正畸疼痛的临床研究

疼痛是正畸牙移动过程中的最常见症状之一。许多研究表明疼痛已经成为患者中断正畸治疗最主要的原因之一,随着患者对治疗舒适度要求的增加,如何监测正畸疼痛,如何减轻正畸治疗过程中的疼痛成为正畸医生的研究热点。本文就正畸过程中产生的疼痛特点以及临床上正畸疼痛的控制方法以及研究进展做一综述。     

正畸治疗疼痛的研究进展

疼痛是正畸治疗中最常见的问题之一,随着患者对治疗舒适度要求的增加,如何认识正畸治疗中的疼痛特点,如何减轻正畸治疗的疼痛程度,成为正畸医师关注的研究热点.本文就正畸治疗时疼痛的特点和减轻疼痛方法的研究进展作一综述.     

正畸疼痛的临床与基础研究进展

疼痛是正畸治疗过程中的常见症状,不仅影响正畸治疗的最终效果,而且影响患者是否接受正畸治疗的意愿。资料显示,95%的正畸患者出现过不同程度的疼痛症状。如何消除或减轻正畸疼痛,确保正畸矫治效果,改善口腔医疗服务质量,已成为越来越多的正畸医师和患者关注的问题之一。本文总结了正畸治疗中疼痛的表现、特点及可能的机制,并分析比较了目前临床上常用的镇痛措施,旨在进一步明确正畸疼痛的外周神经机制,为临床提供切实可行的疼痛缓解方案。     

艾森克人格因素对成人正畸治疗疼痛的影响研究

目的探讨艾森克人格因素对成人正畸患者治疗过程中疼痛的影响,为正畸治疗过程中进行心理治疗以缓解治疗疼痛提供指导依据。方法选择进行正畸治疗的成人患者100例,治疗前由患者填写个人情况,并完成艾森克人格问卷,戴矫治器后采用视觉模拟评分法填写正畸治疗疼痛情况。对结果进行统计分析。结果艾森克人格E量表标准分同正畸疼痛呈负相关(-0.287～-0.358),而P、N、L量表的标准分均与正畸疼痛不相关。E标准分高的组(E≥60)和E标准分低的组(E<60)的正畸疼痛情况之间存在显著差异(P<0.05)。结论外向人格倾向者对疼痛的评分值低于内向人格倾向者。患者的人格倾向会影响患者的疼痛主诉程度,治疗前应对正畸患者进行必要的心理行为干预,以利于患者的健康与合作,提高口腔治疗效果。     

音乐缓解正畸治疗性疼痛的临床研究

目的 探讨音乐对正畸治疗性疼痛的缓解作用。方法 根据随机对照原则将初戴固定矫治器的165例患者分为音乐组和空白组,音乐组采用音乐干预正畸性治疗疼痛,空白组不采用任何干预疼痛的措施。应用视觉模拟评分法（VAS）评估受试者的正畸治疗性疼痛强度,并分析受试者的年龄、性别、情绪及人格对音乐缓解正畸疼痛效果的影响。结果 有效调查率为85.45％。音乐组的正畸治疗性疼痛低于空白组（P<0.05）。音乐组和空白组中情绪不稳定患者较情绪稳定患者疼痛明显,内向型人格患者较外向型人格患者疼痛明显（P<0.05）。音乐组中女性患者较男性患者疼痛明显（P<0.05）。结论 音乐对正畸治疗性疼痛的缓解有较好的效果。音乐缓解正畸治疗性疼痛男性优于女性,外向型人格优于内向型人格,情绪稳定者优于不稳定者。     

正畸牙移动疼痛相关介质的基础研究进展

在正畸治疗过程当中，疼痛是最为常见、最为棘手的问题之一，它不但关系到正畸治疗成效，而且关系到患者接受正畸治疗的意愿，其中包括年龄小的患者的依从性，年龄大的患者的疼痛敏感性。寻求有效地减少正畸治疗过程中的疼痛，掌握正畸疼痛的基本规律，已成为正畸学的重要研究方向之一。本文就正畸疼痛相关介质的基础研究进展做一综述。     

自锁托槽联合必理通和正畸保护蜡减轻固定正畸初始疼痛的研究

目的探索减轻固定正畸治疗初始疼痛的方法。方法随机选择42例患者作为治疗组,在安放Clippy自锁托槽矫治器前后,嘱患者口服必理通,并发放正畸保护蜡,嘱患者在口腔颊部软组织受到矫治器刺激时自行使用。选择42例采用传统直丝弓矫治器矫治的患者作为对照组。通过问卷调查表了解初始疼痛的发生强度和持续时间,并对其进行统计学分析。结果对照组初始疼痛发生率为92.8%,治疗组初始疼痛发生率为71.4%,两组初始疼痛发生率差异有统计学意义（P〈0.05）。治疗组初始疼痛的平均强度减弱,疼痛持续时间缩短。结论自锁托槽、必理通和正畸保护蜡联合应用可有效减轻固定正畸治疗伴发的初始疼痛。     

半导体激光照射减轻正畸治疗疼痛的临床观察

目的 观察半导体激光局部照射的方法对减轻正畸治疗中疼痛的临床效果。方法 对戴入初始弓丝的128例正畸患者,其中63例患者应用半导体激光照射其受力前后的牙根部区域,照射次数1～2次。余65例患者作为对照组。通过问卷调查了解疼痛发生的时间、持续时间并进行统计学分析。结果 应用半导体激光照射组疼痛的发生时间迟,疼痛持续时间短。对照组疼痛发生率为96.92％,照射组疼痛发生率为79.37％。结论 半导体激光局部照射对减轻正畸伴发的疼痛有效。     

正畸加力后牙周疼痛与龈沟液中生物活性物质变化的相关研究

目的 观察正畸患者正畸加力后疼痛的时间变化规律，了解正畸加力前后龈沟液中生物活性物质的变化特点，以及两者之间的相关性。方法 采用放射免疫测定法，测定正畸患者50例样本上颌侧切牙受唇向倾斜力前和后12h、24h、48h、72h龈沟液中前列腺素E2(PGE2)、P物质(SP)、白细胞介素-6(IL-6)和巨噬细胞集落刺激因子(GM—CSF)的浓度变化，记录并描述正畸加力后疼痛的时间规律。对正畸加力后疼痛与生物活性物质的变化进行相关分析。结果 正畸加力后12h左右开始出现疼痛，24h左右疼痛程度最高，72h左右明显减轻。正畸加力后12h左右PGE2、SP、IL-6和GM—CSF的浓度升高，24h后SP、PGE2达到高峰，而IL-6和GM—CSF的浓度无明显变化；72h，IL-6和GM—CSF保持较高水平，而PGEa、SP的浓度明显下降。结论 正畸牙加力后疼痛呈规律性变化，而这种变化与牙周某些局部生物活性物质如SP和PGE2的浓度变化相关。     

正畸扩弓治疗中疼痛与昼夜节律相关性的研究

目的：研究按照昼夜节律进行正畸加力控制,获得昼夜节律对正畸扩弓治疗中疼痛的影响和作用,为临床上更有效地进行正畸加力治疗后的疼痛控制。方法：34例连续正畸扩弓治疗病例,男18例,女16例,年龄10.8～12.8岁,腕骨片示均处于生长发育高峰期,采用相同固定快速扩弓装置,每日加力时间按照人体昼夜节律规律分为0点、3点、6点、9点、12点、15点、18点、21点8个时段组,每组加力方式相同,利用MPQ疼痛量表进行疼痛程度的观察,通过统计学软件进行余弦拟合及多样本t检验。结果：不同性别对于疼痛的耐受力有区别,女性对于正畸扩弓治疗疼痛的耐受力低于相同情况下男性。正畸加力后疼痛量化结果显示正畸加力后疼痛基本符合昼夜节律规律。峰值出现在0点,而谷值出现在12点的时间节点。结论：人体昼夜节律可以影响正畸扩弓治疗后的疼痛程度。按照昼夜节律进行正畸扩弓矫治可以获得更好的疼痛控制效果。提示正畸扩弓加力较合适在午间进行,这样有利于控制正畸患者的疼痛。     

Attitudes and perceptions of adults towards orthodontic treatment in an Asian community

Abstract – A retrospective survey of 358 local Chinese adult orthodontic patients was undertaken to determine the motivating factors behind orthodontic treatment and the discomfort caused by fixed orthodontic appliances. From the completed questionnaires of 203 patients, the principal conclusions were that the improvement in dento-facial aesthetics following orthodontic treatment enhanced their self-confidence and self-esteem in a majority of patients; discomfort in oral soft tissues and teeth were transient and did not exceed 7 days; transient pain from teeth was experienced by 91% of patients and in 39% of these patients the discomfort to teeth was experienced with each new archwire or elastic force application. These results may be useful in relating discomfort levels to prospective orthodontic patients. It was also evident in the study that several cross-cultural differences existed in the attitudes of our patients compared to those reported in Caucasians.     

Clinical outcome of mini-screws used as orthodontic anchorage

Background: Implants and orthodontics are an important combination to obtain intraoral anchorage and eliminate the disadvantages linked with extraoral anchorage such as compliance problems, aesthetical, and social factors. The mini-screw is a simple, relatively low-cost method to provide intraoral anchorage.
Purposes: The aims of this study were to evaluate clinical success and longevity of mini-screws during orthodontic treatment and to assess the patient's opinion.
Materials and Methods: Fifty mini-screws were inserted in the mandible and maxilla of 21 patients with a flapless technique under local anesthesia. The patients were recalled after 2 weeks and from then on every other 2 months, and periodontal parameters and stability of the screws were evaluated at regular intervals. Patients received a questionnaire to assess their opinion regarding the treatment.
Results: Thirty-three mini-screws (64%) remained stable sufficiently long to obtain the effect during the orthodontic movement. The survival was comparable in mandible or maxilla, and not related to the orthodontic forces applied or time of activation of the load. The results do suggest that a waiting period of 1 week before loading improves success, and mini-screws inserted into the anterior region score better also compared to the posterior region. Initial periodontal parameters, which are very important in prognosis of orthodontic treatment, are not influencing the success rate in the examined group. Patients complained in 40–50% of the cases of pain during or after surgery, but this did not negatively affect the final general satisfaction with the treatment.
Conclusion: The mini-screw implant is an easy and an inexpensive method for temporary anchorage of orthodontic appliances. The functioning time is short, however, and retreatment may often be required.     

脑啡肽及其与牙疼痛关系的研究进展

正畸治疗过程中,大多数患者会出现各种不同程度的牙疼痛。正畸疼痛相关因子也成为国内外学者研究的热点。属内源性阿片肽家族的脑啡肽在牙疼痛信号的传导和调控中有重要作用。本文就脑啡肽及其与牙疼痛的关系作一综述。     

儿童固定正畸治疗与疼痛的相关分析

目的：分析固定正畸治疗后患儿的疼痛情况,以期指导正畸的I临床工作和术后护理。方法：随机选取335例进行固定矫治器治疗的儿童患者,采用视觉模拟评分法（VAS）在治疗后2h、6h、夜间、24h、2d、3d及7d分别测量其术后疼痛情况,进行评分及统计分析。结果：正畸治疗2h后疼痛开始加重,其后24h内疼痛程度于夜间达到最高水平,第2d开始疼痛减轻,第7d基本恢复正常状态。咀嚼与否及前后牙的疼痛情况基本相似。结论：VAS法可有效分析儿童接受正畸治疗后的疼痛情况,为医生临床工作和治疗后护理提供有益的指导。     

低能量半导体激光缓解正畸不同阶段牙齿疼痛的临床研究

目的　研究低能量半导体激光对佩戴固定矫治器正畸患者在初始排齐和牙弓完全整平后滑动法关闭拔牙间隙2个阶段加力后牙齿疼痛的缓解作用。方法　选取2017年7月至2018年2月于北京协和医院口腔科就诊处于正畸初始阶段的患者19例,处于滑动法关闭拔牙间隙阶段的患者17例。采用单盲、自身牙弓左右侧对照的研究方法,正畸加力后使用低能量半导体激光（810 nm、0.5 W、4 W/cm2）分别照射研究侧牙弓颊侧、腭侧牙周膜区域（连续波模式、40 s/颗）,对照侧相应区域采用指示光进行照射。加力后1周内,患者每日填写疼痛数字评价量表,采用Mann-Whitney检验比较研究侧和对照侧的疼痛差异。结果　在正畸初始阶段应用低能量半导体激光照射,在加力后前3 d均可显著减轻咬合痛,在加力后第1天可显著减轻自发痛（P < 0.05）;而在滑动法关闭拔牙间隙阶段,低能量半导体激光缓解这2种疼痛的作用在研究侧和对照侧间无明显差异（P > 0.05）。结论　低能量半导体激光可明显缓解临床患者在正畸初始阶段的疼痛。     

正畸疼痛的影响因素及临床表现

目的探讨正畸治疗中患者疼痛的影响因素、临床表现;为预防和治疗提供方法依据。方法对59例接受正畸治疗的患者进行综合问卷随访调查,将患者按年龄(青少年组和成人组)和性别分组,影响因素为社会主观因素(心理焦虑恐惧、文化程度、职业)和自然客观因素(畸形程度);临床表现由无疼痛、疼痛开始的部位、强度、时间、持续时间、结束时间表示。χ2检验和方差统计分析比较各年龄组和男女性别组的不同影响因素和临床表现的差异。结果青少年组正畸重度疼痛与心理焦虑恐惧、文化程度、职业各项均无关(P>0.05),而与畸形程度相关(P<0.05);畸形越明显疼痛越严重。成人则相反,其疼痛与社会因素均相关(P<0.05),而与本身的畸形程度无相关(P>0.05);在青少年组和成人组中,男女各项因素比较均无显著相关(P>0.05)。结论正畸治疗患者疼痛在青少年与患者病变本身的严重程度有关,与社会因素无关;而成人则主要与社会主观因素有关与病变本身相关不明显。年龄是而性别不是正畸疼痛的影响因素。     

A longitudinal evaluation of pulpal pain during orthodontic tooth movement

Objectives – To examine the longitudinal changes in pulpal sensitivity to electrical stimulation and the relationship to pulpal sensitivity as measured by electrical stimulation and subjective reports of tooth pain after archwire insertion. Design – Non‐randomized, prospective trial, with matched controls. Setting and Sample Population – Regional Clinical Dental Research Center at the University of Washington School of Dentistry. Eighteen adult subjects of age 13–37 years. Nine experimental subjects planned for orthodontic treatment. Nine control subjects matched for gender and age who did not have orthodontic treatment. Experimental Variable – Fixed orthodontic appliances and initial archwire placement in experimental subjects compared with `no treatment' control subjects. Outcome Measure – Subjective assessments of orthodontic tooth pain were made using visual analogue scales. Electrically evoked detection and pain thresholds were determined using a computer‐controlled tooth stimulator. Data were gathered at five time points: after bracket placement (baseline), 1 h after placement of initial archwires, 1 day after archwire placement, 1 week after archwire placement, and 1 month after archwire placement. Comparable time intervals were used for the `no treatment' control subjects. Results – Subjective ratings of treatment‐evoked tooth pain in the experimental group were the greatest at the post‐archwire day 1 observation and progressively decreased for the remaining observations. Control subjects reported little pain at any of these observation times. The detection and pain threshold changes from baseline showed no statistical differences over time or between groups. While not statistically significant, a trend was noted where reports of greater orthodontic tooth pain were associated with increased sensitivity to electrical stimulation (i.e. lower detection and pain thresholds). Conclusion – Orthodontic patients experience significant pain and discomfort 1 day after initial archwire placement (i.e. activation). Future research should investigate whether self‐reports of treatment‐evoked tooth pain intensity are associated with pulpal sensitivity.     

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??Objective    To compare the pain in adult female patients with the application of the invisalign® and Damon Q self-locking brackets during initial orthodontic treatment. Methods    Totally 81 orthodontic adult female patients were selected and randomly divided into 2 groups??44 patients in experimental group wore invisalign® aligners while 37 patients in control group wore Damon Q self-locking brackets appliances. VAS was used to evaluate the time of occurrence of pain and the degree of the pain at 2 h??4 h??8 h??24 h??2 d??3 d??4 d??5 d??6 d and 7 d after the orthodontic treatment. SF-MPQ was used to evaluate the nature of the pain and the incidence of ulcer. Results    Totally 76 effective questionnaires had been collected??and no significant differences were demonstrated in the overall rates of occurrence or the degree of the pain in both groups within the observation period??P > 0.05????but the nature of the pain was different. The incidence rate of ulcer in experimental group was lower than in control group. Conclusion    Basically there is pain in the patients who wear invisalign and Damon Q self-locking brackets for the first time?? but the nature of the pain and the occurrence of ulcer have significant difference.