自锁托槽对非拔牙矫治病例软硬组织和牙弓变化的临床研究

发布时间：2019-06-04 06:07

【摘要】：目的：自锁托槽是近年来较为流行的一种固定矫治器。与传统托槽相比，自锁托槽在临床使用中有诸多的优势，如摩擦力较小，椅旁时间较短，舒适度好等。但关于自锁托槽是否能够扩大牙弓，减少拔牙，又不致使切牙过度唇倾，国内外研究均有很大争议。本研究旨在评价自锁托槽对非拔牙患者正畸治疗前后牙弓形态及颅面部软硬组织的变化，以探讨自锁托槽对牙列及颅面形态的影响，为自锁托槽在临床中更好的应用提供依据。 方法:选取40例非拔牙矫治病例，其中20例使用传统直丝弓托槽，20例使用3B自锁托槽进行矫治。制作正畸治疗前后的患者上、下颌模型，拍摄患者头颅侧位片。对模型和头颅侧位片的标志点进行多项测量：①测量治疗前上下牙弓拥挤度；○2测量治疗前后上颌的牙弓宽度（包括：牙弓尖牙牙尖宽度、第一前磨牙颊尖宽度、第一前磨牙中央窝宽度、第二前磨牙颊尖宽度、第二前磨牙中央窝宽度、第一磨牙近中颊尖宽度、第一磨牙中央窝宽度）；○3治疗前后牙弓长度（包括牙弓前、中、全段长度）。○4治疗前后头颅侧位片能反应骨面型和上下切牙唇倾度和凸度的共13个项目（∠SNA、∠SNB、∠ANB、Yaxis、∠U1-L1、U1-NA、∠U1-NA、L1-NB、∠L1-NB、UL-EP、LL-EP、Z角、N’-Sn-Pg）。测量结果进行统计学分析。结果： 1)治疗前两组患者的上、下牙弓拥挤度无明显差异（P0.05），均为轻～中度拥挤，两组样本特征相似，具有可比性。 2)治疗后两组患者的上颌牙弓宽度均较治疗前增加，尤其是上颌前磨牙区宽度增加明显（P0.05）。自锁托槽组双尖牙区宽度的增加较传统组明显，但两者的差异无统计学意义（P0.05）。 3)治疗后两组患者的上、下颌牙弓长度均较治疗前增加（P0.05）。自锁托槽组牙弓前段长度的增加较传统组明显，而传统组牙弓中段长度的增加较明显，但两者的差异无统计学意义（P0.05）。4)治疗后两组患者的上、下牙弓周长均较治疗前增加（P0.05）。自锁 托槽组上下牙弓周长的增加较传统组明显，但两者的差异无统计学意义（P0.05）。5)头影测量结果显示：自锁组患者出现下前牙唇倾，唇部形态无前突。 两组托槽的差异无统计学意义（P0.05）。结论：对于牙列拥挤的非拔牙矫治，无论采用自锁托槽还是传统直丝 托槽，都具有增加牙弓宽度、牙弓长度及牙弓周长的作用，自锁托槽对双尖牙区宽度的增加较为明显，但两者之间的差异无统计学意义。自锁托槽仍会引起前牙唇倾及侧貌改变。与传统直丝托槽相比，自锁托槽并不能显著扩大牙弓，减少拔牙。
[Abstract]:Objective: self-locking bracket is a popular fixed appliance in recent years. Compared with the traditional bracket, the self-locking bracket has many advantages in clinical use, such as less friction, shorter chair time, good comfort and so on. However, there is a lot of controversy at home and abroad about whether the self-locking bracket can expand the dental arch, reduce the extraction of teeth, and do not lead to excessive lip inclination of incisors. The purpose of this study was to evaluate the changes of dental arch morphology and craniofacial soft and hard tissue before and after orthodontic treatment in patients with non-extraction, so as to explore the effect of self-locking bracket on dentition and craniofacial morphology, and to provide evidence for better clinical application of self-locking bracket. Methods: 40 cases of non-extraction orthodontic treatment were selected, of which 20 cases were treated with traditional straight wire arch bracket and 20 cases with 3B self-locking bracket. The upper and lower jaw models were made before and after orthodontic treatment, and lateral cephalometric films were taken. The marking points of the model and lateral cephalometric radiography were measured as follows: (1) the congestion of upper and lower dental arch was measured before treatment; 02 the width of maxillary arch was measured before and after treatment (including: cusp width of dental arch, buccal tip width of first premolar, width of central fossa of first premolar, width of buccal tip of second premolar, width of central fossa of first premolar, width of central fossa of second premolar, The width of the first molar near the middle buccal tip and the width of the central fossa of the first molar); 03 the length of dental arch before and after treatment (including the length of anterior, middle and full segment of dental arch). 04 the lateral cephalic film before and after treatment can reflect the bone surface type and upper and lower incisor lip inclination and convexity of 13 items (鈮，

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