上下颌唇挡对替牙晚期儿童牙(牙合)的影响

目的研究上下颌唇挡同时应用对替牙晚期儿童牙(牙合)的影响.方法选择替牙晚期上下牙列轻度或中度拥挤患儿12例,上下颌均采用唇挡治疗8个月,进行治疗前后X线头影测量分析和模型测量分析,并对治疗前后的测量值变化进行配对t检验.结果唇挡治疗后,SNA、SNB分别增加1.02°和0.97°(P＜0.05),上下切牙前移均是牙冠向近中倾斜,而根尖相对固定的控制性倾斜,旋转中心接近根尖.上下磨牙远中倾斜效果不同,上磨牙远中倾斜直立,旋转中心接近牙冠;下磨牙远中倾斜移动,旋转中心接近阻抗中心;上颌磨牙间牙弓宽度、牙弓周径分别增加4.12mm和5.09mm(P＜0.01),下颌磨牙间牙弓宽度、牙弓周径分别增加4.07mm和6.86mm(P＜0.01).结论在儿童生长发育高峰期,唇挡可有效地引起上下颌牙弓横向和纵向变化,减轻或解除上下牙弓拥挤.     

上颌唇挡早期矫治引起的牙弓三维变化分析

目的 研究唇挡早期矫治上颌拥挤病例引起的牙弓三维改变.方法 选取正畸患者12例,平均年龄9.8岁.为缓解上颌的拥挤,戴用唇挡8个月.戴用唇挡前后取记存模型,进行三维数字化,以第三腭皱为参考将治疗前后的模型重叠,分析牙齿三维位置改变及倾斜度的变化.配对t检验比较治疗前后牙弓宽度和上牙弓弧形长度的差异.结果 戴用唇挡后,牙齿三维方向的改变以后部牙弓的变化最为显著,矢状向上颌第一前磨牙、第一磨牙分别远中移动2.08、2.03mm,上牙弓弧形长度增加5.12mm;垂直向上颌第一前磨牙升高1.17mm,第一磨牙升高0.72mm;横向上颌第一前磨牙间宽度增加2.62mm,第一磨牙间宽度增加3.08mm;以上各测量均有统计学意义(P＜0.05).同时上颌切牙存在少量前移、扩宽和唇倾.上颌切牙唇倾度增加3.90°,第一磨牙远中倾斜度增加8.23,有显著性差异(P＜0.05).结论 上颌唇挡可以缓解轻中度的牙弓拥挤.唇挡引起的牙弓长度增加主要是由于磨牙的远中移动、后倾以及牙弓的扩宽.     

Lower lip sucking habit treated with a lip bumper appliance

The patient was an 11-year-old girl with a lower lip sucking habit with increased overjet, maxillary generalized spacing, and mandibular incisor irregularity. Hyperactivity of the mentalis muscle and deepening of the labiomental sulcus because of the abnormal sucking habit was observed. Orthodontic treatment was started with a lip bumper appliance to break the lower lip sucking habit and continued with fixed orthodontic mechanotherapy. The lip bumper appliance therapy resulted in the elimination of the lower lip sucking habit, musculus mentalis hyperactivity, and labiomental strain in addition to a gain in arch length, improvement of the lower incisor inclinations, and overjet reduction.     

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近年来,许多正畸医生对安氏Ⅱ1错畸形伴下颌前牙轻度唇向倾斜的患者多倾向于不拔牙治疗而运用唇挡这一功能性矫治器进行治疗,这一技术受到人们越来越多的关注。本文就唇挡的作用原理、制作要求、矫治效果及效果的稳定性等几方面加以综述。     

改良唇挡扩弓后牙齿及牙槽骨变化的 CBCT 研究

目的：研究改良唇挡单侧扩弓后牙齿及牙槽骨的变化。方法：20例单侧完全性唇腭裂患者应用改良唇挡进行单侧扩弓,扩弓前后分别进行CBCT扫描重建,测量裂隙侧牙齿及牙槽骨的变化并进行统计学分析。结果：①未经扩弓治疗的单侧完全性唇腭裂隙患者裂侧尖牙和前磨牙相对于健侧均表现为舌倾,其中尖牙舌倾最明显;②牙及牙槽骨均发生颊倾;颊侧牙槽骨倾斜度大于腭侧,变化量与牙齿的颊倾程度呈正相关性;③根尖基骨宽度增加。结论：唇挡扩弓后牙槽骨随牙齿的颊倾发生适应性改建,同时唇挡刺激牵引牙根尖基骨的改建,在适应症范围内唇挡扩弓是安全有效的。     

A technique for measurement of intraoral lip pressures with lip bumper therapy

One of the reported effects of functional appliance therapy is muscular adaptation achieved through the use of vestibular shields. To develop a method for measuring these effects, 10 children with Class I molar occlusion in the late mixed-dentition stage underwent lip bumper therapy for 8 months. Semiconductor pressure transducers mounted on Tru-Tain stents in the mandibular midline and left canine areas were used to measure lip pressures with the patient at rest and during five functional exercises. Resting and speaking lip pressures for the midline transducer showed significant increases 1 month after lip bumper placement and then decreased to near or below pretreatment levels, possibly an adaptive response. Left-side resting pressures also showed a gradual decrease. In contrast, left-side speaking pressures showed no significant changes over time. The swallowing pressures were not replicable because of excessive background fluctuations. The results of this study indicate that this method has potential for improving clinical diagnosis. The preliminary data also suggest an adaptive response of lip muscles that varies according to anatomic location.     

A longitudinal study of incremental expansion using a mandibular lip bumper

A retrospective study using models was performed to evaluate the incremental expansion that occurred during mandibular lip bumper therapy in 44 adolescent patients. The purpose was to determine whether expansion occurs evenly between appointments or whether it attenuates with treatment time. Dental cast measurements were made for arch width and arch length. Treatment duration was broken into near-equal time segments and compared. Results showed that about 50% of the total expansion achieved occurred within about the first 100 days. Forty percent of the total amount of expansion occurred during the next 200 days, with only about 10% of the total expansion occurring after the first 300 days. It is unnecessary to have the appliance in place for longer than 300 days. The percentage of expansion that occurred at each time segment was not related to whether the patient had concomitant maxillary expansion.     

上颌窦对上颌后牙显微根尖手术的影响

显微根尖手术是临床上保存牙髓根尖周病患牙的有效手段之一,也是治疗其疑难病例的必备技术。但由于位置靠后操作空间狭小、根尖与上颌窦毗邻,导致在上颌后牙区进行根尖外科手术仍存在一定挑战。本文就上颌窦与上颌后牙解剖关系、对显微根尖手术影响以及辅助技术如:3D打印手术导板、超声骨刀等在上颌后牙区手术中的应用进行总结。文献复习结果表明,上颌后牙根尖与上颌窦空间关系通常分3类:根尖突进上颌窦底;根尖与上颌窦底相接触;根尖和上颌窦底之间有间隙或空间。术前CBCT检查后结合患牙根尖周和上颌窦状态以及根尖病损到上颌窦距离评估手术难度,术中应用导板、内窥镜、超声骨刀等以使手术更加安全可靠和精准微创,但后者在临床上的普及仍需进一步推广。目前尚缺乏高质量的上颌后牙区现代显微根尖手术长期疗效的临床研究。     

The effect of anterior tooth retraction on lip position of orthodontically treated adult Indonesians.

This study was conducted to determine upper and lower lip changes after orthodontic treatment of bimaxillary dental protrusion in adult Indonesians. Pretreatment and posttreatment cephalograms of 40 patients (6 males and 34 females) who required extraction of 4 premolars, were traced, superimposed, and measured. The changes of anterior tooth position (measured as the horizontal distance from the incisal tip to a constructed vertical through sella) were correlated with changes in the upper and lower lip positions with the Pearson correlation method. Significant positive correlation was found between changes of the maxillary and mandibular incisors with the changes in both the upper lip (r(U1) = 0.39, P <.05; r(L1) = 0.44, P <.01) and the lower lip (r(U1) = 0.44, P <.01; r(L1) = 0.51, P <.01) positions. By using stepwise multiple regression, it was found that for every millimeter of mandibular incisor retraction, 0.4 mm of upper lip retraction and 0.6 mm of lower lip retraction were produced. This study concluded that, for this Indonesian sample, a strong correlation exists between mandibular anterior tooth retraction and the position of both lips.     

Cleft lip and palate management with maxillary expansion and space opening for a single tooth implant.

An adult Class I malocclusion with a unilateral cleft lip and palate is presented. The maxillary transverse deficiency was managed with orthopedic expansion and the missing lateral incisor with space opening, bone grafting, and single tooth implant. The mild maxillary retrognathia and deficient lip support was managed with dental compensation.     

上颌埋伏第三磨牙与多生牙融合1例

融合牙是由2个牙胚间的釉质或牙本质融合在一起而形成.上颌牙融合多发生在侧切牙和尖牙间,极少发生在第三磨牙和多生牙之间.本文报道1例发生在左上颌埋伏第三磨牙与多生牙之间的融合牙.     

Long-term stability of lip bumper therapy followed by fixed appliances

Lip bumper treatment has been shown to successfully increase arch width, procline the incisors, and distalize molars. However, few studies have been performed showing the long-term stability of lip bumper treatment. In this study, mandibular casts taken by a single practitioner from 51 patients treated with lip bumpers without rapid palatal expansion were analyzed at pretreatment, post-lip bumper treatment, posttreatment, and long-term out of treatment. Measurements of arch width, arch depth, arch length, and anterior crowding were made. During treatment, there was a mean decrease in irregularity of 3.73 mm, with a posttreatment increase of 0.76 mm, for a net decrease of 2.97 mm. Despite posttreatment decreases, significant gains in arch width were maintained for extended periods of time. The intercanine width had a net increase of 1.78 mm (19% relapse), first premolars 3.39 mm (26% relapse), second premolars 2.58 mm (34% relapse), and first molars 2.17 mm (20% relapse). Lip bumper treatment along with fixed appliances is an effective means to obtain long-term increases in arch width and decreases in the irregularity index.     

The tooth root within the maxillary sinus

Abstract — Histological observations in three cases of tooth root displacement to the maxillary sinus show that under certain conditions the root may be accepted by the tissues. General and local factors in the defenco mechanism and the existence or otherwise of periapical pathosis must be considered in determining the treatment.     

不翻瓣上颌前牙即刻牙种植术临床效果评价

目的 研究不翻瓣上颌前牙即刻牙种植术在牙种植患者中的临床价值。方法 选取2014年9月—2015年8月收治的88例即刻牙种植术患者,根据投硬币法分为实验组和对照组,每组各44例。对照组为翻瓣上颌前牙即刻种植术,实验组为不翻瓣上颌前牙即刻种植术。观察比较2组患者的手术时间、种植体成活率、牙槽骨状况、满意度、美观度及术后症状。采用SPSS11.5软件包进行数据分析。结果 实验组手术时间[（29.34±2.42）min]显著短于对照组[（55.32±3.54）min]（P<0.05）,牙槽骨质量[（0.84±0.04）mm]显著优于对照组[（1.21±0.07）mm]（P<0.05）,种植成活率[93.18%（41/44）]显著高于对照组[72.73%（32/44）]（P<0.05）。治疗后,实验组患者的VAS评分[（8.32±0.42）分]和PES评分[（11.24±0.43）分]显著高于对照组[（5.78±0.24）分、（8.45±0.58）分]（P<0.05）。实验组患者术后疼痛[18.18%（8/44）]、红肿[15.91%（7/44）]、出血[11.36%（5/44）]发生率显著低于对照组[38.64%（17/44）、34.09%（15/44）、29.55%（13/44）]（P<0.05）。结论 不翻瓣种植术能提高牙种植患者的满意度、美观度及种植成功率,减少手术时间,减轻患者的疼痛感,降低术后疼痛、红肿等症状的发生率。