无托槽隐形矫治拔牙病例上切牙压低实现量及其影响因素分析  

Achieved intrusion amount of the maxillary incisors and the influencing factors in clear aligner extraction cases

作　　者：廖乃麒 钱语然 李渊 唐振兴 赵志河[1] 李宇[1] LIAO Naiqi;QIAN Yuran;LI Yuan;TANG Zhenxing;ZHAO Zhihe;LI Yu(State Key Laboratory of Oral Diseases&National Clinical Research Center for Oral Diseases,Department of Orthodontics,West China Hospital and School 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10期720-726,共7页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：四川省重大科技专项项目(2022ZDZX0031)。

摘　　要：目的探讨无托槽隐形矫治拔除上颌前磨牙病例中,上切牙的压低实现量及其影响因素。方法本研究已通过单位伦理委员会审查批准,并获得患者知情同意。根据纳入、排除标准,纳入拔除双侧上颌第一前磨牙、采用无托槽隐形矫治的成年女性患者共30例,获取患者治疗前后的锥形束CT数据,进行三维重建和配准对齐。建立空间坐标系,测量上颌中切牙与侧切牙的压低实现量,计算压低实现率,并利用多元线性回归分析探讨影响压低实现量的相关因素。结果上颌切牙的整体压低实现率为54%,其中上颌中切牙(48%)小于上颌侧切牙(59%),差异有统计学意义(P<0.001)。回归分析显示压低设计量、分步压低设计与压低实现量呈正相关;舌移设计量、Ⅱ类颌间牵引的使用与压低实现量呈负相关;而初始覆、初始覆盖、拥挤度、上中切牙唇倾度、第一期牙套佩戴副数、尖牙区附件类型、后牙区附件类型及是否设计前牙平导与压低实现量无显著相关性。结论拔除上颌第一前磨牙的无托槽隐形矫治病例中,上颌中切牙压低实现率小于上颌侧切牙。上切牙压低实现量受多种因素影响,为提高隐形矫治拔牙病例的垂直向控制效果,应综合考虑这些因素。Objective To investigate the achieved intrusion amount of the maxillary incisors and the influencing factors in clear aligner cases treated with extraction of premolars.Methods This study has been reviewed and approved by the Ethics Committee,and informed consent has been obtained from patients.Thirty adult female patients who underwent extraction of the bilateral maxillary first premolars followed by clear aligner therapy were included.CBCT data before and after treatment were obtained,and three-dimensional reconstruction with registration alignment was performed.A spatial coordinate system was established,and the achieved intrusion amount was measured,followed by calculation of the intrusion efficacy.The factors related to the achieved intrusion amount were investigated through multiple linear regression analysis.Results The overall efficacy of maxillary incisor intrusion was 54%,with the maxillary central incisors(48%)lower than the lateral incisors(59%),which was statistically significant(P<0.001).Regression analysis showed that the designed intrusion amount and the stepwise intrusion design were positively correlated with the achieved intrusion amount.The designed retroclination amount and use of classⅡintermaxillary elastics were negatively correlated with the achieved intrusion amount.The initial overbite,overjet,crowding,upper central incisor inclination,amount of the first series of aligners,canine attachment type,posterior teeth attachment type and bite ramps had no significant correlation with the achieved intrusion amount.Conclusion In maxillary first premolar extraction cases treated with clear aligners,the upper central incisors have lower efficacy of intrusion movement than the lateral incisors.The achieved intrusion amount of maxillary incisors was influenced by multiple factors,which should be considered comprehensively for better vertical control in such cases.

关 键 词：无托槽隐形矫治 锥形束CT 牙移动实现率 压低移动 切牙 减数 正畸治疗 过山车效应 

分 类 号：R78[医药卫生—口腔医学]