青少年重度骨性Ⅲ類開（牙合）病例掩飾性正畸治療的療效分析
發(fā)布時間：2018-08-13 14:29
【摘要】：目的:探討運用掩飾性正畸治療手段矯治青少年患者重度骨性Ⅲ類開牙合畸形的臨床效果。方法:選擇2011年沈陽市口腔醫(yī)院正畸科收治的重度骨性Ⅲ類開牙合畸形的青少年患者2例。均為14歲,女性,恒牙早期,都為生長發(fā)育高峰期后(Cvs4)的患者。病例一為重度高角型患者,ANB角-5°,左右兩側尖牙、磨牙均為完全近中關系,上牙列Ⅰ度擁擠,下牙列Ⅱ度擁擠,全牙弓反牙合,廣泛開牙合,前牙開牙合6mm,反覆蓋3mm,上頜牙列中線正,下頜牙列中線左偏2mm,軟組織側貌呈現凹面型。病例二為均角型患者,ANB角-4°,右側尖牙、磨牙為完全近中關系,左側尖牙、磨牙為中性關系,上頜牙列Ⅱ度擁擠,下頜牙列Ⅰ度擁擠,全牙弓反牙合,前牙區(qū)存在廣泛開牙合約2.5mm,上頜牙列中線右偏1mm,下頜牙列中線左偏4mm,軟組織側貌呈現凹面型。矯治前采用Tweed-Merrifield個體化診斷分析法評估兩病例難度指數分別為240.5和137.75,均屬于重度。全面分析頭影測量結果,提示為正畸正頜聯(lián)合治療適應證,但患者及家屬強烈排斥手術。故利用神山分析法輔助分析病因,制定代償性矯治計劃,采取單純正畸掩飾性治療。病例一采用直絲弓矯治技術,拔除雙側下頜第一磨牙,滑動內收關閉拔牙間隙,矯治過程中配合使用上頜牙合墊。病例二采用直絲弓矯治技術結合上頜快速擴弓治療。矯治中均使用皮圈牽引調節(jié)中線及尖窩咬合關系。用常規(guī)頭影測量方法分析治療前后軟硬組織的改變。結果:治療結束后,兩例患者全口牙齒排列整齊,尖牙磨牙關系基本恢復中性,上下前牙建立良好覆牙合覆蓋關系,上下牙列中線基本對正,側貌和咬合功能均得到改善,患者對治療結果非常滿意。兩病例矯治前后影像學指標變化:⑴ANB角分別增大2°、2.5°,Wits值分別增加3mm、4.5mm,矢狀不調改善,且APDI分別減小4.5°、6.5°,骨性Ⅲ類傾向減弱;⑵牙合平面角分別減小9°、2°,牙合平面逆時針旋轉建牙合;⑶面型角分別增大5°、2.5°,Z角分別減小5.5°、6°,軟組織凹面型得到改善;⑷MP-FH分別增大1.5°、2°,MP-SN分別增大1°、1.5°,下頜平面出現輕微順時針旋轉;(5)病例一上前牙代償性唇向傾斜,下前牙代償性舌向傾斜;病例二擴弓的療效顯著,上前牙唇傾度減小,下前牙唇傾度與矯治前差別不大;(6)病例一Gn-Ar-L1增大4°、ANS-Ar-U1增大1.5°、Go-Ar-M減小4°,L7-MP減小1.4mm,表明上下前牙垂直高度增大,且下前牙升高較多,下頜第二磨牙壓低;病例二,ANS-Ar-U1增大3°、Gn-Ar-L1增大1.5°、PNS-Ar-M增大1°、Go-Ar-M增大3°、L6-MP增大1.5mm,提示上下前牙及下頜磨牙垂直向高度均有增加。結論:本文展示的兩例青少年骨性Ⅲ類開牙合病例,經Tweed-Merrifield個體化的診斷分析法評估其難度指數為重度,多項頭影測量指標提示為正畸正頜聯(lián)合治療適應證。矯治前借助神山開牙合分析法尋找牙性代償潛力,從病因機制出發(fā)制定科學合理的矯治方案,把握青少年患者生長發(fā)育的特點,結合患者非手術治療的強烈意愿,采取正畸掩飾性治療依然取得了良好的矯治效果:借助青少年患者生長發(fā)育高峰期后仍具有的良好骨改建能力,矯治后ANB角增大,上下頜骨矢狀向不調減輕;下頜平面角有輕度增加,提示我們矯治中應高度重視下頜順時針旋轉生長傾向,設法抑制其不利的生長趨勢,并控制上下后牙的高度;通過牙及牙槽性改變調整患者牙合平面,最終糾正開牙合,并建立良好覆牙合覆蓋關系及磨牙關系;改善軟組織側貌及咬合功能。
[Abstract]:Objective:To investigate the clinical effect of masked orthodontic treatment on severe skeletal class III open bite deformity in adolescents.Methods:Two adolescents with severe skeletal class III open bite deformity were selected from the Department of Orthodontics, Shenyang Stomatological Hospital in 2011.All of them were 14 years old, female, early permanent teeth, all after the peak of growth and development (Cvs4). The first case was a severe high angle type. The ANB angle was - 5 degrees, the left and right canines, the molars were completely near the center. The upper dentition was 1 degree crowded, the lower dentition was 2 degree crowded, the whole arch was crossbitten, the teeth were widely opened, the anterior teeth were opened 6 mm, the maxillary dentition was 3 mm, the mandibular dentition was 2 mm, the soft tissue profile was concave. Case 2 was an angle-averaged patient with ANB angle-4 degrees, right canine, molar, left canine, molar, neutral, maxillary dentition II degree crowding, mandibular dentition I degree crowding, total arch crossbite, anterior teeth area with extensive occlusion about 2.5mm, maxillary dentition 1 mm, mandibular dentition 4 mm, soft tissue profile. Tweed-Merrifield individualized diagnostic method was used to evaluate the difficulty indices of the two cases, which were 240.5 and 137.75, respectively. Cephalometric results were analyzed comprehensively, suggesting indications for combined orthodontic treatment, but patients and their families strongly rejected the operation. In case 1, the first mandibular molars were extracted with straight wire technique, the extraction space was closed by sliding adduction, and the maxillary occlusal pad was used in the course of treatment. In case 2, the straight wire technique was used in combination with rapid maxillary expansion. Results: After the treatment, the whole teeth of the two patients were arranged neatly, the relationship between canine and molar was basically restored to neutral, the upper and lower anterior teeth had a good overbite and overbite relationship. The upper and lower alignment of the central line was basically opposite to the front, and the profile and occlusal function were obtained. The changes of imaging indices before and after treatment were as follows: (1) Angle of ANB increased by 2 degrees, 2.5 degrees, Wits increased by 3 mm, 4.5 mm, sagittal imbalance improved, APDI decreased by 4.5 degrees, 6.5 degrees, and skeletal class III tendencies decreased respectively; (2) Angle of occlusal plane decreased by 9 degrees, 2 degrees, and occlusal plane rotated counterclockwise to establish occlusion; _MP-FH increased by 1.5 degree, 2 degree, MP-SN increased by 1 degree and 1.5 degree respectively, and mandibular plane rotated slightly clockwise. (5) In case one of the upper anterior teeth, compensatory labial tilt of the lower anterior teeth, compensatory lingual tilt of the lower anterior teeth. Inclination of lower anterior teeth was not significantly different from that before treatment. (6) In case 1, Gn-Ar-L1, ANS-Ar-U1, Go-Ar-M, L7-MP and Gn-Ar-L1 increased by 4, 1.5, 4 and 1.4 mm respectively, indicating that the vertical height of upper and lower anterior teeth increased, and the pressure of mandibular second molar was lower. In case 2, ANS-Ar-U1 increased by 3, Gn-Ar-L1 increased by 1.5, PNS-M increased by 1, G-Ar-M increased by 1, G-M decreased by 1 degree. The o-Ar-M and L6-MP increased by 3 degrees and 1.5mm respectively, suggesting that the vertical height of both upper and lower anterior teeth and mandibular molars increased. Conclusion: Two cases of skeletal class III open bite in adolescents and adolescents were evaluated by Tweed-Merrifield individualized diagnostic analysis. Several cephalometric indices suggested that they were suitable for orthodontic treatment. Syndrome: Before orthodontic treatment, the potential of tooth compensation was found by Shenshan occlusal analysis method, and a scientific and reasonable treatment scheme was made according to etiological mechanism. The characteristics of growth and development of adolescent patients were grasped. Combined with the strong desire of non-surgical treatment, the orthodontic masking treatment still achieved good results: adolescent patients were given the aid of students. After treatment, ANB angle increased and sagittal maladjustment of maxilla and mandible decreased, and mandibular plane angle increased slightly, suggesting that we should attach great importance to the clockwise growth tendency of mandible, try to restrain its unfavorable growth trend and control the height of upper and lower posterior teeth. Sex change adjusts the occlusal plane, corrects open bite, establishes good overbite overbite and molar relationship, improves soft tissue profile and occlusal function.
【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】：2015
【分類號】：R783.5
[Abstract]:Objective:To investigate the clinical effect of masked orthodontic treatment on severe skeletal class III open bite deformity in adolescents.Methods:Two adolescents with severe skeletal class III open bite deformity were selected from the Department of Orthodontics, Shenyang Stomatological Hospital in 2011.All of them were 14 years old, female, early permanent teeth, all after the peak of growth and development (Cvs4). The first case was a severe high angle type. The ANB angle was - 5 degrees, the left and right canines, the molars were completely near the center. The upper dentition was 1 degree crowded, the lower dentition was 2 degree crowded, the whole arch was crossbitten, the teeth were widely opened, the anterior teeth were opened 6 mm, the maxillary dentition was 3 mm, the mandibular dentition was 2 mm, the soft tissue profile was concave. Case 2 was an angle-averaged patient with ANB angle-4 degrees, right canine, molar, left canine, molar, neutral, maxillary dentition II degree crowding, mandibular dentition I degree crowding, total arch crossbite, anterior teeth area with extensive occlusion about 2.5mm, maxillary dentition 1 mm, mandibular dentition 4 mm, soft tissue profile. Tweed-Merrifield individualized diagnostic method was used to evaluate the difficulty indices of the two cases, which were 240.5 and 137.75, respectively. Cephalometric results were analyzed comprehensively, suggesting indications for combined orthodontic treatment, but patients and their families strongly rejected the operation. In case 1, the first mandibular molars were extracted with straight wire technique, the extraction space was closed by sliding adduction, and the maxillary occlusal pad was used in the course of treatment. In case 2, the straight wire technique was used in combination with rapid maxillary expansion. Results: After the treatment, the whole teeth of the two patients were arranged neatly, the relationship between canine and molar was basically restored to neutral, the upper and lower anterior teeth had a good overbite and overbite relationship. The upper and lower alignment of the central line was basically opposite to the front, and the profile and occlusal function were obtained. The changes of imaging indices before and after treatment were as follows: (1) Angle of ANB increased by 2 degrees, 2.5 degrees, Wits increased by 3 mm, 4.5 mm, sagittal imbalance improved, APDI decreased by 4.5 degrees, 6.5 degrees, and skeletal class III tendencies decreased respectively; (2) Angle of occlusal plane decreased by 9 degrees, 2 degrees, and occlusal plane rotated counterclockwise to establish occlusion; _MP-FH increased by 1.5 degree, 2 degree, MP-SN increased by 1 degree and 1.5 degree respectively, and mandibular plane rotated slightly clockwise. (5) In case one of the upper anterior teeth, compensatory labial tilt of the lower anterior teeth, compensatory lingual tilt of the lower anterior teeth. Inclination of lower anterior teeth was not significantly different from that before treatment. (6) In case 1, Gn-Ar-L1, ANS-Ar-U1, Go-Ar-M, L7-MP and Gn-Ar-L1 increased by 4, 1.5, 4 and 1.4 mm respectively, indicating that the vertical height of upper and lower anterior teeth increased, and the pressure of mandibular second molar was lower. In case 2, ANS-Ar-U1 increased by 3, Gn-Ar-L1 increased by 1.5, PNS-M increased by 1, G-Ar-M increased by 1, G-M decreased by 1 degree. The o-Ar-M and L6-MP increased by 3 degrees and 1.5mm respectively, suggesting that the vertical height of both upper and lower anterior teeth and mandibular molars increased. Conclusion: Two cases of skeletal class III open bite in adolescents and adolescents were evaluated by Tweed-Merrifield individualized diagnostic analysis. Several cephalometric indices suggested that they were suitable for orthodontic treatment. Syndrome: Before orthodontic treatment, the potential of tooth compensation was found by Shenshan occlusal analysis method, and a scientific and reasonable treatment scheme was made according to etiological mechanism. The characteristics of growth and development of adolescent patients were grasped. Combined with the strong desire of non-surgical treatment, the orthodontic masking treatment still achieved good results: adolescent patients were given the aid of students. After treatment, ANB angle increased and sagittal maladjustment of maxilla and mandible decreased, and mandibular plane angle increased slightly, suggesting that we should attach great importance to the clockwise growth tendency of mandible, try to restrain its unfavorable growth trend and control the height of upper and lower posterior teeth. Sex change adjusts the occlusal plane, corrects open bite, establishes good overbite overbite and molar relationship, improves soft tissue profile and occlusal function.
【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】：2015
【分類號】：R783.5
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