不同拔牙模式对高角开（牙合）患者面部垂直向变化的影响

发布时间：2018-07-03 15:59

本文选题：前牙开(牙合) + 高角型　；参考：《大连医科大学》2016年硕士论文

【摘要】：目的:通过对高角开(牙合)患者正畸前后X线头颅侧位片的测量,回顾分析在两种不同拔牙模式下矫正开(牙合)时,牙齿移动的不同机制以及对面部垂直向变化的影响是否存在差异,从而为临床矫治设计提供参考。方法:从沈阳市口腔医院正畸科2008年-2013年间就诊的患者中选取24例已经结束的高角开(牙合)患者,38°SN-MP54°,32°FH-MP47°。为避免患者在调整磨牙关系时产生的误差,所有患者的磨牙关系为中性。24例患者均为轻中度开(牙合),前牙区至少有4颗切牙呈开(牙合)状态,开(牙合)程度0-4.2mm不等。对于有吐舌、口呼吸等不良习惯的患者,首先建议破除不良习惯。为了观察磨牙前移量,两组患者上下颌均为轻中度拥挤(1mm拥挤度5mm)。上下颌牙弓宽度协调,前牙Bolton指数均正常,所有患者治疗前均没有颞下颌关节症状。将24名患者按照拔牙方式的不同分为两组,拔除4颗第一前磨牙组为E4组(男2例女10例,初诊平均年龄16.89±3.26岁),拔除4颗第二前磨牙组为E5组(女12例,初诊平均年龄16.89±4.81岁)。所有患者采用0.022英寸槽沟系统的直丝弓矫治器,前牙整体滑动内收法关闭拔牙间隙,最终磨牙均达到安氏Ⅰ类咬合关系。所有患者在正畸过程中均没有使用后牙(牙合)垫、口内辅弓(如MEAW)、口外牵引装置(如高位牵引头帽等)及影响磨牙前移的强支抗装置(如种植钉、Nance弓、TPA等)。正畸前后头颅侧位片采用同一X射线系统进行拍摄,并由同一正畸医师进行描片测量。本研究测量指标包括牙性指标12项,骨性指标15项。使用SSPS 17.0软件对测量结果进行统计学分析,组内前后变化采用配对t检验,组间牙齿及颅颌面垂直向变化使用独立样本t检验,P0.05具有统计学意义。结果:(1)治疗前两组各项指标没有显著差异(P0.05);(2)两组治疗后开(牙合)均得到明显改善,E4组覆(牙合)增加3.27±0.94(P0.001),E5组覆(牙合)增加3.59±1.34(P0.001);(3)两组矫正后前下面高及前面高均增加,E4组平均增加量分别为3.01±2.41mm和3.17±3.06mm,E5组平均增加量分别为2.90±2.01mm和3.56±3.65mm,均有统计学意义(P0.05);(4)两组下颌平面角治疗前后均没有差异(P0.05);(5)E5组上下颌第一磨牙前移量大于E4组(P0.05),且中切牙回收量小于E4组(P0.05);(6)两组治疗前后变量间其他测量指标没有显著差异(P0.05)。结论:1.无论哪种拔牙模式都不能使高角开(牙合)患者产生下颌骨的逆时针旋转,亦不能使前下面高减小;2.在临床上设计拔牙矫治方案时,应更多的考虑患者的拥挤度,面凸度,磨牙咬合关系,牙齿的健康状况等。
[Abstract]:Objective: to retrospectively analyze the effects of two different extraction modes on orthodontic radiographic lateral radiographs in patients with high angle open (occlusal) teeth. The different mechanisms of tooth movement and the influence on the vertical change of face are different, so as to provide reference for clinical orthodontic design. Methods: from 2008 to 2013, 24 patients with high angle open (occlusal) were selected from orthodontic department of Shenyang Stomatology Hospital. They were 38 掳SN-MP54 掳and 32 掳FH-MP47 掳. In order to avoid the error in adjusting the molar relationship, the molar relationship of all patients was neutral. 24 patients were mild or moderate open (occlusal), at least 4 incisors in the anterior teeth were open (occlusal), and the degree of open (occlusal) 0-4.2mm was different. For patients with bad habits such as spitting and breathing, it is first recommended to break down bad habits. In order to observe the anterior displacement of molars, the upper and lower mandibles in both groups were 1mm crowding 5mm. The width of maxillary arch was coordinated and Bolton index of anterior teeth was normal. All the patients had no temporomandibular joint symptoms before treatment. 24 patients were divided into two groups according to different extraction methods. Four first premolars were extracted in E4 group (male, 2 female, 10 cases, mean age 16.89 卤3.26 years old), and 4 second premolars were extracted in E5 group (12 female, mean age 16.89 卤4.81 years old). All the patients were treated with a straight wire appliance with a 0.022 inch grooving system. The extraction space was closed by the method of integral sliding and closing of the anterior teeth, and the final molar achieved the class I occlusal relationship. During orthodontic treatment, all patients did not use posterior teeth (occlusal) pad, intraoral arch (MEAW), extraoral traction device (such as high traction head cap) and strong Anchorage device (such as implant nailing Nance arch TPA). The lateral head radiographs were taken with the same X-ray system and measured by the same orthodontic physician before and after orthodontics. This study included 12 dental indexes and 15 bone indexes. SSPS 17.0 software was used to analyze the results of statistical analysis, the changes of pre-and post-group changes were matched t test, and the vertical changes of teeth and craniomaxillofacial were analyzed by independent sample t-test (P0.05). Results: (1) there was no significant difference between the two groups before treatment (P0.05); (2). After treatment, the occlusal (occlusal) increased by 3.27 卤0.94 (P0.001) and 3.59 卤1.34 (P0.001); (3) respectively. The average increment of the two groups were 3.01 卤2.41mm and 3.17 卤3.06mmE5, respectively, which were 2.90 卤2.01mm and 3.56 卤3.65mm, respectively (P0.05); (4). There was no significant difference between the two groups before and after treatment (P0.05); (5). The anterior displacement of the first molar in the E5 group was higher than that in the E4 group (P0.05), and the anterior displacement of the first molar in the E5 group was higher than that in the E4 group (P0.05). The amount of tooth recovery was less than that of E4 group (P0.05); (6). There was no significant difference in other measurements between the two groups before and after treatment (P0.05). Conclusion 1. Neither extraction model can cause the mandible to rotate counterclockwise in high angle open (occlusal) patients, nor can it reduce the anterior and lower height by 2%. In clinical design, more consideration should be given to the degree of crowding, facial convexity, molar occlusion, tooth health and so on.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R783.5

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