心理干预对青少年正畸患者心理及疗效影响研究

目的 探讨心理干预对于青少年正畸患者心理及疗效的影响。方法 选择2008年7月至2010年7月江苏省连云港市第二人民医院口腔科就诊的错牙合畸形患者62例,随机分为干预组及对照组,每组各31例,均采用标准直丝弓固定矫治。干预组予以正畸治疗同时辅以心理干预,对照组则仅进行常规正畸治疗。治疗前后根据抑郁自评量表（SDS）与焦虑自评量表（SAS）评分以及疗效标准进行评定。结果 青少年错牙合畸形患者正畸治疗前均有不同程度的焦虑或抑郁心理。干预组心理状况改善明显,两组SAS、SDS评分差异均有统计学意义（均P＜0.05）。两组治疗后疗效差异有统计学意义（P＜0.05）。结论 心理干预可明显降低青少年错牙合畸形患者焦虑抑郁心理,进而影响正畸治疗效果。     

新书简介

由我国著名口腔正畸学家、北京大学口腔医学院曾祥龙教授主编的《现代口腔正畸学诊疗手册》现已出版发行。该书以手册形式介绍口腔错畸形的现代诊断与治疗方法。第一篇介绍口腔正畸学检查与诊断技术、错畸形的分类、诊断以及矫治计划制定中的若干重要问题 ;第二篇矫治器与矫治技术篇内容涵盖当今国内外常见的可摘矫治器、功能矫治器和固定矫治器 ,并对 10余种现代固定矫治技术的特点与应用有重点介绍 ;第三篇错畸形的矫治对乳牙期、替牙期、恒牙早期、成人患者矫治中面临的主要问题分别予以讨论 ,以常见错畸形为主 ,也涉及其他学科 …     

安氏Ⅱ类错畸形患者矫治时间的影响因素分析

目的初步分析影响安氏Ⅱ类错畸形患者矫治时间的因素。方法随机选择2006—2012年在我科进行全程双颌固定正畸治疗结束的安氏Ⅱ类错畸形患者70例,记录患者拔牙与否、矫治时间、就诊次数、矫治过程中矫治器损坏次数、失诊及弹性牵引,比较患者矫治时间和就诊次数之间的差异,分析其与相关因素间的相互关系。结果安氏Ⅱ类错畸形患者的平均矫治时间为26.3个月(14～40个月);拔牙、矫治器损坏、失诊及弹性牵引延长了患者的矫治时间。结论拔牙、矫治器损坏、失诊及弹性牵引延长了安氏Ⅱ类错畸形患者的矫治时间。     

舌侧正畸技术的临床应用研究

目的 :本文报告了作者临床应用舌侧矫治器的经验体会 ,以期对舌侧正畸矫治技术的技术要点进行总结 ,同时对舌侧矫治器的治疗效果进行评价。方法 :对 2 2例已完成病例 (9例为不拔牙、13例为拔牙矫治 )的错类型、拔牙模式、矫治程序、治疗时间及矫治效果等进行分析。结果 :不拔牙病例平均疗程 15个月 ,拔牙病例平均疗程 2 7个月。矫治效果良好。且治疗过程中不暴露矫治器 ,达到了隐形治疗的目的。结论 :舌侧正畸矫治器及矫治技术是一种高效能的隐形的固定矫治技术 ,可对各种错畸形进行治疗 ,在我国正畸临床将有很好的应用前景。     

固定矫治器配合垫矫治反21例

前牙反是较常见的错畸形，在江油市人民医院口腔科就诊的错畸形患者中占１９％，常伴有后牙近中错和前牙拥挤，临床表现为下颌前突，上颌发育不足或两者兼有的凹面形。作者近２年采用固定矫治器配合垫矫治２１例反畸形，疗效显著，现报告如下。１临床资料本组...     

口内颌间牵引矫治儿童骨性Ⅲ类错

介绍一种上颌全包式垫，下颌牙列粘结带钩弓丝、橡皮圈口内颌间牵引矫治儿童Ⅲ类错。矫治器制作简易，取戴方便，疗程短，疗效好，是一种活动与固定矫治器结合应用矫治儿童骨性Ⅲ类错的新疗法     

安氏II类错治疗的进展与探讨

1999年 9月中华口腔医学会口腔正畸专业委员会和中华口腔医学杂志编委会主办了题为“安氏ＩＩ类错的诊断与治疗”的口腔正畸专题研讨会。在治疗方面集中研讨了不拔牙矫治、功能矫治器和直丝弓矫治器 3个议题。研讨会内容反映了当前国内外的学术动态 ,会议取得了成功。一、安氏ＩＩ类错的不拔牙矫治拔牙矫治自 2 0世纪初起至 30年代 ,在Ａｎｇｌｅ的“牙齿大小与牙槽弓必然适应”的理论误导下 ,美国当时几乎所有的错病例均采用扩大牙弓的不拔牙矫治方法。但由于矫治完成后许多病例的畸形复发 ,使人们认识到这一矫正理论的片面性。此后 …     

功能矫治器治疗三维方向错牙合畸形的研究

目的：：评价功能矫治器治疗下颌后缩同时伴有垂直向、横向不调错畸形的疗效。方法：对20名下颌后缩同时伴有垂直向、横向不调错畸形的患者(平均年龄12.8岁)采用功能矫治器及固定矫治器双期矫治,通过X线头影测量比较矫治前、中、后有关指标的变化并进行统计分析。结果：所有患者功能矫治后,SNB增大(P<0.05),ANB减小(P<0.05),上磨牙压低并后移(P<0.05),下磨牙升高并前移(P<0.05)。双期矫治后,前牙达到正常覆覆盖关系,后牙达到中性关系或尖窝交错的咬合关系,下颌平面未发生明显的顺时针旋转,上下颌牙列矢状向、垂直向、横向关系协调。结论：采用功能矫治器双期矫治下颌后缩同时伴有垂直向、横向不调的错畸形,可获得满意的治疗效果。     

斜面导板治疗安氏Ⅱ1下颌后缩稳定性的临床研究

在临床上,安氏Ⅱ1下颌后缩型错牙合畸形多采用非拔牙矫治,其矫治后的稳定性受到多种因素的影响[1] 。本文将观察采取固定矫治器加斜面导板导下颌向前,治疗安氏Ⅱ1下颌后缩及保持后牙合位在矢状方向的稳定性。1　材料与方法1 1　病例选择选取山西省人民医院正畸科1994～1999年安氏Ⅱ1下颌后缩型非拔牙矫治病例2 0例,均采用固定矫治配合斜面导板矫治,Hawley保持器保持,矫治结束后随访观察3年的病例。病例选择标准如下:( 1)年龄11～18岁的恒牙期健康患者,无正畸治疗史;( 2 )临床诊断为安氏Ⅱ1错牙合,下颌后缩型;( 3 )采用固定矫治器加斜面导板…     

Herbst双期拔牙矫治对颞下颌关节骨性结构影响的锥形束CT研究

目的 应用锥形束CT（CBCT）研究Herbst双期拔牙矫治对颞下颌关节骨性结构的影响。方法选取15例以下颌后缩为主要临床表现的恒牙列早期安氏Ⅱ类错牙合患者,采用Herbst双期拔牙矫治,在Herbst矫治器矫治前两周（T1期）、Herbst矫治器初戴入矫治时（T2期）、Herbst矫治器拆除时（T3期）及二期固定矫治器拆除时（T4期）时进行CBCT扫描,应用InvivoDental软件对CBCT图像进行三维重建和相关测量。结果1）14例患者（28侧颞下颌关节）在T3期出现髁突后上区外侧边缘高密度、内部区域低密度类似“新月形”的增生影像。2）T3-T2期、T4-T1期,髁突前后径平均增加了0.62、0.66mm（P<0.01）;髁突头高度平均增加了0.54、0.53mm（P<0.01）。结论Herbst功能矫治器能促进髁突发生生长改建。     

Stability of anterior crossbite correction: A randomized controlled trial with a 2-year follow-up

Objective:To compare and evaluate the stability of correction of anterior crossbite in the mixed dentition by fixed or removable appliance therapy.Material and Methods:The subjects were 64 consecutive patients who met the following inclusion criteria: early to late mixed dentition, anterior crossbite affecting one or more incisors, no inherent skeletal Class III discrepancy, moderate space deficiency, a nonextraction treatment plan, and no previous orthodontic treatment. The study was designed as a randomized controlled trial with two parallel arms. The patients were randomized for treatment with a removable appliance with protruding springs or with a fixed appliance with multibrackets. The outcome measures were success rates for crossbite correction, overjet, overbite, and arch length. Measurements were made on study casts before treatment (T0), at the end of the retention period (T1), and 2 years after retention (T2).Results:At T1 the anterior crossbite had been corrected in all patients in the fixed appliance group and all except one in the removable appliance group. At T2, almost all treatment results remained stable and equal in both groups. From T0 to T1, minor differences were observed between the fixed and removable appliance groups with respect to changes in overjet, overbite, and arch length measurements. These changes had no clinical implications and remained unaltered at T2.Conclusions:In the mixed dentition, anterior crossbite affecting one or more incisors can be successfully corrected by either fixed or removable appliances with similar long-term stability; thus, either type of appliance can be recommended.     

Maxillary molar distalization or mandibular enhancement: a cephalometric comparison of comprehensive orthodontic treatment including the pendulum and the Herbst appliances.

Several methods of Class II treatment that do not rely on significant patient compliance have become popular during the last decade, including several versions of the Herbst appliance and the pendulum or Pendex molar-distalization appliances. Yet, these 2 general approaches theoretically have opposite treatment effects, one presumably enhancing mandibular growth, and the other moving the maxillary teeth posteriorly. This study examined the treatment effects produced by 2 types of the Herbst appliance (acrylic splint and stainless-steel crown) followed by fixed appliances, and the pendulum appliance followed by fixed appliances. For each of the 3 treatment groups, lateral cephalograms were analyzed before the start of treatment (T1) and after the second phase of treatment (T2). Patients were matched according to age and sex. The comprehensive treatment time for the pendulum group was 31.6 months, and the acrylic and crowned Herbst groups were treated for 29.5 months and 28.0 months, respectively. Overall from T1 to T2, there were no statistically significant differences in mandibular growth among the 3 groups. Skeletal changes accounted for a larger portion of molar correction in the Herbst treatment groups than in the pendulum group. Patients in the pendulum group had an increase in the mandibular plane angle. Conversely, the mandibular plane angle in patients treated with either Herbst appliance closed slightly from T1 to T2. At T2, the chin points (pogonion) of patients in both Herbst groups, however, were located slightly more anteriorly than were the chin points of the pendulum patients. It is likely that the slight downward and backward rotation of the mandible occurring during treatment in the pendulum patients accounted for much of this difference. The treatment effects produced by the 2 types of Herbst appliance were similar at T2, in spite of their differences in design. It is important not to generalize the findings of this comparison beyond the appliance systems evaluated. The 2 general approaches we evaluated involved a substantial dentoalveolar component in the treatment of Class II malocclusion. A comparison of a molar-distalizing appliance such as the pendulum with other types of functional appliances might yield differing results.     

Investigations on the Influencing of the Subgingival Microflora in Chronic Periodontitis

AIM: The aim of the present study was to investigate changes in the subgingival flora in adults with chronic periodontitis undergoing orthodontic fixed appliance therapy. PATIENTS AND METHODS: In seven adult patients who had undergone nonantibiotic periodontal pretreatment, the subgingival bacteria were subjected to microbiological examination and the number of periodontopathogenic organisms was determined before (T1: prior to treatment being started), during (T2: 6 weeks after orthodontic treatment was started) and after the end of orthodontic treatment (T3: 6 weeks after removal of the fixed appliances). RESULTS AND CONCLUSION: During the fixed appliance therapy (metal brackets, NiTi archwires, stainless steel archwires), a marked reduction was observed in the total bacteria count from the subgingival pocket despite the clinical periodontal parameters remaining almost unchanged. However, the total count of some highly pathogenic bacteria rose again slightly after the end of treatment. We attribute the marked improvement in the periodontopathogenic bacteria spectrum under fixed appliance therapy with metal brackets, NiTi archwires and stainless steel archwires to metal corrosion entailing the release of primarily nickel ions, which have a toxic effect on bacteria and thus enable the regeneration of the physiological bacterial flora. In none of the patients was a deterioration of the periodontal status observed during and after fixed appliance therapy.     

Influence of Supplemental Written Information on Adolescent Anxiety,Motivation and Compliance in Early Orthodontic Treatment

Objectives:To test the null hypotheses that supplementation of verbal information with written information when obtaining consent to orthodontic treatment has no effect on (1) anxiety, motivation and apprehension related to treatment and (2) compliance in the early stages of fixed appliance therapy.Materials and Methods:Seventy-six adolescents who were due to start fixed appliance therapy were randomly allocated to receive verbal information only or verbal and written information before orthodontic treatment. Participants'' anxiety, motivation, and apprehension were assessed using a questionnaire that was completed prior to meeting the orthodontic clinician (T1), following consent to treatment (T2), and after 12 weeks of treatment (T3). Appointment attendance, appliance breakages, and periodontal scores were used as measures of patient compliance.Results:Sixty participants completed the study. At T2 there was no change in anxiety scores for either group (P  =  .412); however, increased motivation was detected in the group that had been given both written and verbal information (P  =  .049). At T3 both groups demonstrated similar reductions in anxiety (P  =  .311) and apprehension (P  =  .790) and similar levels of motivation (P  =  .756). A reduction in periodontal scores (P  =  .065), better appointment attendance (P  =  .732), and fewer breakages (P  =  .525) were reported in the group that was given additional information, although these changes were not statistically significant.Conclusions:Supplementation of verbal information with written information resulted in improved motivation for orthodontic treatment but had no statistically significant effect on anxiety, apprehension, or patient compliance.     

A follow-up study of early treatment of pseudo Class III malocclusion

This study investigated the long-term outcome of 27 consecutive young patients diagnosed with pseudo Class III malocclusion treated with simple fixed appliance (2 x 4 appliance), which resulted in a positive overjet in all cases. Of the original sample of 27 patients, 25 patients (93%) were examined at the five-year follow-up. Two patients dropped out soon after the active treatment was completed. Of the remaining 25 patients, 20 patients had had no other treatment other than treatment with 2 x 4 appliance, and the other five patients had undergone additional comprehensive fixed appliance therapy because of crowding. Lateral cephalograms were obtained before and after active treatment with the 2 x 4 appliance and at five-year follow-up. The long-term results showed that at the five-year follow-up all 25 patients still maintained a positive overjet. The immediate treatment outcome in the sagittal plane was the same for those who had had 2 x 4 appliance treatment only and those who had had additional treatment with comprehensive fixed appliance treatment, but lower face height increased (P < .01) and the mandibular plane angle opened (P < .05) more in those who had had additional treatment, comprehensive fixed appliance treatment. During the five-year follow-up period, the dental compensation and the growth of the jaw were similar in both groups. In conclusion, in young patients diagnosed with pseudo Class III malocclusion and treated early with a 2 x 4 appliance, the overjet was corrected, and the treatment result was maintained in the long term.     

Long-term evaluation of the molar movements following Pendulum and fixed appliances

Objective:To describe the molar movements and skeletal changes associated with Pendulum-fixed appliance treatment and the long-term postretention period.Subjects and Methods:The treatment sample consisted of 76 Class II patients, 35 males and 41 females. Lateral cephalograms were obtained at the start of treatment (T1); the end of distalization (T2); the end of orthodontic fixed appliance therapy (T3); and long-term observation (7 years 2 months later; T4). Mean age was 12 years 11 months at T1, 13 years 8 months at T2, 15 years 4 months at T3, and 22 years 5 months at T4. The average amount of Class II molar relationship was 3.1 mm, with a mean overjet of 5.9 mm at the beginning of treatment. A paired t-test was used to identify significant between-group differences between T2–T4 and T3–T4.Results:Distal molar movement was obtained during the distalization phase (T2), and more than half of the distalizing effect was maintained at the end of maxillary growth (T4). Most of the relapse occurred during fixed appliance therapy (T3), whereas no significant change was detected in the postretention period (T4). The molar relationship did not show any significant difference between T2 and T4. The vertical facial dimension increased during the distalization phase (T2) and fixed appliance therapy (T3) but returned to the initial values during the postretention period (T4).Conclusions:The Pendulum appliance induces significant dentoalveolar effects, which can be partially maintained during the long-term period. The Class I molar relationship does not change during completion of individual growth. Increase in vertical facial dimension represents a temporary effect.     

Effects of rapid maxillary expansion on conductive hearing loss

OBJECTIVE: To test the null hypothesis that rapid maxillary expansion (RME) with a rigid bonded appliance has no effect on conductive hearing loss (CHL) in growing children. MATERIALS AND METHODS: Fifteen growing subjects (mean age 13.43 +/- 0.86 years) who had narrow maxillary arches and CHL participated in this study. Three pure-tone audiometric and tympanometric records were taken from each subject. The first records were taken before RME (T1), the second after maxillary expansion (T2) (mean = 0.83 months), and the third after retention (mean = 6 months) and fixed appliance treatment (approximately 2 years) periods (T3). The data were analyzed by means of analysis of variance (ANOVA) and least significant difference (LSD) tests. RESULTS: Hearing levels of the patients were improved and air-bone gaps decreased at a statistically significant level (P < .001) during active expansion (T2-T1) and the retention and fixed appliance treatment (T2-T3) periods. Middle ear volume increased in all observation periods. However, a statistically significant increase was observed only in the T2-T3 period. No significant change was observed in the static compliance value. CONCLUSIONS: The hypothesis is rejected. RME treatment has a positive and statistically significant effect on both improvements in hearing and normal function of the eustachian tube in patients having transverse maxillary deficiency and CHL.     

Herbst双期拔牙矫治对颞下颌关节位置影响的CBCT研究

目的:探讨Herbst双期拔牙矫治对颞下颌关节位置关系的影响.方法:纳入15例恒牙列早期安氏Ⅱ类错(牙合)下颌后缩患者,一期矫治采用Herbst矫治器,然后拔除每位患者的4个前磨牙;二期矫治采用edgewise固定矫治器.在Herbst矫治器矫治前两周(T1期)、Herbst矫治器初戴入矫治时(T2期)、Herbst矫治器拆除时(T3期)及二期固定矫治器拆除时(T4期)分别拍摄锥形束CT(cone beam computed tomography,CBCT).应用InvivoDental软件对CBCT图像进行三维重建,再对颞下颌关节间隙进行测量,并进行统计分析.结果:T1-T2-T3期,关节前间隙先减小后增大,关节上间隙、关节后间隙先增大后减小;T3-T4期,关节上、后间隙进一步减小,关节前间隙无明显变化;与T1期比,T4各关节间隙的变化均无明显差异.结论:髁突在关节窝中的位置在Herbst矫治开始时向前下移位,一期功能矫治结束时尤其双期矫治结束时几乎回到了治疗前的位置.     

成人固定正畸治疗前后的口腔健康相关生活质量

目的 探讨错(牙合)畸形及正畸治疗对患者口腔健康相关生活质量(OH-QoL)的影响趋势和程度,分析可能影响患者生活质量的因素.方法 用口腔健康研究量表(OHIP-14中文版)测量不同类型错(牙合)畸形人群治疗前后的口腔健康生活质量.运用统计分析方法比较162例成人患者正畸治疗开始后1个月(T1)、3个月(T2)、6个月(T3)、12个月(T4)、治疗结束拆除矫正器(T5)、治疗结束后6个月(T6)的口腔健康生活质量变化,分析患者OH-QoL的变化趋势和可能的影响因素.结果 量表各领域中Angle Ⅰ类错殆组及Angle Ⅱ类错(牙合)组在心理不适(领域3)得分最高,而Angle Ⅲ类错(牙合)组在功能限制(领域1)得分最高,患者正畸治疗开始后1个月(T1)OHIP-14平均总得分最高(P＜0.05);同时T0与T1 、T1与T2、T2与T3、T4与T5、T5与T6比较差异均有统计学意义(P＜0.05).正畸治疗后(T6)得分低于治疗前(T0)(P＜0.05),即患者治疗后总体OH-QoL比治疗前提高.各条目中,正畸治疗前(T0)“其他人面前觉得不自在”最常给错(牙合)畸形患者带来负面影响,T1“出现过明显疼痛”、“吃什么东西都不舒服”、“在其他人面前觉得不自在”、“感到紧张不安”、“对自己的饮食不满意”给固定正畸患者带来负面影响最大,与正畸治疗前(T0)比较差异均有统计学意义(P＜0.05).结论 口腔健康状况对本研究患者OH-QoL的影响主要体现在心理不适领域,而对于AngleⅢ类错(牙合)畸形患者的负面影响主要体现在功能障碍方面;错(牙合)畸形的固定正畸矫治过程会对患者产生一定的消极影响,治疗后能改善患者口腔健康,提高患者的口腔健康相关生活质量.