埋伏弯根上颌中切牙序列矫治的研究

目的探讨埋伏弯根上颌中切牙有效的正畸牵引治疗方法。方法选择11例患者共12颗埋伏弯根上颌中切牙为研究对象,常规拍摄定位X线片,配合口内检查、模型分析等,确定埋伏牙的位置及其与邻牙的相互关系,采用封闭式导萌、选择性根管治疗及根尖切除术、修复治疗等方法进行矫治。结果12颗埋伏牙通过治疗后顺利进入正常牙列,未见牙根吸收粘连,建立了良好的咬合关系。9例唇侧埋伏弯根上颌中切牙患者的临床牙冠唇倾角度较大,4例根尖位于唇侧黏膜下,进行了根管治疗加根尖切除术,其中1例行烤瓷冠改形修复;其余5例未做根管治疗,暂行观察。2例腭侧埋伏弯根上颌中切牙的疗效稳定。结论埋伏弯根上颌中切牙采用序列矫治可以取得良好的美观和功能效果。     

活动矫治器+封闭式牵引术矫治上颌埋伏倒置弯曲中切牙48例报告

目的:观察上颌埋伏阻生的倒置弯曲中切牙正畸牵引治疗的效果.方法:选择48例、52颗无萌出能力的上颌埋伏阻生倒置弯曲中切牙,分别经螺旋CT定位、拓展间隙后,行手术联合正畸牵引治疗,观察治疗后的萌出状况、破龈时间、牙髓活力等,以成功、有效和失败评判疗效.结果:本组48例、52颗埋伏中切牙中,成功36颗,占69.23％;有效15颗,占28.85％;失败1颗,占1.9％.牙髓活力检测均正常;未见牙根吸收和黏连.结论:对替牙期儿童的上颌埋伏阻生倒置弯曲中切牙,选择合适的适应证、通过螺旋CT精确定位、恰当的间隙拓展以及活动牵引矫治器的合理应用,是治疗成功的关键.     

倒置埋伏阻生上颌中切牙的临床矫治效果研究

目的 探讨倒置埋伏阻生上颌中切牙的矫治时机和矫治方法.方法 选择10例患者共10颗上颌单侧倒置埋伏阻生中切牙为研究对象.矫治前常规拍摄全口曲面断层片、CT片,确定倒置埋伏牙的冠根形态及其与邻牙的关系.根据埋伏牙的翻转角度选择面弓式前方牵引器或主弓丝牵引.牵引结束测试牙髓活力.结果 通过7～14个月牵引,倒置埋伏阻生的上颌中切牙基本达到牙列的正常位置;埋伏牙牙髓活力测试结果为25.9±2.8,对侧同名牙为25.0±3.3,差异无统计学意义(t=1.15,P=0.159).结论 倒置埋伏阻生的上颌中切牙并非一定需要拔除,选择恰当的时机对倒置埋伏阻生的上颌中切牙给予有效的外科-正畸联合治疗,效果较好.     

上颌埋伏阻生中切牙的影像学分类

目的:探讨上颌埋伏阻生中切牙的三维图像分类特征。方法:根据103例上颌中切牙埋伏阻生患者螺旋CT的Dicom原始数据,应用Mimics10.0软件重建出上颌埋伏阻生中切牙的三维图像,分析上颌埋伏阻生中切牙的阻生特点,并对其进行分类。结果:共有埋伏牙106颗。74颗牙为唇侧阻生,倒置阻生33颗,水平阻生28颗,倾斜阻生13颗;20颗为腭侧阻生,倾斜阻生11颗,水平阻生9颗;12颗为垂直阻生。上颌埋伏阻生中切牙根据牙冠的位置在垂直向、冠状向、矢状向可分为3类,即①唇侧埋伏阻生型,包括唇侧倾斜埋伏阻生型、唇侧前后水平埋伏阻生型、唇侧倒置埋伏阻生型;②腭侧埋伏阻生型,包括腭侧倾斜埋伏阻生型、腭侧后前水平埋伏阻生型;③垂直埋伏阻生型。结论:上颌埋伏阻生中切牙从三维方向上可分为3类,每一类又可分多个亚型,包括唇侧(倾斜、前后水平、倒置)埋伏阻生、腭侧(倾斜、后前水平)埋伏阻生和垂直埋伏阻生。     

3D打印装置个性化牵引上颌埋伏中切牙(附病例报告)

目的 采用数字化个性化打印牵引装置牵引埋伏上颌中切牙.方法 选取一例上颌中切牙埋伏患者,由于磨牙萌出高度不足及乳牙冠修复无法采用传统牵引装置,利用数字化设计个性化牵引装置对埋伏上颌中切牙牵引助萌.结果 个性化牵引装置固位、施力良好,成功实现上颌阻生埋伏牙助萌,治疗后牙根发育正常,牙周组织改建良好.结论 数字化牵引装置能...     

上颌埋伏倒置中切牙3例及文献复习

目的探讨上颌埋伏倒置中切牙病例的临床特点、诊断及治疗方法,以期为临床诊治提供参考。 方法回顾性分析南方医科大学附属深圳妇幼保健院2017—2019年期间收治的3例上颌埋伏倒置中切牙患者的临床表现、影像学表现、治疗方法及治疗效果,并进行相关文献复习。 结果3例上颌埋伏倒置中切牙病例主要表现为单侧上颌中切牙缺失、邻牙倾斜、缺牙间隙变小,锥形束CT（CBCT）检查均发现缺隙处有1颗唇侧倒置埋伏中切牙,其中1例牙根根尖孔已闭合,另外2例牙根发育至根尖1/2 ~ 1/3,现有冠根比≥1∶1,牙根弯曲部分在根尖1/2 ~ 1/3。3例均采用外科开窗联合正畸牵引进行治疗,患牙均顺利进入牙列,无松动,咬合良好,未出现明显牙根吸收。 结论上颌埋伏倒置中切牙的矫治难度较大,应掌握其临床特点及治疗原则,重视矫治时机的选择及矫治方法设计,提高患牙保存率。     

上颌埋伏阻生中切牙的临床研究

目的统计温州医学院附属口腔医院正畸科门诊病例中上颌埋伏阻生中切牙的患病率、唇腭侧的比例及治疗情况。方法选取2005年1月至2008年1月期间,在温州医学院附属口腔医院正畸科就诊的错殆患者中,所有在放射科拍摄过螺旋CT的上颌中切牙埋伏阻生的患者。统计其发病、治疗情况。结果2005年1月至2008年1月期间,在温州医学院附属口腔医院正畸科共有8763名患者,上颌中切牙埋伏阻生者共103名。男性50名,女性53名。唇侧阻生71名（其中3名为双侧阻生）,腭侧阻生20名,垂直阻生12名。其中76颗埋伏牙采用外科手术结合正畸牵引治疗,27颗采取外科拔除,3颗采用减阻助萌术。结论在温州医学院附属口腔医院正畸门诊患者中上颌中切牙埋伏阻生约占1．18％,男女比例基本一致,唇侧阻生最常见,上颌埋伏阻生中切牙的治疗以外科手术结合正畸治疗为主。     

上颌中切牙埋伏阻生的正畸治疗:28例报道

目的:通过对无萌出能力的埋伏阻生上颌中切牙进行外科开窗术 正畸牵引治疗,探讨埋伏上颌中切牙正畸牵引治疗的效果。方法:对28例30颗无萌出能力埋伏阻生的上颌中切牙进行外科开窗术 正畸牵引治疗。结果:28例埋伏牙中,1例已牵引萌出,因间隙不足,家长拒绝拔牙而未排齐;1例牵引3个月后萌出,因无时间复诊而放弃治疗,未排齐;其余均牵引入列,28例埋伏牙平均破龈时间为4.5个月,最长为10个月,最短为1个月;28颗埋伏牙牙髓活力测试全部正常,未见根吸收、黏连;4颗唇侧出现1￣4mm的牙龈退缩;2颗分别出现1.0mm和2.5mm的边缘骨丧失。结论:治疗的时机、合理的矫治方法、减少手术创伤、牵引力的大小以及支抗和炎症的有效控制是治疗成功的关键。     

埋伏牙引发上颌中切牙根尖周炎2例

病例1病人女,12岁。因发现两上颌中切牙间隙逐渐增宽2年就诊。否认牙痛史或前牙外伤史。检查:上颌左右中切牙之间缝隙宽约0.9 mm,11牙冠灰暗无光泽,探光滑无龋,叩(±),松动2度,电测牙髓活力无反应。X线片示:11牙根吸收达根长2/3,根尖卵圆形密度减低区,直径约13mm,边界清晰,无骨白线形成;13埋伏阻生,牙冠抵于11牙根。初步诊断:11根尖周肉芽肿,牙根吸收;13埋伏阻生。治疗:局麻下唇侧翻瓣去骨拔除13,刮除病变软组织,庆大霉素冲洗后缝合创面。术后2周11行根管治疗术。病检报告:根尖周肉芽肿(图1)。病例2病人男,26岁。因右上颌前牙区疼痛10 d就…     

导杆式矫治器治疗上颌唇侧倒置埋伏中切牙

目的:探讨导杆式矫治器治疗上颌唇侧倒置埋伏阻生中切牙的临床效果及治疗作用。方法:术前拍摄曲面断层片、头颅侧位片及CBCT明确诊断和定位患牙,用导杆式矫治器对16例上颌唇侧倒置埋伏中切牙进行外科-正畸联合治疗。固定保持1年后,拍CBCT评价远期疗效。测量矫治后埋伏牙和对侧同名牙的根长,用SPSS17.0软件进行配对t检验。结果:16例唇侧倒置埋伏中切牙均牵引入牙列排齐,牙髓和牙周状况良好。保持1年后X线及临床检查示埋伏牙均正常。埋伏牙的根长(8.32±1.70)mm短于对侧同名牙(10.12±1.71)mm(P<0.001)。结论:对未成年患者应保留上颌埋伏中切牙;导杆式矫治器是治疗上颌唇侧倒置埋伏中切牙的一种有效方法。     

附件对隐形矫治器内收上前牙影响的三维有限元分析

目的    通过拔除上颌第一前磨牙后前牙内收的隐形矫治三维有限元模型,分析切牙上设置附件对牙齿移动方式的影响。方法    基于1例成年患者颌骨的锥形束CT影像数据,按照切牙上有无附件,构建4组拔除第一前磨牙的上颌隐形矫治模型,分别为切牙无附件组、侧切牙单附件组、中切牙单附件组和双附件组;导入Ansys Workbench三维有限元软件,设置4个上切牙控根压入内收的隐形矫治过程,分析牙列初始位移和附件的应力分布。结果    切牙无附件组及中切牙单附件组均发生4个切牙的舌向倾斜移动,后牙产生不同程度的近中倾斜移动,尖牙近中倾斜伴有伸长;侧切牙单附件组及双附件组切牙呈整体内收压入移动趋势,切牙附件的龈方可观测到压应力集中。结论    隐形矫治内收上前牙时,在侧切牙放置附件有助于切牙整体内收的表达,而中切牙附件对牙移动方式的影响较小。     

弯根牙的临床综合治疗及正畸早期矫治的可能性

弯根牙是指由于各种原因造成的牙冠与牙根（或部分牙根）形成一定弯曲角度的牙齿。文章总结了临床弯根牙的病因、形成机制、临床错牙合表现、治疗原则、治疗时机选择、治疗的生物学及生物力学考虑;介绍了临床正畸治疗方法与原则,并且着重对牙根正在形成的前牙弯根牙的临床治疗体会及临床治疗对前牙发育的优势进行了阐释,认为早期弯根牙治疗能促进牙根形成、避免弯根严重化及弯曲牙根暴露。同时,文章还强调并提出前牙弯根阻生牙需早期矫治的临床证据,探讨了前牙弯根牙早期治疗的可能性,为弯根牙的临床早期正畸治疗提供了新思路。     

Applications for Direct Composite Restorations in Orthodontics

BACKGROUND AND AIM: Besides prosthetic and indirect, laboratory-produced restorations, the focus of dental therapy is increasingly on restorative measures and direct restorations as minimally invasive treatment concepts. Thus, the use of direct composite restorations with modern restorative materials for the shaping and recontouring of teeth in combination with orthodontic treatment offers a diversified, extensive sphere of application. The aim of the study was to demonstrate applications for direct composite restorations with reference to selected cases. MATERIAL AND METHODS: The composites used were hybrid composites, which offer increased abrasion resistance and color stability and are applied incrementally. Special attention was paid to the shape, color and structure of the tooth. CASE REPORTS: The case reports present patients in whom relatively narrow or peg-shaped teeth were built up with composite to correct various tooth size discrepancies or cuspids were recontoured by means of direct composite restorations following orthodontic space closure in cases with missing lateral incisors. Similarly, space closure was achieved using orthodontically repositioned lateral incisors recontoured to resemble central incisors after traumatic loss of upper central incisors. Finally, direct composite restorations were used for retention following completion of orthodontic treatment. CONCLUSIONS: Observations over recent years confirm the stability of composites in both form and color, as well as their ability to maintain gingival health. Our case reports demonstrate that, subject to a corresponding indication, recontouring single teeth using direct composite restorations can optimize orthodontic treatment results.     

Changes in the gingival thickness and keratinized gingival width of maxillary and mandibular anterior teeth after orthodontic treatment

ObjectivesTo evaluate changes in the gingival thickness (GT) and keratinized gingival width (KGW) of the maxillary and mandibular central and lateral incisors and canines after fixed orthodontic treatment and their association with sagittal tooth movement (STM).Materials and MethodsIn this study of both arches, 60 periodontally healthy subjects who had completed fixed orthodontic treatment were included. Using pretreatment and posttreatment lateral cephalograms, STM of the maxillary (1-NA angle and distance, and 1-SN angle) and mandibular (1-NB angle and distance, and IMPA angle) incisors were evaluated to divide the subjects into protrusion and retrusion groups. Pretreatment and posttreatment GT was identified via transgingival probing, and KGW was calculated from the free gingival margin to the mucogingival junction.ResultsThe intragroup pretreatment and posttreatment comparison results showed a significant decrease in the GT of the maxillary and mandibular anterior teeth in the protrusion and retrusion groups and a decrease in the KGW of the maxillary lateral incisors in the protrusion group. Pearson correlation coefficient analyses for maxillary and mandibular anterior teeth revealed that the GT changes were not significantly associated with STM. However, a positive correlation existed between the KGW of tooth numbers 13 and 41 and STM.ConclusionsSTM was not significantly associated with decreased GT of the maxillary and mandibular anterior teeth, but it was positively correlated with the KGW of tooth numbers 13 and 41.     

Clinical and radiographic study of pulpectomy and root canal therapy.

A clinical and radiographic reexamination of 2,459 roots 2-7 years after initial pulpectomy or root canal therapy is presented. The overall success rate, which was 53%, was not affected by the sex or age of the patient, or by the jaw in which the tooth was situated. The tooth group, however, had a significant influence on the success rate, the worst results being obtained for incisors and especially the mandibular central and maxillary lateral incisors. The prognosis was clearly better for the pulpectomies than for the root canal therapy. Mortal pulpectomy was found to succeed more often than vital. The presence of a primary periapical rarefaction worsened the success rate. The success rate was lower for the teeth in which a posttreatment prosthetic crown had been fitted. Fillings which went beyond the apex had a significantly lower success rate than those which nearly or exactly reached the apex.     

正畸矫治对根管治疗牙齿牙根吸收程度影响的CBCT研究

目的利用CBCT评价正畸治疗对根管治疗牙齿牙根吸收程度的影响。方法选择上下颌牙齿轻中度拥挤的成年患者16例,患者上颌前牙中至少有一颗已行根管治疗。使用0.558 8 mm槽沟的MBT托槽进行非拔牙矫治。于治疗前、后分别拍摄头颅CBCT,并分别测量根管治疗牙齿以及对侧同名牙齿的长度。采用配对t检验进行统计分析。结果 16例患者一共有18颗上颌前牙接受过根管治疗,其中包括6颗中切牙,8颗侧切牙,4颗尖牙。平均治疗时间为(18.3±2.6)个月。治疗前,已行根管治疗牙齿牙根平均长度(22.68±2.14)mm;治疗后,牙根平均长度为(21.98±2.05)mm。治疗前,对侧同名活髓牙牙根平均长度(22.61±2.01)mm;治疗后,牙根平均长度为(22.01±2.37)mm。两组差别无统计学意义。按照牙位单独分析,亦无统计学差异。结论利用CBCT能够很好地观察正畸治疗后牙根吸收的情况。在轻中度拥挤非拔牙的病例中,正畸治疗并不会增加上颌前牙已行根管治疗牙齿牙根吸收的风险。     

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??Tooth dilaceration is considered as a dental deformity characterized by pronounced angulations of the longitudinal tooth axis. This article reviewed the etiology?? mechanism?? clinical features?? treatment principles?? treatment timing and treatments based on biological and biomechanical thoughts of tooth dilaceration. This article especially illustrated early orthodontic intervention for impacted and dilacerated maxillary central incisors. The early orthodontic intervention showed that the successful tooth alignment could be achieved?? the forms of dilacerated root were improved?? and the chance of root exposure in oral cavity when angular teeth were aligned was reduced. The author suggested the early orthodontic intervention of impacted teeth with dilacerated root was better for root morphologic development and could be a clinical choice for the tooth dilaceration treatment.     

Clinical and radiographic study of pulpectomy and root canal therapy

abstract — A clinical and radiographic reexamination of 2,459 roots 2–7 years after initial pulpectomy or root canal therapy is presented. The overall success rate, which was 53%, was not affected by the sex or age of the patient, or by the jaw in which the tooth was situated. The tooth group, however, had a significant influence on the success rate, the worst results being obtained for incisors and especially the mandibular central and maxillary lateral incisors. The prognosis was clearly better for the pulpectomies than for the root canal therapy. Mortal pulpectomy was found to succeed more often than vital. The presence of a primary periapical rarefaction worsened the success rate. The success rate was lower for the teeth in which a posttreatment prosthetic crown had been fitted. Fillings which went beyond the apex had a significantly lower success rate than those which nearly or exactly reached the apex.