骨性Ⅲ类错合伴下颌不对称畸形的正畸治疗

发布时间：2018-06-13 17:34

本文选题：骨性III类错合畸形 + 下颌不对称畸形　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：探讨骨性III类错合伴下颌不对称畸形正畸掩饰性治疗的临床效果。材料和方法：选取2013年6月在大连医科大学附属第一医院就诊的骨性III类错合伴下颌不对称畸形的19岁女性患者一例。患者为凹面型，下颌前突，下颌向右侧偏斜，下颌骨相对上颌骨发育过度；前牙12与42、43反合伴开合，13与44对刃，11与41、31对刃；磨牙关系近中尖对尖；Spee曲线较平直。下颌中线相对于面中线右偏2.5mm;上下牙弓轻度拥挤；患者否认面部肿瘤，外伤等疾病史，家族史中，其母亲也为凹面型，前牙反合。经过对患者模型、头颅侧位片，曲面断层片，头颅正位片以及软组织相片的分析，确定诊断方案。正畸治疗采用多曲方丝弓联合直丝弓的正畸代偿治疗，直丝弓排齐整平后，更换已经加力的多曲方丝弓，配合不同阶段的垂直牵引、中线牵引以及短III类牵引，调整咬合关系。结果：患者历时21个月矫治完成，前牙建立了正常的覆合覆盖，磨牙以及尖牙关系到达中性，下中线较矫治前回正2mm,建立了良好的咬合关系；对治疗前后的硬组织进行分析：上颌骨以及上颌牙长轴在三维方向上基本没有变化；下颌骨有很显著的变化，，SNB减小2.5o，wits值减小8.5mm,B点到FHV的垂直距离减小3mm;L1－NB由23o减小到19o，L1-MP由86o减小到83o，说明下颌切牙代偿性的更加舌倾。治疗前后的软组织分析：下颌前凸的软组织侧貌得到改善，面型由原来的凹面型变为接近直面型。患者正面观下颌偏斜程度有一定的改善。患者及其家长对矫治结果满意。结论：通过多曲方丝弓技术对骨性III类错合伴下颌不对称畸形患者进行正畸掩饰性治疗，患者咬合恢复正常，前牙覆合、覆盖正常，磨牙、尖牙达到中性关系；患者的软组织面型有了一定的改善，尤其是侧貌改善显著。但是,还是存在一定程度的偏斜。说明，利用多曲方丝弓技术对骨性下颌不对称畸形进行正畸掩饰性治疗，对改变其牙齿和牙槽骨的作用很大，对骨的改变很轻微。
[Abstract]:Objective: to investigate the clinical effect of orthodontic concealment treatment of skeletal class III malocclusion with mandibular asymmetry. Materials and methods: a 19-year-old female patient with mandibular asymmetry was selected from the first affiliated Hospital of Dalian Medical University in June 2013. The patients were concave, mandibular protruding, mandibular oblique to the right, the mandible overdeveloped relative to the maxilla, the anterior teeth were 12 and 42O43 opposite with the open and closing 13 and 44 pairs of edges, 11 and 41 of the edges, and the relationship between the molar and the proximal cusp of the teeth was straight. The middle line of the mandible is 2.5 mm right relative to the middle line of the face; the upper and lower dental arch is slightly overcrowded; the patient denies the history of facial neoplasms, trauma and other diseases. In the family history, her mother is concave, and the anterior teeth are concave. The diagnostic scheme was determined by analyzing the patient model, lateral cephalograms, curved tomography, head positives and soft tissue photographs. The orthodontic treatment was performed with multiple square wire arch combined with straight wire arch. After the straight wire arch was leveled out, the multiple curved wire arch was replaced with different stages of vertical traction, midline traction and short type III traction to adjust the occlusal relationship. Results: after 21 months of orthodontic treatment, the anterior teeth were covered with normal cladding, the relationship between molars and canines was neutral, and the inferior midline was 2 mm higher than that of the anterior gyrus, and a good occlusion relationship was established. The hard tissue before and after treatment was analyzed: the maxillary and maxillary long axis had no change in three dimensional direction; There were significant changes in the mandible. SNB decreased 2.5owits, the vertical distance from point B to FHV decreased by 3mmL1-NB from 23o to 19oL1-MP from 86o to 83o. it indicated that the mandibular incisor was more tongue-tilting. Soft tissue analysis before and after treatment: the soft tissue profile of mandibular protruding was improved and the facial shape changed from concave to straight. The degree of mandibular deflection was improved. The patients and their parents were satisfied with the results of the treatment. Conclusion: orthodontic concealment was performed in patients with bone class III malocclusion and mandibular asymmetry by multi-curved wire arch technique. The occlusal of the patients returned to normal, the anterior teeth overlaid, covered normally, the molars and canines reached a neutral relationship. The soft tissue features of the patients improved, especially the side features. However, there is still a certain degree of skew. The results showed that the orthodontic treatment of osteomorphic mandibular asymmetry with multi-curved wire arch technique had a great effect on the change of teeth and alveolar bone, and a slight change on bone.
【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

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