J钩配合直丝弓矫治技术治疗成人双颌前突的病例分析
发布时间：2019-06-06 16:07
【摘要】：目的：J钩配合直丝弓矫治技术矫治成人双颌前突，通过对比矫治前后牙齿以及软硬组织的变化情况，探讨J钩对上前牙矢状向和垂直向的控制以及拔牙矫治后软组织侧貌的改善。 方法：选取沈阳市口腔医院正畸科2011年11月收治的双颌前突患者1例，，女性，18岁。骨性I类，上下颌骨发育正常，上下颌单纯牙性前突，唇外翻，闭唇时颏肌紧张，颏靥窝明显，颏唇沟上抬，下唇过度覆盖上切牙，下唇突出明显(如图1)；双侧磨牙、尖牙中性关系，覆牙合覆盖正常，中线齐，不拥挤。根据初诊模型测量和头影测量数据分析，结合患者主诉后决定采用直丝弓矫治技术，拔除4颗第一前磨牙进行矫治，并在关闭拔牙间隙阶段配合使用头帽J钩进行牵引，牵3向远中保护后牙支抗，同时整体压低和回收上颌前牙来使上下唇后移，改善软组织侧貌。本病例采用美国3M公司生产的3-3陶瓷托槽(0.022*0.025in)进行矫治，使用J钩牵3向远中时牵引力量大小为200g左右，方向与牙合平面平行；压低和回收上颌前牙时牵引力每侧100~150g，牵引方向与牙合平面呈30°向上，佩戴时间每天12小时以上。对矫治前后模型以及头颅侧位片进行测量分析，对比矫治前后患者软硬组织以及牙齿的变化。另外附加一例成人双突应用种植钉增强支抗的病例(见17页)与之作对比。 结果：J钩病例矫治疗程共24个月。矫治结束后患者上下牙排列整齐；双侧磨牙、尖牙中性关系；前牙覆牙合覆盖正常；上下中线正；牙齿尖窝锁结关系良好。凸面型变为直面型，软组织侧貌得到较大程度的改善，患者对矫治结果非常满意。对患者治疗前后头颅侧位片进行测量比较：(1)矢状向改变，SNA减小0.5°，说明上颌骨随着前牙的回收也有少量改建；U1-SN减小12.5°，U1-NA减小11°，L1-MP减小8°，L1-NB减小8°，U1-L1增加21°，说明上下前牙唇倾度、突度均减小；U6-RL增加2.2mm，U1E-RL减小4.8mm说明J钩增强了上后牙支抗，后牙前移少，前牙回收多，患者矢状向得到了很好的控制。(2)垂直向改变，U6-PP未变化说明上后牙在矫治过程中并未伸长；U1E-PP减小2.5mm，U1A-PP减小1.5mm，说明J钩对上前牙有明显的压低；OP-FH减小1°，MP-FH减小1.5°说明下颌骨以及牙合平面得到少量逆时针旋转，说明垂直向得到控制。(3)软组织改变，鼻唇角NLA增加5°，Z角减小8°，UL-EP减小1.4mm，LL-EP减小4.9mm，ULP减小0.7mm，LLP减小4.9mm，上下唇随着切牙的回收后移；NLA增加5°，说明鼻唇沟变浅；上唇厚度增加1.4mm，下唇厚度基本不变，上唇长度无变化，下唇长度代偿性减小2.0mm说明随着牙齿的回收，上下唇形态也得到代偿性改建。 种植钉增强支抗病例：(1)矢状向:U6-RL增加0.7mm，U1E-RL减小5.7mm，垂直向U6-PP不变，说明种植体矢状向可以明显增强支抗；(2)垂直向:U1A-PP减小-0.5mm，说明种植体垂直向对上前牙有轻微的压低作用；U1E-PP增加1.5mm，OP-FH减小1°，大量内收前牙时伴随的钟摆效应使牙合平面顺时针旋转。 结论：(1)头帽J钩牵引在矢状向可内收前牙，保护后牙支抗，明显改善患者侧貌。(2)头帽J钩在垂直向可整体压低上前牙，抵抗回收前牙过程中的钟摆效应；同时控制高角患者的下面高，防止下颌骨顺时针旋转。(3)正畸拔牙矫治后，软组织也得到代偿性改建，上下唇随着切牙内收的量与多种因素相关。(4)J钩与种植体在增强支抗时，在矢状向均可得到很好的控制，但在垂直向控制上J钩优于种植体支抗。
[Abstract]:Objective: To study the effect of J-hook on the sagittal and vertical control of the anterior teeth and the improvement of the profile of soft tissue after tooth extraction. Methods:1 case, female,18 cases of double-jaw process were selected from the orthodontic department of Shenyang Stomatological Hospital in November,2011. The bone type I, the upper and lower mandible are normal, the upper and lower jaw is simple, the upper and lower jaws are simple, the lips are turned out, the upper and lower lips of the upper and lower jaws are tense, the upper and lower lips of the upper and lower lips are obvious (as shown in FIG.1), and the bilateral molars and the sharp teeth have sexual relations, and the overbite cover is positive. It's often, the middle line, it's not. Extruding. According to the data analysis of the initial diagnosis model and the cephalometric measurement data, combined with the patient's complaint, it was decided to use the direct-wire-arch correction technique, to remove the four first premolars for correction, and to cooperate with the head cap J-hook for traction during the closing of the tooth extraction clearance phase, and pull 3 to protect the posterior teeth in the distal direction. The upper and lower lips are removed and the soft tissue side is improved when the upper and lower lips are lowered and recovered at the same time. In this case, the 3-3 ceramic bracket (0.022 * 0.025 in) produced by 3M Company of the United States was used for the treatment. When the J-hook was used for three-way, the traction force was about 200 g, the direction was parallel to the occlusal plane, and the traction force was 100-150g per side when the maxillary anterior teeth were depressed and recovered, and the traction direction was 30 掳 to the occlusal plane. on top, the wearing time is 12 hours a day, To measure and analyze the anterior and posterior model of the correction and the side of the skull, and compare the soft and soft tissue of the patient and the change of the teeth before and after the correction. In addition, an additional case of an adult double-process application (see page 17) was added to the treatment. Bi. Results: A total of 2 cases of J-hook case treatment course 4 months. After the end of the treatment, the upper and lower teeth of the patient are arranged orderly; the bilateral molar and the sharp tooth have sexual relations; the covering of the front teeth is normal; the upper and lower midline is positive; and the tooth tip and the tooth lock are closed The shape of the convex surface becomes the face of the face, the side appearance of the soft tissue is improved to a great extent, and the patient has no effect on the correction result. It is generally satisfactory. The measurement of the head-side panel before and after the treatment of the patient is as follows: (1) the sagittal changes and the reduction of the SNA by 0.5 掳, indicating that the maxilla has little alteration with the recovery of the anterior teeth; the U1-SN is reduced by 12.5 掳, the U1-NA is reduced by 11 掳, the L1-MP is reduced by 8 掳, the L1-NB is reduced by 8 掳, and the U1-L1 increases 21 掳, indicating the inclination of the upper and lower anterior teeth, the degree of penetration decreased, the U6-RL increased by 2.2 mm, and the U1E-RL was reduced by 4.8 mm. The J-hook enhanced the upper posterior teeth support, the posterior teeth advanced less, the anterior teeth were recovered, and the sagittal alignment of the patient was very good Control. (2) Vertical change, U6-PP did not change, the teeth did not extend during the treatment; U1E-PP was reduced by 2.5 mm, and U1A-PP was reduced by 1.5 mm, indicating that the J-hook had a significant depression on the upper anterior teeth; the reduction of OP-FH by 1 掳, and the reduction of MP-FH by 1.5 掳 indicated that the mandible and the occlusal plane were reduced in a small amount The needle is rotated to indicate the vertical orientation To control. (3) Soft tissue change, nasal lip angle NLA increased by 5 掳, Z angle reduced by 8 掳, UL-EP reduced by 1.4 mm, LL-EP reduced by 4.9 mm, ULP was reduced by 0.7 mm, LLP was reduced by 4.9 mm, and upper lower lip was removed with the recovery of the incisor; NLA was increased by 5 掳, indicating that the nasolabial groove was shallow; the upper lip thickness increased by 1.4 mm, the lower lip thickness group The length of the upper lip is not changed, the compensatory reduction of the length of the lower lip is reduced by 2.0 mm. With the recovery of the tooth, the upper and lower lip form is also compensated. (1) Sagittal: U6-RL increased by 0.7 mm, U1E-RL decreased by 5.7 mm, and vertical to U6-PP, indicating that the sagittal alignment of the implant was significantly enhanced; (2) the vertical orientation: U1A-PP was reduced to 0.5 mm, indicating that the implant was vertical to the anterior teeth slightly The pressure of U1E-PP increased by 1.5 mm, OP-FH was reduced by 1 掳, and the pendulum effect associated with the large number of internal anterior teeth was used to make the occlusal plane Clockwise rotation. Conclusion: (1) The head cap J hook is pulled in the sagittal direction to receive the anterior teeth, and the posterior teeth are anti-and bright. improve that lateral appearance of the patient. (2) the head cap J hook can lower the upper front tooth in the vertical direction to resist the pendulum effect in the process of recovering the front teeth; and meanwhile, the lower level of the high-angle patient is controlled, The jaw is rotated clockwise. (3) After the orthodontic tooth extraction, the soft tissue is also compensated, and the upper and lower lips follow the amount of the tooth in the incisor. (4) The J-hook and the implant can be well controlled in the sagittal direction when the reinforcing brace is enhanced, but the J-hook is in the vertical direction
【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
本文编号：2494432
[Abstract]:Objective: To study the effect of J-hook on the sagittal and vertical control of the anterior teeth and the improvement of the profile of soft tissue after tooth extraction. Methods:1 case, female,18 cases of double-jaw process were selected from the orthodontic department of Shenyang Stomatological Hospital in November,2011. The bone type I, the upper and lower mandible are normal, the upper and lower jaw is simple, the upper and lower jaws are simple, the lips are turned out, the upper and lower lips of the upper and lower jaws are tense, the upper and lower lips of the upper and lower lips are obvious (as shown in FIG.1), and the bilateral molars and the sharp teeth have sexual relations, and the overbite cover is positive. It's often, the middle line, it's not. Extruding. According to the data analysis of the initial diagnosis model and the cephalometric measurement data, combined with the patient's complaint, it was decided to use the direct-wire-arch correction technique, to remove the four first premolars for correction, and to cooperate with the head cap J-hook for traction during the closing of the tooth extraction clearance phase, and pull 3 to protect the posterior teeth in the distal direction. The upper and lower lips are removed and the soft tissue side is improved when the upper and lower lips are lowered and recovered at the same time. In this case, the 3-3 ceramic bracket (0.022 * 0.025 in) produced by 3M Company of the United States was used for the treatment. When the J-hook was used for three-way, the traction force was about 200 g, the direction was parallel to the occlusal plane, and the traction force was 100-150g per side when the maxillary anterior teeth were depressed and recovered, and the traction direction was 30 掳 to the occlusal plane. on top, the wearing time is 12 hours a day, To measure and analyze the anterior and posterior model of the correction and the side of the skull, and compare the soft and soft tissue of the patient and the change of the teeth before and after the correction. In addition, an additional case of an adult double-process application (see page 17) was added to the treatment. Bi. Results: A total of 2 cases of J-hook case treatment course 4 months. After the end of the treatment, the upper and lower teeth of the patient are arranged orderly; the bilateral molar and the sharp tooth have sexual relations; the covering of the front teeth is normal; the upper and lower midline is positive; and the tooth tip and the tooth lock are closed The shape of the convex surface becomes the face of the face, the side appearance of the soft tissue is improved to a great extent, and the patient has no effect on the correction result. It is generally satisfactory. The measurement of the head-side panel before and after the treatment of the patient is as follows: (1) the sagittal changes and the reduction of the SNA by 0.5 掳, indicating that the maxilla has little alteration with the recovery of the anterior teeth; the U1-SN is reduced by 12.5 掳, the U1-NA is reduced by 11 掳, the L1-MP is reduced by 8 掳, the L1-NB is reduced by 8 掳, and the U1-L1 increases 21 掳, indicating the inclination of the upper and lower anterior teeth, the degree of penetration decreased, the U6-RL increased by 2.2 mm, and the U1E-RL was reduced by 4.8 mm. The J-hook enhanced the upper posterior teeth support, the posterior teeth advanced less, the anterior teeth were recovered, and the sagittal alignment of the patient was very good Control. (2) Vertical change, U6-PP did not change, the teeth did not extend during the treatment; U1E-PP was reduced by 2.5 mm, and U1A-PP was reduced by 1.5 mm, indicating that the J-hook had a significant depression on the upper anterior teeth; the reduction of OP-FH by 1 掳, and the reduction of MP-FH by 1.5 掳 indicated that the mandible and the occlusal plane were reduced in a small amount The needle is rotated to indicate the vertical orientation To control. (3) Soft tissue change, nasal lip angle NLA increased by 5 掳, Z angle reduced by 8 掳, UL-EP reduced by 1.4 mm, LL-EP reduced by 4.9 mm, ULP was reduced by 0.7 mm, LLP was reduced by 4.9 mm, and upper lower lip was removed with the recovery of the incisor; NLA was increased by 5 掳, indicating that the nasolabial groove was shallow; the upper lip thickness increased by 1.4 mm, the lower lip thickness group The length of the upper lip is not changed, the compensatory reduction of the length of the lower lip is reduced by 2.0 mm. With the recovery of the tooth, the upper and lower lip form is also compensated. (1) Sagittal: U6-RL increased by 0.7 mm, U1E-RL decreased by 5.7 mm, and vertical to U6-PP, indicating that the sagittal alignment of the implant was significantly enhanced; (2) the vertical orientation: U1A-PP was reduced to 0.5 mm, indicating that the implant was vertical to the anterior teeth slightly The pressure of U1E-PP increased by 1.5 mm, OP-FH was reduced by 1 掳, and the pendulum effect associated with the large number of internal anterior teeth was used to make the occlusal plane Clockwise rotation. Conclusion: (1) The head cap J hook is pulled in the sagittal direction to receive the anterior teeth, and the posterior teeth are anti-and bright. improve that lateral appearance of the patient. (2) the head cap J hook can lower the upper front tooth in the vertical direction to resist the pendulum effect in the process of recovering the front teeth; and meanwhile, the lower level of the high-angle patient is controlled, The jaw is rotated clockwise. (3) After the orthodontic tooth extraction, the soft tissue is also compensated, and the upper and lower lips follow the amount of the tooth in the incisor. (4) The J-hook and the implant can be well controlled in the sagittal direction when the reinforcing brace is enhanced, but the J-hook is in the vertical direction
【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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