【摘要】：目的：探討臨床中由于多顆上頜前牙缺失而導(dǎo)致上下前牙Bolton指數(shù)不調(diào)的錯(cuò)牙合畸形的正畸治療，研究分析由于上下前牙Bolton指數(shù)不調(diào)所致錯(cuò)牙合畸形的臨床特點(diǎn)及這類錯(cuò)牙合畸形的診斷、設(shè)計(jì)、矯治效果。 方法：選取1例缺失兩顆上頜中切牙及一顆左上側(cè)切牙的患者為研究對(duì)象，女性，年齡13歲，漢族；外傷史5年，外傷導(dǎo)致上頜兩顆中切牙及左側(cè)上頜側(cè)切牙缺失；骨性Ⅲ類；上下頜骨發(fā)育基本正常；兩側(cè)第一恒磨牙中性關(guān)系，左側(cè)尖牙遠(yuǎn)中關(guān)系；左側(cè)尖牙反牙合，右側(cè)上頜第一、第二前磨牙正鎖牙合；右側(cè)下頜第二乳磨牙滯留，，凹面型。矯治設(shè)計(jì)：根據(jù)模型分析、X線頭影測(cè)量及Bolton指數(shù)分析，制定拔除左側(cè)下頜側(cè)切牙的矯治方案。拔除滯留的乳牙及左側(cè)下頜側(cè)切牙，上下牙列固定矯治。排齊整平上下牙列，解除下牙列擁擠；牙合墊加雙曲舌簧解除尖牙反牙合；糾正前磨牙區(qū)正鎖牙合；鎳鈦螺旋推簧拓展缺牙間隙；調(diào)整雙側(cè)尖牙及第一恒磨牙達(dá)到中性關(guān)系。通過(guò)分析矯治前后X線頭顱側(cè)位片，比較矯治前后前牙的角度、上下頜骨及軟組織側(cè)貌的變化情況；通過(guò)矯治前后曲面斷層片觀察牙冠、牙根、牙槽骨等方面的變化。 結(jié)果：矯治療程共20個(gè)月，矯治后解除了下牙列牙齒擁擠不齊，糾正了左側(cè)尖牙區(qū)反牙合及右側(cè)前磨牙區(qū)正鎖牙合。有效拓展上頜前牙缺牙區(qū)間隙，拓寬上頜前牙段牙弓寬度。調(diào)整兩側(cè)磨牙及尖牙關(guān)系至中性，改善咬合關(guān)系。患者及家長(zhǎng)對(duì)矯治效果滿意。(1)通過(guò)模型分析、Bolton指數(shù)分析以及X線頭影測(cè)量，制定拔除左側(cè)下頜側(cè)切牙及滯留的右側(cè)第二乳磨牙的矯治方案。為解除下牙列擁擠、整平Spee曲線、內(nèi)收下前牙提供間隙。近中移動(dòng)左側(cè)下頜尖牙，使左側(cè)尖牙遠(yuǎn)中關(guān)系調(diào)整至中性，最終達(dá)到雙側(cè)尖牙及磨牙中性關(guān)系，后牙達(dá)到尖窩相對(duì)的咬合狀態(tài)。(2)應(yīng)用上頜牙合墊加雙曲舌簧，去除牙合干擾同時(shí)唇向移動(dòng)左側(cè)上頜尖牙及右側(cè)上頜側(cè)切牙，拓寬上頜前牙區(qū)牙弓，改善凹面型。(3)因患者矯治結(jié)束時(shí)15歲，暫不能進(jìn)行缺牙區(qū)種植或修復(fù)治療。在保持器中加樹脂牙進(jìn)行暫時(shí)性美觀修復(fù)，待成人后進(jìn)行缺牙區(qū)義齒修復(fù)。 結(jié)論：該病例通過(guò)全面的模型分析及X線頭影測(cè)量分析，制定拔除單顆下頜側(cè)切牙的矯治方案。這一非常規(guī)拔牙方案，雖然丟失了下頜中線但卻有效的解除了下牙列前牙區(qū)的擁擠，解除了左側(cè)尖牙區(qū)的反牙合，建立前牙正常覆牙合、覆蓋關(guān)系，建立雙側(cè)尖牙和第一磨牙中性關(guān)系。矯治結(jié)束后在壓膜保持器加樹脂牙用于缺隙保持并達(dá)到暫時(shí)性的美觀修復(fù)作用。對(duì)于本病例患者，單頜拔除左側(cè)下頜側(cè)切牙達(dá)到了令人滿意的矯治效果。
[Abstract]:Objective: to investigate the orthodontic treatment of malocclusion due to the absence of multiple maxillary anterior teeth, which leads to the unadjusted Bolton index of the upper and lower anterior teeth. The clinical features of malocclusion caused by the Bolton index of upper and lower anterior teeth and the diagnosis, design and treatment of malocclusion were studied and analyzed. Methods: one patient with two maxillary central incisors and one left upper incisor was selected as the study object, female, aged 13 years, Han nationality, two maxillary central incisors and left maxillary incisors were injured for 5 years; The development of maxillary and mandibular bone was basically normal; the first permanent molar was neutral and the left canine was distal; the right maxillary first and second premolars had positive locking occlusal; the right mandibular second primary molars remained concave. Orthodontic design: according to the model analysis of cephalometric measurement and Bolton index analysis, the orthodontic scheme of extraction of left mandibular lateral incisor was established. The remaining deciduous teeth and left mandibular lateral incisors were extracted and fixed with upper and lower dentition. Straighten the upper and lower teeth to relieve the lower dentition crowding; the occlusal pad and the double curved tongue spring to remove the canine reverse occlusion; correct the anterior molar area; the nickel titanium spiral push spring to expand the missing tooth gap; adjust the bilateral canine and the first permanent molar to achieve neutral relationship. The angle of anterior teeth, the lateral appearance of upper mandible and soft tissue were compared before and after orthodontic treatment, and the changes of crown, root and alveolar bone were observed by curved surface tomograph before and after orthodontic treatment. Results: the treatment course was 20 months. After the correction, the lower teeth were overcrowded, and the right anterior molar and left canine were corrected. The gap between the missing areas of the maxillary anterior teeth was effectively expanded and the arch width of the maxillary anterior segment was widened. Adjust bilateral molar and canine relationship to neutral, improve occlusal relationship. Patients and parents were satisfied with the effect of treatment. (1) through model analysis Bolton index analysis and X-ray cephalometric measurement, the treatment plan for extraction of left mandibular lateral incisor and left second primary molars was established. In order to relieve lower dentition crowding, Spee curve is leveled, and anterior teeth are included to provide space. The proximal and middle movement of left mandibular canine made the distal relationship of left canine adjusted to neutral, and finally achieved the neutral relationship between bilateral canine and molar, and the posterior teeth reached the relative occlusal state of cusp fossa. (2) maxillary occlusal pad and double curved tongue spring were used. Removing the occlusion interference and moving the left maxillary canine and the right maxillary lateral incisor, widening the arch of the maxillary anterior teeth and improving the concave type. (3) because the patients were 15 years old at the end of orthodontic treatment, they could not be implanted or repaired temporarily. Resin teeth were added to the retainer for temporary aesthetic restoration, and for adults, denture restoration was performed in the missing area. Conclusion: through comprehensive model analysis and X-ray cephalometric analysis, the orthodontic program of single mandibular lateral incisor was established. This unconventional extraction program, although it lost the central line of the mandible, effectively relieved the crowding of the anterior teeth of the lower dentition, removed the reverse occlusal in the left canine region, and established the normal overbite and overlay relationship of the anterior teeth. To establish a neutral relationship between bilateral canines and first molars. At the end of orthodontic treatment, plastic teeth were added to the film holder to maintain the gap and to achieve temporary aesthetic repair. In this case, single jaw extraction of left mandibular lateral incisor achieved satisfactory results.
【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)】：R783.5

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