正畸治疗影响成人鼻唇角变化的多元回归分析

目的探索正畸治疗对成人鼻唇角变化的影响。方法挑选125例Ⅰ类和轻度Ⅱ类成人患者,83例拔除第一双尖牙,42例不拔牙治疗,测量治疗前后鼻唇角以及有可能影响鼻唇角的软硬组织测量项目。根据鼻唇角改变值、治疗前上切牙突距大小分组,做多元回归分析,找出影响鼻唇角变化的相关因素。结果鼻唇角的变化与上唇突度改变正相关,治疗前上切牙突距在正常值以外时,其鼻唇角的变化与上切牙唇倾度的改变呈正相关。而正常者,其鼻唇角的改变与上切牙唇倾度无相关性。结论鼻唇角的改变与上唇突度有关,治疗前上切牙位置偏离正常越小,鼻唇角的变化越不明显。     

上颌种植支抗辅助自锁矫正器滑动机制探讨

目的:评价上颌种植支抗结合自锁矫正器非拔牙矫治成人边缘病例的效果.方法:选取20例中度拥挤成人病例,分为G1和G2组.G1组10例,上颌种植支抗辅助自锁矫正器治疗,其中男6例,女4例,年龄18～26岁,平均22岁;G2组10例.单纯自锁矫正器治疗,男女各5例,年龄19～25岁,平均年龄23岁.分别测量分析治疗(或治疗第1阶段牙弓排齐整平拥挤解除)前后模型、头颅定位侧位片.采用SAS8.02软件包对模型测量数据及头影测量分析数据进行统计学处理.结果:2组患者治疗(或第1阶段治疗结束)后上颌磨牙区及前磨牙区宽度均扩大,组间差异无统计学意义:2组上颌第一磨牙倾斜角度改变不明显,组间差异无统计学意义.2组治疗(或第1阶段治疗)前后上切牙唇倾度、上切牙凸距均增大.但G1组较G2组更好地控制了上前牙的位置,组问差异有统计学意义.G1组上颌第一磨牙后移,G2组第一磨牙几乎没有移动,组间差异具有统计学意义.结论:上颌种植支抗结合自锁矫正器,可以通过扩大牙弓宽度,增加牙弓后段深度,非拔牙矫治中度拥挤病例.与单纯自锁矫正器治疗相比,更好地维持了上前牙的位置,保持良好的鼻唇关系、上唇突度和侧貌,较传统的口外弓及摆式矫治器具有一定的优势.     

自锁托槽非拔牙矫治下牙列拥挤的临床研究

目的 比较自锁托槽和传统结扎式托槽非拔牙矫治牙列拥挤患者的下牙列变化,探讨自锁托槽解除牙列拥挤的机制.方法 选择26例下牙列拥挤患者,分为自锁组和传统组,每组13例,分别使用自锁托槽(Damon3)和传统托槽(传统结扎式托槽)进行非拔牙矫治.对矫治前后变化进行配对t检验,逐步回归分析拥挤解除机制以及影响下切牙唇倾度改变量的相关因素.结果 矫治前后两组患者下颌尖牙间、前磨牙间牙弓宽度改变量及下切牙唇倾度改变量比较,差异均无统计学意义(P>0.1);矫治后自锁组下颌第一磨牙间牙弓宽度增加1.42 mm、下切牙凸距增加2.66 mm,传统组下颌第一磨牙间牙弓宽度增加0.65 mm、下切牙凸距增加1.57 mm,两组比较,差异有统计学意义(P<0.1).回归分析显示,自锁组对下切牙唇倾度变化量解释的总测定系数高达96.6%,被选入模型的变量为矫治前下颌拥挤度、下颌平面角、第一磨牙间牙弓宽度,以及矫治前后尖牙及第一前磨牙间牙弓宽度改变量.结论 非拔牙矫治下牙列拥挤时,自锁组和传统组患者均出现下切牙唇倾及下牙弓宽度增加,自锁组第一磨牙间牙弓宽度增加量及下切牙前移量较传统组多;自锁组下切牙唇倾度的改变不仅受拥挤度和矫治前牙弓宽度影响,而且受患者自身骨面型及牙弓宽度变化的影响.     

微种植支抗矫治成人骨性Ⅱ类突面型患者的矢状向疗效观察

目的 使用微种植支抗矫治成人骨性Ⅱ类突面型,观察矫治前后矢状向牙齿突度和唇突度变化.方法 选取36例治疗结束的成人骨性Ⅱ类突面型患者,所有患者均是拔除4颗第一前磨牙使用自攻型微种植体作为支抗内收前牙.对治疗前、后头颅侧位片进行测量分析.结果 36例患者的切牙、软组织等测量指标发生显著性变化,上切牙内收(5.98±3.8...     

自锁托槽不拔牙矫治牙弓形态变化的研究

目的探讨和分析采用自锁矫治技术进行不拔牙矫治,治疗前后牙弓形态的变化。方法选择40例牙列拥挤的患者,使用自锁托槽进行不拔牙矫治,对治疗前后的记存模型进行测量,分析矫治前后牙弓形态发生的变化。结果矫治后牙弓长度和宽度均有明显的增加,牙弓宽度增加主要发生在前磨牙区。上颌中切牙唇向前移和第一磨牙发生远中向后移量无显著性差异。牙弓变化与牙列拥挤度显著相关。结论采用自锁矫治技术对拥挤病例进行不拔牙矫治,治疗后牙弓宽度和长度增大,上颌牙弓长度增加由上颌切牙唇向移动和磨牙远中移动共同作用所致。     

MBT技术矫治成年与青少年双颌前突软硬组织改变及相关性分析

目的采用3M unitek MBT托槽拔牙矫治双颌前突的成人及青少年,研究治疗前后软硬组织的变化情况,预测矫治后的疗效。方法选择双颌前突病例30例,成人15例,青少年15例。拔除4个第一双尖牙,使用3MMBT矫治器进行矫治,对矫治前后的38项软硬组织指标进行对比,通过配对t检验评价软硬组织变化的情况。结果经拔牙矫治,成人患者主要发生切牙内收和唇部突度减小,与治疗前相比有显著性差异,但无骨性相关;而青少年软组织面型改变不仅与牙性指标有一定的相关性,而且与下颌骨的生长有关。结论MBT矫治技术矫治成人与青少年双颌前突可以改善面部的软组织平衡,但并没有改变矢状骨骼类型,该技术可以很好地进行垂直向的控制。     

微种植体支抗矫治骨性Ⅱ类错牙合的临床应用8例

目的探索不接受正颌手术骨性Ⅱ类错牙合患者一种可行的矫治方法。方法骨性Ⅱ类错牙合前牙轴略唇倾或前牙轴正常伴轻、中度拥挤患者8例,其中男3例,女5例。用微种植体支抗技术采用拔除上智齿替代常规减数前磨牙矫治使上牙弓整体向远中移动,达到磨牙尖牙Ⅰ类咬合关系,改善软组织侧貌。结果微种植体支抗技术矫治骨性Ⅱ类错牙合可使牙齿达到Ⅰ类咬合关系,解除拥挤,X线头影测量A点、B点无明显变化,上牙弓整体向远中移动,前牙轴唇倾度减少,切牙内收,软组织侧貌有一定改善。结论微种植体支抗技术为不接受正颌手术骨性Ⅱ类错牙合前牙轴略唇倾或前牙轴正常伴轻中度拥挤患者提高了掩饰治疗的效果。     

Angle Ⅱ^1病例矫治前后软硬组织变化及相关分析

目的研究Angle Ⅱ1病例矫治前后面部软硬组织的变化以及软、硬组织变化之间的相关关系.方法对30例Angle Ⅱ1病例矫治前后的X线头颅侧位定位片进行分析,共测量29个硬组织项目和8个软组织项目,用Spss10.0分析矫治前后软硬组织结构的改变及软、硬组织改变之间的相关关系.结果Angle Ⅱ1病例矫治后的硬组织改变主要表现为上下切牙唇倾度的减小,(牙合)平面角的增加及磨牙的伸长;软组织的变化表现为鼻唇角及上下唇角的增大,上唇厚度的增加;切牙唇倾度的减小与唇部软组织的变化之间存在相关关系.结论正畸矫治主要引起上下牙齿的位置变化,对面部骨骼无明显的影响;AngleⅡ1病例的矫治应充分利用拔牙间隙,减小前牙唇倾度,以达到面部软组织外形的和谐.     

青少年双颌前突患者矫治后软硬组织变化的头影测量分析

目的探讨青少年双颌前突患者拔牙矫治后软硬组织的变化及其比例。方法选择拟拔除4颗第一前磨牙矫治的青少年上颌前突患者20例,矫治前后拍X线头颅侧位片,进行X线头影测量,对测量数据进行统计学分析。结果青少年患者矫治后上唇与上切牙内收比例为0.71∶1,下唇与下切牙的内收比例为0.28∶1;切牙的唇倾度减小,SND角增大（t=3.62,P〈0.01）;下颌平面角（t=2.14,P〈0.05）、平面角（t=2.37,P〈0.05）减小;上唇厚度（t=1.35,P〉0.05）、下唇厚度（t=1.45,P〉0.05）无变化;鼻点到H线的距离（t=9.85,P〈0.01）、鼻唇沟到H线的距离（t=3.62,P〈0.01）和颏唇沟到H线的距离（t=3.91,P〈0.01）均减少。结论双颌前突青少年患者侧貌的改善是由于在上、下唇内收的同时下颌骨仍具有向前生长的潜力,下颌平面逆时针旋转以及上唇内收比例比下唇大1倍等共同作用的结果。     

成年人颏部形态与正畸拔牙设计相关性研究

目的：研究成年人边缘型牙列拥挤病例正畸治疗前后X线头颅侧位片,分析颏部形态在颅面部硬组织侧貌形态中的作用,及其是否可作为临床矫治设计中判断是否拔牙的指标。探讨颏部突度对成年人临界拔牙病例矫治设计的影响。方法：选取50例年龄18～34岁已完成正畸治疗的错牙合畸形患者,男22名,女28名。其中25例为拔牙矫治,拔除4个前磨牙,25例采用非拔牙矫治。矫治后侧貌良好,覆牙合覆盖正常,完成头影测量29项,并对50例临床牙牙合畸形拔牙与非拔牙病例正畸治疗前牙颌面硬组织、及软组织治疗前后变化进行对比的回顾性研究,进行成组设计和配对设计t检验。并进行拔牙概率的回顾性分析。结果：治疗前拔牙组与非拔牙组在Pog-NB,U1-NP,SNP测量项目在2组之间存在显著性差异,Pog-NB,U1-NP与拔牙概率存在高度相关关系。拔牙组颏部突度明显小于非拔牙组,上切牙唇倾度明显大于非拔牙组。治疗前、后软组织在2组病例无统计学意义的差异。结论：对于成年人临界拔牙病例制定矫治计划时,为达到良好的侧貌,要综合考虑影响侧貌的鼻唇颏协调一致。颏部突度越小,上切牙唇倾度和突度越大拔牙的概率越大。     

Orthodontics and the upper airway

One of the general aims of orthodontic treatment and of the combination of orthodontics and orthognathic surgery is to achieve good occlusion and aesthetic improvement, especially in cases of severe dentoskeletal deformities. However, on many occasions, the parameters of the upper airways are not taken into account when the aims of conventional treatment are fulfilled. Patients with obstructive alterations during sleep represent for the orthodontist a type of patient who differs from the normal; for them, treatment should include the objective of improving oxygen saturation. Here, functional considerations should outweigh purely aesthetic ones. It is important, when making an orthodontic, surgical or combined diagnosis for a patient, to bear in mind the impact that treatment may have on the upper airways. Good aesthetics should never be achieved for some of our patients at the expense of diminishing the capacity of their upper airways.     

Effects of age and gender on upper airway, lower airway and upper lip growth

The aim of the present retrospective study was to evaluate the influence of age and gender on upper and lower airway width and upper lip length. In this study, 390 lateral cephalograms were divided into 13 age groups (ranging from 6 to 18 years) and were analyzed. The intergroup differences were analyzed using a MANOVA (Multivariate Analysis of the Variance), and the intragroup differences were analyzed using an ANOVA (Analysis of the Variance) and Tukey's test. The results of the present study indicated that although the airway width and the upper lip length increased with age, the lower airway width exhibited variable growth between the ages of six and eighteen years. The airway width was significantly greater in females than males, whereas the upper airway width was similar between these two genders. The lip length was significantly shorter in females than males. The lower airway width and upper lip length were significantly different between males and females, whereas the upper airway width was similar for the genders. The upper airway width and upper lip exhibited incremental growth between the ages of six and eighteen years. The upper lip closely followed the growth pattern of the upper airway width; the growth plateaued between the ages of 6 and 9 years, increased from 9 to 16 years and plateaued from 16 to 18 years.     

Dental erosion and upper gastrointestinal disorders

The orodental status, particularly dental erosions, of 109 patients with upper gastrointestinal symptoms was examined. In 44 patients, the underlying pathosis was associated with increased acid output in the stomach (reflux esophagitis or duodenal ulcer), while in 48 patients who underwent cholecystectomy, the duodenogastric reflux was alkaline. In 17 patients with gastric ulcer, the gastric secretion was usually normal. The diagnoses were made with gastroscopy. Seven patients with dental erosion were found, and they all came from the group of 35 dental patients with reflux esophagitis or duodenal ulcer. No erosions were seen in the other diagnostic groups (F = 0.02). Thus, gastrointestinal disorders with increased output of gastric acid may be linked with dental erosions. The finding emphasizes the need for accurate diagnosis and appropriate treatment of patients with upper gastrointestinal symptoms in order to avoid irreversible lesions in the teeth.     

Relationship between upper body obesity and periodontitis

Upper body obesity, related to visceral fat accumulation, is known to increase the risk of various adult diseases, especially type 2 diabetes and cardiovascular disease. This study was conducted to clarify the relationship between upper body obesity and periodontitis. We studied 643 apparently healthy, dentulous Japanese adults who attended programs at Fukuoka Health Promotion Center. Waist-hip ratio, body-mass index (BMI), and body fat were significant risk indicators for periodontitis after adjustment for known risk factors (p < 0.002). Subjects were divided into four BMI (or body fat) categories. In only the subjects with high waist-hip ratio, higher categories of BMI (or body fat) significantly increased the adjusted risk of periodontitis, compared with subjects with low waist-hip ratios and the lowest category of BMI (or body fat). The reported relationship between cardiovascular disease and periodontitis should be reconsidered, since abdominal adiposity or visceral fat can be related to both diseases.     

Subjective and objective perception of upper incisors

The purpose of this study was to evaluate the subjective judgment (SJ) of patients on their own dental appearance and to correlate the results with objective measurements (OM) of their dentition concerning the appearance of the upper incisors. Seventy-five participants (30 men and 45 women) with normal well-being were included in the study. In a questionnaire they judged the appearance of their upper incisors. Furthermore, OM were evaluated by the investigator with regard to the following points: (i) absolute length of the upper central incisors, (ii) their length exposed during laughing, (iii) width-to-length ratio of central incisors and (iv) the proportion between the width of the lateral and central incisors. The subjective results were registered on visual-analogue scales. For the objective results standardized photographs were taken. No gender dependent differences could be found for the objectively measured parameters (median): OM1, 10.7 mm; OM2, 8.1 mm; OM3, 0.81; OM4, 0.79. However, significant correlations between subjective and objective results (SJ1/OM1, SJ2/OM2, SJ3/OM3) could be shown for men, but not for women. The maximum of the calculated regression-curves for men reflect 'golden standard values' well known from the literature. The degree of satisfaction concerning appearance of anterior incisors in accordance with golden standard values is higher for men than for women.