多颗上颌前牙缺失拔除单颗下颌侧切牙的正畸治疗

发布时间：2018-08-02 07:41

【摘要】：目的：探讨临床中由于多颗上颌前牙缺失而导致上下前牙Bolton指数不调的错牙合畸形的正畸治疗，研究分析由于上下前牙Bolton指数不调所致错牙合畸形的临床特点及这类错牙合畸形的诊断、设计、矫治效果。方法：选取1例缺失两颗上颌中切牙及一颗左上侧切牙的患者为研究对象，女性，年龄13岁，汉族；外伤史5年，外伤导致上颌两颗中切牙及左侧上颌侧切牙缺失；骨性Ⅲ类；上下颌骨发育基本正常；两侧第一恒磨牙中性关系，左侧尖牙远中关系；左侧尖牙反牙合，右侧上颌第一、第二前磨牙正锁牙合；右侧下颌第二乳磨牙滞留，，凹面型。矫治设计：根据模型分析、X线头影测量及Bolton指数分析，制定拔除左侧下颌侧切牙的矫治方案。拔除滞留的乳牙及左侧下颌侧切牙，上下牙列固定矫治。排齐整平上下牙列，解除下牙列拥挤；牙合垫加双曲舌簧解除尖牙反牙合；纠正前磨牙区正锁牙合；镍钛螺旋推簧拓展缺牙间隙；调整双侧尖牙及第一恒磨牙达到中性关系。通过分析矫治前后X线头颅侧位片，比较矫治前后前牙的角度、上下颌骨及软组织侧貌的变化情况；通过矫治前后曲面断层片观察牙冠、牙根、牙槽骨等方面的变化。结果：矫治疗程共20个月，矫治后解除了下牙列牙齿拥挤不齐，纠正了左侧尖牙区反牙合及右侧前磨牙区正锁牙合。有效拓展上颌前牙缺牙区间隙，拓宽上颌前牙段牙弓宽度。调整两侧磨牙及尖牙关系至中性，改善咬合关系。患者及家长对矫治效果满意。(1)通过模型分析、Bolton指数分析以及X线头影测量，制定拔除左侧下颌侧切牙及滞留的右侧第二乳磨牙的矫治方案。为解除下牙列拥挤、整平Spee曲线、内收下前牙提供间隙。近中移动左侧下颌尖牙，使左侧尖牙远中关系调整至中性，最终达到双侧尖牙及磨牙中性关系，后牙达到尖窝相对的咬合状态。(2)应用上颌牙合垫加双曲舌簧，去除牙合干扰同时唇向移动左侧上颌尖牙及右侧上颌侧切牙，拓宽上颌前牙区牙弓，改善凹面型。(3)因患者矫治结束时15岁，暂不能进行缺牙区种植或修复治疗。在保持器中加树脂牙进行暂时性美观修复，待成人后进行缺牙区义齿修复。结论：该病例通过全面的模型分析及X线头影测量分析，制定拔除单颗下颌侧切牙的矫治方案。这一非常规拔牙方案，虽然丢失了下颌中线但却有效的解除了下牙列前牙区的拥挤，解除了左侧尖牙区的反牙合，建立前牙正常覆牙合、覆盖关系，建立双侧尖牙和第一磨牙中性关系。矫治结束后在压膜保持器加树脂牙用于缺隙保持并达到暂时性的美观修复作用。对于本病例患者，单颌拔除左侧下颌侧切牙达到了令人满意的矫治效果。
[Abstract]:Objective: to investigate the orthodontic treatment of malocclusion due to the absence of multiple maxillary anterior teeth, which leads to the unadjusted Bolton index of the upper and lower anterior teeth. The clinical features of malocclusion caused by the Bolton index of upper and lower anterior teeth and the diagnosis, design and treatment of malocclusion were studied and analyzed. Methods: one patient with two maxillary central incisors and one left upper incisor was selected as the study object, female, aged 13 years, Han nationality, two maxillary central incisors and left maxillary incisors were injured for 5 years; The development of maxillary and mandibular bone was basically normal; the first permanent molar was neutral and the left canine was distal; the right maxillary first and second premolars had positive locking occlusal; the right mandibular second primary molars remained concave. Orthodontic design: according to the model analysis of cephalometric measurement and Bolton index analysis, the orthodontic scheme of extraction of left mandibular lateral incisor was established. The remaining deciduous teeth and left mandibular lateral incisors were extracted and fixed with upper and lower dentition. Straighten the upper and lower teeth to relieve the lower dentition crowding; the occlusal pad and the double curved tongue spring to remove the canine reverse occlusion; correct the anterior molar area; the nickel titanium spiral push spring to expand the missing tooth gap; adjust the bilateral canine and the first permanent molar to achieve neutral relationship. The angle of anterior teeth, the lateral appearance of upper mandible and soft tissue were compared before and after orthodontic treatment, and the changes of crown, root and alveolar bone were observed by curved surface tomograph before and after orthodontic treatment. Results: the treatment course was 20 months. After the correction, the lower teeth were overcrowded, and the right anterior molar and left canine were corrected. The gap between the missing areas of the maxillary anterior teeth was effectively expanded and the arch width of the maxillary anterior segment was widened. Adjust bilateral molar and canine relationship to neutral, improve occlusal relationship. Patients and parents were satisfied with the effect of treatment. (1) through model analysis Bolton index analysis and X-ray cephalometric measurement, the treatment plan for extraction of left mandibular lateral incisor and left second primary molars was established. In order to relieve lower dentition crowding, Spee curve is leveled, and anterior teeth are included to provide space. The proximal and middle movement of left mandibular canine made the distal relationship of left canine adjusted to neutral, and finally achieved the neutral relationship between bilateral canine and molar, and the posterior teeth reached the relative occlusal state of cusp fossa. (2) maxillary occlusal pad and double curved tongue spring were used. Removing the occlusion interference and moving the left maxillary canine and the right maxillary lateral incisor, widening the arch of the maxillary anterior teeth and improving the concave type. (3) because the patients were 15 years old at the end of orthodontic treatment, they could not be implanted or repaired temporarily. Resin teeth were added to the retainer for temporary aesthetic restoration, and for adults, denture restoration was performed in the missing area. Conclusion: through comprehensive model analysis and X-ray cephalometric analysis, the orthodontic program of single mandibular lateral incisor was established. This unconventional extraction program, although it lost the central line of the mandible, effectively relieved the crowding of the anterior teeth of the lower dentition, removed the reverse occlusal in the left canine region, and established the normal overbite and overlay relationship of the anterior teeth. To establish a neutral relationship between bilateral canines and first molars. At the end of orthodontic treatment, plastic teeth were added to the film holder to maintain the gap and to achieve temporary aesthetic repair. In this case, single jaw extraction of left mandibular lateral incisor achieved satisfactory results.
【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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