安氏Ⅰ类牙列拥挤错（牙合）畸形的拔牙矫治

发布时间：2018-03-16 05:15

  本文选题：牙列拥挤　切入点：拔牙矫治　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨应用拔牙矫治对安性I类伴牙列拥挤患者的临床矫治效果和思考。 方法：选取大连博士口腔门诊2010年收治的青少年患者一例，女性，11岁，生长发育期，骨性I类，均角，安氏I类，牙列拥挤，上颌拥挤度4.3mm，属于中度拥挤。下颌拥挤度（包括整平Spee曲线以及下切牙唇倾）为8.0mm，属于中度拥挤，前牙覆盖为3.7mm，属于I度深覆盖，覆牙合为下前牙切缘咬在上切牙舌面超过切1/2,不足2/3，属于Ⅱ度深覆牙合。上颌第二磨牙未萌出。下切牙牙轴舌倾，IMPA为80度。双侧尖牙，磨牙关系均为中性关系。上下颌中线对正，下颌Spee曲线左右两侧均为1.5mm。本病例根据检查结果，采用拔除上颌第一前磨牙和下颌第二前磨牙的拔牙模式进行矫治，应用陶瓷托槽排齐整平上下颌牙列，控制上下磨牙在关闭间隙阶段的牙齿移动一致性，上下颌磨牙应用弱支抗，滑动法关闭拔牙间隙，头帽Ｊ钩结合Ⅱ类牵引矫治深覆牙合和控制颌骨生长方向。治疗结束后，结合矫治前后ｘ线头颅侧位片重叠图和测量结果进行分析对比。 结果：矫治疗程为31个月，上下颌牙列排齐整平，解除牙列拥挤，牙列无间隙存在，上颌中线对正，前牙覆盖减小为2.9mm，属于正常覆盖，覆牙合为下前牙切缘咬在上切牙舌面切1/3处，属于正常覆牙合，全口牙列咬合关系稳定，尖牙，磨牙关系保持中性关系，上颌第二磨牙萌出，上下第二磨牙建立咬合关系，颞下颌关节活动正常，无压痛，无关节弹响，对比治疗前后曲面断层片分析，牙根发育正常，全口牙根无明显吸收，ｘ线头颅侧位片前后对比结果显示，（1）上下颌骨正常生长发育，ANB由治疗前的4度减小为3度。（2）上切牙轻微唇倾，U1-SN增加2度，下切牙牙冠唇倾，L1-NB增加5度，IMPA则增加了4度，U1-L1减少至127度，上下切牙牙轴交角改善更加自然。（3）颌骨面高均有所增长，ANS-Me由58mm增加至60mm，下颌升支高度增加3mm，面高指数（FHI）由65%增加至70%,颌骨垂直向比例更加协调。（4）上下颌骨均有所增长，上颌骨长度ANS-PNS增加1mm，下颌骨长度Co-Po增加5mm，颌骨长度增长使得矢状向变化更加协调。（5）软组织侧貌更为协调自然，Z角由治疗前的64度增大至71度，ULP和LLP均各自减小到4mm，颏部和上下唇突度更加自然。 结论：对于生长发育期牙列拥挤的安氏I类患者，，综合其他测量结果以及仔细分析考量，选择合理的拔牙模式进行拔牙矫治，往往可以收到非常良好的矫治效果。
[Abstract]:Objective: to investigate the clinical effect and thinking of dental extraction in patients with class I and dentition crowding. Methods: in 2010, a young patient, female, aged 11 years, was selected from the Department of Stomatology in Dalian. The age of female was 11 years old, the growth and development period, bone type I, average angle, class I of Ann's, and dentition crowded. The mandibular crowding (including leveling Spee curve and lower incisor labial tilting) was 8.0mm, which was moderately crowded, and the anterior tooth overlay was 3.7mm, which belonged to I-degree deep overlay, and the mandibular crowding (including leveling Spee curve and lower incisor labial inclination) was 8.0mm. The overbite is the incisal edge of the lower incisor and more than 1 / 2 / 2, less than 2 / 3 of the upper incisor tongue. It belongs to the second degree of deep overbite. The maxillary second molar does not erupt. The IMPA of the lower incisor axis is 80 degrees. The molar relationship was neutral. The central line of the upper and lower mandible was positive, and the left and right sides of the mandibular Spee curve were 1.5 mm. According to the results of the examination, the extraction model of the first premolar and the second premolar of the maxilla was used to correct the molar. The ceramic brackets were used to level the upper and lower dentition, to control the consistency of tooth movement between the upper and lower molars in the closing space, to apply weak Anchorage to the upper and lower molars, and to close the extraction space by sliding. The head cap J hook combined with class 鈪

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