矩形附件厚度与位置变化对矫正尖牙扭转的影响  

Effects of the changes of thickness and placement position of rectangular attachment on canine tooth torsion correction

作　　者：陈周艳 周容 何淞 吴定丹 吴稀 白蕊 黄跃 Chen Zhouyan;Zhou Rong;He Song;Wu Dingdan;Wu Xi;Bai Rui;Huang Yue(Department of Stomatology,Yaan People's Hospital,Yaan 625000,Sichuan Province,China;Department of Stomatology,Mianyang City Hospital of Traditional Chinese Medicine,Mianyang 621000,Sichuan Province,China;Hospital of Stomatology,Southwest Medical University,Luzhou 646000,Sichuan Province,China;Affiliated Stomatology Hospital of Jinan University School of Stomatology,Foshan 528000,Guangdong Province,China)

机构地区：[1]雅安市人民医院口腔科,四川省雅安市625000 [2]绵阳市中医医院口腔科,四川省绵阳市621000 [3]西南医科大学附属口腔医院,四川省泸州市646000 [4]暨南大学口腔医学院•附属口腔医院,广东省佛山市528000

出　　处：《中国组织工程研究》2020年第16期2513-2519,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家自然科学基金青年基金(81300903)，项目负责人：黄跃~~

摘　　要：背景:临床上采用无托槽隐形矫治器矫治扭转牙时,主要通过联合使用邻面去釉、增加附件及过矫治来提高矫治效率,但附件的选择及放置等仅依靠医师经验和习惯而定,其产生的效果是否不同目前暂无相关报道。目的:通过三维有限元法探究矩形附件的存在及厚度和放置位置对隐形矫治器矫正左上颌尖牙扭转的影响。方法:通过离体牙扫描数据分别建立矫治器-附件-尖牙-牙周膜-松质骨-皮质骨(有附件组)与矫治器-尖牙-牙周膜-松质骨-皮质骨(无附件组)有限元模型。其中有附件组中的附件厚度又分为0.5,0.75,1.0,1.5 mm(附件的放置位置、垂直高度、水平宽度和放置方向均设为一致),放置位置又分为近中、远中、合方、正中、龈方5个区域(附件的厚度、垂直高度、水平宽度和放置方向均设为一致)。将各组的矫治器以尖牙牙体长轴(X轴)为旋转中心轴,将矫治器远中扭转2°,在MSC.Marc.Mentat软件中模拟运算,收集各应力、位移分布云图及最大应力、位移值。结果与结论:①无论是否使用矩形附件,模型最终状态时尖牙均发生了不同程度的顺时针扭转,无附件组与有附件组模型尖牙位移及牙周膜应力分布趋势一致,但有附件组模型中尖牙位移值及牙周膜各种应力值均不同程度的大于无附件组;②随着矩形附件厚度的增加,尖牙的最大位移随之增大,分别为42.94,49.32,52.52,59.39μm;③当矩形附件放于尖牙牙冠唇面不同位置时,尖牙的最大位移值变化规律为正中与龈方差别不大,但两者均明显大于合方,而近中、远中向的变化不规律;④结果表明,附件的使用不会改变初戴矫治器瞬间尖牙的移动方式,其仅在矫正扭转尖牙时起到了协同作用;附件厚度对矫治器扭转表达有一定的影响,当厚度增大时尖牙所发生的最大位移及牙周膜受力越大;矩形附件在牙冠唇面合、龈方向的粘接位置越靠�BACKGROUND: Using interproximal enamel reduction, adding attachments and over-correction are major methods to improve the efficiency of correcting tooth torsion when using clear aligners in the clinic. However, the choice and placement of attachments depend on the experience and habits of orthodontists, and whether the effects are different has not been reported. OBJECTIVE: To explore the effects of rectangular attachment with different thicknesses and locations on the left maxillary canine tooth torsion in clear aligner by three-dimensional finite element analysis. METHODS: The finite element models of the clear aligner-attachment-maxillary canine-periodontal ligament-spongy bone-cortical bone and the clear aligner-maxillary canine-periodontal ligament-spongy bone-cortical bone were established according to the scanning data of in vitro maxillary canine. The models with attachments were divided into four groups based on different thicknesses of attachment, namely 0.5, 0.75, 1.0, and 1.5 mm groups. The placement positions were divided into five areas: mesial, distal, occlusal, median, and gingival of canine. 2° clockwise rotation of the tooth axis(X axis) was applied to the clear aligner. The action of the appliance and the canine were calculated by MSC.Marc.Mentat software. Then, the nephograms of stress and displacement, and the maximum stress and displacement values were collected. RESULTS AND CONCLUSION:(1) Whether the rectangular attachment was used or not, the two models’ distribution of canine’s displacement and periodontal stress were the same. The stress values of periodontal ligament were all higher than those witho ut rectangular attachment.(2) With the thickness of rectangular attachment increasing, the maximum displacement values of the canine increased gradually, which were 42.94, 49.32, 52.52 and 59.39 μ m, respectively.(3) When the rectangular attachment was place d in different positions, the maximal displacement of canine teeth the attachment of which was placed on the median was almost th

关 键 词：无托槽隐形矫治器 附件 尖牙 扭转 三维有限元分析 口腔生物材料 附件厚度 附件放置位置 

分 类 号：R459.9[医药卫生—治疗学] R783.5[医药卫生—临床医学]