本文選題：前牙開(牙合) + 高角型�。� 參考：《大連醫(yī)科大學》2016年碩士論文

【摘要】：目的:通過對高角開(牙合)患者正畸前后X線頭顱側(cè)位片的測量,回顧分析在兩種不同拔牙模式下矯正開(牙合)時,牙齒移動的不同機制以及對面部垂直向變化的影響是否存在差異,從而為臨床矯治設計提供參考。方法:從沈陽市口腔醫(yī)院正畸科2008年-2013年間就診的患者中選取24例已經(jīng)結束的高角開(牙合)患者,38°SN-MP54°,32°FH-MP47°。為避免患者在調(diào)整磨牙關系時產(chǎn)生的誤差,所有患者的磨牙關系為中性。24例患者均為輕中度開(牙合),前牙區(qū)至少有4顆切牙呈開(牙合)狀態(tài),開(牙合)程度0-4.2mm不等。對于有吐舌、口呼吸等不良習慣的患者,首先建議破除不良習慣。為了觀察磨牙前移量,兩組患者上下頜均為輕中度擁擠(1mm擁擠度5mm)。上下頜牙弓寬度協(xié)調(diào),前牙Bolton指數(shù)均正常,所有患者治療前均沒有顳下頜關節(jié)癥狀。將24名患者按照拔牙方式的不同分為兩組,拔除4顆第一前磨牙組為E4組(男2例女10例,初診平均年齡16.89±3.26歲),拔除4顆第二前磨牙組為E5組(女12例,初診平均年齡16.89±4.81歲)。所有患者采用0.022英寸槽溝系統(tǒng)的直絲弓矯治器,前牙整體滑動內(nèi)收法關閉拔牙間隙,最終磨牙均達到安氏Ⅰ類咬合關系。所有患者在正畸過程中均沒有使用后牙(牙合)墊、口內(nèi)輔弓(如MEAW)、口外牽引裝置(如高位牽引頭帽等)及影響磨牙前移的強支抗裝置(如種植釘、Nance弓、TPA等)。正畸前后頭顱側(cè)位片采用同一X射線系統(tǒng)進行拍攝,并由同一正畸醫(yī)師進行描片測量。本研究測量指標包括牙性指標12項,骨性指標15項。使用SSPS 17.0軟件對測量結果進行統(tǒng)計學分析,組內(nèi)前后變化采用配對t檢驗,組間牙齒及顱頜面垂直向變化使用獨立樣本t檢驗,P0.05具有統(tǒng)計學意義。結果:(1)治療前兩組各項指標沒有顯著差異(P0.05);(2)兩組治療后開(牙合)均得到明顯改善,E4組覆(牙合)增加3.27±0.94(P0.001),E5組覆(牙合)增加3.59±1.34(P0.001);(3)兩組矯正后前下面高及前面高均增加,E4組平均增加量分別為3.01±2.41mm和3.17±3.06mm,E5組平均增加量分別為2.90±2.01mm和3.56±3.65mm,均有統(tǒng)計學意義(P0.05);(4)兩組下頜平面角治療前后均沒有差異(P0.05);(5)E5組上下頜第一磨牙前移量大于E4組(P0.05),且中切牙回收量小于E4組(P0.05);(6)兩組治療前后變量間其他測量指標沒有顯著差異(P0.05)。結論:1.無論哪種拔牙模式都不能使高角開(牙合)患者產(chǎn)生下頜骨的逆時針旋轉(zhuǎn),亦不能使前下面高減小;2.在臨床上設計拔牙矯治方案時,應更多的考慮患者的擁擠度,面凸度,磨牙咬合關系,牙齒的健康狀況等。
[Abstract]:Objective: to retrospectively analyze the effects of two different extraction modes on orthodontic radiographic lateral radiographs in patients with high angle open (occlusal) teeth. The different mechanisms of tooth movement and the influence on the vertical change of face are different, so as to provide reference for clinical orthodontic design. Methods: from 2008 to 2013, 24 patients with high angle open (occlusal) were selected from orthodontic department of Shenyang Stomatology Hospital. They were 38 擄SN-MP54 擄and 32 擄FH-MP47 擄. In order to avoid the error in adjusting the molar relationship, the molar relationship of all patients was neutral. 24 patients were mild or moderate open (occlusal), at least 4 incisors in the anterior teeth were open (occlusal), and the degree of open (occlusal) 0-4.2mm was different. For patients with bad habits such as spitting and breathing, it is first recommended to break down bad habits. In order to observe the anterior displacement of molars, the upper and lower mandibles in both groups were 1mm crowding 5mm. The width of maxillary arch was coordinated and Bolton index of anterior teeth was normal. All the patients had no temporomandibular joint symptoms before treatment. 24 patients were divided into two groups according to different extraction methods. Four first premolars were extracted in E4 group (male, 2 female, 10 cases, mean age 16.89 鹵3.26 years old), and 4 second premolars were extracted in E5 group (12 female, mean age 16.89 鹵4.81 years old). All the patients were treated with a straight wire appliance with a 0.022 inch grooving system. The extraction space was closed by the method of integral sliding and closing of the anterior teeth, and the final molar achieved the class I occlusal relationship. During orthodontic treatment, all patients did not use posterior teeth (occlusal) pad, intraoral arch (MEAW), extraoral traction device (such as high traction head cap) and strong Anchorage device (such as implant nailing Nance arch TPA). The lateral head radiographs were taken with the same X-ray system and measured by the same orthodontic physician before and after orthodontics. This study included 12 dental indexes and 15 bone indexes. SSPS 17.0 software was used to analyze the results of statistical analysis, the changes of pre-and post-group changes were matched t test, and the vertical changes of teeth and craniomaxillofacial were analyzed by independent sample t-test (P0.05). Results: (1) there was no significant difference between the two groups before treatment (P0.05); (2). After treatment, the occlusal (occlusal) increased by 3.27 鹵0.94 (P0.001) and 3.59 鹵1.34 (P0.001); (3) respectively. The average increment of the two groups were 3.01 鹵2.41mm and 3.17 鹵3.06mmE5, respectively, which were 2.90 鹵2.01mm and 3.56 鹵3.65mm, respectively (P0.05); (4). There was no significant difference between the two groups before and after treatment (P0.05); (5). The anterior displacement of the first molar in the E5 group was higher than that in the E4 group (P0.05), and the anterior displacement of the first molar in the E5 group was higher than that in the E4 group (P0.05). The amount of tooth recovery was less than that of E4 group (P0.05); (6). There was no significant difference in other measurements between the two groups before and after treatment (P0.05). Conclusion 1. Neither extraction model can cause the mandible to rotate counterclockwise in high angle open (occlusal) patients, nor can it reduce the anterior and lower height by 2%. In clinical design, more consideration should be given to the degree of crowding, facial convexity, molar occlusion, tooth health and so on.
【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】：2016
【分類號】：R783.5

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