细丝弓技术在安氏Ⅱ类1分类拔牙患者直丝弓矫治的临床研究

doi:10.13591/j.cnki.kqyx.2023.12.006

摘要/Abstract

摘要：

目的通过细丝弓技术在安氏Ⅱ类1分类拔牙患者直丝弓矫治的临床应用,观察矫治前后牙颌和软组织侧貌的变化,为临床正畸矫治提供参考。方法本研究采用回顾性的研究方法,纳入符合研究标准的24例安氏Ⅱ类1分类拔除4颗第一前磨牙,粘结MBT直丝弓矫治器,采用细丝弓技术矫治的患者。正畸治疗前后拍摄头颅侧位片,使用SPSS 15.0 软件进行配对t检验分析,P<0.05有统计学意义。结果 24例患者正畸治疗完成后,磨牙及尖牙中性,覆牙合覆盖正常,U1-NA角和L1-MP 角分别减小15.78°和6.18°,上下颌切牙切端内收7.56和2.27 mm,下颌磨牙近中移动4.41 mm,上颌磨牙近中移动1.17 mm。下颌切牙压低2.42 mm,下颌磨牙伸长1.21 mm。然而,上颌切牙和磨牙垂直向无明显变化。软组织侧貌改变明显,NLA角增大13.77°上下唇突点相对于审美平面分别减小2.90 mm和3.83 mm。结论安氏Ⅱ类1分类拔牙患者粘结直丝弓矫治器,采用细丝弓技术矫治,矢状方向和垂直方向支抗控制良好,软组织侧貌改善明显。

关键词: 安氏Ⅱ类1分类, 细丝弓技术, Ⅱ类颌间牵引, 直丝弓矫治器

Abstract:

Objective To evaluate dentoskeletal and soft-tissue profile changes in Class Ⅱ division 1 extraction cases treated by the light archwire technique with straight-wire appliances. Methods A total of 24 Class Ⅱ division 1 cases met the inclusion criteria and were treated with the light archwire technique with a straight-wire appliance. Lateral cephalometric measurements were performed before and after treatment, and the statistical analysis was performed using SPSS 15.0 software. Significant changes were evaluated by paired t-tests at a 0.05 significance level. Results After performing the active treatment in 24 subjects, the molar and cuspid relationships were neutral, and normal overjets and overbites were established. U1-NA (°) and L1-MP (°) decreased by 15.78° and 6.18°, respectively. Maxillary and mandibular incisors retracted by 7.56 mm and 2.27 mm, respectively. The mesial movement of the mandibular molars was 4.41 mm, and the mesial movement of the maxillary molars was 1.17 mm. The lower incisors were intruded by 2.42 mm, and the lower molars were extruded by 1.21 mm. However, vertical changes in the maxillary incisors and molars were not significant. Remarkable soft-tissue changes were noted after orthodontic treatment. The NLA increased by 13.77°. The prominence of the upper and lower lips to the aesthetic plane were significantly decreased by 2.90 mm and 3.83 mm, respectively. Conclusion The Class Ⅱ division 1 patients treated with the light archwire technique with a straight archwire appliance showed good control of sagittal and vertical dimensions after the extraction of four first premolars, and the profile was significantly improved.

Key words: Class Ⅱ division 1 malocclusion, light archwire technique, Class Ⅱ intermaxillary elastics, straight-wire appliance

中图分类号:

R783.5

李国永,齐元园,蔡斌,徐向华,程慧娟,王燕玲. 细丝弓技术在安氏Ⅱ类1分类拔牙患者直丝弓矫治的临床研究[J]. 口腔医学, 2023, 43(12): 1086-1090.

LI Guoyong,QI Yuanyuan,CAI Bin,XU Xianghua,CHENG Huijuan,WANG Yanling. Light archwire technique in Class Ⅱ division 1 extraction cases with straight-wire appliances[J]. Stomatology, 2023, 43(12): 1086-1090.

图/表 8

图1

图2

图3

图4

图5

表1

表2

表3

参考文献 18

[1]	李国永, 蔡斌. 高角安氏Ⅱ类1分类拔牙患者的临床治疗[J]. 中华口腔正畸学杂志, 2015, 22(1):15-19.
[2]	Almuzian M, Alharbi F, McIntyre G. Extra-oral appliances in orthodontic treatment[J]. Dent Update, 2016, 43(1):74-76,79-82. pmid: 27024904
[3]	Kim JW, Lee NK, Sim HY, et al. Failure of orthodontic mini-implants by patient age, sex, and arch; number of primary insertions; and frequency of reinsertions after failure: An analysis of the implant failure rate and patient failure rate[J]. Int J Periodontics Restorative Dent, 2016, 36(4):559-565. doi: 10.11607/prd.2675
[4]	Chen YJ, Chang HH, Huang CY, et al. A retrospective analysis of the failure rate of three different orthodontic skeletal anchorage systems[J]. Clin Oral Implants Res, 2007, 18(6):768-775. doi: 10.1111/clr.2007.18.issue-6
[5]	Vicioni-Marques F, Pimentel DJB, Matsumoto MAN, et al. Orthodontic mini-implants: Clinical and peri-implant evaluation[J]. J World Fed Orthod, 2022, 11(1):22-28.
[6]	Wu TY, Kuang SH, Wu CH. Factors associated with the stability of mini-implants for orthodontic anchorage: A study of 414 samples in Taiwan[J]. J Oral Maxillofac Surg, 2009, 67(8):1595-1599. doi: 10.1016/j.joms.2009.04.015
[7]	王大为, 冯志才, 朱双林, 等. 掌握Begg矫正技术的再探讨[J]. 广东牙病防治, 2007, 15(1):34-35.
[8]	Upadhyay M, Yadav S, Nagaraj K, et al. Dentoskeletal and soft tissue effects of mini-implants in Class Ⅱ division 1 patients[J]. Angle Orthod, 2009, 79(2):240-247. doi: 10.2319/013008-52.1 pmid: 19216590
[9]	Ozaki T, Ozaki S, Kuroda K. Premolar and additional first molar extraction effects on soft tissue. Effects on high Angle Class Ⅱ division 1 patients[J]. Angle Orthod, 2007, 77(2):244-253. doi: 10.2319/0003-3219(2007)077[0244:PAAFME]2.0.CO;2
[10]	李国永, 蔡斌, 周晓秋, 等. 细丝弓技术矫治安氏Ⅱ类1分类拔牙患者在两种矫治器中的疗效比较[J]. 实用口腔医学杂志, 2016, 32(5):678-681.
[11]	Janson G, Niederberger ALG, Janson G, et al. Stability of Class Ⅱ malocclusion treatment with Class Ⅱ elastics[J]. Am J Orthod Dentofacial Orthop, 2023, 163(5):609-617. doi: 10.1016/j.ajodo.2021.10.017
[12]	Tominaga JY, Tanaka M, Koga Y, et al. Optimal loading conditions for controlled movement of anterior teeth in sliding mechanics[J]. Angle Orthod, 2009, 79(6):1102-1107. doi: 10.2319/111608-587R.1 pmid: 19852600
[13]	张晓芸, 杨维国, 许天民, 等. 磨牙支抗曲打开咬合前牙压入力分布的有限元研究[J]. 现代口腔医学杂志, 2002, 16(4):307-309.
[14]	Chhibber A, Upadhyay M, Shetty VS, et al. Cephalometric comparison of vertical changes between Begg and preadjusted edgewise appliances[J]. Eur J Orthod, 2011, 33(6):712-720. doi: 10.1093/ejo/cjq176
[15]	Pearson LE. Vertical control in treatment of patients having backward-rotational growth tendencies[J]. Angle Orthod, 1978, 48(2):132-140. pmid: 277076
[16]	Cusimano C, McLaughlin RP, Zernik JH. Effects of first bicuspid extractions on facial height in high-angle cases[J]. J Clin Orthod, 1993, 27(11):594-598.
[17]	冯建坤, 王宏宇, 李杨, 等. MBT技术结合微种植钉支抗治疗青少年骨性Ⅱ类高角错牙合畸形的临床效果研究[J]. 口腔医学, 2019, 39(12):1108-1112.
[18]	李硕, 胡炜. 种植支抗对成人高角病例垂直向控制效果的对比研究[J]. 中华口腔正畸学杂志, 2018, 25(4):181-185.

测量项目	矫治前		矫治后		矫治前后变化		P
测量项目	平均值	标准差	平均值	标准差	平均值	标准差	P
U1-SN角/(°)	118.49	8.68	102.72	5.12	-15.78	5.87	0.000^***
U1-L1角/(°)	108.21	6.48	128.45	5.11	20.24	6.73	0.000^***
IMPA角/(°)	102.45	6.90	96.27	7.12	-6.18	2.63	0.000^***
U1/PP距/mm	30.56	3.05	31.01	3.10	0.92	2.29	0.092
U6/PP距/mm	24.83	3.18	25.57	2.97	0.74	1.21	0.065
L1/MP距/mm	44.31	3.56	41.89	3.01	-2.42	3.43	0.038^*
L6/MP距/mm	35.47	2.78	36.67	2.90	1.21	0.92	0.009^**
U1/PTV距/mm	64.18	2.69	56.62	2.48	-7.56	2.98	0.000^***
L1/PTV距/mm	56.88	2.71	53.90	2.32	-2.27	1.61	0.004^**
U6/PTV距/mm	27.92	2.40	29.09	2.56	1.17	1.98	0.041^*
L6/PTV距/mm	29.03	3.81	32.44	4.75	4.11	2.10	0.006^**
覆盖/mm	7.28	2.61	2.82	0.91	-4.46	2.26	0.003^**
覆牙合/mm	2.78	2.01	2.17	0.58	-0.61	-1.90	0.361

测量项目	矫治前		矫治后		矫治前后变化		P
测量项目	平均值	标准差	平均值	标准差	平均值	标准差	P
SNA角/(°)	80.81	3.46	80.52	3.75	-0.29	1.12	0.019^*
SNB角/(°)	75.10	3.41	74.63	3.22	-0.47	0.63	0.068
ANB角/(°)	5.71	2.32	5.89	2.48	0.18	2.31	0.376
SN-MP角/(°)	35.03	5.16	35.18	5.31	0.42	2.46	0.216
FMA角/(°)	29.16	4.68	29.27	4.79	0.10	1.32	0.227
前下面高/mm	72.76	6.01	73.69	6.89	0.93	2.01	0.121
前面高/mm	125.21	7.43	126.02	7.14	0.81	1.78	0.155
后面高/mm	78.29	6.86	79.19	7.02	0.90	1.61	0.021^*
后面高/前面高/(%)	62.78	4.56	62.91	4.41	0.13	1.42	0.325

测量项目	矫治前		矫治后		矫治前后变化		P
测量项目	平均值	标准差	平均值	标准差	平均值	标准差	P
G-SN-Pg角/(°)	14.11	5.01	14.65	5.27	0.53	2.28	0.463
鼻唇角/(°)	89.04	8.12	102.81	6.39	13.77	6.31	0.000^***
E平面-Ss距/mm	2.39	1.98	-0.51	2.10	-2.90	1.78	0.003^**
E平面-Li距/mm	4.86	2.13	1.03	1.36	-3.83	1.97	0.004^**