易位埋伏上颌尖牙的正畸—外科联合治疗

发布时间：2018-03-21 12:29

本文选题：易位埋伏　切入点：尖牙　出处：《大连医科大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:运用正畸固定矫治联合外科牙周翻瓣术将易位埋伏的上颌尖牙牵引至牙列内正常位置,探讨易位埋伏上颌尖牙的治疗方法。方法:选取2例沈阳市口腔医院正畸科收治的错牙合畸形患者为研究对象,所选病例均为恒牙牙合期,患者的依从性好,能主动接受并配合外科牙周翻瓣手术。经临床检查和影像学分析诊断为上颌阻生尖牙易位埋伏于同侧上颌中切牙与上颌侧切牙之间,牙冠向近中并与中切牙牙长轴约成45°角,埋伏牙牙根邻近上颌窦底,牙根已基本发育完成,根尖孔基本闭合,萌出动力不足,长期不能自行萌出。客观分析易位埋伏尖牙的阻生原因,掌握其埋伏位置,埋伏牙及邻牙周围牙周组织状况,采用正畸固定矫治联合外科牙周翻瓣术,开拓间隙,合理选择支抗,弹性橡皮链60g轻力牵引,将易位埋伏尖牙牵引至牙列正常位置。分别在术前术后收集患者面、牙合像,拍摄曲面断层片观察易位埋伏上颌尖牙的变化及牙周状况,拍摄头颅侧位片,分析上下颌颌骨变化、上下颌前牙的唇倾程度以及软组织侧貌的改变情况。结果:本文所选2例患者都获得了令人满意的的疗效。2例患者矫治所用时间平均为29个月。正畸固定矫治联合外科牙周翻瓣术成功地将易位埋伏的上颌尖牙牵引到牙列正常位置并与邻牙接触良好,无前伸牙合及侧方牙合干扰,牙髓活力无异常。典型病例矫治前后骨性变化:未发现较明显的骨质异常,两侧髁突形态基本不变。SNA角增加1.0°,NA-PA角增加3.5°,MP-FH角增加4.0°,ANS-Me/N-ME增加0.6%,Wits值增加2.1mm,SNB角减少0.5°,APDI角减少7.5°,NP-FH角减少9.0°;典型病例治疗前后牙齿位置的变化:患者的13、34均已纳入牙弓至正常位置,13、34牙根根尖1/3远中弯曲,22、23牙根略微向远中倾斜,其余牙牙根互相平行,无明显的根吸收。U1-SN角增加3.5°,U1-NA角增加9.0°,L1-NB角增加8.4°,L1-MP角增加6.0°;典型病例治疗前后软组织的变化:矫治后部分龈乳头轻微红肿,13腭侧牙龈无明显退缩,其余未见异常。术后测量结果显示FCA、ULP距、LLP距、EPUL距、EPLL距均有所增大,NLA减小,Z角从79°减小到正常值73°,上下唇突度正常,鼻、唇、颏三者比例协调,侧貌美观。结论:运用正畸固定矫治联合外科牙周翻瓣术,能有效地将易位埋伏上颌尖牙排列到牙列正常位置。典型病例治疗后易位埋伏尖牙与邻牙接触良好,牙髓活力正常,未见明显骨质吸收及根吸收。患者上下颌牙弓宽度及矢状向关系更为协调,改善了软硬组织侧貌,患者对治疗效果满意;通过正确诊断易位埋伏上颌尖牙的位置,生长情况,灵活掌握牵引时机与牵引方向,利用直丝弓矫治器有效控制转矩,全面考虑支抗问题,轻力加以牵引,采用正畸固定矫治联合外科牙周翻瓣术助萌易位埋伏上颌尖牙,可以有效地将其牵引至牙列正常位置,达到美观、平衡、稳定的矫治目标。
[Abstract]:Objective: to apply orthodontic fixation combined with orthodontic orthodontic orthodontic surgery to pull the transposed maxillary canine teeth to the normal position in the dentition. Methods: two patients with malocclusion were selected from orthodontic department of Shenyang Stomatology Hospital. The maxillary impacted canine translocation was found to be located between the ipsilateral maxillary central incisor and the maxillary lateral incisor, with the crown approaching the center and at an angle of about 45 掳with the long axis of the central incisor. The root of the ambushed tooth is near the floor of the maxillary sinus, the root has basically developed, the apical foramen is basically closed, the eruption power is insufficient, and can not erupt on its own for a long time. The periodontal tissue around the buried teeth and adjacent teeth was treated by orthodontic fixation combined with surgical periodontal flap surgery to open up the gap and select Anchorage reasonably. The elastic rubber chain was drawn by 60 g light force. The transposition canine teeth were towed to the normal position of dentition. The patients' faces and occlusal images were collected before and after operation. The changes and periodontal status of the transposition maxillary canine teeth were observed on curved surface tomograms, and the lateral cephalic films were taken. The changes of maxillary and maxillary bone were analyzed. Results: satisfactory results were obtained in 2 cases of maxillary and mandibular anterior teeth. The average time for correction was 29 months. The orthodontic fixation was combined with orthodontic fixation. The orthopedic periodontal flap successfully towed the transposed maxillary canines to the normal position of the dentition and had good contact with the adjacent teeth. There was no disturbance of anterior and lateral occlusal, no abnormal pulp activity. The bone changes of typical cases before and after orthodontic treatment: no obvious bone abnormality was found. The condylar shape of bilateral condyle is almost unchanged. The angle of SNA increases by 1.0 掳and NA-PA angle increases by 3.5 掳and the angle of MP-FH increases by 4.0 掳ANS-MeP / N-ME increases by 0.6 mm SNB angle decreases by 0.5 掳and APDI angle decreases by 7.5 掳and NP-FH angle decreases by 9.0 掳. Changes of tooth position before and after treatment in typical cases: 1334 of the patients were included in the dental arch to positive. The root tip 1/3 distal to the root tip was slightly tilted to the distal end of the tooth, and the root of the tooth was slightly tilted to the distance. The roots of the other teeth were parallel to each other, the root resorption. U1-SN angle increased by 3.5 掳and U1-NA angle increased by 9.0 掳and L1-NB angle increased by 8.4 掳and the angle of L1-MP increased by 6.0 掳. The results of postoperative measurement showed that the distance between ULP and EPUL / EPLL increased and the angle of NLA decreased from 79 掳to 73 掳, and the upper and lower lip protrusions were normal, and the ratio of nose, lip and chin was in harmony. Conclusion: orthodontic orthodontic fixation combined with surgical periodontal valvulation can effectively arrange the transposition maxillary canine teeth to the normal position of dentition. After treatment, the transposition canine teeth are in good contact with the adjacent teeth, and the pulp activity is normal. There was no apparent bone absorption and root resorption. The width and sagittal relationship of maxillary and mandibular arch were more harmonious, the soft and hard tissue profile was improved, the patients were satisfied with the therapeutic effect, and the position and growth of the maxillary canine teeth were ambushed by correct diagnosis. Using straight wire appliance to control torque, fully consider the problem of Anchorage, apply light force to traction, and apply orthodontic fixation and orthodontic orthodontic orthodontics combined with periodontal flap surgery to help the maxillary canine teeth to be ambushed. It can be effectively towed to the normal position of dentition to achieve aesthetic, balanced, stable correction goal.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R783.5

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