扩弓联合推磨牙远移的临床疗效及相关问题研究

发布时间：2018-04-09 20:05

本文选题：扩弓联合推磨牙远移　切入点：Howes分析　出处：《大连医科大学》2017年硕士论文

【摘要】：牙列拥挤是最为常见的青少年错畸形,其矫正核心是获得解除拥挤所需的间隙。获得间隙的方法有两种:一是拔牙、二是非拔牙。如果仅考虑到牙齿的排列、咬合关系则拔牙矫治可以解决绝大多数病例的间隙需求。但是对于一些面型较好的青少年患者,为了避免拔牙矫治可能对其面型造成的不利影响,非拔牙是一种选择。临床上常用的非拔牙矫治方法包括快速扩弓、推磨牙远移、邻面去釉等。基于上颌结节及磨牙后间隙的生理特点,推磨牙向远中从而获得间隙的办法已得到临床大部分医生的肯定。利用生长发育潜力,通过打开腭中缝进行上颌牙弓扩展为拥挤的牙列提供间隙是解决牙列拥挤的另一个有效办法,但是上颌牙弓的扩大使下颌牙弓难以与其匹配,扩弓矫治的适应症也因此受到很大的限制。随着材料学的发展,临床上出现了许多对中重度牙列拥挤青少年患者非拔牙矫治取得良好疗效的病例报告,但是大部分医生对于非拔牙矫治技术的稳定性及临床疗效仍持怀疑态度。目前对于非拔牙矫治方法的研究大多集中于牙弓形态变化及其对侧貌的影响方面,关于矫治后牙量和骨量协调性及长期稳定性的文献较少。本研究将两种非拔牙方法----快速扩弓和推磨牙远移联合应用,对牙列拥挤伴牙弓狭窄的青少年患者于矫治初期进行上下联合扩弓治疗,同时,对于单纯横向扩弓所得间隙不足以解除拥挤的患者,以扩弓器作为强支抗推磨牙向远中移动。选取PAR指数和HOWES分析对患者矫治前后及随访时的牙模型进行观察验证扩弓联合推磨牙远移技术的临床疗效及长期稳定性,为今后的临床医生设计矫治方案时提供参考,本论文具体如下:研究目的研究扩弓联合推磨牙远移矫治完成的患者其牙量及骨量的协调性,及其临床疗效和长期稳定性。研究方法选取扩弓联合推磨牙远移矫治完成的中度牙列拥挤青少年患者51例,其中男性30例,女性21例,对其矫治前后及随访四年以上的研究模型进行测量。利用Howes指数及PAR指数对其矫治前后、及随访时模型进行测量,采用配对样本T检验对以上研究所得数据进行统计分析。结果1.本研究样本中,矫治前上下颌PMBAW/TM(双尖牙基骨弓宽径/牙量)分别为(41.40±2.14)%、(41.53±1.94)%均小于44%(Howes认为只有当PMBAW/TM≥44%时,这样基骨弓才足够容纳12个牙齿),矫治后PMBAWU/TMU(上颌双尖牙基骨弓宽径/牙量)为(46.72±3.29)%,PMBAWL/TML(下颌双尖牙基骨弓宽径/牙量)为(45.09±2.32)%,矫治前后Howes指数结果变化有明显统计学意义,说明矫治结束后,本研究样本基骨弓宽度增加,牙量和骨量关系趋于协调。2.从矫治结束后到随访期间PMBAWU/TMU变化无统计学意义,说明本矫治方法增大青少年患者牙弓宽度,所获得的腭中缝的改建效果稳定。3.下颌BALL/TML(下颌基骨弓长度/牙量)从矫治前到矫治后增加了(x=5.49,p0.001),且从矫治结束到随访时变化无统计学意义。PMBAWL/TML纯增加量为(x=3.97,p0.001),从矫治结束到随访时无明显变化,说明对于青少年患者来说扩弓配合下颌推磨牙远移所获得的间隙是稳定的。4.PAR加权总分值平均减少25.32±4.12,说明矫治后错极大改善,随访时PAR总分值增加为4.89±3.35,但PAR加权总分值减少百分率为78.32±6.12,在30%以上说明随访时错仍为改善,并为出现变差或无改变的情况。从矫治结束到随访期间,除牙牙齿排列和覆变化有统计学意义,其余各项分值均表现出良好的稳定性。结论1.扩弓联合推磨牙远移矫治中度拥挤青少年患者可以获得牙量和骨量的协调,且由于其矫治方法利用青少年生长发育潜能,产生较多骨性的变化,其矫治后疗效稳定。2.下颌牙列拥挤的青少年患者可以通过改良下颌螺旋扩弓器快速直立下牙列和推磨牙远移技术获得间隙解除拥挤,矫治后牙量骨量趋于协调且矫治效果稳定。
[Abstract]:Crowding is the most common adolescent malocclusion, its core is the discharge gap correction required. Get crowded clearance method has two kinds: one is the extraction, two non extraction. If only considering the tooth arrangement, it can solve the occlusion relation extraction treatment demand gap. But the vast majority of cases for some good type of young patients, in order to avoid the adverse effects of tooth extraction may have on the surface of the non extraction, is a choice. Non extraction treatment methods commonly used clinically include rapid maxillary expansion, molar distalization, interproximal enamel reduction. The physiological characteristics of the maxillary tuberosity and retromolar gap based on the grind the tooth to far to get the gap has been affirmed. Most clinical doctors use growth potential, by opening the maxillary palatal arch expansion to provide clearance is to solve the dentition in crowded dentition Another effective way to crowded, but the maxillary arch expansion of the mandibular arch is difficult to match, expansion of appliance and the indication has been limited. With the development of material science, many of the clinical signs of severe dentition crowding in adolescent patients with non extraction cases cure good curative effect however, most of the doctors for the stability of non extraction treatment technology and clinical efficacy is still skeptical. The current research on non extraction treatment methods are mostly concentrated on the dental arch form changes and its influence on the profile, and the amount of bone on correcting posterior coordination and the long-term stability of the literature. In this study, two kinds of non extraction methods: rapid maxillary expansion and molar distalization of combined application of dental crowding with narrow dental arch in the treatment of adolescent patients with early on joint expansion therapy, at the same time, for the single The pure income gap maxillary expansion is not enough to lift the crowded patients to palatal expansion as anchorage molar distal movement. Select the index of PAR and HOWES were observed to verify the analysis of arch expansion joint Distalizing technology clinical curative effect and the long-term stability of dental model before and after treatment and follow-up, provide a reference the design scheme of treatment for clinicians in future, this paper is as follows: To study the coordination of expansion joint Distalizing appliance complete with teeth and bone, and its clinical efficacy and long-term stability. The method of selection of expansion joint Distalizing appliance complete moderate crowding in adolescent patients in 51 cases, including 30 cases of male, female 21 cases, measured on the research model for more than four years before and after treatment and follow-up. It on before and after treatment with Howes index and PAR index, and the follow-up model. For the measurement of the above study, the data were analyzed using paired samples T test results of 1. samples. In this study, treatment of anterior mandibular PMBAW/TM (premolar basal bone arch width / teeth) respectively (41.40 + 2.14)% and (41.53 + 1.94)% were less than 44% (Howes that only when when PMBAW/TM is greater than 44%, so the base bone arch is enough to accommodate 12 teeth), after treatment of PMBAWU/TMU (maxillary premolar basal bone arch width / tooth size) for (46.72 + 3.29)%, PMBAWL/TML (mandibular premolar basal bone arch width / tooth size) for (45.09 + 2.32)%, the number of results there was significant changes to Howes before and after treatment, that after the end of treatment, the sample base bone arch width increased, no significant amount of tooth and bone to coordinate.2. from after the end of treatment to PMBAWU/TMU during the follow-up change, the treatment methods of adolescent patients increases the width of dental arch, the palatal modification The effect of.3. BALL/TML (build stable mandibular lower basal bone arch length / teeth) from before treatment to after treatment increased (x=5.49, p0.001), and from the end of the treatment to the follow-up, no significant changes in.PMBAWL/TML net increase amount (x=3.97, p0.001), from the end of the treatment to the follow-up showed no obvious change for adolescent patients with mandibular arch expansion Distalizing gap is gained by.4.PAR weighted total score stability is reduced by an average of 25.32 + 4.12, shows that after treatment the wrong greatly improved, follow-up PAR score increased to 4.89 + 3.35, but the PAR value decreased weighted total percentage was 78.32 + 6.12, in more than 30% follow-up wrong is still improving, and for the worse or no change. From the end of the treatment to the follow-up period, in addition to significant teeth arrangement and cover change, the rest of the score showed good stability. The conclusion of the 1. expansion joint push Molar distalization coordination for moderate adolescent patients can get crowded teeth and bone, and the correction method using the adolescent growth potential, changes produce more bone, its curative effect is stable after treatment of.2. mandibular crowding in adolescent patients can quickly erect improved mandibular screw dentition and molars far shift technology gap release congestion, correcting posterior bone mass tends to be stable and coordinated treatment effect.

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R783.5

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