Uvulo-glossopharyngeal dimensions in non-extraction, extraction with minimum anchorage, and extraction with maximum anchorage

The aim of this study was to investigate upper respiratory airway dimensions in non-extraction and extraction subjects treated with minimum or maximum anchorage. Lateral cephalograms of 39 Class I subjects were divided into three groups (each containing 11 females and 2 males) according to treatment procedure: group 1, 13 patients treated with extraction of four premolars and minimum anchorage; group 2, 13 cases treated non-extraction with air-rotor stripping (ARS); and group 3, 13 bimaxillary protrusion subjects treated with extraction of four premolars and maximum anchorage. The mean ages of the patients were 18.1 ± 3.7, 17.8 ± 2.4, and 15.5 ± 0.88 years, respectively. Tongue, soft palate, hyoid position, and upper airway measurements were made on pre- and post-treatment lateral cephalograms and the differences between the mean measurements were tested using Wilcoxon signed-ranks test. Superior and middle airway space increased significantly (P < 0.05) in group 1. In group 2, none of the parameters showed a significant change, while in group 3, middle and inferior airway space decreased (P < 0.01). The findings show that extraction treatment using maximum anchorage has a reducing effect on the middle and inferior airway dimensions.     

The use of an osseointegrated implant for orthodontic anchorage to a Class II Div 1 malocclusion.

This case report describes the use of an osseointegrated implant to maximize anchorage in a 24-year-old female orthodontic patient with an Angle Class II, Division 1 malocclusion. Preadjusted edgewise appliance therapy was performed by extraction of only the maxillary first premolars. The osseointegrated implant was placed in the median-sagittal region of the hard palate for maximum orthodontic anchorage and connected to maxillary first molar bands via a transpalatal arch. Total treatment time was 2 years and 8 months. Cephalometric superimposition revealed the achievement of maximum molar anchorage in the maxilla, resulting in satisfactory occlusal and facial improvements. Histological analysis of the implant-bone interface demonstrated that the fixture was successfully osseointegrated. In conclusion, the osseointegrated implant placed in the median-sagittal palate was shown to be an effective orthodontic system that can be used clinically as a rigid intraoral anchorage.     

种植体支抗对高角拔牙病例垂直向控制的颌（牙合）面改变

目的探索以微螺钉种植体支抗压低磨牙对高角拔牙病例进行后牙垂直向控制的临床应用。方法20例矢状骨面型Ⅰ类或Ⅱ类的高角拔牙病例,采用MBT直丝弓矫治技术,于第一、第二磨牙间颊侧植入MAS微螺钉种植体作为垂直向支抗对磨牙实施持续轻力压低,同时微螺钉也作为矢状向支抗结合滑动法回收前牙。结果治疗后X线头影测量分析结果显示：上颌磨牙平均压低2．27mm; MP／SN角平均减小2．8°,SNPo角平均增加1．34°;面角（NsPos／FH）角平均增加3．18°;差异均有统计学意义（P〈0．001）。结论微螺钉种植体支抗压低磨牙能够为高角拔牙病例提供有效的后牙垂直向控制,患者软组织侧貌显著改善。     

强支抗拔牙对双颌前突青少年上气道的影响

目的: 利用锥形束CT（cone beam computed tomography, CBCT）从三维方向上研究强支抗拔牙内收对双颌前突青少年上气道的影响。方法: 回顾分析本院50例予以强支抗拔牙治疗的双颌前突青少年治疗前、后的CBCT资料,测量治疗前、后上气道的变化。采用SPSS 17.0软件包对数据进行配对t检验和Pearson相关性分析。结果: 治疗后,口咽和咽下的体积、平均截面积、最小截面积显著减小(P<0.001);口咽、咽下的横截面形态更趋于椭圆形(P<0.001)。Pearson相关分析发现,下颌切牙内收、舌骨后移与咽下气道平均截面积减少有显著相关性(P<0.05);上、下颌切牙内收与舌骨后移有显著相关性(P<0.01)。结论: 对于青少年双颌前突患者,制订治疗计划时应兼顾上气道形态,避免造成上气道狭窄,影响患者正常发育。     

微螺钉种植体支抗对高角非开拔牙病例后牙垂直向控制的临床初步研究

目的初步探索采用微螺钉种植体支抗压低磨牙对高角非开[牙合]拔牙病例进行后牙垂直向控制。方法7例矢状骨面型Ⅰ类或Ⅱ类的高角非开[牙合]病例，减数双尖牙矫治，MBT直丝弓矫治技术，上下颌第一、二磨牙间植入MAS微螺钉种植体作为垂直向支抗对磨牙实施持续轻力压低，结合摇椅弓控制前牙覆[牙合]，种植体同时也作为矢状向支抗用于滑动法回收前牙。结果所有患者拔牙间隙全部关闭后的治疗结果显示：上颌磨牙平均压低2．43mm，MP／SN角平均减小3．35°，差异具有极显著性（P〈0．001）；下颌磨牙平均压低1．79mm，前牙覆[牙合]平均减小2．63mm，差异均具有显著性（P〈0．01）。结论微螺钉种植体支抗压低磨牙可以作为一种新的垂直向控制手段为高角非开[牙合]拔牙病例提供有效的后牙垂直向控制。     

微钛板支抗在远中移动磨牙中的临床应用

目的介绍微钛板支抗在远中移动磨牙中的临床效果及特点。方法选择7名应用微钛板矫治患者,分析其治疗前后头颅侧位片、模型等临床资料,测量磨牙远中移动量。结果 1)利用微钛板远中移动磨牙效果明显,最多可达3.5mm。2)中轻度牙列拥挤患者利用微钛板远中移动磨牙获得间隙排齐整平牙列,不需拔除双尖牙便可达到较理想的治疗效果。结论微钛板作为一种绝对支抗,远中移动磨牙有效而稳定,同时可避免常规拔牙矫治,维持上下颌第二磨牙间的全部牙齿和牙弓的连续性。     

Effectiveness of the transpalatal arch in controlling orthodontic anchorage in maxillary premolar extraction cases: A systematic review and meta-analysis

Objective:To evaluate the effectiveness of the transpalatal arch (TPA) as an anchorage device in preventing maxillary molar mesialization during retraction of the anterior teeth after premolar extraction.Materials and Methods:This systematic review intended to include patients indicated for upper premolar bilateral extraction and subsequent retraction of anterior teeth, considering the use of TPA as an anchorage tool in one of the treatment groups. The search was systematically performed, up to April 2015, in the following electronic databases: Medline, Embase, and all evidence-based medicine reviews via OVID, Cochrane Library, Scopus, PubMed, and Web of Science. Risk of bias assessment was performed using Cochrane''s Risk of Bias Tool for randomized clinical trials (RCTs) and Methodological Index for Nonrandomized Studies (MINORS) for non-RCTs.Results:Fourteen articles were finally included. Nine RCTs and five non-RCTs presented moderate to high risk of bias. Only one study investigated the use of TPA in comparison with no anchorage, failing to show significant differences regarding molar anchorage loss. A meta-analysis showed a significant increase in anchorage control when temporary anchorage devices were compared with TPA (mean difference [MD] 2.09 [95% confidence interval {CI} 1.80 to 2.38], seven trials), TPA + headgear (MD 1.71 [95% CI 0.81 to 2.6], four trials), and TPA + utility arch (MD 0.63 [95% CI 0.12 to 1.15], 3 trials).Conclusion:Based on mostly moderate risk of bias and with some certainty level, TPA alone should not be recommended to provide maximum anchorage during retraction of anterior teeth in extraction cases.     

自攻型微钛钉种植体增强磨牙支抗的临床应用研究

目的　介绍自攻型微钛钉种植体用于正畸支抗的临床经验 ,评价该型种植体作为强支抗的有效性。方法　在 6 7例采用自攻型微钛钉种植体作为支抗的临床病例中 ,选择 5例II类骨型、上牙弓前突或双牙弓前突患者 ,矫治设计上颌均为减数双侧第一前磨牙 ,支抗设计为磨牙强支抗。内收前牙阶段的治疗应用自攻型微钛钉支抗种植体 ,种植体植入上颌第一恒磨牙与第二前磨牙颊侧根尖部之间的牙槽间隔 ,以每侧 15 0～ 2 0 0g力滑动法内收前牙。比较内收前后头颅X线侧位片 ,测量前牙内收情况和磨牙支抗的变化。结果　 5例牙弓突度均得到明显改善 ,切牙切缘平均内收 6 4mm ,支抗磨牙平均前移 0 3mm ,均获得磨牙强支抗的效果。治疗过程中种植体均保持了稳定 ,种植体周围软组织健康。结论　自攻微型钛钉种植体能作为稳定的骨性正畸支抗 ,代替口外力的使用 ,起到磨牙强支抗的效能。该型种植体具有操作简单灵活 ,可即刻加力 ,不依赖患者合作的优点     

正畸治疗中磨牙的拔除和保留(九)——微型自攻种植钉支抗的初步应用

目的：探讨种植体支抗在涉及磨牙拔除和保留的正畸病例中的应用效果。方法：在7例涉及磨牙拔除和保留病例中应用微型自攻种植钉以增强后牙或前牙的支抗。结果：7例矫治病例所应用的种植体均显示明显的支抗效果。结论：微型自攻种植钉在矫治严重和复杂的错殆畸形病例中是有效增强支抗的手段。     

压低辅弓增加后牙支抗的临床应用研究

目的：研究压低辅弓在尖牙远移过程中增加后牙支抗的临床效果。方法：选择需要强支抗,上颌减数第一双尖牙的患者30例,随机分为研究组和对照组,每组15例,研究组采用上颌NANCE弓,配合0.017＂×0.025＂TMA压低辅弓,30°后倾弯,150g力远中牵引尖牙至第二双尖牙,对照组采用上颌NANCE弓,配合口外弓。将矫治前后的头颅侧位定位片和三维模型进行对比分析,其变化量进行独立t检验。结果：研究组在尖牙远中移动的过程中,右侧上颌第一磨牙近中移动0.77mm,近中腭向扭转8.9°;左侧上颌第一磨牙近中移动约0.72mm,近中腭向扭转8.8°;右侧上颌尖牙远中移动约5.5mm,远中腭向扭转10.3°;左侧上颌尖牙远中移动约5.71mm,远中腭向扭转15.1°。与对照组相比无显著性差异。且第一磨牙在前后向的位移与尖牙的位移和磨牙的扭转存在高度相关性。结论：30°后倾弯的压低辅弓在远中移动尖牙过程中,可以为后牙提供强支抗。     

Screw-type implants used as anchorage for lingual orthodontic mechanics: a case of bimaxillary protrusion with second premolar extraction

We present a case of bialveolar protrusion treated with second premolar extraction. The patient did not agree to placement of a visible labial appliance or to the use of a headgear. Therefore, a lingual orthodontic appliance was used, and titanium screws were placed into the buccal alveolar bone for orthodontic absolute anchorage and support of en masse retraction of the anterior teeth. Cephalometric superimposition and panoramic radiographs showed little anchorage loss and good occlusion at the end of treatment. Our results suggest that lingual treatment combined with a screw-type implant anchorage provides reliable and comfortable results for those seeking invisible treatment.     

Extraction treatment of a Class II division 2 malocclusion with mandibular posterior discrepancy and changes in stomatognathic function

This case report describes the successful extraction treatment of a Class II division 2 malocclusion with mandibular posterior discrepancy and a congenitally missing maxillary lateral incisor on the left side. The posterior space in the mandibular arch was small, and the mandibular second molars were impacted, with distal tipping. The discrepancies in the maxillary and mandibular arches were resolved by extraction of the maxillary lateral incisor on the right side and the mandibular second premolars on both sides. The mesial movement of the mandibular first molars occurred appropriately, with the second molars moving into an upright position. A lip bumper was used with a preadjusted edgewise appliance in the maxillary dentition to reinforce molar anchorage and labial movement of the retroclined incisors. Despite the extraction treatment, a deep bite could be corrected without aggravation as a result of the lip bumper and utility arch in the mandibular dentition. Thus, an Angle Class I molar relationship and an ideal overbite were achieved. The occlusal contact area and masticatory muscle activities during maximum clenching increased after treatment. The maximum closing velocity and the maximum gape during chewing increased, and the chewing pattern changed from the chopping to grinding type. The findings in the present case suggest that the correction of a deep bite might be effective for improving stomatognathic function.     

微型种植体支抗对拔牙矫治病例的垂直向控制研究

目的：评估利用微型种植体支抗关闭间隙对拔牙矫治病例的垂直向控制情况.方法：回顾研究26例安氏Ⅱ类错（牙合）畸形或安氏Ⅰ类伴双颌前突,拔除4颗前磨牙矫治的病例.根据采用不同的支抗方式,把所选病例分为A、B两组,每组13例.A组采用微型种植体支抗,B组采用Nance托＋横腭杆（TPA）增强支抗,两组病例均利用滑动法关闭拔牙间隙.分析比较两组病例治疗前后X线头影测量的变化.结果：经T检验显示两组病例SN-MP、OP-SN、ANS-Me、U 1-PP、U6-PP、Yaxis之间的变化具有统计学意义（P＜0.05）.结论：与传统的Nance托联合TPA作为支抗相比,微型种植体支抗关闭拔牙间隙,能对患者的垂直向支抗提供良好的控制.     

Soft tissue changes after upper premolar extraction in Class II camouflage therapy

The long-term effect on the facial profile has led many orthodontists to attempt Class II division I camouflage treatment without extraction. Practitioners may cite "dishing in the face" as a reason not to extract. Previous investigations have evaluated the soft tissue response after maxillary incisor retraction, but few have evaluated the effect of maximum retraction in skeletal mandibular deficient Class II patients with essentially no crowding. Twenty-seven Class II division I Caucasian patients with a mean of 8.62 mm of overjet, little to no arch length deficiency, and maximum anchorage requirements were treated with extraction of only maxillary first premolars. Pre- and posttreatment lateral cephalograms were taken. Using several skeletal and soft tissue cephalometric measures, the treatment changes were assessed. The mean maxillary incisor retraction was 5.27 mm, the mean maxillary lip retraction was 2.03 mm, and the mean mandibular lip retraction was 1.23 mm. All the patients finished with good overall facial harmony and balance. The maxillary first premolar extraction for orthodontic camouflage may be a viable treatment option, especially if the patient has full upper lips and only a relative mandibular deficiency.     

Biomechanical aspects of the space gaining therapy according to Cetlin

The non extraction technique according to N. Cetlin for the treatment of crowded and protrusive dentitions in class I and class II malocclusions is assessed. The intent of this article is to outline the approach to non extraction treatment with the following major clinical objectives: 1) space gaining in both maxillary and mandibular arches; 2) anchorage preservation throughout treatment and 3) intrusion of the maxillary incisors.     

Atypical orthodontic extraction pattern managed by differential en-masse retraction against a temporary skeletal anchorage device in the treatment of bimaxillary protrusion

This report introduces an innovative treatment approach of selecting atypical and unconventional teeth for orthodontic extraction without compromising the quality of treatment outcomes by using temporary skeletal anchorage devices in patients with bimaxillary protrusion. Both patients introduced in this report had solid Class I molar relationships with bimaxillary anterior protrusion without facial or dental midline asymmetry. Their chief concerns were significant facial convexity, which conventionally requires the extraction of all 4 first premolars. However, 3 second premolars and 1 first premolar were removed in the first patient, and 2 second premolars and 2 first premolars were removed in the second patient. All second premolars extracted had previously had root canal treatment and large prosthodontic restorations, which resulted in a compromised short lifespan of the teeth relative to the natural dentition. To manage these cases of asymmetric extraction space in a symmetric dental and skeletal environment, 2 mini-implants were placed in the posterior maxillary interradicular spaces, 1 on each side. Despite the unusual asymmetric extraction of teeth, superimposition of the pretreatment and posttreatment cephalometric tracings shows excellent treatment outcomes of facial convexity reduction by asymetric maximum retraction of the anterior teeth with no change in the molar relationships.     

Immediate Loading of Palatal Implants in Stillgrowing Patients: a Prospective, Comparative, Clinical Pilot Study

OBJECTIVE: The objective of this prospective, comparative study was to evaluate the potential of allowing immediate (within 72 hours) loading of palatal implants used for maximum orthodontic anchorage. This is in contrast to the standard protocol calling for a healing period of 12 weeks. MATERIALS AND METHODS: Sixteen patients with a mean age of 14.22+/-1.37 years for whom orthodontic treatment with maximum anchorage was indicated were randomized into two groups. In the SB (immediate loading) group (n=8, mean age 14.15+/-1.2 years), the implants were employed to provide maximum anchorage for a 1.2 x 1.2 mm TPA wire in combination with a molar band within 72 hours of insertion. In the KB (conventional loading) group (n=8, mean age 14.30+/-1.57 years), the implants were not used for maximum anchorage until a 12-week healing period had elapsed. Patients in both groups with implants that were clinically unstable after insertion were excluded from the study. After conclusion of the treatment, the implants were explanted and embedded using the sawing-grinding technique after Donath. Bone-implant contact (KIK) was analyzed using Bioquant Osteo software version 7.10.10. RESULTS: The objective of the orthodontic treatment, to achieve maximum anchorage of the first molars, was achieved in both groups. In the SB group, the mean bone-implant contact was 55.0%+/-21.6. In the KB group, the mean bone-implant contact was 73.1%+/-19.8. With a p-value of 0.1661, the difference between the bone-implant contact values was not statistically significant. CONCLUSION: The results of our clinical study demonstrate that when implants are clinically stable following insertion, it seems that a 12-week healing phase during which the implants are not loaded leads to a non-statistically significant improvement in osseointegration.     

Orthodontic anchorage--Evidence-based evaluation of anchorage capacity and patients' perceptions

Orthodontic anchorage is the ability to resist unwanted reciprocal forces and reinforcement of anchorage by supplementary appliances, in or outside the mouth, is often needed to obtain successful results. In the last 10 years, interest in appliances that use implants has been growing. Successful orthodontic treatment demands effective methods and systematic evaluation of different treatment approaches is therefore essential. Several studies on the efficiency of various anchorage systems have been published, but a critical appraisal or interpretation of evidence that systematically considers validity, results, and relevance has not been made. Analysis of treatment modalities must also include patients' perceptions and potential side-effects. The overall aim of this thesis was to evaluate a new anchorage technique that incorporates osseointegration and compare it with conventional methods concerning effects on tooth movements in adolescents and their acceptance and experience of the additional surgical procedures that osseointegration involves. The following anchorage systems were analyzed: Onplant system, Orthosystem implant, headgear and transpalatal bar. This thesis was based on four studies: Paper I systematically reviewed the efficiency of orthodontic anchorage systems and interpreted the methodological quality of the selected studies from an evidence-based perspective. The literature search spanned January 1966 - December 2004 and was later extended to July 2007. Paper II, a methodological study involving 60 adolescent patients, examined the validity and reliability of a new questionnaire for assessing adolescent patients' perceptions of orthodontic treatment. The questionnaire was based on focus group interviews. Papers III and IV were randomized controlled trials involving 120 adolescent patients in orthodontic treatment. Paper III evaluated and compared adolescent patients' perceptions of premolar extractions and surgical placement of Onplants and Orthosystem implants. Paper IV compared anchorage capacities of the four systems. These conclusions were drawn: The scientific evidence, found in the review, was too weak to evaluate the efficiency of various anchorage systems (conventional and osseointegrated) during space closure after premolar extraction, and most studies have quality problems. Future randomized controlled trials are recommended. The new questionnaire, developed from focus group interviews, had overall acceptable to good reliability and high face validity. It can therefore be recommended for use in the assessment of adolescents' experiences of orthodontic treatment. Pain intensity after surgical placement of an Orthosystem implant was less than after Onplant installation and premolar extraction. Pain intensity after Onplant installation and premolar extractions were comparable. With respect to pain intensity, discomfort, and analgesic     

种植支抗及J钩在Tweed矫正理念中的应用研究进展

［摘要］ 正畸治疗中正确的支抗设计、控制和应用是取得良好矫正效果的重要因素,传统的Tweed方丝弓矫正技术中系统的支抗预备在各类错牙合正畸技术的发展起到了关键的作用。现今临床上已有多种增强支抗的装置可供正畸医师选择,但仍不能起到绝对支抗的效果。因此,临床中伴有严重拥挤、深覆盖等不希望丢失支抗的病例,牙齿排齐和侧貌的改善受到影响,虽然口外装置是加强支抗的有效方法,但由于操作较繁复,在临床上患者常有排斥的心理,近年来正畸种植体支抗的出现,较好地解决了临床支抗选择的问题。但对于一些高角骨性Ⅱ类患者,使用传统口外支抗还是种植支抗,能起到患者面型最大改善的作用,Tweed理念中的支抗预备是否可以经由种植支抗的多方应用而起到更为符合现今正畸医师的操作理念的作用,这是现今临床中我们关注的问题。     

安氏Ⅱ类1分类成年女性患者强支抗内收前牙后上气道及周围结构变化的研究

目的 评价安氏Ⅱ类1分类患者采用强支抗内收前牙矫治前后对上气道以及周围结构的改变.方法 筛选安氏Ⅱ类1分类成年女性患者9例,拍摄锥形束CT(cone-beam computed tomography,CBCT),采用Dolphin Imaging 11.5软件,对照研究分析患者经拔牙矫治前后上气道以及舌骨位置的相关指标.结果 安氏Ⅱ类患者经拔牙矫治后上颌前牙大幅度内收,下切牙唇倾度减小(P＜0.05),下颌平面角以及上颌第一磨牙位置未见明显变化.上气道鼻咽部、口咽部、喉咽部体积,面积,上下界宽度以及气道最小横截面积均未见显著性变化(P＞0.05),而舌骨位置在垂直向上舌骨点位置没有变化,双侧舌骨体点至水平面[G(L)-X与G(R)-X]距离增大,差距有显著意义(P＜0.01)矢状向上舌骨点至颏后点(H-RGN)距离减小,舌骨体点至冠状面(H Z)以及右侧舌骨体点到冠状面[G(R)-Z]距离增大,差距有统计学意义(P＜0.05).结论 安氏Ⅱ类1分类成年女性错(牙合)畸形患者在拔除四颗第一前磨牙并使用强支抗内收前牙后使上下颌前牙大幅度内收,面型得到较大改善,但在治疗前后患者鼻咽部、口咽部、喉咽部气道的高度、宽度、体积、表面积并未出现明显改变.舌骨未出现明显的整体性移动.