成人安氏Ⅱ类拔牙病例无托槽隐形矫治的支抗控制效果评估

doi:10.13591/j.cnki.kqyx.2023.09.010

摘要/Abstract

摘要：

目的探究无托槽隐形矫治在成人安氏Ⅱ类错𬌗病例中的应用,评估其支抗控制效果。方法选取30例安氏Ⅱ类错𬌗畸形患者,通过隐形矫治技术进行正畸治疗,均采取拔除第一前磨牙后开始矫治,方案设计上目标牙基于CBCT三维方向过矫治,拍摄矫治前后头颅侧位片,测量所有患者头影测量指标,用SPSS 20.0软件进行统计学分析。结果 30例患者磨牙关系调整为中性,前牙覆𬌗覆盖恢复正常,面型明显改善。骨性头影测量项目中上颌骨A点位置矫治前后差异有统计学意义,SNA减小1.63°±1.45°;牙性头影测量项目矫治前后差异均有统计学意义(P<0.05),矫治后上下颌前牙明显回收,U1-NA距减少(4.52±3.79)mm,L1-NB距减少(4.55±3.16)mm;矫治后患者垂直向高度均得到良好的控制,𬌗平面发生一定程度的顺时针旋转;矫治前后第一磨牙头影测量项目中部分指标差异具有统计学意义(P<0.05),第一磨牙近中根尖点到过Ptm点做腭平面的垂线的距离增加(0.99±1.59)mm,第一磨牙近中颊尖点到过Ptm点做腭平面的垂线的距离增加(1.51±1.42)mm。结论 Ⅱ类错𬌗畸形支抗控制有效,疗效良好。

关键词: 隐形矫治, 支抗, Ⅱ类错𬌗

Abstract:

Objective To investigate the clinical application of Invisalign in treatment of Class Ⅱ malocclusion and evaluate its effect of anchorage control. Methods Thirty Class Ⅱ malocclusion patients were enrolled in the study, which was treated by Invisalign with premolar extraction. Terminal position in Clincheck was overcorrected based on CBCT. Cephalograms of pre-treatment and post-treatment were measured. The data were analyzed by SPSS 20.0. Results The overbite of all the 30 patients were back to normal and their lateral profile improved significantly after treatment. The skeletal analysis showed that only point A was significantly changed. SNA decreased by 1.63°±1.45°. The teeth analysis showed that upper and lower anterior teeth were retracted. After treatment, the distance of U1 to NA and L1 to NB reduced by (4.52±3.79) mm and (4.55±3.16) mm, respectively. The differences were statistically significant (P<0.05). The control of vertical direction were effective, while clockwise rotation occured on the occlusion plane. The maxillary first molar analysis showed that the distance of UMC to Ptm and UMA to Ptm increased by (1.51±1.42) mm and (0.99±1.59) mm. The differences were statistically significant (P<0.05). Conclusion Invisalign is an effective appliance for treating Angle Class Ⅱ case, and can control anchorage effectively.

Key words: clear aligner, anchorage, Class Ⅱ malocclusion

中图分类号:

R783.5

陈燕玲, 张晟, 麦理想, 欧卜宾. 成人安氏Ⅱ类拔牙病例无托槽隐形矫治的支抗控制效果评估[J]. 口腔医学, 2023, 43(9): 819-824.

CHEN Yanling, ZHANG Sheng, MAI Lixiang, OU Bubin. Evaluation of the effect of anchorage control in adult Angle Class Ⅱ tooth extraction case with clear aligner[J]. Stomatology, 2023, 43(9): 819-824.

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观察指标	治疗前	治疗后	差值	t	P
SNA/(°)	81.38±2.98	79.75±3.10	1.63±1.45	6.42	0.000
SNB/(°)	77.43±3.21	77.21±3.54	0.22±1.83	0.60	0.562
ANB/(°)	4.11±0.93	2.45±0.93	1.66±1.83	5.07	0.000
MP-SN/(°)	36.76±5.24	36.44±5.57	0.32±2.05	0.79	0.447
OP-SN/(°)	17.43±3.86	21.22±4.66	-3.79±5.48	3.76	0.001
U1-SN/(°)	113.81±5.59	99.82±3.09	13.99±7.67	10.09	0.000
L1-MP/(°)	102.22±6.28	93.80±3.03	8.42±9.39	4.93	0.000
U1-NA距离/mm	8.27±2.65	3.75±1.49	4.52±3.79	6.51	0.000
L1-NB距离/mm	9.54±2.05	4.99±1.36	4.55±3.16	7.75	0.000
U1-L1/(°)	110.62±8.42	132.41±4.87	-21.79±15.71	7.57	0.000
覆盖/mm	4.28±2.05	2.25±1.21	2.03±2.74	4.16	0.001
覆??/mm	1.55±2.28	1.42±0.69	0.13±2.74	0.20	0.840
UM-PP/(°)	78.02±5.85	80.73±5.40	-2.71±3.52	4.20	0.001
UM-SN/(°)	72.06±6.30	74.06±5.49	-2.00±2.81	3.87	0.001
UMA-PP距离/mm	6.09±2.37	5.72±2.44	0.37±1.37	1.64	0.130
UMC-PP距离/mm	21.15±3.68	21.07±3.65	0.08±2.11	0.26	0.799
UMA- PtPt'距离/mm	23.35±4.19	24.34±4.68	0.99±1.59	3.12	0.010
UMC- PtPt'距离/mm	20.80±4.30	22.31±4.64	1.51±1.42	5.78	0.000