【摘要】：思路隨著人類的進(jìn)化和人們飲食習(xí)慣的變化,頜骨發(fā)育不斷退化,而牙齒退化并不明顯,從而頜骨的大小不能夠順利容納所有的牙齒,錯牙合畸形的發(fā)病率就越來越更加普遍,以及人們對口腔牙齒美容和牙齒健康功能需求的不斷提升,越來越多的人選擇牙齒矯正。拔牙矯正技術(shù)和非拔牙矯正技術(shù)一直是口腔正畸界研究和爭論的焦點(diǎn),尤其是許多牙性擁擠的邊緣性病例,越來越多的學(xué)者傾向于選擇非拔牙矯正技術(shù),他們研究如何增加骨量開拓牙弓中的間隙,其中推磨牙向遠(yuǎn)中是最多的增加骨量的方法之一。傳統(tǒng)的推上頜磨牙向遠(yuǎn)中移動技術(shù)對患者合作的依賴程度較大,或者在制作及操作上較為麻煩,且效果不夠穩(wěn)定,1992年Hilgers發(fā)明了經(jīng)典的Pendulum擺型矯治器,本研究旨在經(jīng)典的Pendulum擺型矯治器的基礎(chǔ)上加以改良,通過頭顱定位側(cè)位片描點(diǎn)、測量常見的骨性及牙性指標(biāo)的變化,研究改良Pendulum擺型矯治器最佳適應(yīng)癥的選擇,以及臨床操作中值得注意的一些操作事項(xiàng),更好地應(yīng)用于臨床。 目的口腔正畸臨床上由于患者上頜乳磨牙早失、上頜乳牙先天缺失等原因?qū)е律项M磨牙萌出后向近中移位的安氏Ⅱ類錯牙合,上頜前部牙列擁擠、前突等需要開拓牙弓中間隙,而上頜骨發(fā)育尚可,可以通過增加骨量,尤其通過推上頜磨牙向遠(yuǎn)中移位,并同時能夠矯正磨牙的Ⅱ類錯牙合關(guān)系。本研究對經(jīng)典的Pendulum擺型矯治器加以改良,在牙性安氏Ⅱ類錯牙合中遠(yuǎn)中移動上頜磨牙對牙槽和骨骼結(jié)構(gòu)的影響,以研究其作用機(jī)制并更好地應(yīng)用于口腔正畸臨床。 方法選擇安徽省口腔醫(yī)院正畸科臨床中年輕恒牙牙合牙性安氏Ⅱ類錯牙合21例,其中男9例,女12例,年齡10.6-14.5歲,平均12.8歲。使用改良Pendulum擺型矯治器遠(yuǎn)中移動上頜磨牙3.2-5.7個月,平均4.38個月。改良Pendulum擺型矯治器遠(yuǎn)中移動上頜磨牙前和后拍攝X線頭顱定位側(cè)位片,使用硫酸紙重疊描點(diǎn)、測量,對于前后牙性及骨性指標(biāo)的變化采用配對T檢驗(yàn)進(jìn)行分析。 結(jié)果X線頭顱定位側(cè)位片上顯示每側(cè)后牙區(qū)牙弓中平均開出7.31m m的間隙,其中雙側(cè)上頜第一磨牙后移占開出間隙的64.8%,牙冠向后傾斜平均增加為18.640,平均每月向后移動為1.27mm。上頜第一磨牙平均壓低0.69mm,上頜前磨牙平均伸長1.02mm,面下垂直距離平均增加2.19mm。上頜中切牙唇傾平均增加3.39°和切端唇展平均增加1.13mm。 結(jié)論改良Pendulum擺型矯治器是一種能夠快速有效的遠(yuǎn)中移動上頜磨牙的裝置,能夠快速矯正磨牙安氏Ⅱ類錯牙合關(guān)系,同時能夠開拓牙弓中所需要的間隙,以能夠解除牙弓中的擁擠以及能夠內(nèi)收前牙所需要的間隙,并且能夠改善患者的面型。但是,在口腔正畸臨床中我們需要注意的是,改良Pendulum擺型矯治器在推上頜磨牙向遠(yuǎn)中移動的同時也可以導(dǎo)致上頜第一磨牙向遠(yuǎn)中傾斜移動、切牙唇向傾斜移動、以及面下1/3高度的增加,下頜骨輕微的順時針旋轉(zhuǎn)。
[Abstract]:With the evolution of human and the change of people's eating habits, the development of the jaw is deteriorating, and the degeneration of the teeth is not obvious, so that the size of the jaw is not able to accommodate all the teeth smoothly, and the incidence of the malocclusion is more and more common. as well as the increasing demand for oral and dental care and dental health, more and more people choose to correct their teeth. The technique of tooth extraction and the technique of non-extraction of tooth extraction have been the focus of the study and debate of the oral orthodontics, especially the borderline cases of many dental crowding, and more and more scholars tend to choose non-tooth extraction and correction techniques, and they study how to increase the amount of bone to develop the gap in the dental arch. in which the molar is one of the most effective ways to increase the amount of bone in the distal direction. The traditional push-to-maxillary molar is more dependent on the patient's cooperation, or is more troublesome in the manufacture and operation, and the effect is not stable. In 1992, Hilgers invented the classical Pendulum-type appliance, which is aimed at the improvement of the classical Pendulum-type appliance. The choice of the best indication for the modified Pendulum pendulum appliance and some of the operational matters to be noted in clinical operation can be better applied to the clinical application. Objective To study the clinical effect of oral orthodontics, such as the early loss of the maxillary first molars, the congenital absence of the maxillary deciduous teeth, and the other causes, such as the second malocclusion of the maxillary molars, the crowding of the anterior teeth of the maxillary anterior teeth, the anterior process and the like, and the need to develop the gap in the dental arch, while the development of the maxilla can, by increasing the amount of bone, especially by pushing the maxillary first molar in the distal direction, and at the same time be able to correct the type II, wrong-tooth closing of the molar, This study is to improve the classical Pendulum-type appliance, and to move the effect of the maxillary molar on the tooth and bone structure in the tooth-and-tooth type 鈪，

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