正畸治疗中非常规拔牙的临床应用分析

目的 通过回顾性研究,对非常规拔牙在固定正畸治疗中的构成比以及影响拔牙方案选择的相关因素进行探讨。方法 对四川大学华西口腔医院正畸科2012年4月—2014年3月两年间有病历资料记录的7 344例固定正畸患者进行系统抽样,对抽取的734例样本的矫治方案及多项可能对矫治方案有影响的因素进行统计,计算拔牙矫治率、非常规性拔牙矫治率,重点研究影响非常规拔牙的相关因素,并对所有因素进行统计学分析,以评价其对非常规拔牙矫治方案制定的影响程度;对其中部分病例进行非常规拔牙和常规拔牙的疗效对比评价。结果 约55.31%（406/734）的患者采用拔牙矫治,其中常规拔牙矫治占59.11%（240/406）,主动性非常规拔牙占23.15%（94/406）,被动性非常规拔牙占17.73%（72/406）。经统计分析,对主动性非常规拔牙方案制定有影响的因素有患者性别、年龄、医生性别、个别牙情况、Angle分类、中线偏斜程度等6项因素;对于被动性非常规拔牙,就诊前相应牙的缺失或被拔除是其直接影响因素。非常规拔牙和常规拔牙的矫治效果无统计学差异（P>0.05）。结论 患者性别、年龄、医生性别、个别牙情况、Angle分类、中线偏斜程度、就诊前是否有牙缺失等因素对患者矫治方案的制定有一定影响;此外,还应同时考虑到矫治方案的预期效果,综合分析以制定个体化矫治方案。

Comprehensive assessment of atypical-extraction orthodontic treatment

Objective To discuss through retrospective study associated factors influencing orthodontists to develop ortho-dontic treatment plans and to calculate constituent ratio of a typical extraction in orthodontic treatment.Methods Systematic sampling was performed among 7344 orthodontic patients, who received orthodontic treatment from April 2012 to March 2014 in the Department of Orthodontics, West China Hospital of Stomatology, Sichuan University. The study included statistical data on factors that may influence development of treatment plans. Samples were used to calculate extraction-ratio and atypical-extraction-ratio. Research focused on associated factors influencing development of treatment plans while evaluating correlation significances of each factor. Finally, treatment outcomes of atypical-extraction were compared with those of typical-extraction. Results Among studied patients, 55.31% (406/734) received orthodontic extraction treatment. In orthodontic-extraction-treated patients, typical-extraction accounted for 59.11% (240/406), orthodontists-selected atypical-extraction accounted for 23.15% (94/406), and passive atypical-extraction accounted for 17.73% (72/406). With statistical analysis, we inferred associated factors influencing development of treatment plans as follows: sex and age of patients, sex of orthodontists, accurate condition of specific teeth, Angle's classification, and degree of midline deviation. Tooth loss before treatment also directly influences passive atypical-extraction. Statistically significant factors were not obtained. Significant difference of treatment outcome was not observed between atypical-extraction and typical-extraction-orthodontic treatment (P>0.05).Conclusion Above mentioned factors may influence orthodontists to develop treatment plans. However, orthodontists should also consider expected results of treatment strategies to prepare indi-vidual treatment plans on the basis of comprehensive analysis.