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锁[牙合]可发生于单侧或双侧,分为正锁[牙合]和反锁牙合。处于游离端位置的第二磨牙区锁[牙合]的矫治一直是正畸治疗中的一个难点。本文主要介绍了利用微小种植体支抗腭移或颊移上颌后牙,颊移下颌后牙解决第二磨牙区正、反锁[牙合]的方法,并对如何解决矫治中会出现的锁[牙合]伴上下后牙近中倾斜、拥挤的情况进行了详细描述。     

Stress distribution produced by the correction of the mandibular second molar in lingual crossbite

The purpose of this study was to evaluate the stress distribution produced in the dentoalveolar system by a mandibular posterior crossbite appliance used for the correction of mandibular second molars in lingual version. A photoelastic model was fabricated using a photoelastic material (PL-3) to simulate alvelolar bone and ivory-colored resin teeth. The model was observed anteriorly and posteriorly with a circular polariscope and photographically recorded before and after activation of mandibular posterior crossbite appliances. An uncontrolled tipping and an extrusive force were generated when the traction force was applied on the buccal surface of the mandibular second molar. A controlled tipping and an intrusive force were generated when the traction force was applied on the lingual surface of the mandibular second molar. We concluded that to escape the extrusion and uncontrolled tipping that creates occlusal interferences associated with the correction of mandibular second molars in lingual version, the lingual traction force is more useful than the buccal traction force.     

下颌固定舌弓矫治第一磨牙反的临床应用研究

目的探讨下颌固定舌弓缩小下颌第一恒磨牙宽度的方法矫治第一恒磨牙反。方法选择正畸临床恒牙列第一恒磨牙反的患者14例,用固定舌弓缩小下颌第一恒磨牙的宽度矫治第一磨牙反,观察第一磨牙咬合关系变化,测量治疗前后下颌第一磨牙中央窝间距及舌侧龈缘的间距。结果 14例患者平均使用下颌固定舌弓2～5个月,第一恒磨牙反解除,矫治前后下颌第一磨牙中央窝间距差异具有显著性(P<0.05),舌侧龈缘间距差异不显著(P>0.05)。观察1年未见复发。结论下颌固定舌弓能有效缩小下颌第一恒磨牙宽度,矫治第一恒磨牙的反,其机理是缩小的舌弓通过磨牙带环将磨牙舌向倾斜。     

后牙锁牙合矫治之临床改良新型矫治器的设计与应用

后牙锁牙合是口腔临床常见的错牙合类型,即上下颌后牙颊舌向关系的异常,严重影响口颌功能、美观、健康。考虑到医疗资源分配、医师自身技术水平及患者自身意愿,很难说某一种矫治方法完全适用于某一病例。医师应充分了解该后牙锁牙合发生的原因后,根据具体情况选用、改良或设计快速有效安全舒适的方法。本文对后牙锁牙合的病因、危害、临床传统矫治方法的不足、改良设计后牙锁牙合矫治器所要遵循的要点,治疗中可能出现问题的防治做一综述,以及介绍了3种改良新型矫治器的应用,为临床工作选用实用性方法治疗后牙锁牙合提供参考。     

Ⅲ类颌间牵引治疗无生长潜力唇腭裂术后患者前牙反（牙合）的机制研究

目的：比较单侧完全性唇腭裂术后患者前牙反（牙合）解除前后颅面结构变化,探讨Ⅲ类颌间牵引治疗单侧完全性唇腭裂术后患者前牙反（牙合）的机制。方法：选择单侧完全性唇腭裂术后前牙反（牙合）患者20名,其中男15名,女5名,平均年龄（14.36±1.06）岁。所有患者在牙列排齐和整平的基础上行Ⅲ类颌间牵引,测量前牙反（牙合）解除前后头颅定位侧位片上反映颅面结构的各项指标,用配对t检验比较治疗前后的变化。结果：前牙反（牙合）解除后,SNB、L1-MP、OP-SN、NLA、ULP减小,ANB、MP-SN、NA-PA、U1-SN、U6-FH、L1-MP、L6-MP、ULL、LLL、LLP、UL-EP增大,差异有统计学意义。前牙反（牙合）解除前后SNA、U1-FH、LL-EP、ISD差异无统计学意义。结论：对于恒牙期唇腭裂术后反（牙合）的患者,Ⅲ类颌间牵引在纠正上下颌牙齿及牙槽关系不调的同时,能掩饰颌骨矢状向Ⅲ类关系,使软组织侧貌得到显著改善。     

Adaptive functional changes in the swallowing pattern of the tongue following expansion of the maxillary dental arch in subjects with and without cleft palate

In seven subjects with unilateral cleft lip and palate (UCLP), two subjects without cleft but with complete lingual crossbite, and two subjects with normal occlusion, tongue contact patterns against the hard palate, lingual surfaces of maxillary and mandibular teeth, and mandibular lingual mucosa during swallowing were analyzed three-dimensionally using electropalatography (EPG), before and after lateral expansion of the maxillary dental arch and after 3 months of retention. Before maxillary lateral expansion, all of the subjects with cleft palate showed no palate-tongue contact at rest, and limited movement of the tongue anteriorly and upward through the entire swallow cycle. Furthermore, the tongue contacted the hard palate for a relatively brief time during swallowing compared with the subjects without cleft with normal occlusion. After expansion, the tongue was seen to contact all areas of the hard palate and the lingual surface of the maxillary dentition for a longer period of time. After 3 months of retention, the tongue maintained contact with all lingual areas of the mandibular and maxillary arches and the hard palate.     

早期上颌扩弓纠正单侧后牙反改善功能性下颌偏斜

目的:通过头颅定位后前位片(P-A)测量,探讨上颌扩弓纠正单侧后牙反牙合,改善早期功能性下颌偏斜的临床效果。方法:混合牙列或早期恒牙列,上颌单侧后牙反牙合伴有/或不伴有前牙反牙合,下颌功能性偏斜病例16例,采用上颌Quad-Helix扩弓方法,矫治前后头颅定位后前位片(P-A)测量分析,用统计软件处理数据。结果:单侧后牙反牙合矫正后,面部不对称有明显改善。结论:混合牙列或早期恒牙列,由于单侧后牙反牙合导致的功能性下颌偏斜,采用扩大上颌牙弓方法,可使下颌骨的不对称得到明显改善,是早期纠正下颌功能性偏斜的有效方法。     

成人骨性反(牙合)患者口周肌压力

目的 :研究骨性反牙合患者的口周肌压力特征 ,了解口周肌压力与牙颌形态的相关性。方法 :以 2 0名成人骨性反牙合患者为研究对象 ,检测了姿势位时上下切牙区、尖牙区、磨牙区颊 (唇 )舌侧口周肌压力。结果 :与对照组相比 ,除了上下磨牙区舌侧口周肌压力外 ,骨性反牙合组中的口周肌压力大于对照组中对应区域口周肌压力 (P <0 .0 1)。骨性反牙合患者同一牙弓内左右两侧口周肌压力值无显著性差异 ,各测量区域颊侧压力均大于相应部位的舌侧压力 (P <0 .0 1) ;除了尖牙区唇侧外 ,上下对应区域口周肌压力下颌大于上颌 (P <0 .0 1) ;各牙位口周肌压力中 ,下颌唇侧的口周肌压力最大 (P <0 .0 1)。结论 :牙颌形态影响口周肌压力的大小 ,骨性反牙合患者口周肌压力的最显著的特征为姿势位时下切牙唇侧肌压力值最大。     

垫式舌侧矫治器矫治前牙反的疗效观察

目的:将舌侧矫治器进行改良,以达到简化临床操作提高治疗前牙反疗效的目的。方法:制作联冠垫作为固定垫,磨牙舌面管和前磨牙托槽埋于垫中与联冠垫合二为一,成为垫式舌侧矫治器。选择假性前牙反病人30例,统计病人主动治疗时间和反解除时间,治疗前后摄头颅侧位定位片进行头影测量分析,并对软硬组织变化情况进行配对t检验。结果:30例病人治疗后磨牙关系中性,前牙覆覆盖正常,牙列整齐,反解除时间2~5个月,平均3.13个月。X线头影测量数据显示上下颌骨和上下前牙有一定的改变。结论:垫式舌侧矫治器矫治假性前牙反效果良好,并缩短了椅旁操作时间。     

（牙合）垫舌簧活动矫治器矫治乳前牙反三种施力装置的疗效对比研究

目的：寻求一种省时、便捷、有效的垫舌簧加力装置矫治乳前牙反,提高临床工作效率。方法：选择乳前牙反病例22例,随机分为三组。第一组10例应用普通牙科不锈钢丝制作双曲舌簧上颌垫活动矫治器、第二组6例用正畸不绣钢丝制作双曲舌簧上颌垫活动矫治器,第三组6例用正畸不绣钢丝制作双圈曲舌簧上颌垫活动矫治器,分别于1、3、5周复诊加力一次,观察比较三组病例的矫正时间及复诊次数。结果：第一组平均矫正时间10.2周,平均复诊次数10.2次。第二组平均治愈时间10周,平均复诊次数3.7次。第三组平均治愈时间9.7周,平均复诊次数2.3次。三者相比较,矫治时间无显著差异（P〉0.05）,但平均复诊次数却有显著性差异（P〈0.05）。结论：固定正畸用不锈钢丝双圈曲舌簧垫活动矫治器能省时、有效地矫治乳前牙反,可提高临床工作效率。     

Newtom QR-DVT 9000 imaging used to confirm a clinical diagnosis of iatrogenic mandibular nerve paresthesia

This article describes conventional orthodontic treatment of an adult patient leading to lower lip paresthesia. The paresthesia subsided when the cross elastics to correct the patient's single molar crossbite were removed. It was determined with Digital Volumetric Tomography that the inferior alveolar nerve was located lingual to the lower second molar root and was impinged upon with the tipping force of the cross elastic. Treatment to resolve the crossbite without further paresthesia is discussed.     

垫式舌侧矫治器矫治前牙反

目的：对舌侧矫治器进行改良,应用于前牙反的矫治,疗效好,临床操作简化。方法：制作＂联冠垫＂粘固在后牙牙冠上,成为＂固定垫＂,磨牙舌面管和前磨牙托槽埋于垫中和＂联冠垫＂合为一体,成为＂垫式舌侧矫治器＂。结果：6例患者治疗后磨牙关系中性,前牙覆覆盖正常,牙列整齐。结论：垫式舌侧矫治器矫治假性前牙反效果良好,椅旁操作时间减少。     

Three-dimensional analysis of the effects of the treatment on anterior crossbite in the primary dentition

We performed measurement using a 3-dimensional measurement system in study models of children with anterior crossbite in the primary dentition treated using a chin cap and lingual arch, and evaluated changes in the dentition and occlusion after treatment based on measurement values and also using wire frame models. Comparing with the situation before treatment, the overbite of anterior teeth shows improvement to become shallow and the terminal plane becomes vertical type and the occlusal plane becomes flatter. Labioclination of upper anterior teeth, linguoclination of lower anterior teeth and backward movement of lower dentition are observed. Occlusal view shows that both upper and lower dental arch become semicircular configuration. The width, depth and height of the post-treatment dentition became closer to the standard values. Chin cap and lingual arch treatment for anterior crossbite during early childhood is effective, and also helpful in the normal development of occlusion in children.     

前方牵引治疗替牙期骨性Ⅲ类错的牙颌结构变化研究

目的:观察前方牵引在替牙期骨性Ⅲ类错牙合的应用及治疗前后的牙颌结构变化。方法:选择替牙期骨性Ⅲ类错牙合患者9名,应用前方牵引矫治前牙反牙合,正畸前后进行头影测量分析。统计学分析采用配对t检验。结果:SNA角增大4.2°,ANB角增加5.4°,NA-PA增加5.0°,A-VL增加6.1mm,SNB角减少1.2°,B-VL减少0.2mm,1-SN增加6.2°。结论:前方牵引可有效促进上颌骨向前生长,抑制下颌骨生长,同时可导致下颌骨向下向后旋转,上前牙唇倾,下切牙轻度舌倾。     

Combined orthodontic and restorative care of early childhood caries and anterior crossbite: a case report.

This case report describes management of a 3-year-old child with early childhood caries and anterior crossbite. Restorative care was postponed until after crossbite correction to eliminate occlusal interferences associated with premature contact and a functional shift of the mandible. Crossbite correction was performed with a fixed anterior bite plane appliance, and comprehensive restorative care was performed under general anesthesia.     

偏颌畸形患者的牙弓特征

目的　分析偏颌畸形患者的牙弓特征,为临床矫治提供参考。方法　采用三维坐标测量仪在20例偏颌 畸形患者(试验组)和20例正常人(对照组)的牙模型上测量上下颌尖牙、前磨牙和磨牙牙尖的三维坐标值,分 析牙弓矢向和横向的对称性、上下牙弓的协调性和牙齿倾斜度,采用SAS 6·03进行统计学检验。结果　试验组上 颌尖牙和第一前磨牙距腭中缝的距离偏向侧大于偏离侧(P<0·05),下颌从尖牙到第二磨牙偏向侧距中线的距离 小于偏离侧(P<0·05);上颌尖牙和第一前磨牙的牙弓宽度比率较对照组小(P<0·05),而上颌第二前磨牙和第一 磨牙的牙弓宽度比率与正常无统计学差异(P>0·05);上颌后牙偏向侧颊向倾斜度大于偏离侧,下颌后牙偏向侧 舌向倾斜度大于偏离侧(P<0·05);上颌偏向侧和偏离侧牙齿的矢向位置无统计学差异(P>0·05)。结论　偏颌畸 形患者上牙弓前部窄于下牙弓,上颌牙齿矢向位置无差别,而上下颌两侧后牙颊舌向倾斜度存在明显差异。     

小型下颌后退位（牙合）板在前牙反（牙合）矫治中的应用

目的：在前牙反（牙合）矫治中应用一种小型下颌后退位（牙合）板后退下颌,评价其矫治AngleⅢ类功能性-轻、中度骨性前牙反（牙合）病例的临床应用效果.方法：应用小型下颌后退位（牙合）板治疗反（牙合）328例.在打开咬合的同时后退下颌,同时粘固上下颌托槽进行排齐整平.结果：患者侧貌在戴用后退位（牙合）板后明显改善,下颌的有效后退使反（牙合）的矫治变得简单化,治疗时间较传统矫治明显缩短.远期随访疗效肯定.结论：小型下颌后退位（牙合）板适用于下颌可适度后退的前牙反（牙合）病例,可快速矫治前牙反（牙合）.是较固定反式TBA联合前牵引更为理想的装置,结构更小巧,制作更简便,更适用于临床应用.     

改良舌簧和邻间钩活动矫治器

目的：应用改良的便利型舌簧和邻间钩活动矫治器取代目前临床常用的双曲舌簧和邻间钩活动矫治器，并与常用的双曲舌簧在弯制、临床应用、外观等方面进行了比较分析．方法：使用常用不锈钢丝弯制改良便利型舌簧和邻间钩，制作活动矫治器治疗牙性前牙反、内倾型深覆、前牙扭转及轻度拥挤．结果：改良舌簧和邻间钩活动矫治器制作简单，加力方便，临床效果良好．结论：改良便利型舌簧，具有夹板样作用，可同时作用于多个前牙，产生按牙弓弧形均匀扩弓的效果，使舌簧的使用范围扩展．如附以导杆或平导可使作用力方向更易控制．改良便利型舌簧和邻间钩没有游离的末端配合应用使整个矫治器固位好，戴用舒适     

生长发育期反(牙合)伴上颌严重拥挤不拔牙矫治16例报告

目的:探讨生长发育期反(牙合)伴上颌严重拥挤病例不拔牙矫治的临床疗效.方法:16例反(牙合)伴严重拥挤病例男6例,女10例,平均10.5岁.均采用直丝弓矫治器矫治,应用螺旋推簧扩展间隙及上颌前方牵引.平均疗程25个月.选择18项头影测量值,比较矫治前后软硬组织改变情况.结果:矫治后SNA、ANB、颌凸角均有显著增大,U1-SN减小,U1-L1显著增大,AB平面角显著减小,ANS-Me显著增大,FMA、GoGn-SN、Y轴角轻度增大,颏唇角显著减小,上唇突度显著增大,患者软组织侧貌得到明显改善.结论:对于生长发育期的反(牙合)伴上颌严重拥挤病例,矫治设计时应考虑患者的生长潜力,试行不拔牙矫治,使牙齿发育对颌骨发育的刺激作用得以充分表达,可以得到明显的临床效果.     

儿童功能性单侧后牙反患者的髁突对称性及矫治后髁突位置变化的研究

目的探讨儿童功能性单侧后牙反患者的髁突对称性及上颌扩弓治疗后髁突位置的变化。方法选择22例通过上颌扩弓成功矫治的功能性单侧后牙反儿童患者,男10例,女12例,年龄6.0-8.5岁,平均7.5岁作为实验组。另选择22例正常患者,男11例,女11例,年龄6.5-9.0岁,平均7.5岁作为对照组。反组矫治前后与对照组患者均拍摄曲面断层片和双侧闭口位矫正薛氏位片,测量髁突形态的不对称指数和髁突在关节窝中的相对位置。用SPSS 12.0软件进行统计分析。结果反组患者两侧髁突形态无明显不对称,与对照组相比,髁突高度(CH)、升支高度(RH)以及两者之和(CH+RH)的不对称指数均无统计学差异。反组矫治前(T1)两侧髁突在关节窝中的位置有明显差异,非反侧关节前间隙减小(P<0.05),上后间隙增大(P<0.05)。非反侧髁突在关节窝中的位置(R)相对反侧更加靠前(P<0.01)。矫治后(T2)双侧髁突位置变得相对对称。结论儿童功能性单侧后牙反患者的髁突形态相对对称,而髁突位置存在不对称性,说明下颌向反侧发生功能性偏斜,而这种偏斜并未导致髁突发生骨性不对称;正畸治疗可使两侧髁突位置更加协调。