牙齿正畸中直丝弓矫治器与自锁托槽矫治器的效果比较

目的 比较牙齿正畸中直丝弓矫治器与自锁托槽矫治器的应用效果。方法 选取2017年6月~2018年9月我院收治的94例牙齿正畸患者作为研究对象,采用随机数字表法分为对照组和研究组,每组47例。对照组选用直丝弓矫治器治疗,研究组选用自锁托槽矫治器治疗,比较两组治疗前后龈沟液含量、龈沟液炎性因子水平、牙周指标水平与治疗总有效率。结果 治疗后,研究组龈沟液含量、前列腺素E2、肿瘤坏死因子α、白细胞介素1β水平依次为（4.87±0.93）mg、（52.64±4.71）pg/ml、（2.84±0.31）g/L、（35.18±2.34）g/L,分别低于对照组的（6.16±1.02）mg、（60.25±4.43）pg/ml、（3.39±0.27）g/L、（39.64±2.51）g/L,差异有统计学意义（P＜0.05）;治疗后,研究组菌斑指数、龈沟出血指数、牙龈退缩指数、牙周探诊深度、临床附着丧失依次为（0.48±0.28）%、（0.79±0.28）%、（0.79±0.36）%、（2.21±0.83）mm、（1.96±1.42）mm,分别低于对照组的（0.67±0.27）%、（1.08±0.32）%、（0.53±0.33）%、（2.82±0.89）mm、（3.02±1.31）mm,差异有统计学意义（P＜0.05）。研究组治疗总有效率（97.87%）高于对照组（82.98%）,差异有统计学意义（P＜0.05）。结论 与直丝弓矫治器相比,牙齿正畸中自锁托槽矫治器的应用效果更确切,局部炎症反应更轻,且可进一步改善牙周组织。     

Reliability of anatomic structures as landmarks in three-dimensional cephalometric analysis using CBCT

Objective:To identify anatomic structures in three dimensions and examine their reliability to be used as landmarks in a three-dimensional coordinate cephalometric analysis, using cone-beam computerized tomography (CBCT).Materials and Methods:Thirty CBCT images were randomly selected for landmark location. Forty-two anatomic landmarks, which are not included in the traditional cephalometric landmarks, were chosen based on radiographic characteristics that make them pragmatic to mark in the CBCT image slices. The principal investigator marked the full set of landmarks on the software by navigating in the X, Y, and Z axes for every image three times, with each measurement trial being at least 1 week apart. One other investigator also located the landmarks once for each image for reliability purposes. Intraclass correlation coefficients (ICCs) were used to analyze the mean differences in landmark location in all axes.Results:Intra- and interexaminer reliability for x, y, and z coordinates for all landmarks had ICC greater than 0.95 with confidence interval of 0.88–0.99. Mean measurement differences found were <1.4 mm for all landmarks in all three coordinates. Mean measurement error differences obtained in the principal investigator''s trials were primarily <0.5 mm.Conclusion:The most reliable and reproducible landmarks tested for use in CBCT are mental foramina, infraorbital foramina, inferior hamulus, dens axis, foramina transversarium of atlas, medial and lateral condyles of the mandible, superior clinoid processes, and mid-clinoid.     

Influence of cone-beam computed tomography image artifacts on the determination of dental arch measurements

Objective:To compare dental plaster model (DPM) and cone-beam computed tomography (CBCT) in the measurement of the dental arches, and investigate whether CBCT image artifacts compromise the reliability of such measurements.Materials and Methods:Twenty patients were divided into two groups based on the presence or absence of metallic restorations in the posterior teeth. Both dental arches of the patients were scanned with the CBCT unit i-CAT, and DPMs were obtained. Two examiners obtained eight arch measurements on the CBCT images and DPMs and repeated this procedure 15 days later. The arch measurements of each patient group were compared separately by the Wilcoxon rank sum (Mann-Whitney U) test, with a significance level of 5% (α  =  .05). Intraclass correlation measured the level of intraobserver agreement.Results:Patients with healthy teeth showed no significant difference between all DPM and CBCT arch measurements (P > .05). Patients with metallic restoration showed significant difference between DPM and CBCT for the majority of the arch measurements (P > .05). The two examiners showed excellent intraobserver agreement for both measuring methods with intraclass correlation coefficient higher than 0.95.Conclusion:CBCT provided the same accuracy as DPM in the measurement of the dental arches, and was negatively influenced by the presence of image artifacts.     

Esthetic comparison of white-spot lesion treatment modalities using spectrometry and fluorescence

Objective:To compare the esthetic improvements of white-spot lesions (WSLs) treated by fluoride, casein phosphopeptide amorphous calcium phosphate (CPP-ACP), or resin infiltration.Materials and Methods:WSLs were created on human enamel and randomly assigned to four groups: NaF (500 ppm), CPP-ACP, resin infiltration (Icon), or distilled deionized water (DDW; control group). The color change (ΔE) of each specimen was measured with a Crystaleye spectrophotometer, and fluorescence loss (ΔQ) was measured by quantitative light-induced fluorescence (QLF), at different time points after treatment: baseline (0 weeks), 2 weeks, 4 weeks, and 6 weeks.Results:The ΔE and ΔQ baseline values for the four groups before the treatments did not differ significantly. Icon treatment improved the WSL color significantly and gave the lowest ΔE (2.9 ± 1.2 on average) compared with other treatments (P < .01). The Icon treatment also resulted in a significant change in the ΔQ of WSLs compared with baseline (P < .01). In the NaF and CPP-ACP treatment groups, ΔQ showed significant recovery compared with the baseline values only after 4 weeks after treatment (P < .05).Conclusions:Resin infiltration is more effective than NaF or CPP-ACP in providing esthetic improvement of WSLs.     

Dental esthetics and quality of life in adults with severe malocclusion before and after treatment

Objective:To investigate the association between satisfaction with dental esthetics and quality of life, and esthetics satisfaction in relation to esthetic evaluations of three panel groups.Materials and Methods:Fifty-two patients (36 women, 16 men; age 18–61 years) with severe malocclusion were treated in Oulu University Hospital. Of these, 38 and 14 patients underwent orthodontic/surgical treatment and orthodontic treatment, respectively. A questionnaire and dental photographs were collected before and after treatment. The 14-item Oral Health Impact Profile (OHIP-14) was used to measure oral health-related quality of life. Satisfaction with dental esthetics was evaluated using the Visual Analogue Scale. Dental photographs were presented to three panel groups: 30 laypersons, 30 dental students, and 10 orthodontists, who rated the photographs using the Aesthetic Component of the Index of Orthodontic Treatment Need.Results:Oral health–related quality of life (OHIP-14 severity score) and esthetic satisfaction (according to the Visual Analogue Scale) improved after the treatment (P < .001). The most unsatisfied patients reported oral effects more often both before and after treatment. Changes in oral health–related quality of life components of severity, psychological discomfort, and psychological disability correlated positively with the changes in esthetic satisfaction. Orthodontists graded the situation before treatment as worse and the outcome as better than the laypersons; the level of grading by dental students fell between these two groups.Conclusion:Improvement in esthetic satisfaction due to the treatment of severe malocclusion improves oral health–related quality of life, particularly by decreasing psychological discomfort and psychological disability.     

微种植钉近中移动下颌第二磨牙关闭第一磨牙拔牙间隙

目的探讨微种植钉近中移动下颌第二磨牙关闭第一磨牙缺隙的正畸治疗效果。方法对5例第一磨牙缺失患者使用微种植钉近中移动下颌第二磨牙关闭其间隙。结果矫治后尖牙、磨牙中性关系,前牙覆盖、覆袷正常,后牙袷关系良好,下颌第一磨牙拔牙间隙关闭,第二磨牙近中移动量为11．7mm。疗程为18．5～31．0个月,平均为26．1个月。结论在下颌第一、第二双尖牙间采用微种植钉近中移动第二磨牙,能有效地关闭第一磨牙拔牙间隙。     

个性化护理措施对固定正畸矫治的青少年患者托槽脱落率的影响研究

目的 探讨个体化护理措施对接受固定正畸矫治的青少年患者托槽脱落率的影响.方法 将正畸门诊接受固定矫治的120例青少年患者按性别随机均分为四组,A组女患者30例,B组男患者30例,以上两组患者采用个体化护理措施(由专职护士运用语言、示范、文字等教育相结合的方式,从认知、心理、行为、家庭四个方面进行护理),C组女患者30例,D组男患者30例,采用常规正畸护理健康宣教.分别记录四组患者佩戴固定矫治器1个月时托槽脱落的情况,计算托槽脱落率.将A组与C组、B组与D组、A组与B组、C组与D组,分别进行统计分析.结果 佩戴固定矫治器1个月时,四组患者托槽脱落率分别为o.20％、0.40％、1.57％、1.76％,A组与C组比较、B组与D组比较均存在明显统计学差异(P＜0.05);A组与B组比较、C组与D组比较均没有明显统计学差异(P＞0.05).结论 在青少年固定正畸矫治过程中,性别差异不是影响托槽脱落率的主要因素,护士运用个体化的护理措施,提高了患者的主动配合能力,从而降低了患者托槽的脱落率.     

口腔正畸治疗失败的原因分析

目的探讨导致口腔正畸治疗失败的因素,防止发生类似的情况。方法回顾性研究2001年2月—2011年2月正畸效果不理想的病历40例,分析其产生的原因。结果导致正畸治疗失败的原因主要有治疗方案选择不当35%、医患沟通不够30%、医师临床经验不足15%、复发7.5%、医师操作失误5%、患者配合不够5%、不明原因2.5%。结论提高医师的临床诊疗水平、加强与患者的沟通,提高患者的依从性是提高口腔正畸疗效的关键。     

两步法单侧整体推磨牙向后方法临床研究

目的介绍两步单侧整体推磨牙向后的方法，并探讨先倾斜、后竖直的矫治理念在推磨牙向后领域的应用。方法选取单侧磨牙远中关系伴同侧牙列中度拥挤的患者12例，男4例，女8例，年龄10-12岁。采用“先倾斜、后竖直”两步推单侧磨牙向远中，矫正Ⅱ类磨牙关系。磨牙颊沟处粘结一条3．5mm长的不锈钢圆丝作为在X线片上观测磨牙运动的标记线。治疗前、后取研究模型、拍摄头颅侧位定位片和全景片并进行测量分析，对测量结果进行配对资料的t检验。结果所有矫治磨牙均达到中性关系，磨牙平均每月远中移动（1．10±0．75）mm，远中倾斜移动阶段平均需要（4．75±1.85）月，磨牙竖直阶段平均（3．56±0．90）月，治疗前后磨牙倾斜角度以及前牙倾斜角度的差异均无统计学意义（P〉0．05）。结论两步法推磨牙向后可以使磨牙达到完全整体后移的效果，且无明显前牙支抗丧失。