单侧后牙正锁(牙合)伴牙龈肥厚的青少年正畸治疗1例

后牙锁(牙合)是较为常见的一种错(牙合)畸形,其中以第二磨牙锁(牙合)最为常见.锁(牙合)中更为严重的是正锁(牙合),即上颌后牙后牙舌斜面咬在下颌后牙颊斜面的颊侧,影响咀嚼功能、牙周健康、颞下颌关节发育,严重者会造成颌面部发育不对称[1].矫正后牙正锁(牙合)的方法有颌间交互牵引、MEAW 技术以及微种植钉等[2,3]...     

微型钛钉种植支抗在矫治单侧后牙正锁中的应用

目的介绍微型种植体支抗（MIA）在固定矫治中的应用。方法在83例应用钛钉MIA作为绝对支抗的错牙合畸形患者中，选择4例单侧后牙正锁牙合患者为研究对象，使用MIA压低伸长的上颌后牙，牵引舌侧倾斜的下颌后牙以矫正单侧后牙正锁牙合。MIA植入部位为上颌后牙颊侧和腭侧根尖区，以及下颌后牙颊侧根尖牙槽间隔；上颌磨牙的压入力约0.833 N，下颌舌向倾斜牙的颊向牵引力约0.559 N。观察植入术后钛钉周围组织的反应；植入术后和钛钉取出前拍摄全景曲面断层X线片，测量磨牙压入情况。结果采用多部位植入钛钉MIA、上下颌同时牵引的方法可有效矫正单侧后牙正锁牙合，钛钉在治疗过程中保持稳定，其周围仅有轻微炎症。结论作为骨性绝对支抗，MIA能有效压低上颌后牙，扶正舌倾的下颌后牙，矫正单侧后牙正锁牙合。     

改良Activator矫治儿童AngleⅡ错（牙合）病例颞颌关节间隙改变的研究

AngleⅡ类错牙合易引起颞颌关节病 (TMJD) ,本文试图对儿童AngleⅡ类错牙合病例颞颌关节间隙进行分析 ,探讨儿童AngleⅡ类错牙合早期正畸治疗的必要性。材料与方法1.矫治器的结构　改良型Activator的基本构造为上下颌连成一体的树脂基托 ,带有颊曲的唇弓 ,腭杆及与头帽相连的口外弓[1] 。1.1　基托　起传导口周肌力 ,控制上颌及颌位的作用。覆盖在下前牙切端的基托伸展部有压低下前牙的作用 ;后牙诱导面可使上颌后牙沿此面向下后方及颊侧萌长 ,下颌后牙沿此面向上前方及颊侧萌长 ,从而使咬合升高 ,牙弓扩大。1.2　颊曲唇弓　唇弓能传导…     

探讨全口义齿的理想咬合形态

咬合问题,包括下颌位置、下颌运动和牙齿接触三个问题,三者密切相关。本文着重讨论全口义齿的牙齿接触形态。本文所指的牙齿接触形态是下颌侧运动时的接触形态。多数人认为全口义齿的平衡(牙合)是标准(牙合)。1966年Gerbor提出的髁式后牙是根据杵和臼的原理设计的,特点是上颌牙的舌尖和下颌牙的中央窝在正中咬合时接触,而上下颊尖不接触。1973年Pound介绍了舌侧咬合,是由上颌牙的舌尖和下颌牙     

(牙合)垫与交互牵引联用矫治正锁(牙合)的临床应用体会

正锁(牙合)是上颌后牙被锁结在下颌后牙的颊侧,(牙合)面无咬合接触[1].个别后牙正锁(牙合)及单侧多数后牙的正锁(牙合)在临床上较为多见.锁(牙合)对咀嚼功能、颌面发育及颞下颌关节的健康影响都很大,因此临床上应充分重视、及早矫治锁(牙合)关系.     

正常接触位、下颌后退接触位咬合接触的计算机图像分析

目的 :研究正常牙合肌接触位及下颌后退接触位咬合接触的基本规律。方法 :采集 35名正常牙合肌接触位及下颌后退接触位的硅橡胶牙合记录 ,进行计算机图像分析。结果 :肌接触位 33人前牙无接触 ,单颌后牙区接触数为 16 .6± 7.2 ,所有受试者均为双侧接触。肌接触位咬合接触均在牙尖交错位重复出现。接触频率超过 5 0 %的部位位于上颌磨牙颊尖和舌尖的远中斜面 ,下颌磨牙颊尖和舌尖的近中斜面。下颌后退接触位所有受试者均为双侧接触 ,有接触的牙齿数目单颌单侧 2 .7± 0 .8,接触点数目单颌 8.0± 2 .3,前牙无接触 ,接触数目及比率从第二磨牙到第一前磨牙依次减少。接触频率超过 40 %以上的斜面上颌为前磨牙舌尖、磨牙远中舌尖及第二磨牙近舌尖的近中颊斜面 ,下颌为前磨牙及第二磨牙颊尖的远中舌斜面。结论 :以硅橡胶为记录材料准确采集到肌接触位及下颌后退接触位牙合记录 ,经计算机图像分析 ,得出其咬合接触的基本特征。     

后牙锁牙合矫治之临床改良新型矫治器的设计与应用

后牙锁牙合是口腔临床常见的错牙合类型,即上下颌后牙颊舌向关系的异常,严重影响口颌功能、美观、健康。考虑到医疗资源分配、医师自身技术水平及患者自身意愿,很难说某一种矫治方法完全适用于某一病例。医师应充分了解该后牙锁牙合发生的原因后,根据具体情况选用、改良或设计快速有效安全舒适的方法。本文对后牙锁牙合的病因、危害、临床传统矫治方法的不足、改良设计后牙锁牙合矫治器所要遵循的要点,治疗中可能出现问题的防治做一综述,以及介绍了3种改良新型矫治器的应用,为临床工作选用实用性方法治疗后牙锁牙合提供参考。     

第二磨牙正锁的临床矫治

第二磨牙正锁是临床上常见的错畸形之一,表现为上颌第二磨牙舌尖的舌斜面与下颌第二磨牙颊尖的颊斜面相接触,面无咬合关系〔１〕。传统治疗方法是使用垫活动矫治器,解除牙尖锁结关系,颌间交互牵引,纠正第二磨牙正锁〔２〕。笔者分别采用了两种不同的活动矫...     

严重错双牙列修复1例报告

患者，女性，69岁。患颞下颌关节紊乱病40余年，年轻时常发生下颌关节脱位，10余年前觉左侧咬合不良，于1990年作下颌垫，目前关节症状已基本消失，张大口时，偶有颞下颌关节脱位，患者长期只能用右侧咀嚼，现因垫折断要求重作，前来就诊。检查：右侧髁状突区有压痛，张口3指，张口时下颌向右偏斜，下颌中线偏右3mm， 呈正锁，颊尖颊斜面咬在舌尖舌斜面，并有重度磨损。前牙深覆，咬在对颌腭侧牙龈上，缺失、反，及间有0.2mm间隙，双侧后牙颊舌向均正常，无过分倾斜，平面右侧偏低。修复设计：双牙列修复，于间放3个牙间大支托，及间防嵌…     

利用变异唇舌弓矫治单侧后牙正锁(牙合)

对于因一侧下颌后牙严重舌向倾斜,而同侧上颌后牙位置正常所致的单侧完全正锁牙合.笔者采用变异固定唇、舌弓,借助对侧后牙所提供的支抗,分次颊向移动舌向倾斜的后牙,来矫治这类正锁牙合,获得成功.     

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??Abstract??Scissor crossbite refers to an irregular occlusion??in which the mandibular molar cusps are telescoped within the lingual side of the maxillary molars or the other way around??so that there is no intercuspation of the maxillary and mandibular molars. Generally the former occlusion is more common. As it does not affect aesthetics??both patients and their parents or guardians may be unaware of the malocclusion. Sagittal??vertial and transversal dimensions of the maxilla and mandible altered in multi-tooth scissor crossbite patients??resulting in TMD??facial asymmetry??divergence of the occlusal plane and other malocclusion. Chewing function is also affected in the crossbite side. In subsequent craniofacial development??malocclusion would not be improved leading to a more complicated treatment sequence. Early intervention moves teeth by simple appliances??through which occlusion guidance and muscle balance keep the mandible function well??avoiding the aggravation of malocclusion and deformity.     

Interdisciplinary management of unfavorable posterior intermaxillary space

The patient was a case of severe dentoalveolar extrusion of the right maxillary posterior segment due to early loss of mandibular molars. Therefore, it is difficult to replace the missing teeth with either fixed or removable prostheses. Her occlusion was Angle Class II malocclusion and no mandibular molars for anchorage on the right side. A posterior maxillary subapical osteotomy was utilized for reestablishing the intermaxillary space. A titanium alloy miniplate placed in the right mandible provide skeletal anchorage to distalize the anterior mandibular teeth. Dental implants were placed to restore masticatory function.     

Treatment of a Class II Division 1 malocclusion with a severe unilateral lingual crossbite with combined orthodontic/orthognathic surgery

A 24-year-old woman had a Class II Division 1 malocclusion with a severe unilateral crossbite. The crossbite was due partially to the maxilla being much wider than the mandible, allowing the mandibular left canine and first and second premolars to overerupt, impinging on the palatal tissue in habitual occlusion. The maxillary left segment from the lateral incisor to the first molar also overerupted producing 2 planes of occlusion. The malocclusion was treated successfully with comprehensive orthodontics, combined with a 2 piece Lefort I osteotomy procedure, a 3 tooth mandibular segmental osteotomy procedure, and a bilateral sagittal split osteotomy procedure.     

Orthodontic-surgical treatment of Class III malocclusion with mandibular asymmetry

Class III skeletal malocclusion may present several etiologies, among which maxillary deficiency is the most frequent. Bone discrepancy may have an unfavorable impact on esthetics, which is frequently aggravated by the presence of accentuated facial asymmetries. This type of malocclusion is usually treated with association of Orthodontics and orthognathic surgery for correction of occlusion and facial esthetics. This report presents the treatment of a patient aged 15 years and 1 month with Class III skeletal malocclusion, having narrow maxilla, posterior open bite on the left side, anterior crossbite and unilateral posterior crossbite, accentuated negative dentoalveolar discrepancy in the maxillary arch, and maxillary and mandibular midline shift. Clinical examination also revealed maxillary hypoplasia, increased lower one third of the face, concave bone and facial profiles and facial asymmetry with mandibular deviation to the left side. The treatment was performed in three phases: presurgical orthodontic preparation, orthognathic surgery and orthodontic finishing. In reviewing the patient's final records, the major goals set at the beginning of treatment were successfully achieved, providing the patient with adequate masticatory function and pleasant facial esthetics.     

小型下颌后退位（牙合）板在前牙反（牙合）矫治中的应用

目的：在前牙反（牙合）矫治中应用一种小型下颌后退位（牙合）板后退下颌,评价其矫治AngleⅢ类功能性-轻、中度骨性前牙反（牙合）病例的临床应用效果.方法：应用小型下颌后退位（牙合）板治疗反（牙合）328例.在打开咬合的同时后退下颌,同时粘固上下颌托槽进行排齐整平.结果：患者侧貌在戴用后退位（牙合）板后明显改善,下颌的有效后退使反（牙合）的矫治变得简单化,治疗时间较传统矫治明显缩短.远期随访疗效肯定.结论：小型下颌后退位（牙合）板适用于下颌可适度后退的前牙反（牙合）病例,可快速矫治前牙反（牙合）.是较固定反式TBA联合前牵引更为理想的装置,结构更小巧,制作更简便,更适用于临床应用.     

骨性Ⅱ类错牙合女性患者上颌磨牙近远中倾斜度的CBCT分析

目的:分析骨性Ⅱ类错牙合女性患者上颌磨牙近远中倾斜情况,以期为临床治疗提供参考。方法:选取骨性Ⅱ类错牙合30例及个别正常牙合10例治疗前CBCT数据,以眼耳平面、腭平面及牙合平面测量上颌磨牙倾斜度,并将患者测量项目与个别正常牙合数据进行单样本t检验。将骨性Ⅱ类高角、均角和低角间进行单因素方差分析,并把不同垂直骨面型间的测量项目与下颌平面角及牙合平面角进行Pearson相关性分析。结果:在FH平面、腭平面及牙合平面为参考平面时,骨性Ⅱ类U6较个别正常牙合更加远中倾斜。以腭平面及FH平面为参考时,骨性Ⅱ类低角组到高角组,U6有远中倾斜趋势。以牙合平面为参考时,U7在高角组到低角组有远中倾斜趋势。结论:为代偿上下颌骨矢状向关系不调,骨性Ⅱ类错牙合U6有远中倾斜。骨性Ⅱ类U6随下颌平面角的增加代偿性远中倾斜,但U7远中倾斜趋势不明显。无论何种骨性Ⅱ垂直骨面型,U6代偿性倾斜移动以维持咬合力沿牙齿长轴传递。     

Nonsurgical correction of an adult skeletal class III and open-bite malocclusion

This case report presents an adult skeletal Class III and open-bite malocclusion case treated without surgical intervention using fixed edgewise technique, reverse headgear, and Class III and anterior box elastics. The patient was a 16-year-old Turkish female who had completed her growth and development. She had a four mm open bite, maxillary retrognathia, a crossbite in the anterior and left posterior, and hypoplasia of the maxillary laterals. In addition, the patient's first molars had previously been extracted because of caries, and extraction spaces were present. We applied a Roth edgewise appliance and a reverse headgear to be used at night only for the first six months. The objective in using a reverse headgear was to displace the maxillary teeth toward the mesial and to rotate the maxilla in a clockwise direction. In the mandible, we retracted the mandibular incisors and canine teeth and moved the second molars mesially toward the first molar extraction space. There would thus be no need for any prosthetic restoration in the mandible. At the end of treatment, we obtained a Class I dental relationship, an ideal occlusion relationship, and an esthetic dental and facial relationship. Treatment of the patient was completed in 20 months.     

正畸治疗中磨牙的拔除和保留（五十三）——利用骨钉矫治生长发育期上颌后缩下颌前突型反

目的：评价骨钉前方牵引治疗对生长发育期上颌后缩下颌前突型反[牙合]病例的矫治效果。方法：选择替牙晚期和恒牙早期骨性Ⅲ类错病例8例,男2例,女6例,年龄11～14岁,平均12.2岁。均为上颌发育不足并伴有下颌、下牙弓轻度前突的凹面型,在双侧上颌颧牙槽嵴区植入骨钉,骨钉与牵引面罩的牵引钩相连,与[牙合]平面成向前下30°夹角,力值维持在350g左右,每日戴用时间为10～12h。有3例恒牙早期病例因牙列拥挤或下牙弓前突,设计对称拔除了上、下颌第二或第三磨牙,植入下颌磨牙骨钉以牵引排齐内收下牙弓。结果：8例患者前方牵引5～10个月,平均7个月,均有效解除前牙反[牙合]。结论：应用骨钉做前方牵引,牵引力通过上颌骨阻力中心,不会致颌骨出现异常旋转。牵引力完全作用在颌骨上,避免了对牙齿产生副作用。骨钉还可用于牵引上下颌牙列远中移动,减少上前牙唇倾并增强前方牵引对下牙弓的矫治作用。     

改良固定斜面导板矫治安氏Ⅱ类畸形伴后牙锁牙合的临床研究

[摘要] 目的 观察应用改良固定斜面导板在矫治安氏Ⅱ类1分类伴第二磨牙正锁牙合中的临床效果。方法 临床应用改良固定斜面导板,通过术前、术后X线头影测量分析和测量临床牙冠高度,对18例上颌第二磨牙正锁牙合伴安氏Ⅱ类1分类患者进行研究,男7例,女11例,年龄13～16岁,平均14.5岁。结果 经过3～4个月的矫治,上颌第二磨牙正锁牙合解除,前面高增加(2.67±0.56)mm,后面高增加(1.64±0.26)mm,矢状关系改善,覆盖减小,上下前磨牙均有显著萌长,下颌多于上颌。下磨牙亦明显萌长,上磨牙萌长不明显。结论改良固定斜面导板是一种简单有效的矫治上颌第二磨牙正锁牙合的口内装置,并能快速打开咬合,前移下颌,尤其适用于安氏Ⅱ类1分类短面型低角患者。