前牙开畸形颅面形态的分类研究

目的　对前牙开畸形进行分类研究 ,为临床诊断和治疗提供参考。方法　随机选取116例恒牙期前牙开患者 ,借助计算机X线头影测量技术对其颅面软硬组织及气道结构进行测量 ,综合运用多种现代多元统计方法 ,对开畸形的颅面形态进行分类。结果　对年龄、性别、颅面特征等 15 6项指标经聚类和主成分分析精简为 30个变量 ,再通过因子分析提取出 4个因子 (下颌旋转因子、面高因子、牙骨矢状因子和上颌旋转因子 )。采用逐步聚类法对 116例患者的 4个因子得分进行聚类分析 ,将前牙开畸形这一群体分为牙齿槽型开、下颌顺时针旋转型开、长面型开、上颌逆时针旋转型开和骨性Ⅲ类开 5类并归纳出可供临床使用的简单分类方法。结论　对前牙开畸形进行分类在诊断和矫治设计中起着重要作用。     

Closure of the anterior open bite using mandibular sagittal split osteotomy

Anterior open bite is a common problem in orthognathic practice that confers functional and aesthetic handicaps on affected patients. Its management varies, and it is one of the most challenging disorders to treat. The orthodontic and surgical approach to the treatment of skeletal anterior open bite is still debated, and the results are controversial. The relapse rate is high with all the techniques in current use. The cause of relapse is multifactorial and one of the main factors is the type of osteotomy used. Over the last 30 years preference has moved from mandibular sagittal split osteotomy (MSSO) alone, to maxillary procedures only, or to bimaxillary operations, with maxillary procedures alone being thought to confer the best stability and predictability. The aim of this study was to evaluate the results of correction of anterior open bite with the MSSO immediately after operation, and 1 year postoperatively.     

Dentoskeletal changes following mini-implant molar intrusion in anterior open bite patients

Objective:To evaluate skeletal and dental changes after intrusion of the maxillary molars in subjects with anterior open bite.Materials and Methods:This retrospective cephalometric study evaluated skeletal and dental changes resulting from the use of maxillary orthodontic mini-implants in 31 consecutively treated patients. Radiographs were taken at the start and end of maxillary molar intrusion to evaluate the associated changes. Statistical analysis was performed using a one-sample t-test.Results:The mean treatment observation time was 1.31 years (SD  =  2.03). The maxillary first molars (P  =  0.0026) and second molars (P  =  0.039) were intruded. However, the mandibular first molars (P  =  0.0004) and second molars (P  =  0.003) erupted in adolescent patients. Both the maxillary and mandibular first molars inclined distally (P  =  0.025 and P  =  0.044, respectively). The mandibular plane angle decreased (P  =  0.036), lower facial height decreased (P  =  0.002), and the occlusal plane angle increased (P  =  0.009). The overbite increased (P < .0001). The ANB angle decreased (P < .0001). Mandibular dental and skeletal changes were more apparent in adolescents, while adults tended toward maxillary changes.Conclusions:Vertical traction from orthodontic mini-implants reduces the maxillary posterior dentoalveolar height, thereby assisting orthodontic closure of anterior open bite. However, simultaneous eruption or extrusion of the mandibular molars should be controlled. Adolescent patients tend to demonstrate more favorable effects of mandibular autorotation than do adults.     

Unusual cause of iatrogenic anterior open bite after bilateral sagittal split mandibular advancement osteotomy

We describe a case of anterior open bite after bilateral sagittal split mandibular advancement osteotomy. The discrepancy in height between the proximal and distal segments at the osteotomy sites damaged the soft tissue and caused bony interferences. Removal of the maxillary third molars and bilateral removal of bony interferences of the distal segments using a bur led to full resolution and a good orthognathic outcome on follow-up.     

Prediction of mandibular movement and its center of rotation for nonsurgical correction of anterior open bite via maxillary molar intrusion

Objectives:To evaluate quantitatively the relationship between molar intrusion (change [Δ] maxillary first molar [U6]–palatal plane [PP]) and changes in vertical and sagittal cephalometric parameters and to determine the center of mandibular autorotation.Materials and Methods:Twenty-one patients diagnosed with anterior open bite and successfully treated with molar intrusion (overbite [OB] > 0 mm) were retrospectively enrolled. Lateral cephalograms taken before and after molar intrusion were used to measure changes in vertical and sagittal cephalometric parameters. The center of mandibular autorotation was calculated by measuring displacement of gonion (Go) and pogonion (Pog). Paired t-tests were used to compare variables, and linear regression analysis was used to examine the relationship between ΔU6-PP and other variables.Results:The mandible exhibited counterclockwise rotation after maxillary molar intrusion, which led to closure of anterior open bite. Strong linear relationships, in descending order, between ΔU6-PP and ΔOB, Δanterior facial height (AFH), Δvertical reference plane (Pog), and Δsella-nasion to Go-menton (SN-GoMe), were observed. When the maxillary molar was intruded 1 mm, OB increased by 2.6 mm, AFH decreased by 1.7 mm, Pog moved forward by 2.3 mm, and SN-GoMe decreased by 2°. The center of mandibular autorotation was located 7.4 mm behind and 16.9 mm below condylion after molar intrusion.Conclusions:The mandible exhibited counterclockwise rotation after maxillary molar intrusion; the center of mandibular autorotation was located behind and below condylion with individual variations.     

脊髓性肌萎缩症伴开牙合1例

脊髓性肌萎缩症是由于脊髓前角运动神经元和脑干运动神经核变性而导致肌无力、肌萎缩的一种罕见的常染色体隐形遗传疾病。该病临床上极为罕见,本文报道1例脊髓性肌萎缩症伴开牙合的病例。     

微螺钉种植体支抗压低磨牙矫治前牙开(牙合)

近些年来各种骨性支抗系统被开发并应用于临床,来完成牙齿各种类型的运动.微型种植体用于垂直支抗控制方面比传统方法有着更多的优势.本文病例通过应用自攻型微钛钉种植体支抗压低上下颌后部牙齿槽,治疗严重的骨性前牙开(牙合)畸形,证明自攻型微钛钉种植体提供垂直支抗控制的能力.本文也提示通过简单有效的骨性支抗手段,可以提供一种治疗较复杂骨性开(牙合)畸形的全新方法.     

磨牙前倾弯治疗前牙开(牙合)畸形的临床效果评价

目的 开拾畸形在临床治疗上难度较大，治疗方法较单一、局限、疗程长、矫治效果不确定，本文目的在于了解应用前倾弯矫治前牙开He时的矫治效果。方法 对5例前牙开He的患者应用前倾弯进行矫治，通过分析矫治前后X线头颅定位侧住片，评价前倾弯在矫治前牙开He畸形的效果。结果 发现矫治过程中，第一磨牙明显近中倾斜；矫治前后全面高、前后面高有显著性变化；上颌切牙至腭平面、下颌切牙至下颌平面的垂直距离明显增加；下颌第一磨牙至下颌平面的角度明显变大，说明在矫治后上下切牙伸长并向舌侧移动。结论 前倾弯治疗开He主要是通过前牙的伸长和舌侧移动来达到建立覆He的目的，而后牙不仅不能直立，而且会更加近中倾斜，从而使He平面不能改变，而使开He的矫治效果不稳定。     

A case of anterior open bite with severely narrowed maxillary dental arch and hypertrophic palatine tonsils

Abstract

This case report describes an adolescent patient with an open bite and severely narrowed maxillary dentition and hypertrophic palatine tonsils, treated efficiently with rapid maxillary expansion (RME) and subsequent orthodontic tooth alignment using fixed appliances. The treatment demonstrates that RME can be effective for the correction of a severely narrowed maxillary arch, as well as, in this case, the correction of an anterior open bite in an adolescent patient where no substantial vertical skeletal discrepancy existed.     

应用"摇椅形"弓丝矫治前牙开牙合的临床研究

目的　研究“摇椅形”弓丝对前牙开牙合畸形的矫治效果。方法　对 14例前牙开牙合的患者应用“摇椅形”弓丝同时配合前牙区垂直牵引进行矫治 ,通过分析矫治前后X线头颅定位侧位片 ,评价其矫治效果。结果　矫治后上下颌切牙伸长、内收 ,下颌磨牙直立 ,牙合平面改建 ;同时控制了开牙合患者垂直方向的生长。结论　应用“摇椅形”弓丝同时配合前牙区垂直牵引矫治开牙合畸形符合利用固定矫治器治疗开牙合的机理 ,能获得良好的矫治效果。     

恒牙期前牙开(牙合)正畸和外科治疗颅面形态变化的比较研究

通过对正畸治疗和外科治疗成功的病例进行比较分析 ,探讨恒牙期前牙开牙合者正畸治疗和外科治疗引起的颅面形态的变化所在。方法　选择正畸治疗和外科治疗患者各 12人 ,外科治疗组中 5人为外科正畸联合治疗 ,7人为单纯外科治疗。应用计算机X线头影测量对治疗前后颅面软硬组织的形态变化进行比较和统计学分析。结果　正畸治疗的主要作用部位是牙齿和齿槽骨 ,牙齿关系的变化有显著的统计学意义 ;外科治疗组除牙齿关系 (覆牙合、覆盖、下切牙伸长度、上切牙倾斜度 )发生显著变化外 ,骨骼的变化也比较显著 ;正畸治疗组和外科治疗组相比 ,前者牙牙合关系的改善更明显 ,而后者主要以上下颌骨的矢状不调改善为主。正畸外科联合治疗比单纯外科治疗者矢状方向的改变明显且牙齿倾斜度改善。结论　正畸治疗可通过拔牙矫治调整前后牙齿移动的比例 ,达到纠正开牙合 ,改善软组织侧貌的目的 ;正畸治疗以牙齿倾斜度的变化为主 ,而外科治疗还可产生骨骼的变化 ,面型更趋和谐 ;术前术后正畸治疗应列为外科治疗的常规。     

微螺钉种植体支抗压低磨牙矫治前牙开（牙合）

近些年来各种骨性支抗系统被开发并应用于临床,来完成牙齿各种类型的运动.微型种植体用于垂直支抗控制方面比传统方法有着更多的优势.本文病例通过应用自攻型微钛钉种植体支抗压低上下颌后部牙齿槽,治疗严重的骨性前牙开（牙合）畸形,证明自攻型微钛钉种植体提供垂直支抗控制的能力.本文也提示通过简单有效的骨性支抗手段,可以提供一种治疗较复杂骨性开（牙合）畸形的全新方法.     

Stability of anterior open bite in permanent dentition treated using extraction or non-extraction methods: A systematic review and meta-analysis of each method

Purpose

To evaluate the literature on the stability of open bite treatment using extraction or non-extraction methods.

Treatment results and long-term stability of anterior open bite malocclusion

OBJECTIVES: To evaluate treatment results and long-term stability of anterior open bite malocclusion and to identify predictive factors for both treatment results and their stability. DESIGN: Retrospective study. SETTING AND SAMPLE POPULATION: The Department of Orthodontics and Oral Biology at the Radboud University Nijmegen Medical Centre, The Netherlands. Fifty-two patients with an anterior open bite. METHODS: Lateral cephalograms and dental casts were analysed at: start of treatment (Ts), end of treatment (T0), 2 and at least 5 years after the end of treatment (T2 and T5, respectively). A standard cephalometric analysis was performed, while the Peer Assessment Rating (PAR) index was used to evaluate the occlusion. RESULTS: The mean PAR reduction at T0 was 74%, but decreased to 56% at T5. The mean overbite (OB) increased from -3.2 mm (+/- 1.9) at Ts to 0.4 mm (+/- 1.1) at T0, 0.1 mm (+/- 1.6) at T2 and 0.2 mm (+/- 1.8) at T5. Thirty-seven patients (71%) had a positive OB at T0, but the bite opened again in 10 of these patients (27%) from T0 to T5. Forty-four per cent of our patients had an open bite at T5. No pre-treatment variables could predict these changes. CONCLUSION: Treatment response and long-term stability of the anterior open bite was found to be rather poor. This has to be taken into consideration when planning treatment of open bite patients. Prediction of open bite closure at the end of active treatment or at the follow-up was not possible.     

恒牙期前牙开正畸治疗时机和疗效的研究

目的　通过对恒牙初期和恒牙晚期正畸治疗成功的病例进行分析 ,探讨恒牙期前牙开患者正畸治疗的时机及引起颅面形态的变化。方法　选择 13名恒牙初期和 12名恒牙期前牙开患者 ,利用计算机X线头影测量分析治疗前后的软硬组织变化 ,并进行统计学处理。结果　正畸的治疗变化以牙齿倾斜度的变化为主 ,前牙有一定的伸长 ,垂直高度有所增加 ,软组织面型有一定程度的改善。恒牙初期与恒牙期正畸治疗相比 ,除了上下前牙倾斜度的变化以外 ,还存在一定的下颌逆时针旋转趋势 ,而恒牙期者下颌平面角有顺时针旋转倾向。结论　提倡在恒牙初期即开始正畸治疗。     

Segmental alveolar distraction for the correction of unilateral open-bite caused by multiple ankylosed teeth: A case report

Abstract

Ankylosed teeth fail to erupt to meet their counterparts in the opposite jaw. In cases where ankylosis occurs in multiple teeth, the occlusion shows an open bite. This article describes a case of unilateral open bite caused by multiple ankylosed teeth, where treatment involved segmental alveolar bone distraction. A 25-year-old female patient presented with a left-sided unilateral open bite. On the left-hand side, only the lower incisors were not ankylosed. On the right, the maxillary first molar was ankylosed. All these ankylosed teeth were positioned below the occlusal plane. Her mother and brother also had multiple ankylosed teeth, and a familial cause was considered. Orthodontic tooth movement was considered impossible and segmental osteotomy on the left maxillary alveolar bone and downward bone distraction were performed as an alternative. A distractor consisting of orthodontic bands, wires and screws was devised and worn in the left mandibular dentition. Multi-bracket orthodontic appliances were also used for distraction. The amount of vertical movement was 7 mm at the premolar region. Five months after distraction, the multibracket appliance was removed, and fixed and removable retainers were placed. Eight months after distraction, prosthodontic restorations on the occlusal surfaces of the ankylosed teeth were made to obtain the final occlusion. The unilateral open bite was successfully treated and a good occlusion was obtained. The occlusion has shown good long-term stability for more than 3 years.     

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目的评价应用快速磨牙压低器（RMI）压低过长磨牙以矫正骨性前牙开拾畸形的临床效果。方法选择2009年1月至2011年9月佛山市口腔医院正畸科收治的后牙区过度生长的骨性前牙开牙舍患者7例,在磨牙上安装RMI压低磨牙,被压低磨牙上粘接腭杠和舌弓。不施加其它口内外辅助压低力。结果戴RMI后1周内所有患者均存在不适感,1周后一般可适应。3～7个月后患者前牙覆_袷达到1．0—2-3mm。结论RMI可有效地矫正由后牙区过度生长所导致的骨性前牙开牙争畸形。