无托槽隐形矫治器结合微种植体支抗远移上颌磨牙效率的三维重叠研究  

Three-dimensional model superimposition study on efficiency of molar distalization by using removable clear appliance combined with micro-implant anchorage

作　　者：任亚男 宋保龙 封颖丽 普盼君 顾泽旭 Ren Yanan;SonG Baolong;Feng Yingli;Pu Panjun;Gu Zexu(State Key Laboratory of Military Stornatology ＆ National Clinical Research Center for Oral Diseases ＆ Shanxi Clinical Research Center for Oral Diseases ＆ Department of Orthodontics,School of Stomatology,The Fourth Military Medical University,Xi＇an 710032,China（Ren YN,Song BL,Feng YL,Pu P J,Gu ZX)

机构地区：[1]军事口腔医学国家重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,第四军医大学口腔医院正畸科,西安710032

出　　处：《中华口腔正畸学杂志》2018年第2期92-97,共6页Chinese Journal of Orthodontics

基　　金：西安市社会发展引导计划（2016051SF/YX07）

摘　　要：目的探讨无托槽隐形矫治器结合微种植体支抗远移上颌磨牙的效率及在三维方向上的特点，以期为无托槽隐形矫治器的设计提供理论依据。方法选取需进行上颌磨牙远移的安氏Ⅱ类错患者12例，应用无托槽隐形矫治器远中移动上颌磨牙、前磨牙，其中7例结合微种植体牵引尖牙增加支抗，所有患者定期制取阶段研究模型并使用三维扫描仪将模型数字化。通过重叠治疗前与各阶段的三维数字化模型，分析在不同矫治阶段磨牙、前磨牙的远移效率以及在三维方向上的移动特点；对比有无微种植体支抗对磨牙远移效率及前牙支抗的影响。结果微种植体支抗组上颌第二、第一磨牙的远移效率分别为89.20%和83.53%，均比无微种植体支抗组远移效率高，但差异无统计学意义（P〉0.05）；上颌磨牙远移会造成切牙轻度唇向及近中移位，其中微种植体支抗牵引尖牙组前牙支抗损失量较小，但差异无统计学意义（P〉0.05）。当上颌第一磨牙开始远移时，第二磨牙的远移效率明显下降（P〈0.05）。上颌磨牙远移过程中磨牙未见明显旋转，有轻度压低和颊移（P〉0.05），而上颌前磨牙远移过程中发生明显颊舌向旋转（P〈0.05）。结论无托槽隐形矫治器可以有效地远移上颌磨牙、前磨牙，前磨牙远移时易发生颊舌向旋转，磨牙在远移过程中有轻度的压低及颊向移位；使用微种植体支抗可以在一定程度上增加磨牙的远移效率、减小前牙支抗丧失。ObjectiveTo evaluate the efficiency and three-dimensional characteristics of molar distalization by using removable clear appliance combined with micro-implant anchorage, and provide theoretical basis for design of clear appliance.MethodsTwelve patients with Class Ⅱ malocclusion who needed molar distalization were treated with removable clear appliance. Seven of twelve patients use micro-implant as anchorage to pull canines. Plaster cast models were laser-scanned regularly. Models of pre-treatment and in the middle of treatment were superimposed to calculate the efficiency and three-dimensional characteristics of distalization of molar and premolar, and compare the impact of micro-implant on the efficiency of distalization and anchorage of the anterior teeth.ResultsThe mean distalization efficiency of maxillary second molar and first molar were 89.20% and 83.53% in patients with use of micro-implant, higher than that of the patients without use of micro-implant, but the difference was not statistically significant（P〉0.05）. Slightly labial and mesial displacement of incisor existed during molar distalization, patients with micro-implant had less anchorage loss but the difference was not statistically significant（P〉0.05）. When the first molar moved with the second molar, distal efficiency of the second molar declined significantly（P〈0.05）. No obvious rotations were found in molars during ditalization, instead of premolars（P〈0.05）. Slight intrusion and buccal displacement existed during molar distalization（P〉0.05）.ConclusionsUpper molar distalization can be achieved effectively by removable clear appliance. Buccolingual rotations easily happen in upper premolars during distalization. Slight intrusion and buccal displacement existed during molar distalization. Efficiency of molar distalization can be improved and anchorage loss of incisor can be decreased when combined with micro-implant anchorage.

关 键 词：无托槽隐形矫治 磨牙远中移动 微种植体支抗 三维模型重叠 

分 类 号：R783.5[医药卫生—口腔医学]