舌侧矫治联合骨皮质切开术治疗成人严重双颌前突的研究  

A study of the application of corticotomy associated with lingual orthodontics in the treatment of severe bimaxillary protrusion in adults

作　　者：欧阳宁鹃 刘璐 夏伦果[1] 袁玲君[1] 房兵[1] Ouyang Ningjuan;Liu Lu;Xia Lunguo;Yuan Lingjun;Fang Bing(Department of Orthodontics,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,National Clinical Research Center for Oral Disease,Shanghai Key Laboratory of Stomatology,Shanghai 20001l,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔正畸科,上海交通大学口腔医学院,国家口腔医学中心,国家口腔疾病临床医学研究中心,上海市口腔医学重点实验室,上海200011

出　　处：《中华口腔正畸学杂志》2022年第3期121-126,共6页Chinese Journal of Orthodontics

摘　　要：目的研究应用定制式舌侧矫治技术联合应用骨皮质切开术治疗成人严重双颌前突,可否安全有效地实现上前牙压入及根尖部牙槽骨改建。方法本研究为回顾性研究,选取2018年1月至2020年12月于上海交通大学医学院附属第九人民医院正畸科门诊就诊双颌前突病例14例,拔除四个第一前磨牙,应用定制式舌侧矫治器及系统化力学设计,并于治疗中接受上前牙区唇侧骨皮质切开术。治疗前后拍摄头颅定位侧位片及锥形束CT,测量并比较上颌切牙切缘到聘平面距离,牙根不同水平处牙槽骨厚度的变化。结果头影测量分析发现治疗后上下前牙唇倾度减小,软组织额部前移[治疗后上中切牙点-前颅底平面(U1-SN)减小13.09°±1.26,P<0.001,下中切牙-眶耳平面角(FMIA)增大9.31°±3.11°,P<0.001,零子午线-软组织额前点(0-Mer-Pog)增加(3.22±1.43)mm,P<0.001]。锥形束CT影像测量显示治疗后上颌中切牙、侧切牙切缘点到聘平面距离减小,中切牙治疗后压入(1.42±0.66)mm,P<0.001,侧切牙治疗后压入(1.35±0.70)mm,P<0.001。治疗后上颌中切牙及侧切牙根尖部唇侧的牙槽骨厚度增加,中切牙增加(1.02±0.68)mm,P<0.001.侧切牙增加(0.89士0.63)mm,P<0.001。上切牙根中部聘侧的牙槽骨厚度减小,中切牙减少(1.28±0.85)mm,P<0.001;侧切牙减少(1.20±0.69)mm,P<0.001。根尖部聘侧的牙槽骨厚度也减小,中切牙减小(1.39±0.92)mm,P<0.001,侧切牙减小(1.35±0.94)mm,P<0.001。而上切牙冠方、根中部唇侧的牙槽骨厚度以及冠方聘侧牙槽骨厚度的变化无统计学差异。结论应用定制式舌侧矫治器及系统化力学设计,辅以牙槽骨唇侧骨皮质切开微创手术,优化前牙内收过程中的垂直向控制,实现成人严重双颌前突患者上前牙压入及根尖部牙槽骨改建,达到面下1/3及唇部美学重塑。Objective To study whether customized lingual orthodontics assisted with corticotomy can safely and effectively achieve upper anterior teeth intrusion and apical alveolar bone reconstruction in the treatment of severe bimaxilary protrusion in adults,Methods A total of 14 cases of bimaxilary protrusion were selected from January 2018 to December 2020 in the Department of Orthodontics,Shanghai Ninth People's Hospital,Shanghai Jiaotong University,School of Medicine,Four first premolars were extracted,and customized lingual orthodontics were applied with a systematic mechanical design.The patients received corticotomy labilly in the upper anterior region during the treatment.Before and after the treatment,lateral cephalometric radiographs and cone-beam CT(CBCT)were taken,while cephalometric analysis and CBCT measurements of the upper central and lateral incisor were performed to compare the distance between the incisor edge to the palatal plane,the alveolar bone thicknesses of the upper,middle and lower third of the root.The data were statistically analyzed using SPSS 20.0.Results,Cephalometric analysis showed that the inclinations of upper and lower anterior teeth were significantly reduced and chin prominence was improved[After treatment,the angle of upper incisor to sella-nasion plane(U1-SN)changed by 13.09°±1.26°,P<0.001;the Frankfort Mandibular Incisor Angle(FMIA)changed by 9.31°±3.11°,P<0.001;the 0-Meridian-soft tissue Pogonion(0-Mer-Pog')changed by(3.22±1.43)mm,P<0.001].CBCT data showed that the distance between the incisor edge to the palatal plane of the upper central and lateral incisor were significantly decreased[The central incisor intruded by(1.42±0.66)mm,P<0.001;the lateral incisor intruded by(1.35±0.70)mm,P<0.001];the alveolar bone thickness at the labial lower third of the upper central and lateral incisor increased significantly[the thickness at the central incisor increased by(1.02±0.68)mm,P<0.001;that of the upper lateral incisor was(0.89±0.63)mm,P<0.001],the palatal alveolar bone thick

关 键 词：严重双颌前突 定制式舌侧矫治技术 拔牙正畸 骨皮质切开术 

分 类 号：R783.5[医药卫生—口腔医学]