上颌快速扩弓结合自锁技术治疗骨性Ⅲ类错（牙合）合并双侧后牙反（牙合）的病例分析

发布时间：2018-05-19 16:50

本文选题：双侧后牙反牙合 + 正畸治疗　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：探讨在临床中正畸治疗双侧后牙反牙合的方法，评价使用上颌快速扩弓联合自锁托槽矫治双侧后牙反牙合的治疗效果。方法：选取1例双侧后牙反牙合的错牙合畸形患者作为研究对象，男性，年龄16岁，汉族；Angle III类，骨性III类，上下颌骨均发育正常；双侧磨牙近中关系，双侧尖牙中性关系；前牙对刃；上下牙列中线对正；左上侧切牙腭向错位，双侧第一恒磨牙反牙合；上颌牙弓拥挤度通过记存模型测量为9.5mm，下颌牙弓拥挤度通过记存模型测量为4.5mm。对患者进行问诊、专科检查，对其研究模型、面相口内像、头影测量数据等进行诊断分析，征得患者及家长同意，考虑患者主观要求，选择采用以下治疗方案：先采用上颌快速扩弓拓展上颌牙弓宽度，解除后牙反牙合，再使用SmartClipTM自锁矫治器排齐整平上下颌牙列，维持上颌宽度并利用颌间牵引调整上下牙列矢状向不调。治疗前后拍摄面像、口内像、曲面断层片、头颅侧位片，观察颌面、牙齿、骨骼情况。选取北医分析法、Downs分析法、E线等共24项测量项目，对测量项目进行治疗前后对比，反映矫治前后软硬组织数据改变及侧貌变化。结果：矫治疗程共计31个月。矫治结束后患者上下牙列已排齐整平，上下牙列中线对正，前牙覆牙合覆盖均在正常范围内，双侧尖牙、磨牙已达到中性关系；上下颌牙齿无牙合干扰，颞下颌关节开口型、开口度未见异常，双侧关节区无弹响、压痛；从治疗前后记存模型对比可知（1）上牙弓前段长度增加1.5mm，中段长度不变，后段增加1.5mm；下牙弓前段长度增加2mm，中段长度增加1.5mm，后段长度不变；可明显看出见治疗后上下牙弓长度的增加，为解除拥挤和改善矢状向不调提供了帮助。(2)上颌前段牙弓宽度增加了4.5mm，中段牙弓宽度增加了4.5mm，后段牙弓宽度增加了6.0mm；下颌前段牙弓宽度减少了0.5mm，中段牙弓宽度增加了1.5mm，后段牙弓宽度减少了2.0mm。可见通过上颌扩弓及自锁矫治器的固定矫治，上颌牙弓宽度的增加非常明显，对拥挤的解除和后牙反牙合的解除起了关键的作用，而下颌牙弓宽度的缩窄是为了与上颌相匹配，达到正常的覆牙合覆盖关系。从治疗前后头颅侧位片对比可知（1）ANB增加2.5°，说明上下颌骨矢状向不调有所改善；（2）U1-SN增加0.5°、 U1-NA增加1°、L1-MP增加5°、L1-NB增加4.5°、U1-L1减小7.5°，说明上下前牙唇倾度控制良好，下前牙较矫治前更为接近正常数值，且上下前牙凸度变大。（3）MP-SN增大1.5°、MP-FH增大2.5°，说明矫治后面部垂直关系略微增高。（4）治疗后Ls-E、Li-E均增加0.5mm，ULP不变、LLP增加1mm；NLA治疗后相比治疗前增加了5°，说明通过治疗患者获得了更直的面型，侧貌得到改善。结论：该病例通过上颌快速扩弓与自锁托槽联合使用，取得了良好疗效：成功的解除了后牙反牙合和前牙对刃，上下牙列排齐整平，，双侧尖牙磨牙获得中性关系，后牙尖窝关系良好，覆牙合覆盖恢复正常。上颌快速扩弓与自锁托槽的使用解决了上颌牙弓宽度不足以及上下颌牙弓拥挤的问题，且在未拔牙的情况下控制住了前牙的唇倾度，患者软组织侧貌有所改善，可见上颌快速扩弓联合自锁托槽是一种有效的正畸治疗双侧后牙反牙合的方法。
[Abstract]:Objective : To evaluate the effect of orthodontic treatment of bilateral posterior teeth on bilateral posterior teeth by using maxillary rapid arch expansion combined with self - locking bracket .

Methods : One patient with bilateral posterior teeth was selected as the study object , male , aged 16 years old , Han nationality ;
Angle III , bone type III , upper mandible all developed normal ;
Keywords bilateral molar near - middle relation , bilateral cuspal sexual relations ;
a pair of anterior teeth ;
the midline of the upper and lower teeth is aligned ;
the left upper jaw palate is malposition , and the bilateral first permanent molar is anti - occlusal ;
The maxillary arch crowding degree was 9.5 mm through the memory model , and the degree of submaxillary arch crowding was 4.5 mm . The patients were diagnosed and analyzed by using the model , the internal image , the cephalometric data and so on . After the treatment , the maxillary arch width was enlarged , the posterior teeth were removed , and the sagittal alignment of the upper and lower teeth was adjusted by the use of the SmartLock TM self - locking appliance .

Results : The treatment course lasted for a total of 31 months . After the treatment , the upper and lower teeth of the patients had been completely flat , the midline of the upper and lower teeth were in the normal range , the bilateral sharp teeth and the molar teeth had reached the middle - sex relationship ;
There were no occlusal interference on the upper and lower jaw teeth , open type of temporo - mandibular joint , no abnormal opening degree , no elastic ring and tenderness in bilateral joint area ;
Compared with the pre - treatment model , the length of the anterior segment of the maxillary arch was 1.5 mm , the length of the middle segment was unchanged , and the posterior segment was increased by 1.5 mm ;
the length of the front section of the lower arch is increased by 2mm , the length of the middle section is increased by 1.5mm , and the length of the rear section is unchanged ;
( 2 ) The arch width of the maxillary anterior segment increased by 4.5 mm , the width of the middle arch was increased by 4.5 mm , and the width of the posterior arch was increased by 6.0 mm ;
The arch width of the maxillary anterior segment decreased by 0.5mm , the width of the middle arch was increased by 1.5mm , the width of the posterior arch was decreased by 2.0 mm . It was found that the width of maxillary arch decreased by 2.0 mm .
( 2 ) U1 - SN increased by 0.5 掳 , U1 - NA increased by 1 掳 , L1 - MP increased by 5 掳 , L1 - NB increased 4.5 掳 , U1 - L1 decreased by 7.5 掳 , and that of upper and lower anterior teeth increased by 1.5 掳 and MP - FH increased by 2.5 掳 .
NLA increased by 5 掳 before treatment , indicating improved profile and side profile improvement by treatment of patients .

Conclusion : This case has been used in combination with self - locking bracket through maxillary rapid arch expansion . It has achieved good curative effect . The relationship between maxillary arch width and maxillary arch is good , and the relationship between maxillary rapid expanding arch and self - locking bracket is normal . The use of maxillary rapid expanding arch and self - locking bracket solves the problem of maxillary arch width deficiency and maxillary arch crowding .
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R783.5

【参考文献】