青少年重度骨性Ⅲ类开（牙合）病例掩饰性正畸治疗的疗效分析
发布时间：2018-08-13 14:29
【摘要】：目的:探讨运用掩饰性正畸治疗手段矫治青少年患者重度骨性Ⅲ类开牙合畸形的临床效果。方法:选择2011年沈阳市口腔医院正畸科收治的重度骨性Ⅲ类开牙合畸形的青少年患者2例。均为14岁,女性,恒牙早期,都为生长发育高峰期后(Cvs4)的患者。病例一为重度高角型患者,ANB角-5°,左右两侧尖牙、磨牙均为完全近中关系,上牙列Ⅰ度拥挤,下牙列Ⅱ度拥挤,全牙弓反牙合,广泛开牙合,前牙开牙合6mm,反覆盖3mm,上颌牙列中线正,下颌牙列中线左偏2mm,软组织侧貌呈现凹面型。病例二为均角型患者,ANB角-4°,右侧尖牙、磨牙为完全近中关系,左侧尖牙、磨牙为中性关系,上颌牙列Ⅱ度拥挤,下颌牙列Ⅰ度拥挤,全牙弓反牙合,前牙区存在广泛开牙合约2.5mm,上颌牙列中线右偏1mm,下颌牙列中线左偏4mm,软组织侧貌呈现凹面型。矫治前采用Tweed-Merrifield个体化诊断分析法评估两病例难度指数分别为240.5和137.75,均属于重度。全面分析头影测量结果,提示为正畸正颌联合治疗适应证,但患者及家属强烈排斥手术。故利用神山分析法辅助分析病因,制定代偿性矫治计划,采取单纯正畸掩饰性治疗。病例一采用直丝弓矫治技术,拔除双侧下颌第一磨牙,滑动内收关闭拔牙间隙,矫治过程中配合使用上颌牙合垫。病例二采用直丝弓矫治技术结合上颌快速扩弓治疗。矫治中均使用皮圈牵引调节中线及尖窝咬合关系。用常规头影测量方法分析治疗前后软硬组织的改变。结果:治疗结束后,两例患者全口牙齿排列整齐,尖牙磨牙关系基本恢复中性,上下前牙建立良好覆牙合覆盖关系,上下牙列中线基本对正,侧貌和咬合功能均得到改善,患者对治疗结果非常满意。两病例矫治前后影像学指标变化:⑴ANB角分别增大2°、2.5°,Wits值分别增加3mm、4.5mm,矢状不调改善,且APDI分别减小4.5°、6.5°,骨性Ⅲ类倾向减弱;⑵牙合平面角分别减小9°、2°,牙合平面逆时针旋转建牙合;⑶面型角分别增大5°、2.5°,Z角分别减小5.5°、6°,软组织凹面型得到改善;⑷MP-FH分别增大1.5°、2°,MP-SN分别增大1°、1.5°,下颌平面出现轻微顺时针旋转;(5)病例一上前牙代偿性唇向倾斜,下前牙代偿性舌向倾斜;病例二扩弓的疗效显著,上前牙唇倾度减小,下前牙唇倾度与矫治前差别不大;(6)病例一Gn-Ar-L1增大4°、ANS-Ar-U1增大1.5°、Go-Ar-M减小4°,L7-MP减小1.4mm,表明上下前牙垂直高度增大,且下前牙升高较多,下颌第二磨牙压低;病例二,ANS-Ar-U1增大3°、Gn-Ar-L1增大1.5°、PNS-Ar-M增大1°、Go-Ar-M增大3°、L6-MP增大1.5mm,提示上下前牙及下颌磨牙垂直向高度均有增加。结论:本文展示的两例青少年骨性Ⅲ类开牙合病例,经Tweed-Merrifield个体化的诊断分析法评估其难度指数为重度,多项头影测量指标提示为正畸正颌联合治疗适应证。矫治前借助神山开牙合分析法寻找牙性代偿潜力,从病因机制出发制定科学合理的矫治方案,把握青少年患者生长发育的特点,结合患者非手术治疗的强烈意愿,采取正畸掩饰性治疗依然取得了良好的矫治效果:借助青少年患者生长发育高峰期后仍具有的良好骨改建能力,矫治后ANB角增大,上下颌骨矢状向不调减轻;下颌平面角有轻度增加,提示我们矫治中应高度重视下颌顺时针旋转生长倾向,设法抑制其不利的生长趋势,并控制上下后牙的高度;通过牙及牙槽性改变调整患者牙合平面,最终纠正开牙合,并建立良好覆牙合覆盖关系及磨牙关系;改善软组织侧貌及咬合功能。
[Abstract]:Objective:To investigate the clinical effect of masked orthodontic treatment on severe skeletal class III open bite deformity in adolescents.Methods:Two adolescents with severe skeletal class III open bite deformity were selected from the Department of Orthodontics, Shenyang Stomatological Hospital in 2011.All of them were 14 years old, female, early permanent teeth, all after the peak of growth and development (Cvs4). The first case was a severe high angle type. The ANB angle was - 5 degrees, the left and right canines, the molars were completely near the center. The upper dentition was 1 degree crowded, the lower dentition was 2 degree crowded, the whole arch was crossbitten, the teeth were widely opened, the anterior teeth were opened 6 mm, the maxillary dentition was 3 mm, the mandibular dentition was 2 mm, the soft tissue profile was concave. Case 2 was an angle-averaged patient with ANB angle-4 degrees, right canine, molar, left canine, molar, neutral, maxillary dentition II degree crowding, mandibular dentition I degree crowding, total arch crossbite, anterior teeth area with extensive occlusion about 2.5mm, maxillary dentition 1 mm, mandibular dentition 4 mm, soft tissue profile. Tweed-Merrifield individualized diagnostic method was used to evaluate the difficulty indices of the two cases, which were 240.5 and 137.75, respectively. Cephalometric results were analyzed comprehensively, suggesting indications for combined orthodontic treatment, but patients and their families strongly rejected the operation. In case 1, the first mandibular molars were extracted with straight wire technique, the extraction space was closed by sliding adduction, and the maxillary occlusal pad was used in the course of treatment. In case 2, the straight wire technique was used in combination with rapid maxillary expansion. Results: After the treatment, the whole teeth of the two patients were arranged neatly, the relationship between canine and molar was basically restored to neutral, the upper and lower anterior teeth had a good overbite and overbite relationship. The upper and lower alignment of the central line was basically opposite to the front, and the profile and occlusal function were obtained. The changes of imaging indices before and after treatment were as follows: (1) Angle of ANB increased by 2 degrees, 2.5 degrees, Wits increased by 3 mm, 4.5 mm, sagittal imbalance improved, APDI decreased by 4.5 degrees, 6.5 degrees, and skeletal class III tendencies decreased respectively; (2) Angle of occlusal plane decreased by 9 degrees, 2 degrees, and occlusal plane rotated counterclockwise to establish occlusion; _MP-FH increased by 1.5 degree, 2 degree, MP-SN increased by 1 degree and 1.5 degree respectively, and mandibular plane rotated slightly clockwise. (5) In case one of the upper anterior teeth, compensatory labial tilt of the lower anterior teeth, compensatory lingual tilt of the lower anterior teeth. Inclination of lower anterior teeth was not significantly different from that before treatment. (6) In case 1, Gn-Ar-L1, ANS-Ar-U1, Go-Ar-M, L7-MP and Gn-Ar-L1 increased by 4, 1.5, 4 and 1.4 mm respectively, indicating that the vertical height of upper and lower anterior teeth increased, and the pressure of mandibular second molar was lower. In case 2, ANS-Ar-U1 increased by 3, Gn-Ar-L1 increased by 1.5, PNS-M increased by 1, G-Ar-M increased by 1, G-M decreased by 1 degree. The o-Ar-M and L6-MP increased by 3 degrees and 1.5mm respectively, suggesting that the vertical height of both upper and lower anterior teeth and mandibular molars increased. Conclusion: Two cases of skeletal class III open bite in adolescents and adolescents were evaluated by Tweed-Merrifield individualized diagnostic analysis. Several cephalometric indices suggested that they were suitable for orthodontic treatment. Syndrome: Before orthodontic treatment, the potential of tooth compensation was found by Shenshan occlusal analysis method, and a scientific and reasonable treatment scheme was made according to etiological mechanism. The characteristics of growth and development of adolescent patients were grasped. Combined with the strong desire of non-surgical treatment, the orthodontic masking treatment still achieved good results: adolescent patients were given the aid of students. After treatment, ANB angle increased and sagittal maladjustment of maxilla and mandible decreased, and mandibular plane angle increased slightly, suggesting that we should attach great importance to the clockwise growth tendency of mandible, try to restrain its unfavorable growth trend and control the height of upper and lower posterior teeth. Sex change adjusts the occlusal plane, corrects open bite, establishes good overbite overbite and molar relationship, improves soft tissue profile and occlusal function.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R783.5
[Abstract]:Objective:To investigate the clinical effect of masked orthodontic treatment on severe skeletal class III open bite deformity in adolescents.Methods:Two adolescents with severe skeletal class III open bite deformity were selected from the Department of Orthodontics, Shenyang Stomatological Hospital in 2011.All of them were 14 years old, female, early permanent teeth, all after the peak of growth and development (Cvs4). The first case was a severe high angle type. The ANB angle was - 5 degrees, the left and right canines, the molars were completely near the center. The upper dentition was 1 degree crowded, the lower dentition was 2 degree crowded, the whole arch was crossbitten, the teeth were widely opened, the anterior teeth were opened 6 mm, the maxillary dentition was 3 mm, the mandibular dentition was 2 mm, the soft tissue profile was concave. Case 2 was an angle-averaged patient with ANB angle-4 degrees, right canine, molar, left canine, molar, neutral, maxillary dentition II degree crowding, mandibular dentition I degree crowding, total arch crossbite, anterior teeth area with extensive occlusion about 2.5mm, maxillary dentition 1 mm, mandibular dentition 4 mm, soft tissue profile. Tweed-Merrifield individualized diagnostic method was used to evaluate the difficulty indices of the two cases, which were 240.5 and 137.75, respectively. Cephalometric results were analyzed comprehensively, suggesting indications for combined orthodontic treatment, but patients and their families strongly rejected the operation. In case 1, the first mandibular molars were extracted with straight wire technique, the extraction space was closed by sliding adduction, and the maxillary occlusal pad was used in the course of treatment. In case 2, the straight wire technique was used in combination with rapid maxillary expansion. Results: After the treatment, the whole teeth of the two patients were arranged neatly, the relationship between canine and molar was basically restored to neutral, the upper and lower anterior teeth had a good overbite and overbite relationship. The upper and lower alignment of the central line was basically opposite to the front, and the profile and occlusal function were obtained. The changes of imaging indices before and after treatment were as follows: (1) Angle of ANB increased by 2 degrees, 2.5 degrees, Wits increased by 3 mm, 4.5 mm, sagittal imbalance improved, APDI decreased by 4.5 degrees, 6.5 degrees, and skeletal class III tendencies decreased respectively; (2) Angle of occlusal plane decreased by 9 degrees, 2 degrees, and occlusal plane rotated counterclockwise to establish occlusion; _MP-FH increased by 1.5 degree, 2 degree, MP-SN increased by 1 degree and 1.5 degree respectively, and mandibular plane rotated slightly clockwise. (5) In case one of the upper anterior teeth, compensatory labial tilt of the lower anterior teeth, compensatory lingual tilt of the lower anterior teeth. Inclination of lower anterior teeth was not significantly different from that before treatment. (6) In case 1, Gn-Ar-L1, ANS-Ar-U1, Go-Ar-M, L7-MP and Gn-Ar-L1 increased by 4, 1.5, 4 and 1.4 mm respectively, indicating that the vertical height of upper and lower anterior teeth increased, and the pressure of mandibular second molar was lower. In case 2, ANS-Ar-U1 increased by 3, Gn-Ar-L1 increased by 1.5, PNS-M increased by 1, G-Ar-M increased by 1, G-M decreased by 1 degree. The o-Ar-M and L6-MP increased by 3 degrees and 1.5mm respectively, suggesting that the vertical height of both upper and lower anterior teeth and mandibular molars increased. Conclusion: Two cases of skeletal class III open bite in adolescents and adolescents were evaluated by Tweed-Merrifield individualized diagnostic analysis. Several cephalometric indices suggested that they were suitable for orthodontic treatment. Syndrome: Before orthodontic treatment, the potential of tooth compensation was found by Shenshan occlusal analysis method, and a scientific and reasonable treatment scheme was made according to etiological mechanism. The characteristics of growth and development of adolescent patients were grasped. Combined with the strong desire of non-surgical treatment, the orthodontic masking treatment still achieved good results: adolescent patients were given the aid of students. After treatment, ANB angle increased and sagittal maladjustment of maxilla and mandible decreased, and mandibular plane angle increased slightly, suggesting that we should attach great importance to the clockwise growth tendency of mandible, try to restrain its unfavorable growth trend and control the height of upper and lower posterior teeth. Sex change adjusts the occlusal plane, corrects open bite, establishes good overbite overbite and molar relationship, improves soft tissue profile and occlusal function.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R783.5
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