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目的通过对下颌尖牙埋伏阻生进行正畸-外科联合治疗,探讨下颌尖牙埋伏阻生的病因、外科手术暴露部位及正畸牵引导萌方向。方法对2003—2007年就诊于中国医科大学口腔医学院正畸科的5例患者的6颗下颌埋伏阻生尖牙进行正畸-外科联合治疗,先用方丝弓固定矫治器进行间隙扩展,然后根据尖牙位置及与邻牙的关系,采用外科翻瓣导萌术,暴露埋伏尖牙的牙冠,粘接托槽,再选择不同方向和方法对其进行牵引导萌。结果6颗埋伏尖牙均经牵引后排齐,牙髓和牙周情况正常。结论分析下颌尖牙埋伏阻生的病因,选择正确的外科手术暴露部位和正畸牵引导萌方向,可有效地进行矫治。     

上颌尖牙埋伏阻生的外科-正畸联合治疗

目的:探讨尖牙埋伏阻生的外科-正畸联合治疗方法。方法:20例患者28颗上颌埋伏阻生尖牙,先用滑动直丝弓矫治器初步排齐牙列后,再局部间隙扩展,采用外科闭合式助萌技术,暴露埋伏尖牙牙冠,粘贴托槽,再进行正畸牵引导萌。结果:24颗埋伏尖牙均牵引入正常牙列,牙髓、牙周情况正常。有4颗尖牙因横位阻生和根冠成角采用外科拔除。结论:通过外科手术暴露和正畸牵引导萌联合治疗,能有效矫治埋伏阻生尖牙。     

外科翻瓣导萌术结合Edgewise技术治疗上颌埋伏阻生前牙

目的:探讨上颌埋伏阻生前牙的外科、正畸联合治疗方法。方法:32例患者42颗上颌埋伏阻生前牙,先用方丝弓固定矫治器进行间隙扩展,然后根据上颌埋伏牙的位置及与邻牙的关系,分析其阻生的原因,采用外科翻瓣导萌术,暴露埋伏牙的牙冠,粘接托槽,再选择不同的方向和方法对上颌埋伏牙进行正畸牵引导萌。结果:牵引42颗,成功41颗,失败1颗;成功者全部回复到牙列上,整个疗程6～15个月不等。7颗移位阻生牙,除2颗回复到正常位置外,其余5颗均易位排列在牙列上。对埋伏阻生牙的牙髓活力测定结果:4颗牙髓坏死,牙体变色,22颗牙髓活力减低,余均正常。结论:选择良好的适应证、准确的定位、足够的间隙、适当的牵引力,只有通过从上颌埋伏前牙的位置关系,分析其阻生的病因,选择正确的外科手术和正畸牵引导萌的方法,才能有效地矫治上颌埋伏前牙。     

手术联合正畸导萌埋伏尖牙的临床研究

目的探讨外科联合正畸导荫埋伏尖牙的疗效。方法方丝弓矫治技术先排齐牙列,扩展尖牙缺失处间隙,采用外科翻瓣导萌术,暴露埋伏尖牙的牙冠,粘接舌侧扣,对埋伏尖牙进行正畸牵引导萌。结果12颗埋伏尖牙均被牵引至牙列并排齐,牙髓和牙周情况正常。结论正确的外科手术暴露和正畸牵引导萌,能有效牵引埋伏尖牙至牙列。     

上颌埋伏阻生前牙正畸治疗的临床研究

目的：观察上颌埋伏阻生前牙应用固定正畸方法进行矫治的临床疗效,探讨埋伏阻生前牙有效的治疗方法。方法：对49例58颗上颌前牙埋伏阻生病例,应用固定正畸进行矫治,结合牙槽外科开窗术,对埋伏牙进行牵引。其中20颗进行开拓间隙使之自然萌出,38颗进行开窗封闭式牵引导萌矫治。结果：55颗阻生牙矫治后牙髓活力正常、未见埋伏牙及邻牙牙根吸收、牙周组织正常。开窗封闭式牵引导萌有3颗牙治疗失败,总体成功率94.8%。结论：应用固定正畸技术开拓间隙或结合牙槽外科开窗术导萌埋伏阻生牙,可有效保存上颌埋伏阻生前牙。     

锥形束CT在上颌埋伏尖牙正畸牵引手术开窗定位中的应用

目的:评估锥体束CT在上颌埋伏尖牙正畸牵引手术开窗定位中的作用。方法:对12颗上颌埋伏尖牙拍摄锥体束CT,观察其解剖形态、空间位置及毗邻关系,行外科开窗手术后配合正畸牵引,引导其萌出到生理位置。结果:锥体束CT清楚地显示了埋伏上颌尖牙的解剖形态、空间位置及毗邻关系。开窗手术术中所见与锥体束CT显示的上颌埋伏尖牙空间位置信息相一致。12颗埋伏上颌尖牙经外科开窗手术后成功牵引萌出,尖牙形态良好,牙髓活力正常,牵引未引起邻牙牙根吸收。结论:锥体束CT在埋伏上颌尖牙的定位诊断中具有一定的应用价值。     

上颌埋伏尖牙导萌的临床研究

目的探讨上颌埋伏尖牙不同的治疗方法。方法对18例患者的25颗上颌埋伏尖牙进行治疗。首先用直丝弓矫治器拓展埋伏牙的间隙;随后根据患者的年龄、根尖的发育程度、埋伏牙的位置及与邻牙的关系采用不同的导萌方法。9颗上颌埋伏尖牙应用正畸助萌法进行治疗,16颗通过外科翻瓣导萌术进行治疗。结果 25例埋伏牙顺利萌出至正常位置,尖牙及邻近侧切牙牙髓、牙周正常,但正畸助萌法导萌的尖牙牙龈形态更佳。结论正畸助萌法矫治上颌埋伏尖牙效果更佳。     

正畸牵引联合牙槽外科矫治上颌尖牙埋伏阻生的临床观察

目的 观察正畸牵引联合牙槽外科手术矫治上颌尖牙埋伏阻生的临床疗效。方法 对30例上颌尖牙埋伏阻生病例,利用正畸牵引联合牙槽外科手术进行矫治。结果 6例埋伏尖牙,经开拓间隙或减数助萌治疗,3～5个月后自然萌出;24例行牙槽外科开窗术配合正畸牵引,8～12个月后萌出。牙髓活力正常,牙龈形态美观,牙周情况良好。结论 正畸牵引联合牙槽外科手术,可快速有效地矫治上颌埋伏阻生尖牙。     

上颌埋伏尖牙非手术助萌的正畸治疗

[摘要] 目的 探讨上颌埋伏尖牙非手术助萌正畸治疗的适应证及其临床效果。方法 选取10～15岁上颌埋伏尖牙患者20例,应用螺旋CT三维重建技术对其进行诊断,明确埋伏尖牙颌骨内位置、方向及牙根发育情况,选取适合病例12例通过正畸手段为埋伏尖牙开辟间隙,等待其自行萌出;8例采用外科翻瓣导萌术牵引导萌。结果 12例非手术助萌患者,正畸拓展足够间隙后经3～10个月上颌埋伏尖牙均自行萌出至正常位置,牙周附着健康;8例外科手术导萌患者,上颌埋伏尖牙正畸牵引到位后均有不同程度的牙周附着丧失,影响龈缘美观。结论采用螺旋CT三维重建技术可以立体直观的提供埋伏尖牙的信息,为临床医师明确诊断及制定治疗方案提供依据,减少手术适应证,使用非手术助萌的方法可使上颌埋伏尖牙自行萌出,避免手术创伤痛苦,萌出后牙周附着好。     

上颌腭侧阻生尖牙非手术与手术助萌的比较研究

目的探讨上颌腭侧阻生尖牙通过正畸开辟间隙等非手术助萌的适应证、矫治时间及其临床效果。方法选取9例患者的12颗上颌腭侧阻生尖牙为研究对象,通过曲面全景及头颅侧位片判断阻生尖牙在颌骨内的位置、牙齿的发育阶段及患者骨成熟阶段,通过正畸治疗配合头帽口外弓为阻生尖牙开辟间隙,定期拍摄曲面全景片观察阻生尖牙的萌出潜力。结果 7颗阻生尖牙自动萌出,3颗阻生尖牙采取外科开窗联合正畸牵引治疗,2颗阻生尖牙选择外科拔除。结论正畸开辟间隙后阻生尖牙成功萌出的主要因素可以概括为:萌出路径无干扰、骨成熟早期,根尖孔未闭合,而骨发育阶段比牙发育阶段更有指导意义。     

上颌阻生尖牙牵引治疗后邻近切牙牙根吸收情况的研究

目的 分析上颌阻生尖牙正畸牵引治疗后邻近切牙的牙根吸收情况及可能的相关因素。方法 选取上颌尖牙阻生且符合标准的43例患者,年龄10～23岁,共60颗上颌埋伏阻生尖牙。上颌阻生尖牙正畸牵引治疗前后分别拍摄锥形束CT,分析阻生尖牙邻近切牙的牙根吸收程度,并对可能存在的相关因素进行分析。结果 上颌阻生尖牙正畸牵引治疗后,上颌中切牙发生轻、中、重度牙根吸收的概率分别为71.7%、15.0%、13.3%,上颌侧切牙发生轻、中、重度牙根吸收的概率分别为48.3%、36.7%、15.0%,上颌中切牙与侧切牙牙根吸收严重程度存在差异(P<0.05)。位于腭侧及颌骨内、低位且靠近面中线的阻生尖牙,在正畸牵引治疗后,侧切牙牙根吸收程度较重(P<0.05)。低位阻生尖牙牵引治疗后,中切牙牙根吸收较重(P<0.05)。牵引时间较长时,中切牙牙根吸收程度较重(P<0.05)。治疗前已发生牙根吸收的切牙,在阻生尖牙牵引治疗后发生的牙根吸收程度较重(P<0.05)。结论 上颌侧切牙在阻生尖牙正畸牵引治疗后,发生的牙根吸收程度较重。上颌阻生尖牙正畸牵引治疗后,邻近切牙牙根吸收情况与阻生尖...     

Combined surgical and orthodontic approach to reproduce the physiologic eruption pattern in impacted canines: report of 25 patients

The purpose of this study was to evaluate the periodontal variables of impacted maxillary canines that were treated with a combined surgical and orthodontic approach aimed at reproducing the physiologic eruption pattern of canines. Twenty-five patients who presented with unilateral impacted maxillary canines were consecutively enrolled (age range, 13.2 to 23.2 years). They were treated with a surgical flap and orthodontic traction directed to the center of the crest and were evaluated periodontally at the end of treatment and again at a follow-up visit (2 to 5 years posttreatment). Pocket depth, keratinized tissue width, and gingival recession were recorded. At the end of orthodontic treatment, all 25 treated canines presented with normal pocket depth (2.0 +/- 0.3 mm) and a normal amount of keratinized tissue (5.0 +/- 1.2 mm). No sites showed gingival recession. At the follow-up visit, both pocket depths and keratinized tissues were slightly reduced. The combined technique permits traction of the impacted canines to the center of the crest, simulating the physiologic eruption pattern and resulting in correct alignment and good periodontal status.     

埋伏上尖牙与侧切牙发生不完全易位的矫治方法研究

目的 探讨埋伏阻生上尖牙与侧切牙发生不完全易位后的导萌方法,将易位的尖牙牵引至正常位置,以达到美观效果,行使正常功能.方法 选择不完全易位的单侧埋伏阻生上尖牙患者12例（男6例,女6例）,年龄11.5～21.0岁,平均14.5岁,其中尖牙偏腭侧阻生7例,偏颊侧阻生5例.外科手术暴露埋伏牙,应用固定矫治技术,调整牵引方向将埋伏牙牵引至正常位置.结果 易位的尖牙均与侧切牙发生位置交换,尖牙移至正常位置,且具有良好的冠根方向和咬合关系,尖牙及侧切牙均无明显根吸收.平均疗程19个月.结论 将不完全易位的埋伏尖牙牵引入正常位置的难点在于易位埋伏的尖牙翻越相邻侧切牙牙根时,二者不相互阻挡.解决此难点的关键是精确判断尖牙牙冠与侧切牙牙根的位置关系,适时调整牵引方向.     

Short- and long-term periodontal evaluation of impacted canines treated with a closed surgical-orthodontic approach

AIM: The aims were to evaluate and compare the periodontal status of unilateral impacted maxillary canines treated by a combined surgical-orthodontic technique with that of normally erupted controlateral canines. MATERIAL AND METHODS: One hundred and twenty-five patients, consecutively enrolled, aged between 12.8 and 52.0 years, 31 males and 94 females, presented one impacted maxillary canine (test group) and the controlateral canine normally erupted (control group). All cases were treated by a surgical flap and orthodontic traction directed to the centre of the crest and evaluated periodontally at the end of treatment. Fifty-eight patients were followed up for a mean of 3.4 +/- 0.5 years. Pocket depth (PD), keratinized tissue width (KT) and gingival recession were recorded. Multilevel models were created. RESULTS: At the end of the orthodontic treatment, PD and KT of the 125 impacted canines were slightly, but statistically significantly higher than controls. Only one treated canine showed a recession (1 mm). At follow-up (58 patients), this difference decreased and the two groups were not significantly different. CONCLUSIONS: The combined technique permitted the traction of the impacted canines to the centre of the crest, thus simulating a physiological eruption pattern. Correct alignment and good periodontal status were obtained.     

预置支点介导下的上颌近远中阻生尖牙的矫治

目的 探讨预置支点在矫治上颌水平阻生尖牙的作用.方法 水平埋伏阻生上颌尖牙5例,均位于邻牙根方.用直丝弓矫治器进行间隙预备,外科开窗暴露埋伏尖牙的牙冠,将预置支点置于牙颈部,进行正畸牵引,曲面断层片观察邻牙牙根吸收情况.结果 水平阻生尖牙以预置支点为转动中心而移动至正常位置,牙髓和牙周情况良好,邻牙牙根无吸收现象.结论 预置支点水平阻生上颌尖牙的转动中心,对正畸临床治疗有指导意义.     

Orthodontic and periodontal outcomes of treated impacted maxillary canines

OBJECTIVE: To evaluate the influence of pretreatment radiographic features (alpha-angle, d-distance, and s-sector) on (1) the duration of active orthodontic traction and (2) the posttreatment periodontal status (pocket depth [PD] and keratinized tissue width [KT]) of impacted maxillary canines treated by a combined surgical (flap approach) and orthodontic (direct traction to the center of the ridge) treatment. MATERIAL AND METHODS: A study population of 168 patients (168 canines) was evaluated. Multiple regression analysis was used. RESULTS: Pretreatment radiographic variables were associated significantly with the duration of orthodontic traction. Age, sex, and site of impaction did not significantly affect the duration of traction. No significant differences in PD and KT were present at the end of surgical-orthodontic treatment with respect to any of the variables considered. The analysis of PD and KT variables after orthodontic treatment revealed a healthy periodontium. CONCLUSIONS: alpha-angle, d-distance, and s-sector are valid indicators for the duration of orthodontic traction. They are not prognostic indicators of final periodontal status of orthodontically-repositioned canines.     

Maxillary canine impactions related to impacted central incisors: two case reports

AIM: The purpose of this case report is to describe the combined surgical and orthodontic treatment of two cases with an impacted maxillary central incisor and canine in the same quadrant and to discuss the causal relationship between them. BACKGROUND: The most common causes of canine impactions are usually the result of one or more factors such as a long path of eruption, tooth size-arch length discrepancies, abnormal position of the tooth bud, prolonged retention or early loss of the deciduous canine, trauma, the presence of an alveolar cleft, ankylosis, cystic or neoplastic formation, dilaceration of the root, supernumerary teeth, and odontomas. Although impaction of the maxillary central incisor is almost as prevalent as impacted canines its etiology is different. The principal factors involved in causing the anomaly are supernumerary teeth, odontomas, and trauma. REPORTS: Case #1: A 10.5-year-old girl in the early mixed dentition stage presented with a chief complaint of the appearance of her anterior teeth. She had a Class I skeletal pattern and a history of trauma to the maxillary central incisors at age five with premature exfoliation. Radiographs revealed an impacted upper right central incisor in the region of the nasal floor, delayed eruption of the maxillary permanent central incisor, and the adjacent lateral incisor was inclined toward the edentulous space. Treatment was done in two stages consisting of surgical exposure and traction of the impacted central incisor and fixed orthodontic treatment. Case #2: An 11.5-year-old girl presented for orthodontic treatment with the chief complaint of an unerupted tooth and the appearance of her upper anterior teeth. She was in the late mixed dentition period with a Class III skeletal pattern along with an anterior cross-bite with some maxillary transverse deficiency. The maxillary right canine and central incisor were absent, but the maxillary right deciduous canine was still present. Treatment included arch expansion followed by surgical exposure and traction of the impacted teeth and fixed orthodontic treatment. SUMMARY: This case report provides some evidence of a significant environmental influence of an impacted maxillary central incisor on the path of eruption of the ipsilateral maxillary canine. When an impacted maxillary central incisor exists, the maxillary lateral incisor's root might be positioned distally into the path of eruption of the maxillary canine preventing its normal eruption. Ongoing assessment and early intervention might help to prevent such adverse situations from occurring.     

应用全景片预测上颌阻生尖牙正畸治疗时间的探讨

目的： 应用全景片评估上颌阻生尖牙的特征（角度、线距和位置）对正畸牵引时间的影响。方法： 选取60例进行正畸牵引治疗的上颌单侧阻生尖牙患者,通过全景片测量治疗前患者上颌阻生尖牙的特征（角度、线距和位置）,采用SPSS19.0软件包中的多元回归分析影响正畸牵引时间的相关因素。结果： 治疗前阻生尖牙的角度、线距和位置与正畸牵引时间显著相关,性别和左右侧位置对牵引治疗时间无显著影响。结论： 阻生尖牙的角度、距离和位置可以预测正畸牵引时间。     

倒位埋伏阻生上中切牙的临床矫治探索

目的 探索倒位埋伏阻生上颌中切牙的矫治方法,以提高临床矫治效果和保留更多的倒位阻生牙.方法对8例患者的9颗倒位埋伏阻生的上中切牙采用开拓间隙、手术开窗牵引、固定人工支点协助调向、排齐、反向控根等方法进行矫治.结果9颗倒位阻生的上中切牙中,有8颗经过15～30个月的矫治达到正常位置,牙齿稳定,功能正常.剩余1颗因牵引15...