垂直向控制在矫正成人骨性Ⅱ类高角错畸形应用中的研究进展

颌骨与牙包含三个维度：矢状向、横向和垂直向,以往临床上错畸形的矫治常聚焦于前突或后缩问题,而易忽略垂直向问题。垂直向问题往往对矢状向产生影响,如垂直向发育过度患者多呈现高角骨面型,易引起下颌骨顺时针旋转,形成骨性Ⅱ类错畸形。早期由于相应的矫正手段有限,正颌手术一直是骨性Ⅱ类高角面型患者的首选治疗方式。随着种植支抗的出现及应用,使用微钛板和（或）微螺钉种植体可以提高单纯正畸治疗的垂直向控制效果,减小了部分轻、中度垂直向发育过度患者的治疗风险和创伤。本文旨在回顾近年关于正畸代偿及正颌-正畸联合治疗矫正成人骨性Ⅱ类高角病例的研究,从不同方式的控制效果、稳定性分析以及临界病例的治疗方式等方面,对应用垂直向控制纠正骨性Ⅱ类高角错畸形的研究进展进行综述,为临床诊疗和相关研究提供一定的思路和依据。     

正畸治疗中后牙垂直向生长过度的控制

正畸治疗中患者垂直方向生长过度 ,下颌骨向下向后旋转 ,常伴随长面综合征 ,表现为前牙开 ,颏部后缩 ,前下面高过大 ,下颌体长 ,下颌平面角大 ,等等。这种错畸形是正畸治疗中的难点。下颌平面角低的病例大都有强大的咀嚼肌群 ,相反高角病例肌肉组织力量薄弱 ,正畸治疗中容易引起磨牙伸长。而大多数的正畸治疗方法 ,从最初的分牙到细丝轻力整平牙弓 ,都会引起牙齿在垂直方向的移动。另外 ,临床上对患者垂直方向控制的方法大都需要依赖患者的高度配合。因此 ,在正畸治疗中 ,对于垂直方向生长发育过度的患者 ,从治疗设计到矫正过程中均应予…     

口腔正畸与颌面部美学

口腔正畸是一门基于美学的临床应用学科，通过调整牙齿移动以及颌骨关系来协调鼻唇颏的相互关系。正畸医生需要在术前对患者的面部软组织正貌和侧貌进行充分的分析，了解可能存在的颌面部对称性、水平向、垂直向问题，可能的影响因素（增龄性变化和代偿性变化对面部形态的影响）以及在牙齿正畸时给颌面部形态带来的变化，以引导矫治方案的设计与正畸治疗的实施，有效提高正畸临床的效果，本文将以正畸医生视角对指导正畸方案设计的美学评价作一综述。     

正畸-临时修复联合治疗对上颌切牙位置的保持效果

目的:探讨正畸术后即行临时修复治疗对患者上颌切牙位置的保持效果。方法:将于北京大学口腔医院第五门诊部就诊行正畸-修复联合治疗的患者20例，随机分成两组。实验组在正畸治疗完成后即行临时修复治疗，1周内完成永久修复，保持3个月；对照组在正畸治疗完成后即保持3个月，然后行上前牙永久修复治疗。使用数字模型记录实验组与对照组患者分别在正畸-永久修复治疗完成后(T_X1)、保持3个月后(T_X2)、正畸治疗完成后(T_C1)、保持3个月(T_C2)后患牙位置的变化。测量患牙在空间移动中牙轴角度变化、冠切线角度变化、近远中向距离变化、垂直向距离变化等指标，分析患牙移动与保持的效果。结果:两组患者T1与T2时间点相比，患牙位置均有变化。对照组牙轴角度变化、冠切线角度变化、近远中向移动量和垂直向移动量均大于实验组；两组间牙轴角度变化、近远中和垂直向移动量均存在统计学差异(P<0.05)。结论:正畸-临时修复治疗较常规正畸后保持3个月再行修复治疗相比，可有效保持上颌切牙的位置。     

骨皮质切开术及其辅助正畸牙齿垂直向控制研究进展

成人患者多伴有牙周、关节等问题,正畸治疗机制复杂、疗程较长,患者不仅对疗效要求高,对正畸治疗的疗程也颇为关注。骨皮质切开术,通过切开牙齿周围的骨皮质,辅助加速牙齿移动,缩短疗程,为成人正畸提供了一种新的治疗理念与思路。术中辅助植骨,可减轻治疗风险,同时可改善患者的牙周状况。骨皮质切开术日趋成熟,作为一种牙周辅助快速正畸技术在国外已应用于临床。本文将对骨皮质切开术在正畸牙齿垂直向控制中的临床应用、发展、优缺点以及一般临床程序等做一综述。     

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成人患者多伴有牙周、关节等问题,正畸治疗机制复杂、疗程较长,患者不仅对疗效要求高,对正畸治疗的疗程也颇为关注。骨皮质切开术,通过切开牙齿周围的骨皮质,辅助加速牙齿移动,缩短疗程,为成人正畸提供了一种新的治疗理念与思路。术中辅助植骨,可减轻治疗风险,同时可改善患者的牙周状况。骨皮质切开术日趋成熟,作为一种牙周辅助快速正畸技术在国外已应用于临床。本文将对骨皮质切开术在正畸牙齿垂直向控制中的临床应用、发展、优缺点以及一般临床程序等做一综述。     

安氏Ⅱ类1分类高角错（牙合）与下颌骨旋转

安氏Ⅱ类1分类错（牙合）高角病例因同时存在水平向与垂直向不调，一直是正畸治疗的难点。最近的一些研究认为该类错（牙合）的形成与下颌骨异常旋转密切相关。因此，在正畸治疗中如何促进下颌骨前上旋转，抑制下颌骨后下旋转，纠正垂直向与水平向不调已成为关注的焦点。本文就近年来安氏Ⅱ类1分类高角错（牙合）成因与矫治中下颌骨旋转因素的研究进展作一综述。     

不同生长发育期安氏Ⅱ^1错（牙合）正畸治疗前后的垂直向变化

目的本研究目的是比较不同生长发育阶段高角、均角和低角女性正畸治疗后的垂直向变化。方法将我院正畸科1997—1999年开始正畸治疗并现已结束的312名安氏Ⅱ^1错（牙合）女性根据下颌平面角和生长发育阶段分为六组，对其治疗前后头颅侧位片进行分析，用12项头影测量值进行治疗前后变化的评价。结果无论何种垂直骨面型或何种生长发育阶段，正畸治疗后（牙合）平面均顺时针旋转；生长发育期患者治疗后前面高增大，而不处在生长发育期的患者治疗后前面高无明显变化；大于18岁组治疗后下颌平面角无明显变化，而生长发育期患者治疗后下颌平面角的变化与垂直骨面型相关。结论下颌平面角的变化与患者的垂直骨面型有关；（牙合）平面的旋转与正畸治疗有关。     

口腔正畸学

舌侧矫治上颌第-磨牙垂直向移动的有限元研究,安氏Ⅱ类错殆的牙冠宽度与Bolton指数的测量分析,正畸治疗中磨牙的拔除和保留（二十九）——拔除第一磨牙的矫治设计,微钛钉种植体支抗单侧推磨牙向后的临床应用,     

高角和低角病例的诊断、临床特征及正畸治疗特点

由于以往的诊断是以安氏分类为主，正畸医生常常只注意到矢状向错而忽略了垂直向不调。近年来，学者们逐渐认识到垂直面型在错畸形诊断和治疗中的重要性：它不仅为颅面复合体的生长方向提供了线索，而且直接影响治疗的成功与否。垂直向异常有高角和低角两种类型，在三...     

正畸治疗安氏Ⅲ类错伴下颌偏斜的临床研究

目的探讨治疗安氏Ⅲ类错伴有单侧的后牙反、锁和单侧前牙反的牙源性下颌偏斜的有效方法。方法选择安氏Ⅲ类错伴单侧的后牙反、锁和单侧前牙反等牙源性下颌偏斜患者21例,年龄8~25岁,平均15.5岁。单侧后牙反、锁引起的下颌偏斜通过上颌扩弓、上下牙交互牵引纠正宽度不调,促使下颌自行复位;前牙反通过Ⅲ类牵引予以解除。结果 21例患者均取得良好的矫治效果,治疗后颜面对称性和咬合关系恢复正常,颏点偏斜平均减少（2.9±0.6）mm,因长期错导致的下颌骨偏斜亦得到了明显改善。结论牙源性下颌偏斜,经过合理正畸治疗,随着单侧后牙反、锁及单侧前牙反的解除可得到明显的改善。     

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颞下颌关节紊乱病（TMD）是一种由关节结构、咬合、肌功能异常及精神心理等多种因素综合作用形成的口颌面部疾病。闭锁型深覆[牙合]、个别前牙与后牙反[牙合]、后牙锁[牙合]、一侧后牙反[牙合]、下颌偏斜、磨牙伸长、磨牙倾斜等是诱发TMD的高危险[牙合]因素。从整体分析,正畸治疗与TMD并无密切相关性,但部分病例TMD的发生仍可能与正畸治疗不当有关。良好的牙齿排列、正常的前牙覆[牙合]与覆盖关系及后牙尖窝对应关系、牙位与肌位一致、下颌前伸与侧[牙合]平衡是有效预防与缓解TMD的可靠保证。本文对错[牙合]畸形及正畸治疗与TMD的相关性研究文章进行系统回顾,结合正畸临床实际,分析错[牙合]畸形与TMD的内在联系,以及正畸治疗中TMD的风险和防治策略。     

Osteotomy assisted maxillary posterior impaction with miniplate anchorage

This case report presents orthodontic treatment with miniplate anchorage accelerated by osteotomy-assisted maxillary posterior impaction in a severe open bite case. A 14-year-old girl with a severe anterior open bite was treated by intrusion of the maxillary posterior teeth. A segmental osteotomy was applied, and the miniplates were fixed to the zygomatic buttress area. The intrusive force was applied with nickel-titanium closed coil springs using a force of 250 g between the miniplates and the upper first and second molar buccal tubes. The intrusion was completed 2.5 months after osteotomy. The treatment was continued with the fixed orthodontic appliances and completed after 12 months. At the end of treatment, optimal occlusion and the correction of the anterior open bite were achieved. The maxillary molars were impacted 4.0 mm, and the mandibular plane showed a counterclockwise autorotation of 3.0 degrees . The results showed that osteotomy-facilitated orthodontic treatment clearly reduced the treatment time and had no adverse effects. In conclusion, this one-stage osteotomy technique can be an effective option to help molar intrusion in severe open bite cases.     

Advanced periodontal disease and development of anterior open bite. A case report.

Severe anterior open bite in adults is often both functionally and esthetically unacceptable. The treatment usually consists of a combined orthodontic and surgical correction. The stability of open bite treatment results is often poor. The case presented is of marked anterior open bite in a previously normal bite patient with advanced periodontal disease. An etiology for the development of this condition is suggested and a successful treatment described.     

Moebius综合征患者牙颌面特征及正颌正畸治疗远期疗效评价

目的:评价正颌正畸联合治疗Moebius综合征患者的牙颌畸形的远期疗效。方法:Moebius综合征患者3例,经正颌正畸联合会诊制订治疗计划,按照术前正畸、正颌手术、术后正畸的联合治疗模式进行系统治疗,随访1～6a。结果:Moebius综合征患者的牙颌特征主要表现为严重的骨性开畸形。对于牙颌畸形的治疗,主要是通过正颌正畸联合治疗进行矫正,但由于升颌肌群功能障碍,开矫正的复发倾向比较明显,需要术后密切随访治疗。结论:正颌正畸联合治疗能够矫正Moebius综合征患者严重的骨性开畸形,正颌手术后的长期随访对防止开的复发具有重要意义。     

Differential approach to planning apparatus-surgical treatment of patients with combined bite maxillofacial anomalies

A retrospective analysis of treatment of 245 patients with combined bite maxillofacial anomalies is presented. Indications to orthodontic preparation, principles of planning of combined orthodontic and surgical treatment are discussed.     

Nonsurgical orthodontic treatment of a hypodivergent adult patient with bilateral posterior scissors bite and excessive overjet

This report illustrates successful nonsurgical orthodontic treatment of a hypodivergent adult patient with bilateral posterior scissors bite (Brodie bite) and excessive overjet. A 26-year-old woman primarily reported maxillary incisor protrusion. She was diagnosed with Class ll division 1 malocclusion with skeletal Class I, short face, low mandibular plane angle and bilateral posterior scissors bite. A lingual arch with anterior bite block and posterior miniscrews with preadjusted edgewise appliances were used to improve the bilateral scissors bite. After achieving molar occlusion, the maxillary first premolars were extracted, and six miniscrews were used to improve the anterior-posterior and vertical discrepancies. After active treatment for 56 months, the convex facial profile with excessively protruded lips was improved and good interdigitation with ideal incisor relationship was achieved. Additionally, the irregular movements of the incisal path and the bilateral condyles during lateral excursion were improved. At 13 months of retention, a satisfactory facial profile, occlusion, and jaw movements were maintained. The treatment results suggest that miniscrews and fixed bite blocks were effective and efficient to facilitate correction of the bilateral scissors bite, excessive overjet, and vertical relationship correction in this nonsurgical orthodontic treatment.     

第三磨牙阻生致前牙及双尖牙区开的矫治

目的:通过1例第三磨牙阻生致前牙及双尖牙开的矫治,探讨开的矫治原则。方法:2006年于武汉大学口腔医学院正畸科就诊的1例因第三磨牙阻生致前牙及双尖牙开的患者,拔出4颗第三磨牙及一组双尖牙,通过MBT直丝弓矫治技术进行矫正。结果:患者的开得以矫正,面型改善明显,前牙覆覆盖正常,咬合关系良好。结论:在进行开的诊断和设计时,必须认真分析引起开的原因,选择合适的治疗方案。     

Long-term stability of anterior open-bitetherapy: A review

This article reviews the orthodontic literature with respect to long-term stability after orthodontic or combined orthodontic-surgical treatment of anterior open bite. Efforts were made to review the studies in a manner that allowed comparison of treatment success as well as the subsequent stability. The existing literature suggests that approximately 80% of anterior open-bite subjects will have positive overlap at the latest follow-up, whether they undergo only orthodontic therapy or a combination of orthodontic-surgical therapy. However, orthodontic therapies appear to have slightly lower treatment success but better stability than surgical therapy. In other words, fewer subjects achieve positive incisor overlap with orthodontic therapy alone, but almost all that do maintain it. The level of evidence provided by the current literature is not conclusive because many surgical and nonsurgical open-bite studies are characterized by small samples and the potential for selection bias. Thus, well-designed studies are necessary to improve our knowledge of the etiology, therapies, and stability of anterior open bite.     

正畸-正颌手术联合矫治骨性开(牙合)的长期稳定性研究

目的 研究正畸-正颌手术联合矫治骨性开15年后的骨性以及牙性变化.方法 本研究样本为10例成年骨性开患者,所有患者均采用正畸-正颌手术联合矫治.上颌采用了Le Fort I型截骨术,下颌采用了双侧升支矢状劈开截骨术(BSSO).选择患者在正畸治疗前(T1)、治疗后(T2)以及正颌手术后平均15年(T3)的头颅侧位片进行...