传动直丝弓矫治技术与无托槽隐形矫治对错牙合畸形患者的临床效果对比研究

目的:研究传动直丝弓矫治技术与无托槽隐形矫治对错牙合畸形患者的临床效果.方法:选取2016年5月～2017年5月我院收治的错牙合畸形患者90例,按照随机数字表法将患者分为传动直丝弓矫治组、无托槽隐形矫治组各45例.传动直丝弓矫治组患者使用传动直丝弓矫治技术进行治疗,无托槽隐形矫治组使用无托槽隐形矫治进行治疗.对比分析对...     

无托槽隐形矫治技术拔除前磨牙的支抗设计与临床控制

无托槽隐形矫治技术的诞生满足了人们对于牙齿正畸美观、舒适的需求,成为了成人和青少年很好的正畸治疗手段。在最初使用无托槽隐形矫治器时,它只能被用于排齐牙列等简单正畸治疗。随着无托槽隐形矫治器生产商和临床医生对完成病例不断回顾和研究,当前无托槽隐形矫治技术体系不断完善并逐渐精准化,其中对于拔除前磨牙的无托槽隐形矫治也趋于成熟。本文将对无托槽隐形矫治技术拔除前磨牙的支抗设计和临床控制进行综述。     

国产无托槽隐形矫治技术的临床应用初探

目的 将我国自主研发的无托槽隐形矫治技术应用于口腔正畸临床,探讨该矫治器的临床应用情况、存在的问题以及应用前景.方法 选取41例较简单的错(牙合)畸形患者,主要包括牙列间隙、牙列拥挤以及牙周病止畸治疗,应用国产无托槽隐形矫治技术进行正畸治疗.通过层析扫描建立数字化三维牙颌模型,通过激光快速成形技术加工无托槽隐形矫治器,根据治疗方案,为每例患者设计10～40副矫治器.患者每2～3周更换一副矫治器,矫治后评估疗效.结果 所有病例均完成矫治并取得良好的矫治效果,矫治后牙列排齐、无间隙、前牙覆(牙合)覆盖正常,矫治疗程6～25个月,平均18个月.结论 目前,国产无托槽隐形矫治技术仅町矫治相对简单的错(牙合)畸形,并以其透明、美观、舒适、卫生等优点,而具有良好的临床应用前景.     

无托槽隐形矫治技术的生物力学研究进展

近年来无托槽隐形矫治技术发展迅速,已广泛应用于各类错牙合畸形的矫治。但隐形矫治技术的矫治力作用复杂,其生物力学机制仍不明确。构建无托槽隐形矫治器力学模型、精确研究动态正畸过程是目前无托槽隐形矫治技术研究的热点与难点。因此,本文对无托槽隐形矫治技术生物力学的研究进展作一综述。     

无托槽隐形矫治器拔除四个前磨牙矫治拥挤一例报告

我国的无托槽隐形矫治系统（Angelalign TM System）自问世以来,在正畸临床的应用日益广泛,也得到越来越多临床医生的认可。2007年,田杰等首次发表了用国产EAB型无托槽隐形矫治器矫治牙列间隙的病例报道。之后相关的报道越来越多,史真,白玉兴,田杰等报道了拔除下切牙矫治病例。白玉兴等报道了无托槽隐形矫治器在牙周病正畸中的应用。李丽岩报道了一例固定矫治后严重复发病例的隐形矫治与固定矫治联合矫治。     

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本文主要介绍了无托槽隐形矫治器的生产工艺流程及现代无托槽隐形矫治技术的临床应用流程。无托槽隐形矫治器的生产工艺流程主要步骤为：扫描硅橡胶印模或石膏模型,从而获得数字化牙列模型,运用计算机辅助设计与制造（CAD／CAM）系统模拟治疗计划并生产加工母模,采用热压成型技术加工隐形矫治器。现代无托槽隐形矫治技术临床应用主要流程有：临床接诊、病例提交、确认模拟矫治方案、生产矫治器、临床配戴矫治器、精细调整,最终完成治疗并保持。     

无托槽隐形矫治与牙周健康的相关性研究

正畸治疗的目的是矫治患者错牙合畸形,在达到平衡、稳定、美观的治疗效果的同时,减少或避免正畸治疗对患者牙周健康的不利影响。与传统固定矫治器相比,无托槽隐形矫治器具有舒适、美观、可摘、易清洁的优势,已在临床上广泛应用于错牙合畸形的矫治。本文将对无托槽隐形矫治技术对正畸患者牙周健康的影响作一综述,从无托槽隐形矫治力学特性、牙周临床指标和牙周炎症微环境三个方面进行研究与分析,为无托槽隐形矫治技术在临床上的实际应用提供参考。     

硅橡胶二次印模法应用于无托槽隐形矫治印模的护理体会

目的探讨硅橡胶二次印模法应用于无托槽隐形矫治印模的护婵配合。方法无托槽隐形矫治患者50例，采用硅橡胶二次印模法取印模，为无托槽隐形矫治器的制作提供准备条件，结果护士熟练配合医生完成硅橡胶印模，50例患者均取得精确印模，印模过程患者感觉舒适，获得满意的效果。结论护士掌握材料的特点和使用方法，医护配合默契，有利于提高无托槽隐形矫治印模的精确性。     

无托槽隐形矫治中的复诊监控要点

无托槽隐形矫治器是根据数字化模型和牙移动设计方案设计制作的一系列个性化透明矫治器,用于精准移动患者的牙齿。对无托槽隐形矫治的适应证把控和病例的合理诊断设计是治疗成功的前提,而矫治过程中正畸医师对患者的复诊监控更是达到矫治目标的必要条件。本文从复诊监控方法、内容、问题分析和临床处理几方面入手,对无托槽隐形矫治过程中的复诊...     

无托槽隐形矫治对非拔牙病例矫治疗效的临床研究

目的：应用美国正畸专科医师委员会OGS（Objective Grading System）客观评分系统,对无托槽隐形矫治器临床矫正效果进行评价。方法：选择60例20～25岁非拔牙矫治的错颌畸形患者,随机分成两组,实验组采用无托槽隐形矫治器,对照组采用自锁托槽矫治器。用ABO测量尺对矫治完成后的石膏牙模型和全景片分别进行测量,测量参数包括：牙齿排列整齐程度、邻牙边缘嵴高度差值、颊舌向倾斜度差值、矢状向咬合关系差值、咬合接触紧密度、覆盖异常程度、邻面接触紧密度及牙根成角。评分结果输入SPSS13．0统计软件包进行分析。结果：除上下后牙颊舌向倾斜角及咬合接触两项有统计学差异外,其余指标均无统计学差异。结论：无托槽隐形矫治器对错殆畸形非拔牙矫治病例临床矫治效果可达到自锁托槽矫治器矫治的效果。     

双颌前突用无托槽隐形矫治器矫治1例

患者为安氏I类、均角的牙列轻度拥挤伴双颌软组织前突,拔除4个第一前磨牙,应用国产无托槽隐形矫治器矫治,解除牙列拥挤,内收上下前牙,建立前牙正常覆覆盖及尖牙、磨牙中性咬合关系,前突侧貌改善明显。     

无托槽隐形矫治骨性Ⅱ类错HE畸形的临床研究

目的研究无托槽隐形矫治器治疗青少年骨性Ⅱ类下颌后缩错HE畸形的疗效及颞下颌关节的变化,为临床方案的设计提供依据。 方法选择2018—2021年苏州口腔医院正畸科就诊的30例骨性Ⅱ类下颌后缩的青少年患者（男13例、女17例,平均11.5岁）,采用时代天使A6矫治器进行矫治,收集治疗前与治疗后的头颅侧位片及CBCT数据,进行测量,采用配对t检验进行统计学分析,P<0.05为差异有统计学意义。 结果30例青少年骨性Ⅱ类下颌后缩错HE畸形患者采用无托槽隐形矫治器治疗后,SNB增大（t = -2.382,P = 0.021）、ANB减小（t = 7.138,P<0.001）、U1-SN减小（t = 5.195,P<0.001）、面凸角减小（t = 3.443,P = 0.001）、Pog前移（t = 6.048,P<0.001）和Pos前移（t = 6.127,P<0.001）,差异均有统计学意义。SNA、FMA、Z角、UL-Gall和IMPA变化差异无统计学意义（P>0.05）。关节前间隙减小（t = 7.812,P<0.001）、关节后间隙增加（t = -5.636,P<0.001）、髁突垂直高度增加（t = -2.257,P = 0.028）,差异均有统计学意义。上颌尖牙间宽度增加,差异也有统计学意义（t = -2.938,P = 0.005）。 结论无托槽隐形矫治器治疗青少年骨性Ⅱ类下颌后缩患者,可以达到预期效果,应结合影像学资料定制个性化方案,降低治疗风险。     

隐形功能矫治器导下颌向前治疗骨性Ⅱ类安氏Ⅱ类1分类青少年错HE的头影测量研究

目的研究骨性Ⅱ类安氏Ⅱ类1分类错HE畸形青少年患者使用隐形功能矫治器导下颌向前,在矢状向、垂直向及牙齿测量数据方面的改变。 方法选取2018年1月至2021年12月就诊于中山大学附属第三医院口腔正畸科,使用时代天使隐形功能矫治器进行治疗,以下颌后缩为主要病因的骨性Ⅱ类安氏Ⅱ类1分类错HE畸形患者26例[男14例、女12例,年龄（11.4 ± 2.3）岁],调取其导下颌前伸矫治前、后的头颅侧位片进行回顾性研究,对测量结果进行统计学分析,比较功能矫治前后的颌骨及牙齿差异。 结果隐形功能矫治器导下颌向前治疗后A点后移,SNA由（83.5 ± 3.1）°减小到（82.7 ± 2.6）°,差异有统计学意义（t = 2.7,P = 0.013）;B点前移,SNB由（77.7 ± 3.3）°增大到（78.4 ± 3.1）°,差异有统计学意义（t = -2.4,P = 0.027）;ANB由（5.8 ± 1.9）°减小至（4.2 ± 2.1）°,差异有统计学意义（t = 7.5,P<0.001）;U1-SN由（111.1 ± 6.9）°减小到（104.7 ± 7.2）°,差异有统计学意义（t = 9.6,P<0.001）,上前牙内收;L1-MP由（99.7 ± 5.5）°增加到（102.3 ± 6.7）°,差异有统计学意义（t = -3.3,P = 0.003）,下前牙唇倾。垂直向U6-PP、L6-MP分别由（19.6 ± 1.9）、（27.6 ± 3.0）mm增加到（20.3 ± 2.4）和（28.8 ± 3.4）mm,差异有统计学意义（t_U6-PP = -3.1,P_U6-PP = 0.004;t_L6-MP = -5.3,P_L6-MP<0.001）,表明上、下后牙牙槽高度伸长;面下1/3比值ANS-Me/N-Me由（52.6 ± 1.4）%增高至（53.5 ± 1.5）%,差异有统计学意义（t = -5.5,P<0.001）;下颌平面角GoGn-SN由治疗前（31.1 ± 5.8）°增加至（32.1 ± 6.0）°,差异有统计学意义（t = -2.1,P = 0.046）。 结论对生长发育高峰期的骨性Ⅱ类安氏Ⅱ类1分类错HE畸形患者使用无托槽隐形矫治器导下颌向前,可促进颌骨矢状向改建,改善面型,同时协调面下1/3的比例。     

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目的 观察联合应用不同根管充填糊剂治疗慢性根尖周炎的临床疗效.方法 选取2007-2009年山东大学口腔医学院综合科门诊诊治的慢性根尖周炎患者298例(422颗牙),按患者就诊先后顺序随机分为4组.A组(AH Plus糊剂+Vitapex糊剂+牙胶尖)75例患者108颗牙,B组(AH Plus糊剂+牙胶尖)75例患者105颗牙,C组(Vitapex糊剂+牙胶尖)74例患者105颗牙,D组[氧化锌丁香油糊剂(ZOE)糊剂+牙胶尖]74例患者104颗牙.对4组术后7 d、6个月、1年的临床疗效进行比较、分析.结果 298例患者根管充填7 d后复查,A、C组术后反应轻,与B组比较,差异具有统计学差异(P＜0.05);D组术后反应最重,与其他3组比较,差异均有统计学意义(均P＜0.05).根管充填6个月、1年后复查的结果没有差异(P＞0.05),A组有效率最高,与其他3组比较,差异有统计学意义(P＜0.05);D组有效率最低,与其他3组比较,差异有统计学意义(P＜0.05).结论 AH Plus糊剂+Vitapex糊剂+牙胶尖治疗慢性根尖周炎,既诱导了根尖周阴影区的骨质增生修复,又能使根尖孔形成完善的封闭,达到治愈根尖周炎、防止继发感染或复发的目的 .     

Comparative study of apical sealing ability of a new resin-based root canal sealer

The purpose of this study was to compare the microleakage of two root canal sealers, Fibrefill (resin-based sealer) and calciobiotic root canal sealer (CRCS; calcium hydroxide-based sealer), with and without the presence of smear layer. The model used for the measurement of microleakage was a fluid transport model.Sixty human extracted teeth were used in this study. The teeth were divided into four groups and treated as follows. In group A, the smear layer was left intact, and canals were obturated with gutta-percha and Fibrefill. In group B, the smear layer was removed, and canals were obturated with gutta-percha and Fibrefill. In group C, the smear layer was left intact, and the canals were obturated with gutta-percha and CRCS. In group D, the smear layer was removed, and canals were obturated with gutta-percha and CRCS. Microleakage was measured at 7 days, 1 month, and 2 months.The results showed that the Fibrefill groups with and without smear layer leaked significantly less than the CRCS groups at all experimental times. No significant difference was found between the groups of same materials, but the microleakage values were less when the smear layer was removed.     

下颌切牙双根管的显微根管治疗

目的评价显微根管治疗术处理下颌切牙双根管的临床疗效。方法选取143颗需进行根管治疗的下颌切牙（下颌中切牙68颗,下颌侧切牙75颗）,拍摄术前X线正位投照片和偏位投照片。对单根管患牙采用常规根管治疗;对疑为双根管的患牙先常规探查根管,再在牙科手术显微镜下探查并疏通根管,机用镍钛器械预备根管,垂直加压充填技术充填根管。记录根管类型,不同X线投照角度、使用和未使用牙科手术显微镜时多根管的发现率,根据术前、术中及术后X线片评价根管预备和充填效果。结果采用显微根管治疗,下颌中切牙、侧切牙双根管的发现率分别为26.47%、29.33%,X线偏位投照片双根管的发现率高于正位投照片;使用牙科手术显微镜后,多根管的发现率高于未使用时;在牙科手术显微镜下进行根管预备,无根管堵塞、偏移、台阶、器械分离等并发症发生;134颗患牙适充,9颗有糊剂或牙胶超充,无欠充。结论显微根管治疗是处理双根管下颌切牙的有效方法,在牙科手术显微镜下以机用镍钛器械预备根管,垂直加压充填技术充填根管可取得良好的治疗效果。     

Seal ＆ Protect封闭剂治疗牙本质过敏症的疗效评价

目的 观察Seal＆Protect封闭剂治疗牙本质过敏症的作用,通过扫描电镜观察Seal＆Protect封闭人离体牙牙本质小管的效果。方法 牙本质过敏患牙180颗,实验组90颗,用Seal＆Protect治疗,对照组90颗用30％草酸钾治疗。取离体牙30颗,于颈部制备洞型,分3组(第1组涂布Seal＆Protect,第2组涂布30％草酸钾,第3组未经任何处理作空白对照)扫描电镜观察表面形态。结果 实验组治疗后的即刻疼痛缓解有效率100％,3个月复查有效率97.78％,而用30％草酸钾即刻疼痛缓解有效率为96.67％,3个月复查有效率87.78％,两者有显著差异(P<0.05)。SEM观察显示经Seal＆Protect和草酸钾处理,大部分牙本质小管被封闭。结论 Seal＆Protect能有效地封闭牙本质小管,是一种有效的治疗牙本质过敏症的脱敏剂。     

Effect of etching agent on dentinal adhesive interface in primary teeth

The purpose of this study was to evaluate in vitro the effect of a phosphoric acid etchant containing benzalkonium chloride on the dentin/adhesive interface in primary teeth. The teeth had caries lesions involving enamel and dentin, and were stored in a 2% glutaraldehyde solution for 2-4 hours. The teeth were divided into five groups of five teeth each: Group 1: Etching for 15 seconds with a semigel 32% phosphoric acid containing benzalkonium chloride; Group 2: Etching with 35% phosphoric acid for 15 seconds; Group 3: Treated with a 2% benzalkonium chloride in a alcoholic solution; Group 4: Conditioned with a 3% benzalkonium chloride in a alcoholic solution (control group); Group 5: The teeth were untreated (control group). The carious tissue was removed with a carbide bur in high-speed and copious air water spray. The overall dimensions and depths of the cavities were determined by the carious tissue removal. After the caries lesion was removed, the cavity was cleaned with an air-water spray and the dentin was treated according to the specific group. The teeth were then restored with Scotchbond Multi-Purpose Plus (3M, St. Paul, MN) and Z-100 resin-based composite (3M, St. Paul, MN) according to the manufacturer's instructions. After the teeth were restored they were stored in water for 24 hours at room temperature and the restorations polished. After storage the teeth were thermally challenged for 500 cycles in temperatures of 50 C and 550 C and then stored in 100% humidity until the sectioning procedures. The teeth were cut into two sections along the longitudinal axis through the center of the teeth and passed the mesial-distal surfaces through the restoration by using a double-face diamond disc with water coolant. The specimens were ground with 320 up to 600 grit silicon carbide paper and polished with 6 mm and 1 mm diamond paste and 0.25 pm alumina solution. The specimens were etched with 10% citric acid for 1 minute and washed with deionized water. After that, they were deproteinized with 10% NaOCl for 5 seconds. The specimens were dried at room temperature sputter-coated with gold and observed with an SEM for assessment of the morphology of the bonded interface. The interface was observed to determine the presence/absence of hybrid layer formation, resin tags, and gaps. In the groups treated only with benzalkonium chloride solutions, spaces were observed in the resin/dentin interface. Similar findings were observed in the control group, which received no treatment on the dentin before primer application. In these groups neither resin tags or hybrid layer formation was observed. The presence of an amorphous layer, which was unremoved smear layer, was noted. The group treated with 35% phosphoric acid showed a hybrid layer formation (8.15 microns). This layer was linked intimately with the peritubular and intertubular dentin. Tags formation was observed towards the pulp under the hybrid layer. In these specimens the gaps were not observed between the dentin layer and bonding materials. The total removal of the smear layer was observed using 37% phosphoric acid with benzalkonium chloride. A hybrid layer (+/- 7.32 microns) and resin-tags attached to this layer were observed similar to the group in which the 35% phosphoric acid was used. The samples showed total removal of the smear layer and no gaps were observed in the dentin/adhesive interface.     

牙髓血运重建术用于根尖孔宽大的年轻恒牙临床疗效分析

目的:通过对根尖孔未发育完全的年轻恒牙实施牙髓血运重建治疗,并追踪随访患牙9~24个月,观察牙髓血运重建术的临床疗效。方法:对9例(11颗牙)患牙进行常规开髓,清除坏死的牙髓组织,2.5%的次氯酸钠和17%的EDTA溶液冲洗后封入三联抗生素糊剂。待患牙临床症状消失后,对其进行牙髓血运重建术,严密冠方封闭,定期复诊观察。结果:9例(11颗牙)年轻恒牙经牙髓血运重建术治疗后,临床症状全部消失。其中,6颗牙根尖孔闭合,牙根发育,牙髓电活力测试有反应;4颗牙根尖孔闭合,牙根发育,牙髓电活力测试无反应;1颗牙治疗失败。结论:牙髓血运重建术能使牙根继续发育,为治疗牙髓炎症、坏死和根尖周感染的年轻恒牙提供了可选择的方法。     

Evaluation of penetration and adaptation of three different sealers: a SEM study

In this study, dentinal penetration and adaptation of three endodontic sealers were evaluated by using scanning electron microscope (SEM). Seventeen recently extracted, human maxillary anterior teeth were used. After the crowns were removed from the cementoenamel junction, the root canals were instrumented. The teeth were then randomly divided into three groups of five roots each and two teeth were used as controls. The smear layer was removed with EDTA and NaOCl. The canals were obturated with AH 26, CRCS, RSA sealers and gutta-percha using lateral condensation technique. Each root was sectioned longitudinally and then prepared for SEM evaluation. The SEM results showed that AH 26 was the best sealer penetrating into dentinal tubules and adapted to dentinal walls when compared with the CRCS and RSA. The CRCS and RSA occluded the orificies of dentinal tubules. The RSA showed that the penetration was less than AH 26 and more than CRCS.