固定矫治器治疗的儿童口腔健康情况调查

目的:探讨儿童正畸患者的口腔保健情况。方法:随机选取接受固定矫治器治疗的儿童370名,其中男151,女219,分别在戴上固定矫治器后的3个月和半年,进行问卷调查和临床检查判断口腔健康状况。结果:口腔卫生状况差以及没有基本的口腔保健意识的儿童在戴上矫治器后牙石指数、菌斑指数和牙龈指数均显著增高(P<0.01)。儿童正畸患者口腔健康状况与正畸时间长短和其口腔卫生维护意识有关。结论:对于儿童正畸患者必须要同时开展针对性的卫生宣教工作并加强综合防治措施以维护其口腔健康。     

Spine loading in patients with low back pain during asymmetric lifting exertions

Background contextRecurrent low back pain (LBP) is a common and costly problem that might be related to increased spine loads in those with LBP. However, we know little about how the spine is loaded when those with LBP perform lifting exertions.PurposeDocument spine loading patterns of patients with LBP performing symmetric and asymmetric lifting exertions compared with asymptomatic individuals performing the same tasks.Study designSpine loadings during lifting exertions that varied in asymmetric origin as well as horizontal and vertical distance from the spine were compared between asymptomatic subjects and patients with LBP.MethodsSixty-two patients with LBP and 61 asymptomatic individuals performed a variety of lifting exertions that varied in lift origin horizontal and vertical position (region), lift asymmetry position and weight lifted. An electromyography-assisted model was used to evaluate spine loading in each subject during the lifting exertions. Differences in spine loading between the LBP and asymptomatic subjects were noted as a function of the experimental variables.ResultsPatients with LBP experienced greater spine compression and shear forces when performing lifting tasks compared with asymptomatic individuals. The least taxing conditions resulted in some of the greatest differences between LBP and asymptomatic individuals.ConclusionsGreater levels of antagonistic muscle coactivation resulted in increases in spine loading for patients with LBP. Specific lifting conditions that tend to exacerbate loading can be identified by means of physical workplace requirements. These findings may impact acceptable return-to-work conditions for those with LBP.     

正畸专家建议对正畸求治人群矫治决策的影响

目的 探讨正畸专家的建议对正畸求治人群矫治决策的影响.方法 随机选取1例个别正常(牙合)者的口内像作为实验病例,设计电子问卷,以中山大学附属口腔医院正畸求治患者为被试对象,并随机分成两组:正干扰组与负干扰组,让其分别在正畸专家提出建议前、后,对这名实验病例的正畸治疗需要程度进行评分.结果 正干扰组67.96％和负干扰组48.04％的被试者根据正畸专家的建议,调整自己的初始分值,向正畸专家的建议靠拢,但正畸专家的建议在大部分患者的决策中的权重较低;正干扰组12.62％和负干扰组18.63％的被试者忽视正畸专家的建议,坚持自己的初始分值.正、负干扰组间被试者接受建议的比率差异具有统计学意义(P＜0.05),正负干扰组间被试者受建议干扰的程度差异具有统计学意义(P＜0.01).结论 正畸专家的建议对多数正畸求治患者的矫治决策具有不同程度的引导作用,少数患者不受正畸专家建议的影响,临床上需要区别对待.     

正畸患者对颜面美的感知和期望及正畸治疗的意义

目的了解寻求口腔正畸治疗的患者对面部美学的感知和期望,并结合临床治疗原则以指导正畸计划的制定。方法将118例口腔正畸患者分为9-16岁的青少年组和17岁以上的成年组,用问卷调查的方法了解患者对面部美学的理解和对治疗结果的期望,内容包括面部外形、牙齿外观、笑容美学等,结合患者的情况进行综合分析,制定合理的治疗计划。结果改变外貌是患者寻求正畸治疗的首要目的。两组患者均期望治疗后有整齐的牙列,成年组患者对良好的面部外形和美的笑容的感知和期望较高（P〈0.01）青少年组患者对牙列的外观有比较高的感知和期望,对面部外形和笑容美的感知和期望稍低。结论医师充分了解患者对面部美学的感知和期望,有利于制定合理的治疗方案,才能达到双方满意的治疗效果。     

拔牙矫治的临床治疗分析

目的:分析拔牙矫治在临床治疗中的应用情况,了解拔牙位置与错牙合畸形类型的关系。方法:随机抽取临床病例312例,所有病例均为恒牙期错牙合畸形,用固定矫治器矫治,把每个病例的各项资料输入计算机,进行统计分析。结果:Ⅱ类错牙合拔牙矫治比率最高。随着拥挤度、上前牙突度的增加,拔牙的百分比也加大。结论:牙齿拥挤度越大,上前牙越突,拔牙率越高,越倾向于拔除第一前磨牙。     

拔牙与非拔牙正畸治疗对微笑的美学影响

目的 研究拔牙与非拔牙正畸治疗对牙弓宽度以及微笑美学的影响.方法 选正畸临床治疗非拔牙患者和拔除4颗第1双尖牙患者各100例,分别对其矫治前、后模型上颌尖牙间和下颌尖牙间的牙弓宽度进行测量,测量点为尖牙长轴之牙根齿槽部的最突点,测量数据经统计学分析验证结果.结果 正畸矫治前两组患者的上颌及下颌牙弓宽度差异均无统计学意义(P＞0.05).矫治后,非拔牙组下颌宽度增加了0.88 mm(P＜0.001),上颌宽度增加了0.84 mm(P＜0.001);而拔牙组下颌宽度增加了1.64 mm(P＜0.001),上颌宽度增加了1.50 mm(P＜0.001).矫治后,拔牙组比非拔牙组下颌宽度增加了0.59 mm(P＞0.05),上颌宽度减少了0.10 mm(P＞0.05).结论 拔牙矫治与非拔牙矫治不但均未造成上下颌牙弓宽度之降低,反而引起明显的增宽.拔牙矫治导致牙弓缩窄,从而影响微笑的美观的结论不能成立.     

17岁以下儿童与少年脊柱脊髓损伤

报告了１７岁以下儿童及少年脊柱脊髓损伤３０例。占同期脊柱骨折、脊髓损伤的６．０６％。主要致伤原因为高处坠落。损伤节段以腰椎为主，多节段脊柱骨折的发生率为４０％。３０例中２６例有神经系统障碍。分析认为：儿童少年脊柱脊髓损伤中多节段脊柱骨折较多；无明显骨折脱位的脊髓损伤较多；保守治疗效果颇佳且病人恢复快，预后良好。     

Surgical treatment of mandibular prognathism in collaboration with orthodontic treatment in Korea

Mandibular prognathism is defined by John Hunter as follows: The lower jaw projecting too far forward so that the foreteeth pass before those of the upper jaw, therefore disfigurement and malocclusion are two of the main facial characteristics. Other distinguishing features are the coexistence of class III malocclusion, incomplete closure of lip, deviation of the midline, and decrease of labiomental fold. Generally, the functional occlusal relationship and balanced facial harmony cannot be obtained by surgical or orthodontic treatment alone. Its success depends on careful conjoint, supplementary diagnostic, and treatment planning. As a cardinal principle the authors made the following combined surgical and orthodontic treatment plans: (1) Orthodontic treatment relocates and decompensates the malpositioned teeth (remove the masking effect of teeth) and, therefore, skeletal deformity is exposed maximally. (2) Surgical treatment eliminates the maximally exposed skeletal defect. Therefore, dramatic facial balance and functional occlusal relationship are obtained. Treatment planning includes the pre- and postoperative orthodontic treatment, lateral cephalometric prediction tracing (LCPT), and model surgery with dental cast. The authors made it easy with the use of an acrylic dental wafer to coordinate exact occlusal relationship after surgery. We treated mandibular prognathism by using Dautrey's modification of the sagittal split ramus osteotomy (SSRO) (10 cases) and intraoral vertical ramus osteotomy (IVRO) (5 cases) and sometimes additional genioplasty (2 cases). IVRO was used in those cases where (1) the amount of setback was more than 10 mm and (2) where there was a flat gonial angle. Otherwise SSRO was used. Late postoperative relapses were detected from 7 to 38 months (mean 19.6 months), followed up in some degree by cephalometrics, but the functional occlusal relationship proved to be stable. Conclusively, all the patients obtained satisfaction for their facial balance and functional occlusal relationship following combined surgical and orthodontic treatment.     

成人固定正畸治疗牙周疼痛的调查问卷分析

近年来，随着国民经济文化水平的提高，越来越多的成人牙颌畸形患者接受正畸治疗。然而在成人正畸治疗过程中，由于矫治力导致牙周膜缺血、炎症、水肿，大部分患者会出现不同程度的牙周疼痛，尤其是初戴固定矫治器，放置首根弓丝或者更换粗弓丝后几天内疼痛较为严重。有些患者由于疼痛不敢刷牙，影响合作，严重者影响说话、进食、情绪、睡眠等，有的患者甚至会出现烦躁、焦虑影响生活质量而要求放弃治疗。因此，了解成人正畸牙周疼痛的发生和变化规律，对治疗过程中进行干预和和预防显得十分重要。     

非常规拔牙矫治在正畸治疗中的应用

目的：总结分析非常规拔牙矫治的临床经验。方法：非常规拔牙矫治病例29例（男性9例，女性20例），年龄12—30岁，平均18．4岁。根据患者的具体情况，分别结合以下非常规拔牙法进行矫治：拔除一个上中切牙、二个上侧切牙、一个上侧切牙、二个上尖牙、一个上尖牙，一个下中切牙、一个下尖牙、一个下第一磨牙，一个第二磨牙等。结果：所有病例治疗结束后拔牙间隙关闭，前牙覆牙A、覆盖基本正常，后牙咬合关系良好，面貌协调，侧貌美观，患者满意，达到了矫治的目的。结论：在特殊情况下，矫治目标可遵循个性化原则，采用非常规拔牙矫治，可以缩短疗程，达到与患者愿望一致的矫治目的。     

骨性错(牙合)畸形外科手术前后的正畸治疗

目的 探讨骨性错(牙合)畸形外科手术前后正畸治疗方法,以指导临床.方法 对25例年龄为17～36岁的骨性错殆畸形患者先后进行术前正畸、手术治疗和术后正畸.术前正畸包括牙齿的排齐、牙弓的整平、扭转牙的矫正、牙弓的协调和去除前后牙代偿.术后正畸包括关闭剩余间隙、牙齿的精细调整,建立良好的(牙合)关系、理想的覆殆覆盖和牙根平衡.结果 25例骨性错(牙合)畸形,平均术前正畸治疗时间14.41个月(2-23个月),术后正畸治疗时间6.94个月(1.5～13.5个月),治疗完成平均21.35个月(7～35个月).上颌前突患者上颌后退平均5.00 mm,下颌后缩患者下颌前移平均7.25 mm,下颌前突患者下颌后退平均6.55 mm,颏部后缩患者颏前移平均5.33 mm.结论 术前术后正畸治疗是正颌外科手术矫治骨性错(牙合)畸形的重要步骤,也是取得良好矫治效果的基本要求.     

成人与青少年口腔正畸的区别

目的:分析成人与青少年正畸治疗的特点。方法:成人组及青少年组病例各33例,比较其疗程长短和托槽脱落情况及满意率。结果:两组的疗程、病人的满意率无显著差异,但青少年组托槽脱落次数明显多于成人组。结论:治疗条件相同的成人与青少年疗效基本相同。     

CBCT在正畸临床诊断和治疗中的应用

目的:探讨CBCT在正畸临床诊断和治疗中的应用。方法:选取深圳市儿童医院口腔正畸科就诊的正畸患者25例(男12例,女13例),年龄11～16岁,平均13.8岁。入选病例均是因采用传统平片无法确诊,需要拍摄CBCT来辅助诊断和治疗的病例。CBCT影像使用NEW TOM VGi(QRs.r.l.Corp,Verona,Italy)大视野锥形束计算机体层X线摄影机拍摄,采用NEW TOMNNT软件进行图像的重建和分析。结果:CBCT可以清晰的显示阻生牙、异位牙的牙根形态、长度,弯曲牙根与牙长轴所成的角度;三维显示异位牙与邻牙的空间位置关系,邻牙的牙根吸收情况;上颌后牙牙根与上颌窦的位置关系等。结论:CBCT三维重建技术可大大提高正畸病例诊断的准确性,同时也为治疗计划的制定和实施提供了有利指导。     

Accounting for body size deviations when reporting bone mineral density variables in children

Summary  In a child, bone mineral density (BMD) may differ from an age-expected normal value, not only because of the presence of disease, but also because of deviations of height or weight from population averages. Appropriate adjustment for body size deviations simplifies interpretation of BMD measurements. Introduction  For children, a bone mineral density (BMD) measurement is normally expressed as a Z score. Interpretation is complicated when weight or height distinctly differ from age-matched children. We develop a procedure to allow for the influence of body size deviations upon measured BMD. Methods  We examined the relation between body size deviation and spine, hip and whole body BMD deviation in 179 normal children (91 girls). Expressions were developed that allowed derivation of an expected BMD based on age, gender and body size deviation. The difference between measured and expected BMD was expressed as a HAW score (Height-, Age-, Weight-adjusted score). Results  In a second independent sample of 26 normal children (14 girls), measured spine, total femur and whole body BMD all fell within the same single normal range after accounting for age, gender and body size deviations. When traditional Z scores and HAW scores were compared in 154 children, 17.5% showed differences of more than 1 unit and such differences were associated with height and weight deviations. Conclusion  For almost 1 in 5 children, body size deviations influence BMD to an extent that could alter clinical management.