上颌前部埋伏多生牙定位方法及诊断

上颌前部埋伏多生牙多由于上前牙排列不齐,恒牙滞萌,乳牙滞留,上中切牙间隙过宽等原因前来就诊拍片发现。由于易导致错畸形,影响乳恒牙正常替换,需及时拔除。为了确定手术进路,通过X线摄片进行定位,以确定其在颌骨内位置及与正常牙的关系。     

儿童埋伏多生牙临床分析

<正> 儿童混合牙列期因埋伏多生牙易导致多种错(牙合)畸形影响乳恒牙的正常替换,甚至形成含牙囊肿,故常需要及早拨除。然而考虑患儿心理学特点,做到术前准确定位,最大限度地减少手术创伤,就显得非常重要。本文对231例患儿上颌埋伏多生牙的临床分析如下:     

新型口腔间隙保持器临床应用进展

在乳牙列期及混合牙列期,乳牙早失引起的间隙丧失可能影响继承恒牙萌出和牙弓长度发育,增加错(牙合)畸形发生的可能性及其严重程度,同时影响患儿的咀嚼功能和美学需求。因此,及时有效的间隙保持对于儿童的口腔咬合发育十分重要。随着口腔相关学科的发展和学科交叉发展的深入,口腔医学领域出现的技术、材料和设计上的创新逐步应用于间隙保持器的设计与制作。文章将从临床传统间隙保持的方法及其优缺点和间隙保持器技术、材料、设计的新进展等方面做一综述。     

恒牙萌出的时间、顺序与错(牙合)畸形的关系

牙齿的生长发育具有一定的时间性、顺序性。在萌出时间上,乳牙的滞留或早失都会对恒牙咬合关系产生影响。特别是由于乳牙早失发生的时间、恒牙胚在颌骨内的位置不同可使继承恒牙的萌出时间发生很大变化。而且具体个体的牙齿萌出时间还会受到种族、地域等多种因素的影响。在萌出顺序上,遗传或乳、恒牙替换障碍可引起恒牙萌出顺序紊乱,并导致[牙合]关系异常和错[牙合]畸形。临床观察表明：近年来儿童恒牙萌出情况有许多新的变化。因此,认识乳、恒牙替换过程的正常规律以及可能出现的异常情况,对儿童、青少年的口腔保健乃至全身健康都有重要的意义。     

多曲方丝弓技术矫治恒牙期骨性Ⅲ类错(牙合)的颌(牙合)面变化

目的对比多曲方丝弓(MEAW)技术矫治恒牙期骨性Ⅲ类错畸形前后患者颌面变化,了解MEAW技术矫治恒牙期骨性Ⅲ类错畸形的机理.方法选用0.46mm×0.64mm的托槽系统治疗骨性恒牙期Ⅲ类错畸形患者15例.测量矫治前后患者的正中位定位X线头颅侧位片并进行比较.结果L6-Xi减少2.87 mm,L6/MP曾大8.60°,L1-Xi减少2.60mm,OP/MP增大约2.33°.颌骨变化较小.软组织的变化无统计学意义.结论①MEAW矫治恒牙期骨性Ⅲ类错畸形,主要是通过牙齿的移动和牙槽骨的改变而完成的,骨组织及软组织变化是有限的.②MEAW纠正反 ,首先是由于磨牙的明显直立、远中移动,使磨牙关系得到明显改善,为下前牙舌向移动提供了宝贵的间隙.③下前牙在舌向移动与倾斜同时略有升高, 平面变平.     

多曲方丝弓技术矫治恒牙期骨性Ⅲ类错的颌面变化

目的　对比多曲方丝弓 (MEAW )技术矫治恒牙期骨性Ⅲ类错畸形前后患者颌面变化 ,了解MEAW技术矫治恒牙期骨性Ⅲ类错畸形的机理。方法　选用 0 4 6mm× 0 6 4mm的托槽系统治疗骨性恒牙期Ⅲ类错畸形患者 15例。测量矫治前后患者的正中位定位X线头颅侧位片并进行比较。结果　L6_Xi减少 2 87mm ,L6 /MP增大 8 6 0°,L1_Xi减少 2 6 0mm ,OP/MP增大约 2 33°。颌骨变化较小。软组织的变化无统计学意义。结论　①MEAW矫治恒牙期骨性Ⅲ类错畸形 ,主要是通过牙齿的移动和牙槽骨的改变而完成的 ,骨组织及软组织变化是有限的。②MEAW纠正反 ,首先是由于磨牙的明显直立、远中移动 ,使磨牙关系得到明显改善 ,为下前牙舌向移动提供了宝贵的间隙。③下前牙在舌向移动与倾斜同时略有升高 ,平面变平。     

多曲方丝弓技术矫治恒牙期骨性Ⅲ类错的颌面变化

目的　对比多曲方丝弓(MEAW)技术矫治恒牙期骨性Ⅲ类错畸形前后患者颌面变化,了解MEAW技术矫治恒牙期骨性Ⅲ类错畸形的机理。方法　选用0·46 mm×0·64 mm的托槽系统治疗骨性恒牙期Ⅲ类错畸形患者15例。测量矫治前后患者的正中位定位X线头颅侧位片并进行比较。结果　L6-Xi减少2·87 mm, L6/MP增大8·60°,L1-Xi减少2·60 mm,OP/MP增大约2·33°。颌骨变化较小。软组织的变化无统计学意义。结论　 ①MEAW矫治恒牙期骨性Ⅲ类错畸形,主要是通过牙齿的移动和牙槽骨的改变而完成的,骨组织及软组织变化是有限的。②MEAW纠正反,首先是由于磨牙的明显直立、远中移动,使磨牙关系得到明显改善,为下前牙舌向移动提供了宝贵的间隙。③下前牙在舌向移动与倾斜同时略有升高,平面变平。     

根尖片水平移位法对儿童上颌前部埋伏多生牙的定位探讨

近年来，随着口腔保健意识的增强，家长对孩子的牙齿替换时间、排列位置等越来越重视，常因儿童替牙[牙合]期上牙牙列不齐、间隙过宽、滞萌等而就医。临床检查中常发现上颌前牙区有埋伏多生牙存在，有统计其发生率在1％～3％。儿童替牙期的混合牙列埋伏多生牙易导致多种错[牙合]畸形影响乳恒牙的正常替换，故需及早拔除。因此，术前埋伏多生牙的准确定位是手术成功的关键所在。作者收集2001年2月～2004年6月埋伏多生牙病例92例，125枚多生牙，采用根尖片水平移位法拍摄定位牙片，手术验正其准确性。     

替牙期错畸形的治疗

正畸治疗的理想时间通常为恒牙初期,然而对于有些牙源性错畸形,在替牙期可以采用非常简单的矫治方法,在很短时间内矫治完成,阻断错畸形继续发展;对于功能性错,早期阻断异常的神经肌肉反射,治疗简单而且效果良好,但是如果不及时矫正,最终将导致齿槽骨及颌骨异常;对于有些骨性错畸形,在替牙期进行正畸治疗可以利用患者颌骨的生长发育潜力,对颌骨的生长施加影响,纠正或改善颌骨畸形。这些病人若等到恒牙期再开始正畸治疗便错过了正畸治疗的最佳时期,大大增加恒牙期正畸治疗的难度,因此替牙期正畸治疗的目的是尽早纠正已存在的或发展中…     

固定矫治器在儿童牙颌外伤中的应用

儿童易发生外伤,往往造成牙脱位、牙槽突骨折及颌骨骨折,同时伴有唇和牙龈等软组织的撕裂、肿胀。为了恢复牙颌的正常解剖形态和功能,又不损伤颌骨内的牙胚,必须选择理想的固定方法。乳牙列牙冠较短,牙根吸收而致乳牙不稳固,混合牙列期年轻恒牙尚未完全萌出,难于做牙问或颌间牙弓夹板固定;     

��ͯʱ�������ε����ڷ���

小儿从出生到建立完好的恒牙列,是个漫长的过程。在此期间,常见的龋、牙齿发育异常、口腔不良习惯等,均会对牙、颌、面的生长产生影响,导致面型异常及各种错牙合畸形。如对正处于生长发育高峰期的儿童采取早期治疗,治疗效果最好,可使复杂问题简单化,常可在较短的时间内,用比较简单的矫治方法和矫治器改正,及早地阻断错牙合畸形的发展,引导牙、颌、面正常发育。开展早期治疗,要根据儿童的生长发育特点,依据生长发育的规律和发育的顺序进行诊断和治疗。早期治疗可能只是整个治疗计划的一部分,大多数的患儿常常需要到替牙期后再进行后期常规正畸治疗,所以要把乳牙、混合牙列期的早期治疗作为从乳牙、混合牙列期到恒牙列期的整体正畸治疗过程的一个环节来正确认识。     

Management and subsequent 13-year progress of a mandibular fracture with malocclusion in a child – case report

Under acute conditions, maxillofacial injuries may be treated without the opportunity for an assessment of occlusal irregularities, even when there are mandibular fractures, because life-threatening injuries have priority over occlusion. Consequently, mandibular fractures may result in post-trauma malocclusion and facial deformity. The case history reported is of a male patient who had been involved in a traffic accident in childhood and suffered mandibular fractures. The initial incomplete management resulted in persistent deformation of the mandible, disturbance of dental occlusion and difficulty in mastication. These irregularities were corrected during childhood by non-operative orthodontic treatment. When the patient reached adulthood, some permanent teeth were malformed because the fractures had damaged some tooth germs. However, the permanent dentition in general was almost normal as a result of the corrected primary dentition. Although the alveolar deformity due to the injury remained, the mandibular base was satisfactorily remodelled. The case reported supports the view that early restoration of normal dental occlusion before the eruption of permanent teeth contributes to the establishment of good functional dental occlusion of the permanent teeth.     

Longitudinal occlusal changes from primary to permanent dentition in children with normal primary occlusion.

This purpose of this research was to examine the stability of normal occlusion during the transition from primary to permanent dentition. The sample consisted of 128 children (83 boys and 45 girls) 4.5 to 5.5 years old with normal occlusion in the primary dentition. The subjects were reexamined at 12.5 to 13.5 years. None had received orthodontic treatment. Although all the subjects had normal occlusion in the primary dentition, 72.7% (73.5% boys and 71.1% girls) had developed anomalies following eruption of the permanent teeth. These anomalies included crowding, Class II Division 1 or Class II Division 2 malocclusion, mesial occlusion complex, lateral crossbite, anterior crossbite, premature tooth loss, openbite or other anomalies.     

Influence of orthodontic treatment in the primary dentition upon development of the dentition and craniofacial growth

Thirty patients who underwent orthodontic treatment of the primary dentition were examined in this retrospective follow-up study. The mean age at the beginning of treatment was 4.4 (±1.1) years, and at follow-up 15.4 (±1.7) years. Different kinds of malocclusion were present.—Results: The early treatment lasted on average 12.3 (±7.2) months. Treatment time of Class III malocclusion and lateral crossbite was significantly shorter than that of Class II,1 malocclusion, functional Class II,2 malocclusion or anterior open bite (p<0.05). A Class I occlusion was achieved in 90% of the patients during treatment of the primary dentition. No patient treated successfully in the primary dentition showed any relapse to initial malocclusion.—Conclusion: These results suggest that changes in occlusion and mandibular position during treatment in the primary dentition are maintained in the mixed and permanent dentition. It can be concluded that a Class I occlusion following orthodontic treatment in the primary dentition serves as a basis for physiological development of the dentition and craniofacial growth.     

以生理牙合为导向的儿童咬合诱导思维与实践

儿童处于生长发育的活跃期,其颅面骨骼、牙列咬合及面部软组织均处于动态变化过程中。怎样“给孩子一口好牙”是我们应思考的问题。以口腔预防医学为理念,将口腔正畸技术融入儿童口腔疾病治疗中,提出以生理牙合为导向的儿童咬合诱导临床思维与实践,即定期对生长发育期间的儿童进行口腔健康检查,及时发现口腔健康问题,适时采用先进的技术予以干预,并引导建立生理牙合,达到咬合稳定、美观及容貌协调的目的。临床实践涵盖保持乳牙的完整性、维持牙弓长度、干预替牙障碍以及矫治儿童错牙合等方面的内容。     

����������Ϊ����Ķ�ͯҧ���յ�˼ά��ʵ��

??Children are in the active stage of growth and development. Their craniofacial bones??dentition occlusion and facial soft tissues are in the process of dynamic change. How to give children perfect teeth is the problem we need to take into consideration. Orthodontic technique should be integrated into pediatric dentistry??according to the concept of oral preventive medicine. Besides??the clinical thinking and practice of occlusive guidance is proposed in children guided by physiological occlusion. To be specific??it means that during the period of growth and development in children??oral health examination??timely detection of oral health problems and intervention with advanced technology at the right time should be emphasized in order to obtain physiological occlusion??achieving stability??beauty and harmony of the appearance. Corresponding clinical practice includes the maintenance of the integrity of deciduous teeth and the length of dental arch??the intervention of disorders during mixed dentition and the orthodontic treatment for malocclusion in children??etc.     

Angle class I malocclusion in primary dentition and findings in permanent dentition--a follow-up study

The aim of the study was to examine stability and changes in Angle Class I malocclusion from deciduous to permanent dentition in 168 subjects. All the subjects had Class I malocclusion in deciduous dentition, and were examined by the same orthodontist on two occasions during deciduous and permanent dentition. None of the subjects had received orthodontic therapy in the meantime. The results showed considerable changes from primary to permanent dentition. Crowding in primary dentition was retained in permanent dentition in 45.2% cases. In 16.2% cases it changed into normocclusion and 38.6% subjects developed other types of malocclusion. Open bite was retained in permanent dentition in 17.8% cases and in 17.8% subjects transformed into normocclusion. 64.4% subjects developed other types of malocclusion. Cross bite was retained in permanent dentition in 21.4% cases and in 28.6% subjects changed to normocclusion. Other types of malocclusion in permanent dentition developed in 50% subjects. In 30.8% of cases finding of premature loss of deciduous teeth was accompanied by extraction of some permanent teeth. Normocclusion was retained in 19.2% cases while 50% of children developed some type of malocclusion. Crowding, which was retained in permanent dentition in 45.2% cases, showed the highest degree of stability. Children with this type of anomaly in primary dentition displayed the highest frequency of total malocclusions (83.3% subjects). Out of all anomalies in primary dentition, cross bite most frequently switched to normal occlusion in permanent dentition (in 28.6% cases).     

ǰ��ǣ�����ϴ������������ڹ��Ԣ���������ٴ���Ч�о�

目的研究前方牵引联合唇挡矫治替牙期骨性Ⅲ类错的临床疗效。方法选择2010—2011年大庆油田总医院集团五官医院口腔正畸科门诊就诊的替牙期上颌发育不足的骨性Ⅲ类错患者30例。随机分为试验组和对照组,各15例。试验组使用前方牵引联合唇挡进行矫治;对照组则仅使用前方牵引矫治。在治疗前后对所有患者进行X线头影测量分析并比较组间差异。结果试验组治疗前后变化差值与对照组比较,X线头影测量分析结果显示,SNA、ANB、U1-SN、U1-NA角、U1-NA距、Ptm-U6差异均有统计学意义(P<0.01);模型测量结果显示,TAL、AD、拥挤度差异亦均有统计学意义(P<0.01)。结论采用前方牵引和唇挡联合矫治替牙期骨性Ⅲ类错,可有效消除单一采用前方牵引矫治带来的负面影响,是一种切实可行的办法。     

Occlusion revisited

The evaluation of occlusion is of utmost importance, when planning for dental and orthodontic treatment. The occlusal characteristics of normal occlusion change according to the dentoalveolar maturation stages. In primary dentition, flush terminal plane relationship of the second primary molars is desired for a normal molar relationship. In the early mixed dentition stage, cusp to cusp molar relationship is the normal occlusal feature, when posterior primary teeth are in place and leeway space is preserved.     

�����ڹ��Ԣ�������ϻ��μ���̶������о���չ

骨性Ⅲ类错(牙合)是临床上较为复杂的错(牙合)畸形,严重影响牙齿、颌骨及面部的发育.近年来,随着正畸材料的发展与正畸技术的不断提高,固定矫治器及其矫治技术得到蓬勃发展.本文对恒牙期骨性Ⅲ类错(牙合)畸形的固定矫治研究进展做一综述.