种植体支抗在前方牵引中的应用

种植体作为一种新的支抗手段，在前方牵引中的应用能有效促进上颌骨向前生长，减少了传统的前方牵引口内牙和腭支抗引发的一些不利的牙性变化，增加了骨性效应。特别是比较严重的或无法建立有效的牙性支抗的骨性Ⅲ类错（牙合），种植体支抗更具有优势。本文就种植体支抗在前方牵引中的应用作一综述。     

微种植体前方牵引在矫治上颌发育不足引起的骨性Ⅲ类错■中的研究进展

上颌前方牵引常被用于矫治生长发育期上颌骨发育不足引起的骨性Ⅲ类错■畸形,其能够有效地引导上颌向前生长,改善患者上颌骨发育不足的情况。近年来,随着技术的发展,运用微种植体联合上颌前方牵引矫治骨性Ⅲ类错■的治疗方法越来越得到认可。该文将对微种植体联合上颌前方牵引治疗中的植入位点、牵引力值及方向、治疗时机、治疗效果的稳定性等方面进行简要综述。     

前方牵引矫治骨性Ⅲ类错20例临床体会

目的应用上颌前方牵引矫治器矫治骨性Ⅲ错。方法应用上颌前方牵引矫治器对替牙期16例,恒牙早期4例的骨性Ⅲ类错进行矫治。结果上颌前方牵引矫治器具有促进上颌骨向前发育,抑制下颌骨向前发育的作用。患者矫治前后的侧貌得到明显改善,并且建立了基本正常的前牙覆、覆盖关系。结论上颌前方牵引矫治器对矫治上颌发育不足的骨性Ⅲ类错有明显效果。     

钛板种植体上颌前方牵引治疗的初步应用研究

目的初步分析利用钛板种植体支抗前方牵引治疗骨性Ⅲ类上颌后缩畸形的疗效,探索钛板种植体支抗前方牵引的适应证及应用特点。方法对2例以上颌后缩为主的骨性Ⅲ类患者,在上颌唇侧侧切牙和尖牙间植入微型钛板种植体,植入一个月后开始利用种植体前方牵引治疗。治疗前后拍摄头颅定位侧位片,并进行头影测量分析。结果两名患者在前方牵引治疗后SNA角、ANB角、Wits值、NA/PA角、上颌基骨长度、骨性侧貌突度明显增大;反覆盖减小;而U1/SN、U1/PP在治疗前后无显著变化。结论采用钛板种植体作支抗前方牵引上颌骨能有效促进上颌骨的向前生长,上前牙唇倾度增加很小,体现出稳定可靠的骨性支抗效果。     

腭部不同类型快速扩弓配合前方牵引的应用进展

上颌快速扩弓配合前方牵引面具是早期治疗上颌骨发育不足的骨性安氏Ⅲ类错常见方法之一。传统方法常用牙和黏膜支持式装置治疗替牙期及恒牙早期的骨性Ⅲ类患者,随着种植支抗的发展,种植钉被广泛应用于正畸治疗中,展示出稳定的骨性支抗效果。本文将对腭部不同类型快速扩弓配合前方牵引技术作一简要综述,为临床治疗提供参考。     

牙支抗式与骨支抗式矫治早期骨性Ⅲ类错(牙合)畸形的效果比较

目的:比较应用牙支抗式(FM)与前腭旁正中区域微螺钉种植支抗(MSI/FM)的Hyrax结合上颌前方牵引装置矫治替牙期及恒牙列早期上颌骨发育不足的骨性Ⅲ类错畸形的效果。方法:将18例上颌骨发育不足的早期骨性Ⅲ类错畸形患者随机分为2组(n=9),分别采用FM的Hyrax结合上颌前方牵引治疗方案(FM)和用MSI/FM支抗的Hyrax结合上颌前方牵引装置的治疗方案(MSI/FM)。两组均以交替快速上颌骨扩张和收缩(Alt-RAMEC)的方式结合双侧约3.92 N、相对于平面向前、向下30°的前方牵引力,纠正骨性Ⅲ类错畸形。通过Lortho头影测量软件对两组矫治前后的头颅侧位片进行描画重叠并分析矫治前后头影测量指标的变化。结果:矫治后两组患者的软组织侧貌和Ⅲ类错均得到明显改善,MSI/FM组患者的平均矫治时间较短。FM组在以下测量指标中T0和T1之间存在显著差异(P<0.05):SNA、ANB、Co-A、Co-Gn、 Wits、S-Go、Na-Me、MP、 U1-SN、UADH、LADH、Overjet、UL-EP增加,U1-L1减小。MSI/FM组在以下测量指标中T0和T1之间存在显...     

前方牵引与FrankelⅢ矫治反(牙合)的临床比较研究

目的:对比研究前方牵引与FrankelⅢ矫治反(牙合)的临床效果,为临床方法的选择提供指导.方法:前牙反(牙合)患者分别应用前方牵引治疗(16例)和Frankel功能矫治(12例),将两组治疗前后头影测量结果的差异进行统计学分析.结果:两种矫治方法对上颌前牙唇倾度、SNA角及下颌平面角的改变有显著性差异,前方牵引主要导致上颌骨前移.结论:对于上颌发育不足的骨性反(牙合),宜早期开始前牵治疗.     

上颌前方牵引矫治器在骨性Ⅲ类错矫治中的作用

目的　探讨上颌前方牵引矫治器在骨性Ⅲ类错牙合矫治中的作用机理。方法　应用上颌前方牵引矫治12例安氏Ⅲ类骨性错牙合的患者 ,比较矫治前后的临床表现及X线头影测量的结果。结果　患者矫治前后的侧貌得到改善 ,并建立了正常前牙覆牙合、覆盖关系和后牙中性关系。治疗前后的SNA角、ANB角、1-SN角、MP -SN角有显著性的差异。结论　上颌前方牵引矫治器有促进上颌骨向前发育、抑制下颌骨向前发育的效果 ,从而调整上下颌骨的相对位置关系 ,使骨性Ⅲ类错牙合得到矫治     

上颌前方牵引矫治器在骨性Ⅲ类错(牙合)矫治中的作用

目的探讨上颌前方牵引矫治器在骨性Ⅲ类错牙合矫治中的作用机理.方法应用上颌前方牵引矫治12例安氏Ⅲ类骨性错牙合的患者,比较矫治前后的临床表现及X线头影测量的结果.结果患者矫治前后的侧貌得到改善,并建立了正常前牙覆牙合、覆盖关系和后牙中性关系.治疗前后的SNA角、 ANB角、 1-SN角、 MP-SN角有显著性的差异.结论上颌前方牵引矫治器有促进上颌骨向前发育、抑制下颌骨向前发育的效果,从而调整上下颌骨的相对位置关系,使骨性Ⅲ类错牙合得到矫治.     

两种快速扩弓方式联合前方牵引治疗骨性Ⅲ类错的疗效差异分析

目的比较骨支抗方式和牙支持方式快速扩弓联合前方牵引治疗上颌发育不足的骨性Ⅲ类错的疗效差异。方法回顾性选取2020年8月至2022年6月于南京大学医学院附属口腔医院·南京市口腔医院正畸科进行快速扩弓联合前方牵引治疗的处于替牙列中晚期或恒牙列早期的骨性Ⅲ类错伴上颌发育不足的患者26例。患者分为2组(每组13例):骨支抗方式组使用骨支抗方式快速扩弓联合前方牵引装置进行矫治, 其中男性4例, 女性9例, 年龄(10.2±1.7)岁;牙支持方式组使用牙支持方式快速扩弓联合前方牵引装置进行矫治, 其中男性5例, 女性8例, 年龄(10.1±1.0)岁。于矫治前后头颅侧位X线片上测量矢状向线性指标[Y-Is距和Y-Ms距(分别为上切牙切缘点、上颌第一恒磨牙近中接触点至垂直参考轴的距离)、上下颌磨牙相对距离、前牙覆盖等]10项、垂直向线性指标[PP-Ms距(上颌第一恒磨牙近中接触点至腭平面的距离)等]6项和角度指标[SN-MP角(前颅底平面与下颌平面相交的上外角)、U1-SN角(上中切牙长轴与前颅底平面相交的下内角)等]8项, 于矫治前后锥形束CT上测量冠状向指标(上颌左侧和右侧第一磨牙倾斜度等)6项...     

骨种植钉前牵引对骨性Ⅲ类错患者软硬组织侧貌的影响

目的研究采用骨种植钉前牵引对骨性Ⅲ类错患者软、硬组织侧貌的改变。方法选取18例需行前牵引矫治的生长发育期骨性Ⅲ类错患者,采用双侧上颌颧牙槽嵴植入骨种植钉配合面框式前牵引,平均治疗时间为9个月,力值为（3.5±0.1）N。治疗前后头影测量采用Legan&Burstone软组织分析法以及相关硬组织测量,分析比较患者治疗前后软、硬组织变化情况。结果所有患者Ⅲ类错均得到改善,鼻底趋于丰满,颏部顺时针旋转,侧貌由凹面型变为直面型,下唇突度减小,软组织上下面高比、鼻唇角、上唇突度及颏唇沟深度无明显变化。上前牙无明显变化,下前牙舌倾,上颌骨向前生长,A点前移,SNA、ANB增大;SNB减小,下颌骨顺时针旋转。结论骨种植钉前牵引可促进上颌生长,使面中份丰满,且对上颌前牙轴倾度无影响,从而纠正骨性Ⅲ类错。     

钛板种植体支抗前方牵引治疗骨性前牙反(牙合)的临床分析

目的探讨利用钛板种植体支抗前方牵引治疗骨性安氏Ⅲ类上颌后缩畸形的效果。方法8例以上颌后缩为主的骨性安氏Ⅲ类错[牙合]畸形患者，男性4例，女性4例，11～14岁。于上颌侧切牙和尖牙间唇侧植入钛板种植体，1个月后开始前方牵引治疗，对牵引前后头颅侧位X线片的21项测量项目进行分析，对测量结果进行配对t检验。结果SNA角、ANB角、Wits值、NA—PA角、Max-Lth、A-NP距在牵引治疗后均增大，与治疗前相比差异有统计学意义（P〈0．01）；ANS—Me距、IsFHp距、Ms．FHp距、A．FHp距均增大，与治疗前相比差异有统计学意义（P〈0．05）；L1-AP距、OJ、AB—NP角在牵引治疗后均减小，与治疗前相比差异有统计学意义（前1项P〈0．05，后2项P〈0．01）；SNB角、MP-SN角、PP-SN角、U1-PP角、U1-SN角、U1-AP角、L1-MP角、ANS—Me／N—Me比值治疗前后差异均无统计学意义（P〉0．05）。结论钛板种植体支抗能前方牵引上颌骨并有效促进上颌骨向前生长，是稳定可靠的骨性支抗。     

Use of intermaxillary forces in early treatment of maxillary deficient Class III patients: Results of a case series

IntroductionThe early treatment of Class III malocclusion with a protraction facemask can produce forward movement of the maxilla but is generally associated with posterior rotation of the mandible and dentoalveolar compensations. This article shows the dental and skeletal effects of intermaxillary elastics applied to temporary anchorage devices in the treatment of maxillary deficient Class III patients.Materials and methodsA total of 6 patients with skeletal Class III malocclusion were treated with intermaxillary elastics only. This traction was applied between modified miniplates placed in the maxilla and a modified lower acrylic resin plate bonded on mandibular tooth surfaces. To evaluate the orthodontic changes, lateral cephalograms were taken at the start of the treatment (T1), at the end of the orthopaedic treatment (T2) and at the follow-up (T3).ResultsAll patients showed orthopaedic correction of the skeletal Class III relationship with reduction of facial concavity. No dentoalveolar compensations or changes in mandibular position were observed.ConclusionThe treatment of maxillary deficiency with orthopaedic forces from skeletal anchorage directed to the hooks of a modified lower acrylic resin plate bonded on the mandibular tooth surfaces, seems to be a promising technique.     

正畸治疗中磨牙的拔除和保留（五十三）——利用骨钉矫治生长发育期上颌后缩下颌前突型反

目的：评价骨钉前方牵引治疗对生长发育期上颌后缩下颌前突型反[牙合]病例的矫治效果。方法：选择替牙晚期和恒牙早期骨性Ⅲ类错病例8例,男2例,女6例,年龄11～14岁,平均12.2岁。均为上颌发育不足并伴有下颌、下牙弓轻度前突的凹面型,在双侧上颌颧牙槽嵴区植入骨钉,骨钉与牵引面罩的牵引钩相连,与[牙合]平面成向前下30°夹角,力值维持在350g左右,每日戴用时间为10～12h。有3例恒牙早期病例因牙列拥挤或下牙弓前突,设计对称拔除了上、下颌第二或第三磨牙,植入下颌磨牙骨钉以牵引排齐内收下牙弓。结果：8例患者前方牵引5～10个月,平均7个月,均有效解除前牙反[牙合]。结论：应用骨钉做前方牵引,牵引力通过上颌骨阻力中心,不会致颌骨出现异常旋转。牵引力完全作用在颌骨上,避免了对牙齿产生副作用。骨钉还可用于牵引上下颌牙列远中移动,减少上前牙唇倾并增强前方牵引对下牙弓的矫治作用。     

Combined rapid maxillary expansion and protraction facemask in the treatment of class III malocclusions in growing children: A prospective long-term study

A prospective study of 28 growing children (mean age of 8 years 3 months) with Class III malocclusions was consecutively treated using rapid maxillary expansion and maxillary protraction. All patients were treated from a negative overjet to a positive overjet and from a Class III dental malocclusion to a Class I dental relationship. For each patient, a lateral cephalogram was taken before treatment (T1), immediately posttreatment (T2), and after an observation period (T3) averaging 2 years 5 months. Using analysis of variance, the cephalograms were analyzed to determine skeletal and dental changes resulting from treatment. Long-term changes (2 years 5 month observation period) were also evaluated. Results showed that immediately posttreatment, the maxilla moved anteriorly a mean of 1.54 mm and Sella-Nasion-A point increased 0.87°. The maxillary teeth moved anteriorly 2.73 mm and proclined 5.23°, while the mandible rotated in a downward and backward direction. Long-term, the anterior position of the maxilla was maintained, but some of the Class III correction was lost because of mandibular growth. Comparison of this study's results to Riolo's longitudinal Class I data showed that, overall, rapid palatal expansion and maxillary protraction produced a small orthopedic effect with a moderate dentoalveolar effect which together contributed to the correction of the Class III malocclusion.     

Treatment of a severe Class III skeletal discrepancy at an appropriate age

The 13-year-old female patient presented for correction of a severe Class III malocclusion with a Class III skeletal pattern. This was considered an appropriate age for treatment as earlier treatment may have been subject to relapse because significant facial growth may have occurred after treatment, and because treatment at a later age may have required orthognathic surgery. Initially, maxillary expansion was provided to widen the maxilla and to free the circum-maxillary sutures. Maxillary protraction headgear was worn to perform sagittal skeletal improvement. Fixed orthodontic appliances were placed to align the dentition and Class III elastics were used to improve intercuspation and stability. Patient cooperation was crucial for success. The skeletal changes provided rewards that included significantly improved facial and dental appearance, while avoiding orthognathic surgery.     

上颌前牵引矫治骨性Ⅲ类错[牙合]畸形的研究进展

Ⅲ类错[牙合]畸形是一种与遗传及发育相关的颌面畸形，随生长呈加重趋势。在儿童生长发育过程中，适时、适当地应用矫形力进行上颌前牵引治疗，可以矫治上颌发育不足产生的骨性Ⅲ类错畸形，改善上颌骨发育，获得较理想的面型。但多年以来，正畸医师在其治疗时机的选择，联合快速腭扩展的疗效评价，支抗及长期稳定性评价等方面，一直存在较大的争议。本文仅就近年来的相关研究进展作一综述。     

快速扩缩弓并前牵引矫治恒牙早期安氏Ⅲ类错殆的疗效

目的研究上颌前方牵引联合快速扩缩弓治疗恒牙早期安氏Ⅲ类错黯的骨性及牙性疗效。方法选取10例恒牙早期安氏Ⅲ类错殆患者,观察6个月作为观察对照期,随后应用前方牵引联合快速扩缩弓矫治6个月为治疗期．应用Pitchfork分析法比较对照期和治疗期在平均功能性殆平面上骨骼及牙齿的位置变化。结果磨牙关系改变了7．2mm（t=6．85．P〈0．05）,包括骨性改变4．4mm、牙性改变2．8mm;骨性改变中上下颌骨贡献率约为1：3,牙性改变中上下磨牙贡献率约为2：3。结论前方牵引联合快速扩缩弓可有效治疗恒牙早期安氏Ⅲ类错胎,可取得较大的牙殆关系改善。     

Orthopaedic Protraction of the Maxilla with Miniplates: Treatment of Midface Deficiency

Class III malocclusion is a consequence of maxillary deficiency and/or mandibular prognathism, resulting in an anterior crossbite and a concave profile. Early class III malocclusion treatment with reverse pull headgear generally results in maxillary skeletal protraction but is frequently also accompanied by unfavourable dentoalveolar effects. Titanium miniplates used as temporary anchorage device might permit equivalent favourable skeletal changes without unwanted dentoalveolar effects. We report two cases having class III malocclusion with maxillary deficiency treated by using titanium miniplates. Cephalometric tracings were done pre and post treatment to determine the anatomic changes during the course of treatment.