青少年临界病例非拔牙矫治前后颏部变化的分析

发布时间：2018-05-28 22:24

本文选题：青少年 + 临界病例　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：通过对青少年临界病例进行非拔牙矫治，比较其矫治前后颏部位置形态的变化，分析临床非拔牙矫治对颏部变化的作用，同时探讨生长发育因素对颏部的影响，以达到为正畸实践工作所借鉴的目的。方法：选择沈阳市口腔医院二零一零年暑期就诊的青少年男性患者一例，为骨性Ⅱ类错牙合，深覆牙合Ⅲ°、深覆盖Ⅲ°、上牙列存在牙间散隙、下牙列轻度拥挤，磨牙关系为左侧正常、右侧轻度远中错牙合关系，两侧尖牙是轻度远中错牙合关系，软组织侧貌显示面中部前突，颏唇肌紧张，口唇闭合困难；沈阳市口腔医院正畸科室的五位专家一致评定其为临界病例，且非拔牙矫治方案得到一致认可。上下颌使用直丝弓矫治技术，上颌牙列序列排齐的同时配合使用口外弓颈牵引，内收上前牙，改善上前牙的倾斜度；使用上颌斜导刺激下颌骨进一步生长发育；关闭上下颌牙列间散隙，配合使用皮圈牵引，精细调整牙齿咬合关系。矫治前后均拍摄全牙弓曲面断层片以及头颅侧位片，并对矫治前后的头颅侧位片进行头影描绘并测量，比较分析前后颏部软硬组织的变化以及软组织侧貌改善情况。结果：经过非拔牙矫治后，上下牙列排列整齐；Spee曲线较平直；覆牙合覆盖在前牙达到正常，尖牙以及磨牙的关系恢复到正常；下牙列中线与上牙列中线均不偏斜且相互对齐，上下颌牙齿均达尖窝交错咬合关系。矫治前后牙弓长度变化为：上牙弓前段、中段的长度减小，后段长度增加。矫治前后牙弓宽度变化为：上牙弓前段、中段的宽度减小，后段宽度增加。颏唇肌紧张得到缓解，无口唇闭合困难，唇突度减少，颏部形态改变，侧貌有改善，患者对矫治结果满意。对比矫治前后的牙牙合颅面关系测量项目：SNA减小，SNB增大， ANB减小，提示上颌骨发育受限制，下颌骨继续发育，上下颌骨差异减小；下颌平面角及Y-axis基本不变，提示垂直向控制较成功；NP-FH、Po-NB、SL、 Co-Po、ANS-Me、N-Me变大，提示随下颌骨的生长，颏部突度增大，全面高及下面高增加；UI-SN、 UI-NP、UI-AP、UI-LI减小，提示上切牙内收、突度减小，上、下切牙间的突度减小；ULP、LLP、 Z角、Ns-Sn-Pos、FCA减小，提示唇突度减小，面型突度减小，侧貌改善。矫治后李某的颏部硬组织变化为：颏高度、颏厚度、颏前厚、颏后厚、颏前厚/颏后厚、颏凹陷均有不同程度的增大，颏高/颏厚、颏部最小厚度/颏厚、颏角变小，，提示颏部随着生长发育向前向下生长，颏突度增加，体积变大，形态改变，并且这种改变利于面型的改善。对比矫治前后颏部软组织的数据见：颏唇沟的变浅，颏唇沟弧度变大，颏部的长度减小、弧度变大，颏部的突度也变大，EP-UL、 EP-LL减小，提示颏部软组织形态发生改变；随着下颌骨的前下移位、上下唇突度的减小、颏部突度的变大，软组织侧貌突度减小，最终侧貌得到改善。结论：1.临床正畸在诊断和治疗时，要考虑到颏部的生长发育，以便对矫治结果做出更好的预测；还要积极利用生长发育，促进颏部向前发育，以便更好的改善面型。2．在本研究中，青少年临界病例经过非拔牙矫治后，颏部的软、硬组织形态位置发生了变化，颏唇关系得到了协调，最终软组织侧貌改善。
[Abstract]:Objective: To compare the changes of the position of the chin position before and after the correction of the non extraction of the critical cases in adolescents, and to analyze the effect of the clinical non extraction treatment on the mental change of the chin, and to explore the influence of the growth and development factors on the chin, so as to achieve the purpose of the orthodontic practice.
Methods: a case of adolescent male patients in the summer period of 2010 in Shenyang City stomatology hospital was selected as a case of skeletal Class II malocclusion, deep overlying teeth and deep coverage of 3 degrees, upper teeth with interdental gaps, mild crowding in the lower teeth, the molar relationship to the left normal, the right light degree of far middle and wrong teeth, and the mild and middle and wrong teeth on both sides. Joint relationship, the side of the soft tissue showed the middle protrusion of the middle face, the stress of the chin lip muscle, and the difficulty of lip closure; five experts in the orthodontic Department of Shenyang oral hospital agreed that it was a critical case, and the non extraction treatment scheme was agreed. The maxillary orthodontic orthodontic technique was used, the maxillary dentition sequence was arranged together with the out of the mouth bow. Cervical traction, adduction of upper anterior teeth, improvement of the inclination of the upper anterior teeth; further growth and development of the mandible with maxillary oblique guidance; closure of the gap between the upper and lower jaw teeth, the use of the skin ring traction, and the fine adjustment of the relationship between the teeth and the occlusion. The cephalometric depiction and measurement were performed, and the changes of soft and hard chin and soft tissue profile were compared and analyzed.
Results: after orthodontic treatment, the upper and lower teeth were arranged neatly, the Spee curve was more straight, the overlying teeth were covered with the anterior teeth to normal, the relationship between the canine and the molar was restored to normal, the middle line and the middle line of the lower teeth were not skewed and aligned, both the upper and lower teeth were interlocked with the cusp nest. The length of the dental arch before and after correction was changed. In the anterior segment of the upper arch, the length of the middle segment decreased and the length of the posterior segment increased. The width of the dental arch was changed before and after the correction: the anterior segment of the upper arch, the width of the middle segment, the width of the posterior segment increased, the mental tension of the chin lip was relieved, the lip closed, the lip process decreased, the chin shape changed, the side appearance improved, the patient was satisfied with the correction results. The contrast correction was satisfactory. Contrastive correction The measurement of the relationship between the teeth and the craniofacial relationship before and after treatment: SNA decreased, SNB increased, and ANB decreased, suggesting that the maxillary development was restricted, the mandible continued to develop, the difference in the maxilla and mandible decreased; the mandibular plane angle and the Y-axis were basically unchanged, suggesting that the vertical control was more successful; NP-FH, Po-NB, SL, Co-Po, ANS-Me, N-Me became larger, suggesting the growth of the mandible, UI-SN, UI-NP, UI-AP, UI-LI decreased, suggesting that the upper incisor was adducted, the sudden degree decreased, and the upper and lower incisor decreased; ULP, LLP, Z angle, Ns-Sn-Pos, and FCA decreased, suggesting that the labial process decreased, the face pattern decreased and the side appearance improved. The mental height and chin thickness of Li's chin was the mental height and mental thickness after correction. Degree, chin thickness, chin thickness, chin thickness / Chin thick, mental depression all increased in varying degrees, chin high / chin thickness, mental thickness / chin thickness, chin thickness, chin angle smaller, suggesting that chin part grew along with growth and development, mental process increased, volume increased, morphologic change, and this change was beneficial to the improvement of face type. The mental soft tissue before and after correction were compared. The data showed that the chin lip sulcus was shallow, the chin lip sulcus radian became larger, the chin length decreased, the radian increased, the chin degree increased, the EP-UL, EP-LL decreased, suggesting the mental soft tissue morphology changed; with the mandible anterior and lower displacement, the decrease of the upper and lower lip, the mental process increased, the soft tissue appearance decreased and the final side appearance was obtained. To improve.
Conclusion: 1. in the diagnosis and treatment of clinical orthodontics, the growth and development of the chin should be taken into account in order to make a better prediction for the results of the orthodontic treatment. It is also necessary to make positive use of growth and development to promote the forward development of the chin, so as to better improve the face type.2. in this study. The position of the chin changed, the chin lip relationship was coordinated, and the soft tissue profile improved.
【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】：R782.11

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