、 Z角、Ns-Sn-Pos、FCA減小，提示唇突度減小，面型突度減小，側(cè)貌改善。矯治后李某的頦部硬組織變化為：頦高度、頦厚度、頦前厚、頦后厚、頦前厚/頦后厚、頦凹陷均有不同程度的增大，頦高/頦厚、頦部最小厚度/頦厚、頦角變小，，提示頦部隨著生長發(fā)育向前向下生長，頦突度增加，體積變大，形態(tài)改變，并且這種改變利于面型的改善。對(duì)比矯治前后頦部軟組織的數(shù)據(jù)見：頦唇溝的變淺，頦唇溝弧度變大，頦部的長度減小、弧度變大，頦部的突度也變大，EP-UL、 EP-LL減小，提示頦部軟組織形態(tài)發(fā)生改變；隨著下頜骨的前下移位、上下唇突度的減小、頦部突度的變大，軟組織側(cè)貌突度減小，最終側(cè)貌得到改善。 結(jié)論：1.臨床正畸在診斷和治療時(shí)，要考慮到頦部的生長發(fā)育，以便對(duì)矯治結(jié)果做出更好的預(yù)測；還要積極利用生長發(fā)育，促進(jìn)頦部向前發(fā)育，以便更好的改善面型。2．在本研究中，青少年臨界病例經(jīng)過非拔牙矯治后，頦部的軟、硬組織形態(tài)位置發(fā)生了變化，頦唇關(guān)系得到了協(xié)調(diào)，最終軟組織側(cè)貌改善。
[Abstract]:Objective: To compare the changes of the position of the chin position before and after the correction of the non extraction of the critical cases in adolescents, and to analyze the effect of the clinical non extraction treatment on the mental change of the chin, and to explore the influence of the growth and development factors on the chin, so as to achieve the purpose of the orthodontic practice.
Methods: a case of adolescent male patients in the summer period of 2010 in Shenyang City stomatology hospital was selected as a case of skeletal Class II malocclusion, deep overlying teeth and deep coverage of 3 degrees, upper teeth with interdental gaps, mild crowding in the lower teeth, the molar relationship to the left normal, the right light degree of far middle and wrong teeth, and the mild and middle and wrong teeth on both sides. Joint relationship, the side of the soft tissue showed the middle protrusion of the middle face, the stress of the chin lip muscle, and the difficulty of lip closure; five experts in the orthodontic Department of Shenyang oral hospital agreed that it was a critical case, and the non extraction treatment scheme was agreed. The maxillary orthodontic orthodontic technique was used, the maxillary dentition sequence was arranged together with the out of the mouth bow. Cervical traction, adduction of upper anterior teeth, improvement of the inclination of the upper anterior teeth; further growth and development of the mandible with maxillary oblique guidance; closure of the gap between the upper and lower jaw teeth, the use of the skin ring traction, and the fine adjustment of the relationship between the teeth and the occlusion. The cephalometric depiction and measurement were performed, and the changes of soft and hard chin and soft tissue profile were compared and analyzed.
Results: after orthodontic treatment, the upper and lower teeth were arranged neatly, the Spee curve was more straight, the overlying teeth were covered with the anterior teeth to normal, the relationship between the canine and the molar was restored to normal, the middle line and the middle line of the lower teeth were not skewed and aligned, both the upper and lower teeth were interlocked with the cusp nest. The length of the dental arch before and after correction was changed. In the anterior segment of the upper arch, the length of the middle segment decreased and the length of the posterior segment increased. The width of the dental arch was changed before and after the correction: the anterior segment of the upper arch, the width of the middle segment, the width of the posterior segment increased, the mental tension of the chin lip was relieved, the lip closed, the lip process decreased, the chin shape changed, the side appearance improved, the patient was satisfied with the correction results. The contrast correction was satisfactory. Contrastive correction The measurement of the relationship between the teeth and the craniofacial relationship before and after treatment: SNA decreased, SNB increased, and ANB decreased, suggesting that the maxillary development was restricted, the mandible continued to develop, the difference in the maxilla and mandible decreased; the mandibular plane angle and the Y-axis were basically unchanged, suggesting that the vertical control was more successful; NP-FH, Po-NB, SL, Co-Po, ANS-Me, N-Me became larger, suggesting the growth of the mandible, UI-SN, UI-NP, UI-AP, UI-LI decreased, suggesting that the upper incisor was adducted, the sudden degree decreased, and the upper and lower incisor decreased; ULP, LLP, Z angle, Ns-Sn-Pos, and FCA decreased, suggesting that the labial process decreased, the face pattern decreased and the side appearance improved. The mental height and chin thickness of Li's chin was the mental height and mental thickness after correction. Degree, chin thickness, chin thickness, chin thickness / Chin thick, mental depression all increased in varying degrees, chin high / chin thickness, mental thickness / chin thickness, chin thickness, chin angle smaller, suggesting that chin part grew along with growth and development, mental process increased, volume increased, morphologic change, and this change was beneficial to the improvement of face type. The mental soft tissue before and after correction were compared. The data showed that the chin lip sulcus was shallow, the chin lip sulcus radian became larger, the chin length decreased, the radian increased, the chin degree increased, the EP-UL, EP-LL decreased, suggesting the mental soft tissue morphology changed; with the mandible anterior and lower displacement, the decrease of the upper and lower lip, the mental process increased, the soft tissue appearance decreased and the final side appearance was obtained. To improve.
Conclusion: 1. in the diagnosis and treatment of clinical orthodontics, the growth and development of the chin should be taken into account in order to make a better prediction for the results of the orthodontic treatment. It is also necessary to make positive use of growth and development to promote the forward development of the chin, so as to better improve the face type.2. in this study. The position of the chin changed, the chin lip relationship was coordinated, and the soft tissue profile improved.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R782.11

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