不同减数方法矫治开（牙合）畸形的临床研究

目的:研究不同减数方法矫治开(牙合)时,牙齿移动的不同机制,寻找更有效地矫治开(牙合)畸形的方法.方法:选取20例前牙开(牙合)患者,分析比较8例只拔除第三磨牙和12例拔除前磨牙患者矫治前后X线头颅定位侧位片.结果:只拔除第三磨牙组矫治后上下颌磨牙远中直立,支点降低,前牙伸长,离散的上下颌(牙合)平面汇聚;拔除前磨牙组矫治后磨牙近中移动并直立,相对于(牙合)平面压低,前牙舌向移动并伸长,(牙合)平面改建.结论:对于边缘病例,建议采用拔除前磨牙方法矫治开(牙合).     

无托槽隐形矫治拔牙病例的后牙不同轴倾度对牙齿三维力学影响

目的 研究无托槽隐形矫治技术拔除双侧上颌第一前磨牙病例整体内收前牙，后牙不同轴倾度时，各个牙齿的瞬时受力情况。方法 设置4组后牙不同轴倾度的上颌牙列，T1组后牙为正常牙合轴倾度，T2组后牙在T1组基础上后倾5°,T3组后牙在T1组基础上前倾5°,T4组后牙在T1组基础上前倾10°。拔除双侧第一前磨牙，整体内收前牙0.25 mm,在矫治器六轴力传感器测试平台上测量4组牙列中各个牙齿在三维方向的瞬时力。每组牙列设计12副隐形矫治器。结果 与T1组相比，T2组切牙伸长力减小，尖牙远中向力增加，后牙近中向力减小，磨牙颊向和伸长力增大，差异均有统计学意义(P<0.05)。与T1组相比，T3和T4组切牙舌向力和伸长力增大，尖牙远中向力增大，后牙近中向力也增大，磨牙颊向和伸长力增大，差异均有统计学意义(P<0.05)。结论 后牙后倾时利于前牙转矩的表达，有助于保护后牙支抗，但增加了磨牙的颊向力和伸长力。后牙前倾时，前牙更容易出现转矩丢失，覆牙合加深的现象。后牙越前倾，覆牙合越容易加深，后牙支抗容易丢失。     

无托槽隐形矫治器设计平面导板对上牙列牙齿移动的影响

目的 探讨无托槽隐形矫治器设计平面导板,对上中切牙压低效率的影响及支抗前磨牙、磨牙的变化,以期对无托槽隐形矫治器设计平面导板矫治深覆(牙合)提供参考.方法 分别选取无托槽隐形矫治器设计平面导板和无平面导板矫治深覆(牙合)的病例各6例,两组均设计上中切牙不少于0.7mm的压低,通过前牙压低矫正深覆(牙合).前磨牙及磨牙作为支抗牙不设计移动.以腭穹窿为参照,重叠设计压低前后的数字化模型,比较两组上颌中切牙压低效率的差异,以及两组支抗前磨牙和磨牙的差异.结果 平面导板组上中切牙压低效率为33％,无平面导板组上中切牙压低效率为8％,二者的差异无统计学意义(P＞0.05);平面导板组第一前磨牙、第二前磨牙、第一磨牙和第二磨牙分别伸长0.3、0.1、0.2和0.1mm;无平面导板组第一前磨牙、第二前磨牙、第一磨牙和第二磨牙分别压低0.0、0.2、0.1和0.1mm,两组的差异均有统计学意义(P＜0.05);平面导板组和无平面导板组未设计移动的第一磨牙分别颊倾0.0mm和0.3mm,二者的差异有统计学意义(P＜0.05).结论 无托槽隐形矫治器设计平面导板对上颌中切牙的压低无明显影响,但能有效伸长支抗前磨牙及磨牙,克服无托槽隐形矫治器"(牙合)垫效应"造成的后牙压低,并维持磨牙水平向的位置,对深覆(牙合)的矫正发挥一定作用.     

尖牙近、远中小圈簧在Begg系统打开咬合的应用

笔者在Ｂｅｇｇ技术的实际应用中 ,设计尖牙近中或远中垂直小圈曲簧 ,结合磨牙前小角度后倾曲打开咬合 ,经临床应用 ,前牙压低效果明显 ,前磨牙适当升高 ,整平牙弓快 ,运用国产仿澳丝也能快速打开咬合。方　法1.改进后Ｂｅｇｇ唇弓的弯制 :根据尖牙高低位及是否需压低在尖牙远中或近中龈向打垂直小圈曲并后倾 30°,在第一恒磨牙近中打 15°后倾曲。2 .改进后Ｂｅｇｇ唇弓的应用 :①尖牙高位需压低采用15°后倾曲 30°尖牙远中小圈曲 Ⅱ类颌间牵引。②尖牙低位需升高采用 15°后倾曲 30°尖牙近中小圈曲 Ⅱ类颌间牵引。③尖牙无需升高或…     

应用微型种植体作支抗压低磨牙

目的：探讨微型种植体作为正畸支抗在压低磨牙中的应用。方法：选择5例需要压低磨牙的患者（包括3例开殆患者和两例因对殆牙缺失而致磨牙伸长的修复前正畸患者），使用微型种植体作支抗压低磨牙，治疗前后拍摄头颅侧位定位片，测量比较磨牙在矫治前后的压低量。结果：矫治结束后开殆患者前牙达到正常的覆殆覆盖，修复前正畸患者矫治至缺牙区能进行常规修复。磨牙平均压低3．1mm。结论：应用种植体作支抗能有效地压低磨牙，为某些错合畸形的矫治提供了新思路。     

三维数字化技术测量矫治前后上颌尖牙与后牙轴倾和转矩变化初探

目的 应用三维数字化技术探索正畸治疗中上颌尖牙、前磨牙和磨牙三维位置的变化规律.方法 通过随机数字表随机抽取北京大学口腔医学院·口腔医院正畸科资料完整的病例28例(减数组、非减数组各14例).点激光扫描获得三维数字化牙颌模型,用腭皱重叠方法重叠矫治前后的上颌数字化模型,用三维图像配准技术将矫治后牙齿的临床冠面轴转移至矫治前同名牙上,以矫治后上颌(牙合)平面为共同参考面,分别测量减数和非减数组矫治前后上颌尖牙、前磨牙和磨牙轴倾和转矩的变化.结果 非减数组矫治后第二前磨牙轴倾减小1.5°,矫治前后差异有统计学意义(P＜0.05);矫治后上颌第一、第二前磨牙冠颊向转矩分别增加5.1°和4.2°,与矫治前相比,差异有统计学意义(P＜0.05).减数组矫治后上颌尖牙冠舌向转矩增加3.8°,矫治前后差异有统计学意义(P＜0.05).结论 三维图像配准技术可将矫治前后的数字化牙颌模型置于同一坐标系中测量矫治前后牙齿轴倾和转矩的变化.非减数矫治具有后倾上颌第二前磨牙,颊倾上颌前磨牙的作用;而减数矫治具有舌倾上颌尖牙的作用.     

扩弓和Ⅱ类牵引矫治成人安氏Ⅱ类2分类错

目的 :应用扩大上 /下颌牙弓和Ⅱ类牵引方法矫治成人安氏Ⅱ类 2分类错牙合 ,观察并比较矫治前后硬组织X线头影测量以及模型的变化。方法 :选取临床矫治的安氏Ⅱ类 2分类错牙合成人病例 15例 ,矫治采用非拔牙矫治的扩大上 /下颌牙弓以及Ⅱ类牵引的方法 ,测量矫治前后X线头影测量和模型测量的变化并比较。结果 :头影测量治疗前后上颌骨矢状方向和垂直方向变化不明显 ,下颌骨矢状方向SNB平均增加 2 .5° ,垂直方向下颌平面角平均增加了 2 .7° ,下前面高平均增加了 11.8mm ,上下切牙明显唇倾 ,下颌磨牙明显近移 ;模型测量治疗前后覆牙合明显减小 ,上下颌尖牙间、前磨牙间和上颌磨牙间宽度明显增加 ,下颌磨牙增加不明显。下颌尖牙和磨牙平均近移 4.1mm和 3 .6mm。磨牙关系由Ⅱ类变为I类。结论 :成人安氏Ⅱ类 2分类错牙合可以通过扩大上 /下颌牙弓和II类牵引方法矫治 ,获得满意的治疗结果     

摇椅形唇弓打开咬合前后上颌牙的三维变化

目的:使用激光扫描三维成像技术研究咬合打开前、后上颌牙的三维变化.方法:选取山东大学口腔医学院正畸科收治的15～21岁恒牙期安氏Ⅱ类1分类错(牙合)并同时伴深覆(牙合)患者40例.随机分为2组,每组均在用不同的方法打开咬合后留取石膏牙颌模型,用激光扫描三维成像技术建立数字化研究模型,测量上颌牙在打开咬合前、后的三维变化.采用SPSS13.0软件包对数据进行t检验.结果:在矢状向上,切牙表现为唇向倾斜趋势,尖牙及第一恒磨牙表现为远中移动趋势,第二前磨牙变化不明显.摇椅形唇弓有无弓丝末端回弯及尖牙向后"8"字结扎所引起的切牙和第一恒磨牙的变化有显著差异(P＜0.05),而尖牙和第二前磨牙的变化无显著差异(P＞0.05);在垂直向上,切牙及第一恒磨牙的远中颊尖表现为龈向压低趋势,第二前磨牙表现为(牙合)向升高趋势,尖牙及第一恒磨牙近中颊尖变化不明显,各组之间无显著差异(P＞0.05);在横向上,磨牙区牙弓宽度有增加趋势,尖牙及前磨牙变化不明显,各组之间无显著差异(P＞0.05).结论:标准镍钛摇椅形唇弓打开咬合可引起上颌牙在矢状向、垂直向及横向上的变化,矫治深覆(牙合)效果显著.     

压低磨牙的可摘矫治器制作和临床疗效观察

目的：评估可摘矫治器压低伸长的磨牙的可行性和临床应用价值。方法：选择7例患者,随机采用可摘牙合板式矫治器和真空压膜式矫治器压低伸长的磨牙。治疗前后通过牙颌模型分析评价临床效果。结果：7例患者经过平均3.7个月的治疗均取得比较明显的治疗效果。治疗前后模型分析显示最大压入量为3.05 mm,最小为1.03 mm,月平均压入量为0.58 mm。结论：可摘矫治器用于压低伸长的磨牙有明显的临床效果。可摘矫治器具有美观、便于口腔卫生维护、制作简便、成本低廉的特点。     

扩弓和Ⅱ类牵引矫治成人安氏Ⅱ类2分类错(牙合)

目的:应用扩大上/下颌牙弓和Ⅱ类牵引方法矫治成人安氏Ⅱ类2 分类错(牙合),观察并比较矫治前后硬组织X线头影测量以及模型的变化.方法: 选取临床矫治的安氏Ⅱ类2 分类错(牙合)成人病例15 例,矫治采用非拔牙矫治的扩大上/下颌牙弓以及Ⅱ类牵引的方法,测量矫治前后X线头影测量和模型测量的变化并比较.结果: 头影测量治疗前后上颌骨矢状方向和垂直方向变化不明显,下颌骨矢状方向SNB平均增加2.5°,垂直方向下颌平面角平均增加了2.7°,下前面高平均增加了11.8 mm,上下切牙明显唇倾,下颌磨牙明显近移;模型测量治疗前后覆(牙合)明显减小,上下颌尖牙间、前磨牙间和上颌磨牙间宽度明显增加,下颌磨牙增加不明显.下颌尖牙和磨牙平均近移4.1 mm和3.6 mm.磨牙关系由Ⅱ类变为I类.结论:成人安氏Ⅱ类2分类错牙合可以通过扩大上/下颌牙弓和II类牵引方法矫治,获得满意的治疗结果.     

A prospective clinical trial of the effects produced by the Connecticut intrusion arch on the maxillary dental arch

ObjectiveTo assess and compare the effects produced in the maxillary dental arch by means of Connecticut intrusion arch (CIA) with or without a cinch back on the distal end of the tube of the first molars.Materials and MethodsThis study included 44 patients with a mean age of 13.1 ± 1.8 years treated for deep bite with a CIA randomly divided into two groups: group 1 (G1), 22 patients with initial mean age of 12.72 ± 1.74 years treated with the CIA in the upper arch without a cinch back on the distal surface of the tube of the first molars, and group 2 (G2), 22 patients with an initial mean age of 13.67 ± 2.03 years treated with the CIA with a cinch back. Lateral cephalograms were available before treatment (T1) and after intrusion of maxillary incisors (T2). The mean treatment period was 5.5 ± 1.45 months. Intragroup and intergroup changes in the maxillary incisor and molar positions were analyzed by paired and independent t-tests associated with the Holm-Bonferroni correction method for multiple comparisons (P < .05).ResultsThere were significant differences between groups in terms of maxillary incisor displacement. The maxillary incisors flared labially (2.17°) and proclined (1.68 mm) in group 1, whereas a palatal inclination (−1.99°) and retroclination (−1.13 mm) was observed in group 2. No significant differences were found for the molar positions between the groups.ConclusionsThe presence or absence of a distal bend in CIA affects incisor tipping and proclination during intrusion mechanics.     

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??Objective    To analyze the principle and evaluate clinical effect of correction on skeletal mandibular deviation by multiloop edgewise arch wire ??MEAW??technique in permanent dentition. Methods    MEAW technique was applied to treat 16 cases of skeletal mandibular deviation with 0.56 mm × 0.71 mm MBT bracket system. Panoramics and cephalometric radiographs were taken and compared before and after treatment. Results    After average treatment time of 20 months??totally 16 cases gained perfect therapeutic effect with molar distal tipping and movement??mean value??tipping 7.63°??movement 3.38 mm????lingual inclination in lower anterior teeth with the change 3.31 mm during treatment??but mandible bone remained asymmetric before and after treatment and there was little change happened on jaws. Conclusion    Skeletal mandibular deviation in permanent dentition can be treated successfully by multiloop edgewise arch wire technique??that is so-called “compensatory treatment”.     

多曲方丝弓技术矫治恒牙期骨性下颌偏斜畸形临床研究

目的    探讨多曲方丝弓（MEAW）技术矫治恒牙期骨性下颌偏斜的矫治原理和临床疗效。方法    选取2006—2014年就诊于苏州卫生职业技术学院附属口腔医院正畸科门诊的骨性下颌偏斜患者16例,选用0.56 mm × 0.71 mm MBT系统托槽,采用MEAW技术进行矫治。矫治前后拍摄X线曲面断层片及头颅侧位片,并进行定点测量,对测量结果进行比较分析。结果    16例骨性下颌偏斜患者平均矫治时间20个月,均取得良好的矫治效果。头影测量分析显示,治疗后下磨牙远中直立移动,平均远中直立7.63°,平均远中移动3.38 mm;下前牙平均舌倾内收3.31 mm;下颌骨治疗前后不对称,治疗前后颌骨改变小。结论    采用MEAW技术可有效矫正恒牙期骨性下颌偏斜,为代偿掩饰性矫正。     

A comparison of treatment effects of total arch distalization using modified C-palatal plate vs buccal miniscrews

Objective:The purpose of this study was to compare the treatment effects of palatally vs buccally placed temporary anchorage devices.Materials and Methods:Of 40 Class II division 1 malocclusion patients, 22 were treated with modified C-palatal plate (MCPP) appliances (age 21.9 ± 6.6 years), and 18 (age 24.2 ± 6.8 years) were treated with buccally placed miniscrews between the maxillary first molar and second premolar. A total of 26 linear and angular measurements were analyzed on pre- and posttreatment lateral cephalograms. Multivariate analysis of variance was performed to evaluate the treatment effects within each group and to compare the effects between groups.Results:Overall, the MCPP appliances showed 4.2 mm of distalization, 1.6 mm of intrusion of the first molar with 2° tipping, and 0.8 mm extrusion of incisors. The miniscrew group resulted in 2.0 mm of distalization, 0.1 mm intrusion of the first molar with 7.2° tipping, and 0.3 mm of incisor extrusion. Regarding soft tissue change, in the MCPP group, the upper lip was significantly retracted (P < .001).Conclusions:Comparing the treatment effects between MCPP appliances and buccal miniscrews, the MCPP appliances showed greater distalization and intrusion with less distal tipping of the first molar and more extrusion of the incisor compared to the buccal miniscrews.     

利用压低辅弓增加后牙支抗的生物力学研究

目的确定远中移动尖牙时,使用压低辅弓增加后牙支抗的最适后倾弯角度。方法按照Burstone方法弯制0．017×0．025英寸（1英寸-2．54cm）伊钛丝（TMA）的压低辅弓,主弓丝采用0．016×0．016英寸不锈钢丝,拉尖牙远中移动的拉簧为150g力。设计后倾弯分别为20°、30°、40°,采用口外正畸模拟生物力学检测系统（OrthodonticMeasurementandSimulationSystem,（）Mss）模拟临床加力,分别测量三维状态下切牙段、尖牙段和后牙段受力和力矩情况。结果尖牙远移过程中,无压低辅弓时,尖牙远中移动并倾斜,磨牙近中倾斜10°;压低辅弓的后倾弯为20°时,尖牙远中移动并倾斜,磨牙近中倾斜5°;后倾弯为30°时,尖牙远中移动基本保持直立,磨牙远中倾斜5°;后倾弯为10。时,尖牙远中移动有压低倾向,磨牙远中倾斜超过10°。结论尖牙远中移动时,弯制有30。后倾弯的乐低辅弓既能够增加后牙专精．又不影响前牙的覆[牙合]覆盖。     

压低辅弓增加后牙支抗的临床应用研究

目的：研究压低辅弓在尖牙远移过程中增加后牙支抗的临床效果。方法：选择需要强支抗,上颌减数第一双尖牙的患者30例,随机分为研究组和对照组,每组15例,研究组采用上颌NANCE弓,配合0.017＂×0.025＂TMA压低辅弓,30°后倾弯,150g力远中牵引尖牙至第二双尖牙,对照组采用上颌NANCE弓,配合口外弓。将矫治前后的头颅侧位定位片和三维模型进行对比分析,其变化量进行独立t检验。结果：研究组在尖牙远中移动的过程中,右侧上颌第一磨牙近中移动0.77mm,近中腭向扭转8.9°;左侧上颌第一磨牙近中移动约0.72mm,近中腭向扭转8.8°;右侧上颌尖牙远中移动约5.5mm,远中腭向扭转10.3°;左侧上颌尖牙远中移动约5.71mm,远中腭向扭转15.1°。与对照组相比无显著性差异。且第一磨牙在前后向的位移与尖牙的位移和磨牙的扭转存在高度相关性。结论：30°后倾弯的压低辅弓在远中移动尖牙过程中,可以为后牙提供强支抗。     

Combined Therapy with Pendulum and Lingual Arch Appliances in the Early Mixed Dentition

PATIENTS AND METHOD: In 20 patients with arch length deficiency and anterior crowding, pendulum and lingual arch appliances were inserted simultaneously in the upper and in the lower arch respectively to gain space. The patients were divided into two groups according to their dental eruption stage: ten children (six boys, four girls; mean age: 9 years, 6 months) were in the early mixed dentition, while an adolescent comparison group of the same size (three boys, seven girls; mean age: 12 years, 3 months) were in the permanent dentition at the beginning of treatment. AIM: The main purpose of the study was to investigate whether simultaneous therapy with pendulum and lingual arch appliances is to be recommended, i.e. whether this therapy should take place as interceptive treatment in the early mixed dentition or only in the permanent dentition in adolescence. Parameters were the extent and quality of dentoalveolar effects and the side effects (mesial movement of the incisors, protrusion of the incisors, tipping of molars). RESULTS: The treatment course was documented by means of study casts and lateral cephalograms. Assessment of the diagnostic records yielded the following findings: In the early treatment group the maxillary molars were distalized by the pendulum appliance by a mean distance of 4.0 +/- 1.46 mm, resulting in distal tipping by 6.1 +/- 2.18 degrees. The incisors were moved reciprocally by 1.08 +/- 1.06 mm to anterior and protruded by 7.65 +/- 4.84 degrees. In the comparison group molar distalization and molar tipping were less pronounced (2.86 +/- 1.54 mm/4.25 +/- 3.78 degrees ), while mesial movement of the incisors was comparably high at 1.62 +/- 0.99 mm. At only 3.8 +/- 2.9 degrees, incisor protrusion was significantly less pronounced than in the early treatment group (p = 0.045). The proportion of molar distalization in the total movement was higher in patients in the early mixed dentition: 79.83 +/- 15.38% vs 60.71 +/- 26.64%. During the early therapy with the lingual arch appliance in the lower arch, the molars were uprighted to the distal by 2.4 +/- 0.97 degrees and the incisors were tipped to labial by 5.0 +/- 1.83 degrees. In the adolescent control group, molar uprighting was less pronounced and the degree of incisor protrusion was significantly lower (2.75 +/- 1.11 degrees, p = 0.004). CONCLUSION: With the appropriate indication, the combined therapy with the two compliance-independent appliances described can be recommended for gaining sagittal arch length in the early mixed dentition.     

Effects of a three-dimensional bimetric maxillary distalizing arch

This study aimed to investigate the dental effects of a three-dimensional (3D) bimetric maxillary distalizing arch. The Wilson rapid molar distalization appliance for Class II molar correction was used in 14 patients (10 girls and four boys with a mean age of 12.18 years). The open coil springs were activated with bent Omega stops and Class II intermaxillary elastics. The mandibular anchorage was gained by a 0.016 x 0.016 utility arch with a 3D lingual arch or a lip bumper with a standard lingual arch. The lateral cephalograms taken before and after treatment formed the material of the research. A Wilcoxon test was used to statistically evaluate the treatment effects. The results showed that the distal tipping of the maxillary first and second molars, and first and second premolars and canines were statistically significant. Significant distal movement occurred in all posterior and canine teeth. The maxillary first molar distalization was found to be 3.5 mm. The maxillary incisor showed significant proclination and protrusion. The decrease in overbite was found to be statistically significant. The mandibular plane angle significantly increased by a mean of 0.5 mm. In addition, significant soft tissue changes were observed.     

三段片段弓同时压低和后退上切牙临床研究

目的:评价采用三段片段弓治疗安氏Ⅱ类1分类深覆患者后上颌中切牙、上颌第一磨牙的控制情况.方法:选择12～14岁安氏Ⅱ类1分类高角深覆患者20例,采用三段片段弓,在4个上切牙段阻力中心远中侧2 mm处施加50 g压低力及约20 g后退力,腭杆加强支抗.治疗前及治疗6月后摄X线定位侧位片,并测量和统计.结果:上颌第一磨牙近中移动和垂直伸长量分别为0.60 mm±0.35 mm和0.80 mm±0.52 mm;上颌第一磨牙轴倾角无变化;上中切牙水平后移量及垂直压低量分别为-.20 mm±2.12 mm和3.10 mm±0.54 mm;上中切牙阻力中心后移量及压低量分别为-4.12 mm±1.96 mm和3.20 mm±0.66 mm;上中切牙与腭平面夹角由123.21°±4.26°降低成116.00°±3.96°.结论:三段片段弓技术在同时压低和后退上切牙时,可有效控制后牙支抗,是一种有效的矫治伴有切牙唇倾深覆的方法.     

The relation between the point of force application and flaring of the anterior segment

The purpose of this study was to determine whether application of an intrusive force by an intrusion arch at the distal wings of the lateral incisor brackets causes a change in the axial inclination of the anterior segment. Maxillary incisor intrusion was performed, and records were taken from 40 adolescent patients at the beginning and end of intrusion. Intrusion of the maxillary anterior segment caused a statistically significant mean increase in axial inclination of the central incisor of 8.74 degrees. The following correlations were investigated and found not statistically significant. The correlation between the (1) distance from the point of force application to the center of resistance at the start of intrusion and the change in axial inclination of the incisor, (2) distance from the point of force application to the center of resistance at the start of intrusion and the change in distance from the incisal edge to the distal side of the first molar, (3) distance from the point of intrusive force application to the center of resistance at the start of intrusion and at the end of intrusion, (4) distance from the point of intrusive force application to the center of resistance at the start of intrusion and the change in this distance between start and end of intrusion, and (5) amount of intrusion and the change in axial inclination.