【摘要】：目的:探討應(yīng)用自鎖托槽、直絲弓矯治技術(shù),采用舌弓、后牙組牙強(qiáng)支抗矯治雙頜前突成人患者的治療效果。方法:選取大連市博士口腔診所2011年8月收治的雙頜前突成人患者一例。女性,23歲,初診時(shí)已于外院拔除四顆第一前磨牙。口腔一般檢查:處于恒牙牙合期,輕度牙齦炎,兩側(cè)磨牙為開始安氏Ⅲ類關(guān)系,上頜中線位于正中,下頜中線左偏1mm,上下頜前牙的唇傾度較大;模型檢查測(cè)量結(jié)果:Spee曲線曲度稍深,3.5mm,上下頜牙列擁擠度7.5mm、11.5mm,為中、重度擁擠,覆牙合、覆蓋正常;軟組織正、側(cè)面觀:為凸面型,唇部較突,唇頦部肌肉緊張,頦部稍顯后縮;x線頭影測(cè)量分析結(jié)果:SNA為78.5°,SNB為79.5°,數(shù)值均在正常值范圍內(nèi),ANB為-1°,為輕度Ⅲ類骨面型;上牙軸U1-SN為120°,U1-NA為42°,下牙軸L1-MP為106.5°,下牙軸L1-NB為41.5°,均大于正常值范圍,上下前牙唇傾度均較大;既往史:三年前接受非拔牙正畸治療,否認(rèn)口腔不良習(xí)慣。家族遺傳史:父親牙齒不齊。根據(jù)以上各項(xiàng)測(cè)量結(jié)果分析,決定采用自鎖托槽、直絲弓矯治技術(shù),拔除四顆第一前磨牙的拔牙模式,上頜后牙組牙支抗防止磨牙伸長(zhǎng)及過(guò)度近中移動(dòng),下頜舌桿豎直磨牙并作為強(qiáng)支抗;滑動(dòng)法關(guān)閉拔牙間隙,最后達(dá)到正常的覆頜覆蓋及安氏Ⅰ類尖牙、磨牙關(guān)系。結(jié)果:矯治時(shí)間共29個(gè)月,治療結(jié)束時(shí)可見上下頜牙列解除擁擠,排齊整平;上下頜中線居中對(duì)齊;覆牙合、覆蓋正常;尖牙、磨牙均為安氏Ⅰ類關(guān)系。治療前后X線頭顱側(cè)位片對(duì)比分析結(jié)果顯示:矯治后的SNA減小了1°,SNB減小了1.5°,ANB增大了0.5°,患者上下頜基骨并未發(fā)生較大的變化,但輕度的數(shù)值變化仍使Ⅲ類骨性關(guān)系得到了改善。唇傾的上下前牙得到了較好的回收:U1-SN由120°到104°,減小了16°,U1-NA由42°到27°,減小了15°,L1-MP由106.5°到91°,減小了15.5°,下牙軸L1-NB由41.5°到25°,減小了16.5°。軟組織突度也有較大改善。角度變化:鼻唇角NLA由91°到94°,增大3°;上唇傾角由62°到67°,增大了5°;下唇傾角由52°到59°,增大了7°;距離變化:上唇突度從7mm降低到4.5mm,減小了2.5mm,下唇突度由9.5mm降低到4.5mm,減小了5mm,以上數(shù)值反映上下唇突度均有明顯減小;UL-EP由1mm到-2mm減小了3mm,LL-EP由5mm到0mm,減小了5mm,上下唇均達(dá)到審美線內(nèi),前突的唇部得到了回收;頦溝傾角(PosBs-FH)由105°到92°,減小了13°;Z角由66°到74°,增大了8°;H角由14°到9°,減小了5°;側(cè)面角(G-Sn-Pos)由170°到173.5°,增大了3.5°,以上數(shù)據(jù)均向好的方向變化,且矯治后測(cè)量值均在正常值范圍內(nèi),提示唇頦關(guān)系協(xié)調(diào)。結(jié)論:本病例應(yīng)用自鎖托槽、直絲弓矯治技術(shù),采用拔除四個(gè)第一前磨牙的矯治方法,結(jié)合舌弓、后牙組牙強(qiáng)支抗矯治成人雙頜前突,可以達(dá)到充分利用拔牙間隙回收前牙的目的,從而改善患者軟組織側(cè)貌,使之達(dá)到協(xié)調(diào)平衡的狀態(tài)。
[Abstract]:Objective: to investigate the effect of using self-locking bracket and straight wire arch in the treatment of adult patients with bimaxillary protrusion by using tongue arch and posterior teeth with strong Anchorage. Methods: a case of adult patients with bimaxillary protrusion was selected from Dalian Doctor Stomatology Clinic in August 2011. Female, 23 years old, had four first premolars extracted from the external hospital at first visit. General oral examination: in permanent teeth, mild gingivitis, bilateral molars for the start of the class III relationship, the maxillary median line located in the middle, left side of the mandibular midline 1 mm, the upper and mandibular anterior teeth of a greater degree of labial inclination; The results of model examination were as follows: the curve of Spee curve was slightly deeper (3.5 mm), the crowding degree of upper and lower dentition was 7.5 mm and 11.5 mm, which was moderate and severe crowding, overbite and normal overbite. Soft tissue positive, lateral view: convex type, lip more protruding, lip chin muscle tension, chin slightly retraction; The results of X-ray cephalometric analysis showed that SNA was 78.5 擄and SNB was 79.5 擄. All the values were within the normal range. ANB was -1 擄, which was mild type 鈪，

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