成人双颌前突错（牙合）畸形的临床矫治

发布时间：2019-01-19 18:09

【摘要】：目的：探讨运用固定直丝弓矫治技术，配合口外支抗头帽J钩和口内支抗横腭杆作为强支抗的辅助装置矫治成人双颌前突错牙合畸形患者的临床疗效。方法：选取成人安氏类双颌前突患者一例，病源来自2010年8月29日大连市联合路博士口腔诊所，成人女性，22岁。口腔卫生状况良好，牙周健康，曾有咬指和口呼吸习惯，现已改正；该患者处于恒牙牙合期；左右两侧尖牙、磨牙关系为安氏类关系；上下颌牙列轻中度拥挤；覆颌、覆盖均正常；Spee曲线深度正常；露龈微笑，双颌前牙的轴倾度较唇倾，上下颌中线位于正中，侧貌为凸面型，颏部紧张、后缩。有母亲的家族遗传史。该病例根据其模型分析和X线头影测量等测量和分析结果，采取拔出14、24、34、44及18、28、38、48的拔牙模式，直丝弓矫治技术，在排齐整平上下颌牙列阶段，运用横腭杆控制磨牙，两步法滑动关闭拔牙间隙，配合头帽拉尖牙向远中，待尖牙基本达到中性牙合关系时，使用头帽J钩回收及适当压低前牙，保持前牙良好的覆颌及全口牙齿良好的咬合关系。结果：矫治总疗程为27个月，治疗结束时观察全口牙列排齐整平；拔牙间隙完全关闭；中线位于正中；测量唇倾的前牙牙轴得到明显回收；模型检查前牙覆颌正常、覆盖2mm；磨牙和尖牙为安氏类。对比治疗前后的曲面断层片可见，髁突位置良好，无明显改变，，全口牙齿牙根基本平行，牙槽骨未见明显吸收。对比治疗前后的X线头颅侧位片分析结果：（1）上下颌颅面骨测量值未发生明显变化，牙合平面未发生顺时针旋转，基本保持原位。SNA、SNB未发生明显变化，SNA减小了1°,SNB无变化,ANB减小了1°（2）上牙轴U1-SN由115°减小到108°，下牙轴L1-MP唇倾度由104°减小到91°,L1-NB由42°减小到30°（3）鼻唇角Cm-Sn-Ls增大4°、上唇倾角A UL-FH增大了6°，说明矫治后上唇的突度得到了一定程度的减小;下唇倾角B UL-FH增大了7°，反应下唇也得到了一定程度的改善；ULP从10mm降低到6mm，减小了4mm，LLP由12mm降低到8mm，也减小了4mm，上下唇突度得到明显改善；UL-EP由原来的6mm减小到2mm,LL-EP由9mm减小到5mm，同时减小了4mm，上下唇虽没有达到审美线内，但与矫治前比较，前突的唇部得到了改善；颏沟倾角（Pg B-FH）治疗前70°，治疗后75°；Z角治疗前56°，治疗后65°；H角治疗前21°，治疗后19°；经过治疗后，唇部和颏部的关系趋于协调。侧面角（G-Sn-Pg），软组织面角（FH-Ns-Pg）几乎未发生改变，因此单纯正畸治疗对于改变生长发育已完成的相关指标作用甚微。结论：对于双颌前突安氏类成人患者的矫正治疗，应用固定直丝弓矫治技术，配合口外支抗头帽J钩及口内支抗横腭杆，可以很好地控制磨牙在矢状向和垂直向上的位置，使拔牙间隙充分为回收前牙所利用，进而使患者软组织侧貌协调平衡。
[Abstract]:Objective: to investigate the clinical effect of using fixed straight wire arch technique, combined with external Anchorage head J hook and intraoral Anchorage against transverse palate bar as a strong Anchorage device for the treatment of adult patients with bilateral protrusion malocclusion. Methods: a case of adult patients with andrognathic prognathia was selected. The source of the disease was 22 years old, from the doctor's stomatology clinic in Dalian City on August 29, 2010. Oral hygiene condition, periodontal health, had bite and mouth breathing habits, has been corrected, the patient is in the permanent teeth occlusion period, left and right canine, molar relationship for the relationship between the class, upper and lower dentition mildly and moderately crowded; Spee curve depth is normal, gums smile, the axial inclination of the maxillary anterior teeth is higher than that of the lip, the midline of the upper and lower jaw is in the middle, the side shape is convex, the chin is tense and retraction. Have a mother's family history. According to the results of model analysis and X-ray cephalometric measurement, this case adopted the extraction model of 144U 24444 and 182283848, and the technique of straight-wire orthodontic treatment. In the stage of leveling and leveling the upper and lower dentition, the molars were controlled by the transverse palatal rod, and the molars were controlled by the transverse palatine rod during the stage of leveling and leveling the upper and lower dentitions. Two-step sliding closure of the extraction gap, combined with the head cap to pull the canine to the far, when the canine basically reached neutral occlusion, the head cap J hook was used to recover and lower the anterior teeth properly, to maintain a good overbite and a good occlusion of the whole teeth of the anterior teeth. Results: the total course of correction was 27 months. At the end of the treatment, the whole dentition was leveled out, the extraction space was completely closed, the midline was located in the middle, the anterior tooth axis of the labial inclination was obviously recovered, the overbite of the anterior teeth was normal and covered with 2 mm by model examination. Molars and fangs belong to the Andes class. The position of condyle was good with no obvious change, the root of the whole tooth was basically parallel, and the alveolar bone was not absorbed. The results of X-ray lateral radiographic analysis before and after treatment were as follows: (1) the measured values of craniofacial bone of the upper and lower mandible did not change obviously, the occlusal plane did not rotate clockwise and remained in the position basically. The SNA,SNB did not change significantly and the SNA decreased by 1 掳. SNB did not change. ANB decreased 1 掳(2) U1-SN from 115 掳to 108 掳, L1-MP labial inclination decreased from 104 掳to 91 掳, L1-NB decreased from 42 掳to 30 掳(3) Cm-Sn-Ls increased by 4 掳. The obliquity of upper lip (A UL-FH) increased by 6 掳, which indicated that the protruding degree of upper lip was reduced to a certain extent. The obliquity of lower lip (B UL-FH) increased by 7 掳, and the reaction of lower lip was improved to some extent. The ULP decreased from 10mm to 6 mm, decreased from 4 mm to 8 mm and decreased from 4 mm to 8 mm, and the upper and lower lip protrusions were significantly improved. UL-EP decreased from the original 6mm to 2mm LL-EP from 9mm to 5mm, and decreased by 4mm. The upper and lower lip did not reach the aesthetic line, but compared with before treatment, the protruding lip was improved. Mental sulcus inclination angle (Pg B-FH) was 70 掳before treatment, 75 掳after treatment, 56 掳before treatment at Z angle, 65 掳after treatment, 21 掳before and 19 掳after treatment at H angle, and the relationship between lip and chin tended to be coordinated after treatment. The lateral angle (G-Sn-Pg) and soft tissue facial angle (FH-Ns-Pg) were almost unchanged, so orthodontic therapy had little effect on the change of growth and development. Conclusion: the orthodontic treatment of adult patients with bimaxillary protrusion can control the position of molars in sagittal and vertical direction by using the technique of fixed straight wire appliance, combined with external Anchorage against head cap J hook and intraoral Anchorage against transverse palate bar. The extraction space can be fully used to recover the anterior teeth, and then the soft tissue profile of the patient can be balanced.
【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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