正畸治疗磨牙移动的解剖限制及临床应对  

The anatomical limit and strategies for molar movement during orthodontic treatment

作　　者：杨雨青 赵青[1] YANG Yuqing;ZHAO Qing(State Key Laboratory of Oral Disease&National Clinical Research Center for Oral Disease&Depart-ment of Orthodontics,West China Hospital of Stomatology,Sichuan University,Chengdu 610041,China)

机构地区：[1]口腔疾病研究国家重点实验室、国家口腔疾病临床医学研究中心、四川大学华西口腔医院正畸科,四川成都610041

出　　处：《口腔疾病防治》2023年第9期667-672,共6页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(82171003,81870745)。

摘　　要：随着生物力学的发展及支抗钉等辅助装置的应用,牙齿长距离移动的实现程度大大提升,以代偿骨性问题,达到咬合稳定及颜貌美观的矫治目标。然而,骨开窗、骨开裂、牙根吸收等问题却也较从前更加多发,究其原因,多是忽略了牙移动的诸多限制因素,尤其是解剖结构对于牙移动的影响。本文聚焦于正畸诊疗中磨牙移动的解剖限制,包括牙槽骨骨皮质、上颌窦底、下颌神经管等在牙移动范围内的解剖特征,并对相应的临床应对措施做出了总结:对于牙槽骨骨皮质及下颌神经管,正畸医生应根据临床检查并结合锥形束投照计算机重组断层影像(cone beam computed tomography,CBCT)等影像学检查,先将磨牙牙根进行转矩控制离开骨板,后根据个性化的移动路径控制磨牙的移动量及移动方向;对于与牙根关系密切的上颌窦底,医生应注意轻力、持续力的原则及合适的生物力学原理,实现牙齿的整体移动、穿越上颌窦。总之,临床实践中,应尽可能规避这些解剖结构的限制及带来的风险,从而提升正畸治疗的效果和长期稳定性。In many cases,tooth movement over a considerable distance is needed to meet the major goal of orthodontic treatment,which has always been to correct malocclusion and improve the facial profile in patients with skeletal mal-occlusion.However,tooth movement over a considerable distance also carries risks of dehiscence,fenestration,root exposure,and so forth.The reason lies in neglecting many limits for tooth movement,especially anatomical characteristics.This review focuses on structural limits for orthodontic molar movement,such as the alveolar cortex,the maxillary sinus floor,and the mandibular canal.In addition,we set the strategy in clinical orthodontics.For the alveolar cortex and the mandibular canal,orthodontists are recommended to move the root away from the cortical bone initially and formulate personalized molar movement plans according to clinical examination and cone-beam computed tomography(CBCT)and other imaging examinations.First,the molar root was controlled by torque away from the bone plate,and then,the molar movement amount and direction were controlled according to the personalized movement path.In regard to the maxillary sinus floor,light and continuous forces and scientific biomechanics are suitable for bodily tooth movement.In summary,better therapeutic efficacy and long-term stabilization could be achieved by circumventing the limits and risks caused by anatomical limitations and characteristics.

关 键 词：正畸治疗 解剖限制 磨牙移动 骨开窗 骨开裂 牙槽骨骨皮质 上颌窦底 下颌神经管 锥形束投照计算机重组断层影像 磨牙转矩控制 生物力学 牙龈切除术 

分 类 号：R78[医药卫生—口腔医学]