上颌种植支抗结合颌间牵引在青少年骨性Ⅲ类错[牙合]患者中的应用及疗效评价  

Evaluation of the application and efficacy of elastics between maxillary TADs and lower jaws in skeletal ClassⅢpatients

作　　者：陈旭 李博晟 张京剧 CHEN Xu;LI Bosheng;ZHANG Jingju(Department of Orthodontics,School and Hospital of Stomatology,Tongji University,Shanghai Engineering Research Center of Tooth Restoration and Regeneration,Shanghai 200072,China)

机构地区：[1]上海牙组织修复与再生工程技术研究中心,同济大学口腔医学院·同济大学附属口腔医院正畸科,上海200072

出　　处：《口腔医学》2021年第3期231-236,共6页Stomatology

基　　金：上海市卫计委面上项目(201740135)。

摘　　要：目的对上颌骨发育不足的骨性Ⅲ类患者,在恒牙列期矫治过程中,上颌骨植入种植体进行颌间牵引,探讨其疗效及作用机制。方法在恒牙早期进行的正畸矫治中,应用上颌骨种植支抗+Ⅲ类颌间牵引,纠正Ⅲ类错[牙合],分析矫治前后的头影测量指标变化,探讨牵引对上下颌骨及牙列的影响。结果治疗后患者的Ⅲ类错[牙合]得到明显改善,前牙均达到正常覆[牙合]覆盖。X线头影测量分析显示SNA角增加1.58°,ANB角减小1.62°,面中份长度Co-A距离增加3.07 mm,[牙合]平面逆时针旋转6.06°,Wits值增加7.51 mm;治疗期间,前后面高均有显著增加,前后面高比和下颌平面角保持稳定。结论对于上颌骨发育不足的骨性Ⅲ类青少年患者,利用种植支抗结合固定矫治器进行颌间牵引,可以在一定程度上改善骨性错[牙合]。尽管患者已在恒牙列期,对上颌骨的前方牵引力仍可促进患者上颌骨发育,同时远移下牙弓,促进[牙合]平面逆时针旋转,纠正患者的咬合关系,改善患者面型。相比传统的前方牵引,结合骨性支抗的Ⅲ类牵引对患者的垂直骨面型影响较小。但对于上前牙暴露不足的患者,在矫治器设计时要充分考虑上下前牙的暴露量,注意避免重力牵引使下前牙过长的副作用。Objective For skeletal ClassⅢpatients with maxillary deficiency and permanent dentition,TADs were planted on the maxilla,putting on ClassⅢelastics between the implants and lower jaws.The effects and mechanism of this procedure were evaluated.Methods ClassⅢelastics were put between the implants and the lower dentition in adolescent ClassⅢpatients with permanent dentition.The cephalometric measurements of the patients before and after treatment were analyzed to evaluate the effect and mechanism of the treatment.Results The patients’profile improved after treatment.Normal overbite and overjet were both achieved.SNA Angle increased by 1.58°;ANB Angle decreased by 1.62°.The midface length and Co-A distance increased by 3.07 mm.The occlusal plane was rotated anticlockwise by 6.06°.Wits appraisal increased by 7.51 mm.During the treatment,both anterior and posterior facial height were increased significantly,while P/A facial height ratio and the mandible plane angle remained stable after treatment.Conclusion For ClassⅢpatients with maxillary deficiency who refuse orthognathic surgery,implants on maxilla to retract the lower dentition also have effects of maxillary protraction that can move the midface forward,which will improve the profile of patients.Comparing with facemask maxillary protraction,the mechanics used can better control the clockwise rotation of the mandible and have dental effects on aligning the crowded teeth and rotating the occlusal plane.Because the elastics elongate the lower incisors,the patient’s incisors exposure should be considered when this mechanics is used.

关 键 词：种植支抗 骨性Ⅲ类错[牙合] 颌间牵引 

分 类 号：R783.5[医药卫生—口腔医学]