成人雙頜前突錯（牙合）畸形的臨床矯治
發(fā)布時間：2019-01-19 18:09
【摘要】：目的：探討運用固定直絲弓矯治技術(shù)，配合口外支抗頭帽J鉤和口內(nèi)支抗橫腭桿作為強(qiáng)支抗的輔助裝置矯治成人雙頜前突錯牙合畸形患者的臨床療效。 方法：選取成人安氏類雙頜前突患者一例，病源來自2010年8月29日大連市聯(lián)合路博士口腔診所，成人女性，22歲�？谇恍l(wèi)生狀況良好，牙周健康，曾有咬指和口呼吸習(xí)慣，現(xiàn)已改正；該患者處于恒牙牙合期；左右兩側(cè)尖牙、磨牙關(guān)系為安氏類關(guān)系；上下頜牙列輕中度擁擠；覆頜、覆蓋均正常；Spee曲線深度正常；露齦微笑，雙頜前牙的軸傾度較唇傾，上下頜中線位于正中，側(cè)貌為凸面型，頦部緊張、后縮。有母親的家族遺傳史。該病例根據(jù)其模型分析和X線頭影測量等測量和分析結(jié)果，采取拔出14、24、34、44及18、28、38、48的拔牙模式，直絲弓矯治技術(shù)，在排齊整平上下頜牙列階段，運用橫腭桿控制磨牙，兩步法滑動關(guān)閉拔牙間隙，配合頭帽拉尖牙向遠(yuǎn)中，待尖牙基本達(dá)到中性牙合關(guān)系時，使用頭帽J鉤回收及適當(dāng)壓低前牙，保持前牙良好的覆頜及全口牙齒良好的咬合關(guān)系。 結(jié)果：矯治總療程為27個月，治療結(jié)束時觀察全口牙列排齊整平；拔牙間隙完全關(guān)閉；中線位于正中；測量唇傾的前牙牙軸得到明顯回收；模型檢查前牙覆頜正常、覆蓋2mm；磨牙和尖牙為安氏類。對比治療前后的曲面斷層片可見，髁突位置良好，無明顯改變，，全口牙齒牙根基本平行，牙槽骨未見明顯吸收。對比治療前后的X線頭顱側(cè)位片分析結(jié)果：（1）上下頜顱面骨測量值未發(fā)生明顯變化，牙合平面未發(fā)生順時針旋轉(zhuǎn)，基本保持原位。SNA、SNB未發(fā)生明顯變化，SNA減小了1°,SNB無變化,ANB減小了1°（2）上牙軸U1-SN由115°減小到108°，下牙軸L1-MP唇傾度由104°減小到91°,L1-NB由42°減小到30°（3）鼻唇角Cm-Sn-Ls增大4°、上唇傾角A UL-FH增大了6°，說明矯治后上唇的突度得到了一定程度的減小;下唇傾角B UL-FH增大了7°，反應(yīng)下唇也得到了一定程度的改善；ULP從10mm降低到6mm，減小了4mm，LLP由12mm降低到8mm，也減小了4mm，上下唇突度得到明顯改善；UL-EP由原來的6mm減小到2mm,LL-EP由9mm減小到5mm，同時減小了4mm，上下唇雖沒有達(dá)到審美線內(nèi)，但與矯治前比較，前突的唇部得到了改善；頦溝傾角（Pg B-FH）治療前70°，治療后75°；Z角治療前56°，治療后65°；H角治療前21°，治療后19°；經(jīng)過治療后，唇部和頦部的關(guān)系趨于協(xié)調(diào)。側(cè)面角（G-Sn-Pg），軟組織面角（FH-Ns-Pg）幾乎未發(fā)生改變，因此單純正畸治療對于改變生長發(fā)育已完成的相關(guān)指標(biāo)作用甚微。 結(jié)論：對于雙頜前突安氏類成人患者的矯正治療，應(yīng)用固定直絲弓矯治技術(shù)，配合口外支抗頭帽J鉤及口內(nèi)支抗橫腭桿，可以很好地控制磨牙在矢狀向和垂直向上的位置，使拔牙間隙充分為回收前牙所利用，進(jìn)而使患者軟組織側(cè)貌協(xié)調(diào)平衡。
[Abstract]:Objective: to investigate the clinical effect of using fixed straight wire arch technique, combined with external Anchorage head J hook and intraoral Anchorage against transverse palate bar as a strong Anchorage device for the treatment of adult patients with bilateral protrusion malocclusion. Methods: a case of adult patients with andrognathic prognathia was selected. The source of the disease was 22 years old, from the doctor's stomatology clinic in Dalian City on August 29, 2010. Oral hygiene condition, periodontal health, had bite and mouth breathing habits, has been corrected, the patient is in the permanent teeth occlusion period, left and right canine, molar relationship for the relationship between the class, upper and lower dentition mildly and moderately crowded; Spee curve depth is normal, gums smile, the axial inclination of the maxillary anterior teeth is higher than that of the lip, the midline of the upper and lower jaw is in the middle, the side shape is convex, the chin is tense and retraction. Have a mother's family history. According to the results of model analysis and X-ray cephalometric measurement, this case adopted the extraction model of 144U 24444 and 182283848, and the technique of straight-wire orthodontic treatment. In the stage of leveling and leveling the upper and lower dentition, the molars were controlled by the transverse palatal rod, and the molars were controlled by the transverse palatine rod during the stage of leveling and leveling the upper and lower dentitions. Two-step sliding closure of the extraction gap, combined with the head cap to pull the canine to the far, when the canine basically reached neutral occlusion, the head cap J hook was used to recover and lower the anterior teeth properly, to maintain a good overbite and a good occlusion of the whole teeth of the anterior teeth. Results: the total course of correction was 27 months. At the end of the treatment, the whole dentition was leveled out, the extraction space was completely closed, the midline was located in the middle, the anterior tooth axis of the labial inclination was obviously recovered, the overbite of the anterior teeth was normal and covered with 2 mm by model examination. Molars and fangs belong to the Andes class. The position of condyle was good with no obvious change, the root of the whole tooth was basically parallel, and the alveolar bone was not absorbed. The results of X-ray lateral radiographic analysis before and after treatment were as follows: (1) the measured values of craniofacial bone of the upper and lower mandible did not change obviously, the occlusal plane did not rotate clockwise and remained in the position basically. The SNA,SNB did not change significantly and the SNA decreased by 1 擄. SNB did not change. ANB decreased 1 擄(2) U1-SN from 115 擄to 108 擄, L1-MP labial inclination decreased from 104 擄to 91 擄, L1-NB decreased from 42 擄to 30 擄(3) Cm-Sn-Ls increased by 4 擄. The obliquity of upper lip (A UL-FH) increased by 6 擄, which indicated that the protruding degree of upper lip was reduced to a certain extent. The obliquity of lower lip (B UL-FH) increased by 7 擄, and the reaction of lower lip was improved to some extent. The ULP decreased from 10mm to 6 mm, decreased from 4 mm to 8 mm and decreased from 4 mm to 8 mm, and the upper and lower lip protrusions were significantly improved. UL-EP decreased from the original 6mm to 2mm LL-EP from 9mm to 5mm, and decreased by 4mm. The upper and lower lip did not reach the aesthetic line, but compared with before treatment, the protruding lip was improved. Mental sulcus inclination angle (Pg B-FH) was 70 擄before treatment, 75 擄after treatment, 56 擄before treatment at Z angle, 65 擄after treatment, 21 擄before and 19 擄after treatment at H angle, and the relationship between lip and chin tended to be coordinated after treatment. The lateral angle (G-Sn-Pg) and soft tissue facial angle (FH-Ns-Pg) were almost unchanged, so orthodontic therapy had little effect on the change of growth and development. Conclusion: the orthodontic treatment of adult patients with bimaxillary protrusion can control the position of molars in sagittal and vertical direction by using the technique of fixed straight wire appliance, combined with external Anchorage against head cap J hook and intraoral Anchorage against transverse palate bar. The extraction space can be fully used to recover the anterior teeth, and then the soft tissue profile of the patient can be balanced.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R783.5
本文編號：2411617
[Abstract]:Objective: to investigate the clinical effect of using fixed straight wire arch technique, combined with external Anchorage head J hook and intraoral Anchorage against transverse palate bar as a strong Anchorage device for the treatment of adult patients with bilateral protrusion malocclusion. Methods: a case of adult patients with andrognathic prognathia was selected. The source of the disease was 22 years old, from the doctor's stomatology clinic in Dalian City on August 29, 2010. Oral hygiene condition, periodontal health, had bite and mouth breathing habits, has been corrected, the patient is in the permanent teeth occlusion period, left and right canine, molar relationship for the relationship between the class, upper and lower dentition mildly and moderately crowded; Spee curve depth is normal, gums smile, the axial inclination of the maxillary anterior teeth is higher than that of the lip, the midline of the upper and lower jaw is in the middle, the side shape is convex, the chin is tense and retraction. Have a mother's family history. According to the results of model analysis and X-ray cephalometric measurement, this case adopted the extraction model of 144U 24444 and 182283848, and the technique of straight-wire orthodontic treatment. In the stage of leveling and leveling the upper and lower dentition, the molars were controlled by the transverse palatal rod, and the molars were controlled by the transverse palatine rod during the stage of leveling and leveling the upper and lower dentitions. Two-step sliding closure of the extraction gap, combined with the head cap to pull the canine to the far, when the canine basically reached neutral occlusion, the head cap J hook was used to recover and lower the anterior teeth properly, to maintain a good overbite and a good occlusion of the whole teeth of the anterior teeth. Results: the total course of correction was 27 months. At the end of the treatment, the whole dentition was leveled out, the extraction space was completely closed, the midline was located in the middle, the anterior tooth axis of the labial inclination was obviously recovered, the overbite of the anterior teeth was normal and covered with 2 mm by model examination. Molars and fangs belong to the Andes class. The position of condyle was good with no obvious change, the root of the whole tooth was basically parallel, and the alveolar bone was not absorbed. The results of X-ray lateral radiographic analysis before and after treatment were as follows: (1) the measured values of craniofacial bone of the upper and lower mandible did not change obviously, the occlusal plane did not rotate clockwise and remained in the position basically. The SNA,SNB did not change significantly and the SNA decreased by 1 擄. SNB did not change. ANB decreased 1 擄(2) U1-SN from 115 擄to 108 擄, L1-MP labial inclination decreased from 104 擄to 91 擄, L1-NB decreased from 42 擄to 30 擄(3) Cm-Sn-Ls increased by 4 擄. The obliquity of upper lip (A UL-FH) increased by 6 擄, which indicated that the protruding degree of upper lip was reduced to a certain extent. The obliquity of lower lip (B UL-FH) increased by 7 擄, and the reaction of lower lip was improved to some extent. The ULP decreased from 10mm to 6 mm, decreased from 4 mm to 8 mm and decreased from 4 mm to 8 mm, and the upper and lower lip protrusions were significantly improved. UL-EP decreased from the original 6mm to 2mm LL-EP from 9mm to 5mm, and decreased by 4mm. The upper and lower lip did not reach the aesthetic line, but compared with before treatment, the protruding lip was improved. Mental sulcus inclination angle (Pg B-FH) was 70 擄before treatment, 75 擄after treatment, 56 擄before treatment at Z angle, 65 擄after treatment, 21 擄before and 19 擄after treatment at H angle, and the relationship between lip and chin tended to be coordinated after treatment. The lateral angle (G-Sn-Pg) and soft tissue facial angle (FH-Ns-Pg) were almost unchanged, so orthodontic therapy had little effect on the change of growth and development. Conclusion: the orthodontic treatment of adult patients with bimaxillary protrusion can control the position of molars in sagittal and vertical direction by using the technique of fixed straight wire appliance, combined with external Anchorage against head cap J hook and intraoral Anchorage against transverse palate bar. The extraction space can be fully used to recover the anterior teeth, and then the soft tissue profile of the patient can be balanced.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R783.5
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