上颌骨前部节段骨切开后退术矫治上颌前突微笑露龈畸形的术前正畸

目的　讨论采用上颌前部节段骨切开后退术 (anteriormaxillarysegmentalosteotomy,AMSO)和正畸联合治疗 ,解决上颌骨前突及露龈问题的手术前正畸治疗特点与应注意的问题。方法总结了四川大学华西口腔医学院正畸科采用正畸结合上颌节段骨切开后退术治疗的骨性安氏Ⅱ类 1分类伴露龈微笑病例 2 0例。通过头影测量分析 ,比较手术前后面部软硬组织的变化。结果AMSO手术治疗后患者ANB角平均减小 4 2 5°、上前牙牙槽高度平均减小 5 5mm、上前牙前突程度平均减小 5mm、A点突度平均减小 3mm、上下唇间隙平均减小 3 4mm ,与治疗前相比较 ,各项改变的差异有显著性 (P <0 0 5)。而下切牙下颌平面角、下前牙与NB的距离、上唇长度、上下唇突度 ,各项改变的差异则无显著性 (P >0 0 5)。患者II类骨性前突、微笑露龈面型得到明显改善。结论　正畸结合AMSO能有效地矫正上颌前突、微笑露龈等问题。对于Ⅱ类畸形外科正畸联合治疗的病例 ,提倡单颌手术 ,以简化治疗。术前正畸治疗应注意支抗控制 ;上前牙弓特别是截骨段远中端应予扩大以使其在术中后退时能与后段及下牙弓协调

Pre-surgical orthodontic treatment of skeletal class Ⅱ patients with gingival smile corrected by anterior maxillary segmental osteotomy

OBJECTIVE: To discuss the pre-surgical orthodontic treatment of skeletal class II patients with gingiva smile corrected by AMSO. METHODS: We analyzed the clinical features of 20 skeletal class II patients treated by AMSO combined with Orthodontic treatment and evaluated the effects of AMSO by means of cephalometric analysis. RESULTS: After the AMSO treatment, ANB angle, the height of anterior maxilla, the protrusion of the upper anterior teeth, and the of A point had reduced significantly (P < 0.05). After AMSO, the appearance of patients had been improved markedly. CONCLUSIONS: AMSO can correct the protrusion of the maxilla and gingival smie efficiently. The anchorage of molars should be controlled carefully. The anterior part of the upper arch should be expended orthodontically to make arch relationship. Extract the upper bicuspid half a year before the surgery was recommended. When necessary, genioplasty could be performed.