应用PAR指数评价不同安氏分类牙he关系的研究

目的从牙     

应用PAR指数评估正畸研究生临床教学效果

Richmond等[1]于1992年提出PAR教学质量提供参考指数,它是用于治疗结果评价标准化、一致化而设计的指数,记录了错畸形的所有特征,用于客观评价错畸形严重程度和正畸治疗成功程度。错畸形患者治疗后PAR分值的高低可以从牙颌方面反映治疗效果,分值越低表明治疗后越接近正常的牙颌关系。在PAR指数的临床应用中,主要以治疗前后PAR分值的减少量作为标准,对治疗效果进行客观评价,PAR分值的减少量越多,治疗效果越好。治疗前后PAR分值差异（简称总分差）和PAR分值减少百分率可反映治疗成功的程度,数值越高,矫治效果越好,改善程度越大。由于正畸临床上拔除4个第一前磨牙的安氏Ⅱ类错畸形矫治病例在临床上较为常见,并且有一定的矫治难度,本研究将PAR指数用于正畸研究生对此类病例治疗效果的评估,为正畸研究生教学质量和临床治疗质量的评估提供参考。     

先天缺牙患者正畸矫治效果的PAR指数分析研究

［摘要］ 目的 应用PAR指数评价先天缺牙患者正畸矫治的效果。方法 选择2008—2011年在我院正畸科进行固定正畸治疗的先天缺牙患者22例,记录患者缺失牙数目、部位及矫治时拔牙与否;采用PAR指数对矫治前后的牙齿排列、磨牙牙合关系、覆盖、覆牙合及中线情况进行评估和比较。结果 缺牙部位最常见的是下颌中切牙(54.29%),以少数牙缺失为主;正畸治疗中拔牙矫治者多(63.64%),以补偿性拔牙为主。先天缺牙患者正畸治疗后的PAR总分和加权总分均小于治疗前,正畸治疗前后的PAR指数各项分值间差异均有统计学意义(P<0.01)。矫治后PAR总分值减少(30.59±10.50)分,加权PAR总分值减少(38.09±22.08)分,减少百分率为(71.40±22.46)％。结论 先天缺牙患者多为单侧、单颌缺牙,拔牙矫治者多为补偿性拔牙;PAR指数分析结果显示先天缺牙患者正畸治疗前后牙牙合关系得到了明显改善。     

应用PAR指数评估拔除下颌第一磨牙患者的矫治效果

目的探讨影响拔除下颌第一磨牙患者正畸治疗疗效的相关因素。方法采用PAR指数对28例拔除下颌第一磨牙错验畸形患者的治疗前后模型进行评估分析。结果①治疗后PAR总分值较治疗前减少26.11±8.09,总分值减少百分率为（92.49±4.00）％,权重PAR总分值减少29.61±2.33,权重减少百分率为（96.43±5.20）％。②变差或无改变0例,改善6例（21.43％）,明显改善22例（78.57％）。③后牙猞关系PAR分值减少4.29±3.10,减少百分率为79.64％。结论选用直丝弓矫治系统,尽早使用不锈钢方丝,合理施力和必要矫治技巧是对磨牙进行有效三维控制,取得良好矫治效果的关键。     

应用PAR指数评价安氏Ⅱ类1分类错畸形的矫治效果

目的采用PAR指数评价安氏Ⅱ类1分类错畸形矫治的效果。方法选择100例安氏Ⅱ类1分类错患者,分为4组:不拔牙组、拔上下颌第一前磨牙组、拔上颌第一前磨牙下颌第二前磨牙组、拔上颌第一前磨牙组,采用PAR指数对4组患者矫治前后的牙齿排列、颊侧咬合关系、覆盖、覆及中线情况进行评估和比较。结果治疗前四组病例上前牙排列、下前牙排列及总分有差别;治疗后四组病例颊侧咬合关系、总分、权重总分有差别;第一组及第四组治疗前后中线分值没有差别,第四组治疗前后下牙列排列没有差别;四组病例权重总分差均大于22分,其中第三组权重分差比其他三组大,权重总分减少百分率均大于70%,第一组减少百分率较另外三组低。结论对于安氏Ⅱ类1分类患者经四种方式治疗后均能得到极大改善,但拔牙矫治较不拔牙矫治病例改善更为明显,以上颌拔除第一前磨牙,下颌拔除第二前磨牙改善最为明显。     

正畸治疗中对Bolton指数分析的再认识

正畸是一个间隙处理过程 ,在治疗中医师实际是使用可以获得的间隙或为其创造可用的间隙来矫正错牙合〔1〕。因此 ,在确定矫治计划前 ,需要进行单颌牙弓间隙分析和上下弓之间牙量的Ｂｏｌｔｏｎ指数分析。如果只注重单颌牙弓的间隙分析而忽略Ｂｏｌｔｏｎ指数分析 ,则会影响矫治效果。现将临床资料报告如下。1　材料与方法1.1　模型测量94副模型均由 1人用分规测量 ,每副模型测量 3次 ,取其均值 ,填入测量登记表。根据公式进行计算 ,得出各患者的前牙比、后牙比和全牙比等Ｂｏｌｔｏｎ比值。对Ｂｏｌｔｏｎ比值不在正常范围者 ,通过查表〔2〕…     

正畸治疗需要客观评价指标指数的研究进展

错畸形包括从个别正常到严重影响口腔功能的错,要评价一个个体是否需要正畸治疗是非常困难的,它不仅取决于个体错畸形严重程度,还受到个体主观愿望的影响。本文对正畸治疗需要的客观评价指标指数的研究进展进行了综述。     

修复前的正畸治疗9例报告

口腔正畸学和修复学作为口腔医学的重要组成部分,由于其自身的特性决定了与医学美学的密切关系。作为一名口腔正畸和修复工作者,必须由单纯的医疗工作逐步转化为融美学与医疗于一体,鉴赏并创造美。 由于先天发育因素造成的先天缺牙如畸形牙、过小牙及外伤、牙周病等诸多因素造成的牙缺失,常伴有不同程度的畸形,如散在间隙、反(牙合)、前突或深覆(牙合)等。给修复体的制作带来许多困难,且修复体常不能很好地恢复美观和功能,也极易损坏。对此类病例,笔者尝试先以活动或固定矫治器对畸形进行矫治,以期达到正常(牙合)关系,然后再进行修复,获得满意的疗效。     

Outcome assessment of lingual and labial appliances compared with cephalometric analysis,peer assessment rating,and objective grading system in Angle Class II extraction cases

Objective:To validate our hypothesis that there would be significant differences in treatment outcomes, including cephalometric values, degree of root resorption, occlusal indices, and functional aspect, between cases treated with labial and lingual appliances.Materials and Methods:Twenty-four consecutively treated Class II cases with extractions and lingual appliance were compared with 25 matched cases treated with extraction and labial appliance. Orthodontic treatment outcomes were evaluated by cephalometric analysis, peer assessment rating, and an objective grading system (OGS). Additionally, functional analysis was also performed in both groups after orthodontic treatment. Statistical comparison was performed using the Wilcoxon signed rank test within the groups, and the Mann-Whitney U-test was used to compare between the labial and lingual groups.Results:The only significant difference between the groups was that the interincisal angle was larger in the lingual group than in the labial group. OGS evaluation showed that control over root angulation was significantly worse in the lingual group than in the labial group. There was no significant difference between groups in the amount of root resorption or in functional evaluation.Conclusions:Generally, lingual appliances offer comparable treatment results to those obtained with labial appliances. However, care should be taken with lingual appliances because they are more prone to produce uprighted incisors and root angulation.     

69名正畸专家对正畸疗效满意度主观评价的研究

目的 分析多名正畸专家对正畸治疗后各种临床资料主观评判结果,深入探讨各种单一资料的相关性及其在组合评价中所占比重,以期为正畸疗效客观评价指标的建立提供参考.方法 以院校和安氏分类作为随机抽样的分层因素,利用计算机产生的伪随机数表,从全国6个口腔医学院校正畸科近5年完成的2383例病例中,随机抽取108例作为样本.将样本治疗后模型、头颅侧位X线片和面像作为研究资料,以安氏分类作为随机分组的分层因素,采用计算机产生的伪随机数表将108例病例随机等分为9组.从全国各地邀请正畸专家69名,依据治疗后的各项临床资料或多项资料组合,对每组12例病例的疗效满意度进行排序,并对疗效进行满意和合格判断.结果 相关性方面:模型+头颅侧位X线片(M+C)和模型+面像(M+P)的结果与模型+头颅侧位X线片+面像(M+C+P)结果的相关系数＞0.950.单独评价M与单独评价P、C的相关系数均为0.300左右;单独评价P和单独评价C的相关系数为0.505.权重方面:建立单一资料与组合资料评判结果的回归模型如下:M +C =0.782M +0.308C -0.150,M+P =0.804M +0.233P-0.091,M+C +P=0.764M+0.243P +0.131C-0.291.3个模型的r2均＞0.9.结论 进行正畸疗效评价时,纳入头颅侧位X线片和面像是必要的,采用结合各种单一资料的评判手段能有效地反映组合资料的评判结果,模型与头颅侧位X线片或模型与面像的组合均可全面反映3种资料组合判断的结果.     

Objective treatment outcome assessment of a completely customized lingual appliance: A retrospective study

ObjectiveTo assess the outcome quality of subjects treated with a completely customized lingual appliance (CCLA) in a postgraduate university program, using the ABO Objective Grading System (OGS), by testing the null-hypothesis of a significant proportion of post-treatment cases exceeding an adjusted ‘exam failure’ threshold value of OGS = 24.Materials and MethodsThis retrospective single-arm study included 66 consecutively debonded CCLA cases (m/f 19/47; mean age: 25.1 ± 9 years) treated at Hannover Medical School (MHH, Hannover, Germany). The discrepancy index (DI) was assessed on initial plaster casts. The OGS of the cast-radiograph evaluation was scored for both set-up and post-treatment casts, including the seven components of alignment/rotation, marginal ridges, buccolingual inclination, overjet, occlusal contacts, occlusal relationships and interproximal contacts, to parameterize differences between those.ResultsDI score distribution (≥ 20, < 20) was 25 (37.9%)/41 (62.1%) subjects. Mean initial DI was 17.3 ± 8.5. Mean set-up OGS was 10.4 ± 4.4 (min-max: 3–21), mean final OGS was 17.7 ± 5.9 (min-max: 7–33), and the difference 7.3 (post-treatment - set-up) was statistically significant (p < 0.0001; 95% CI [5.8, 8.7]). The null-hypothesis was rejected: A statistically significant proportion of the final casts (n = 58; 87.8%) scored below OGS = 24 by exact binomial test (P < 0.0001; 95% CI [77.5%, 94.6%]). The rate of a final OGS score < 24 was not significantly different (P = 0.98) between both DI (≥ 20, < 20) groups.ConclusionsThe outcome quality of the CCLA treatment in this postgraduate university setting was high and therefore sufficient for a vast majority of treated cases to pass the ABO-OGS clinical examination.     

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: Institutional outcomes assessment and the role of the Laboratory of Physiology

The Laboratory of Physiology provides support for the diagnosis of functionaldisorders associated with cleft lip and palate and also conducts studies to assess,objectively, the institutional outcomes, as recommended by the World HealthOrganization. The Laboratory is conceptually divided into three units, namely theUnit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unitfor Sleep Studies, which aims at analyzing the impact of different surgical anddental procedures on the upper airways, stomatognathic system and the quality ofsleep of individuals with cleft lip and palate. This paper describes the main goalsof the Laboratory in the assessment of procedures which constitute the basis of therehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics andMaxillofacial Surgery and Speech Pathology.     

在线课程体系在口腔正畸学教学中应用的效果初探

南京医科大学口腔医学院以国家级精品在线开放课程和虚拟仿真实验教学项目为依托,结合学校自主研发的E-learning网络教学平台等在线资源,采用在线教学结合翻转课堂的新型教学模式构建口腔正畸学在线课程体系, 将过程性评价和终结性评价贯穿其中,同时融入专业文献在线汇报和知识重点梳理总结,增加了虚拟交互在线实践训练内容。利用...     

Standardizing the evaluation criteria on treatment outcomes of mandibular implant overdentures: a systematic review

PURPOSE

The aim of this review was to analyze the evaluation criteria on mandibular implant overdentures through a systematic review and suggest standardized evaluation criteria.

MATERIALS AND METHODS

A systematic literature search was conducted by PubMed search strategy and hand-searching of relevant journals from included studies considering inclusion and exclusion criteria. Randomized clinical trials (RCT) and clinical trial studies comparing attachment systems on mandibular implant overdentures until December, 2011 were selected. Twenty nine studies were finally selected and the data about evaluation methods were collected.

RESULTS

Evaluation criteria could be classified into 4 groups (implant survival, peri-implant tissue evaluation, prosthetic evaluation, and patient satisfaction). Among 29 studies, 21 studies presented implant survival rate, while any studies reporting implant failure did not present cumulative implant survival rate. Seventeen studies evaluating peri-implant tissue status presented following items as evaluation criteria; marginal bone level (14), plaque Index (13), probing depth (8), bleeding index (8), attachment gingiva level (8), gingival index (6), amount of keratinized gingiva (1). Eighteen studies evaluating prosthetic maintenance and complication also presented following items as evaluation criteria; loose matrix (17), female detachment (15), denture fracture (15), denture relining (14), abutment fracture (14), abutment screw loosening (11), and occlusal adjustment (9). Atypical questionnaire (9), Visual analog scales (VAS) (4), and Oral Health Impact Profile (OHIP) (1) were used as the format of criteria to evaluate patients satisfaction in 14 studies.

CONCLUSION

For evaluation of implant overdenture, it is necessary to include cumulative survival rate for implant evaluation. It is suggested that peri-implant tissue evaluation criteria include marginal bone level, plaque index, bleeding index, probing depth, and attached gingiva level. It is also suggested that prosthetic evaluation criteria include loose matrix, female detachment, denture fracture, denture relining, abutment fracture, abutment screw loosening, and occlusal adjustment. Finally standardized criteria like OHIP-EDENT or VAS are required for patient satisfaction.     

Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in a teenage population with mild malocclusions

ObjectiveTo assess the efficacy and efficiency of treatment in adolescents presenting with mild malocclusions, comparing outcomes using clear aligners to fixed appliances.Materials and MethodsPatients identified retrospectively and consecutively from one private practice had been treated with either clear aligners (Invisalign, Align Technology, Santa Clara, Calif) or fixed appliances (0.022 Damon, Ormco, Orange, Calif; n = 26/group). Assessments of occlusion were made using the American Board of Orthodontics Discrepancy Index (DI) for initial records and Cast-Radiograph Evaluation (CRE) for final records. Number of appointments, number of emergency visits, and overall treatment time were determined from chart reviews. Data were analyzed using Pearson''s correlation, Wilcoxon rank tests, unpaired t-tests, and Chi-square tests, with significance set to P ≤ .05.ResultsPretreatment, the aligner and fixed groups showed no significant difference in overall severity (DI: 11.9 ± 5.3 vs 11.6 ± 4.8) or in any individual DI category. Posttreatment scores showed finishes for the aligner group had fewer discrepancies from ideal relative to the fixed appliance group (CRE: 30.1 ± 8.3 vs 37.0 ± 9.3; P < .01). Patients treated with aligners had fewer appointments (13.7 ± 4.4 vs 19.3 ± 3.6; P < .0001), fewer emergency visits (0.8 ± 1.0 vs 3.6 ± 2.5; P < .0001), and shorter overall treatment time (16.9 ± 5.7 vs 23.4 ± 4.4 months; P < .0001).ConclusionsOutcomes for treatment of mild malocclusions in adolescents showed equivalent effectiveness of clear aligners compared to fixed appliances, with significantly improved results for clear aligner treatment in terms of tooth alignment, occlusal relations, and overjet. Assessment of the number of appointments, number of emergency visits, and overall treatment time showed better outcomes for treatment with clear aligners.     

Abbe瓣术式发展、手术效果评估方法及影响因素

Abbe瓣是以下唇动脉为蒂的交叉唇瓣,它将含有下唇皮肤、肌肉及黏膜组织的全厚瓣向上旋转,用以修复上唇正中的组织缺损或瘢痕挛缩.自1898年Abbe提出这一术式并将其用于临床之后,对手术方法的改良与创新层出不穷,均旨在解决蒂部体积过大、唇部动度不佳、供区瘢痕形成等问题.手术效果的评价方法有问卷调查、等级评分系统等定性评价方法,以及以唇指数为代表的定量评价方法.影响手术效果的因素包括组织缺损的类型、下唇动脉的走行及位置、组织瓣和蒂部的大小形态等.本文就Abbe瓣的术式发展、手术效果评估方法以及手术效果的影响因素作一综述.