不同牙弓形态和第二前磨牙缺失对上颌磨牙远移中支抗的影响  

Effect of arch shapes and missing second premolars on anchorage during maxillary molar distalization with clear aligners

作　　者：王诗语 黄钖钖 刘浩 杨丽 范典 袁长永 王鹏来 Wang Shiyu;Huang Yangyang;Liu Hao;Yang Li;Fan Dian;Yuan Changyong;Wang Penglai(School of Stomatology,Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Department of Orthodontics,Affiliated Stomatological Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China;Department of Implantology,Affiliated Stomatological Hospital of Xuzhou Medical University,Xuzhou 221000,Jiangsu Province,China)

机构地区：[1]徐州医科大学口腔医学院,江苏省徐州市221000 [2]徐州医科大学附属口腔医院口腔正畸科,江苏省徐州市221000 [3]徐州医科大学附属口腔医院口腔种植科,江苏省徐州市221000

出　　处：《中国组织工程研究》2024年第28期4541-4546,共6页Chinese Journal of Tissue Engineering Research

基　　金：江苏省研究生科研与实践创新计划项目(SJCX21_1155),课题名称:数字化隐形矫治技术应用于种植前正畸的临床疗效研究,项目负责人:范典;徐州市卫生健康委科技项目(XWKYHT20220133),课题名称:无托槽隐形矫治技术在成人深覆牙合治疗中的过矫治研究,项目负责人:杨丽。

摘　　要：背景:无托槽隐形矫治中磨牙远移产生的反作用力会导致支抗牙移位,即支抗丢失。有关牙弓形态和第二前磨牙缺失对支抗的影响尚未见报道。目的:运用有限元分析法研究牙弓形态和第二前磨牙缺失对上颌磨牙远移支抗控制的影响。方法:选取1名成年男性锥形束CT数据,建立上颌骨-上牙列-牙周膜-矩形附件-隐形矫治器模型,双侧上颌第二磨牙设计0.25 mm的远移量,首先,根据第二前磨牙是否缺失分为双侧缺失组与双侧存在组;然后,根据牙弓形态再分为尖圆形、卵圆形、方圆形安氏Ⅱ^(1)和方圆形安氏Ⅱ^(2)牙弓组,共计8组模型。在Ansys软件中计算各组模型支抗牙的位移及牙周膜应力分布。结果与结论:①无托槽隐形矫治器远移上颌第二磨牙后,第一磨牙和前磨牙出现近中倾斜伴伸长,前牙唇倾伴压低;②双侧第二前磨牙缺失后,各组模型第一磨牙前移量明显上升,而第一前磨牙和前牙前移量均减少;方圆形安氏Ⅱ^(1)牙弓组的前牙唇倾量最少,尖圆形牙弓最多,卵圆形牙弓组与尖圆形牙弓组差异不明显,方圆形安氏Ⅱ^(2)牙弓组略高于方圆形安氏Ⅱ^(1)牙弓组;③各组支抗牙牙周膜应力均集中于牙颈部和根尖区,方圆形牙弓组的牙周膜应力水平最低,相较其他组,方圆形牙弓组前牙牙周膜唇侧颈部应力亦明显缓解;④结果提示,方圆形牙弓在前牙支抗控制以及牙周膜应力分布方面更有利,安氏Ⅱ^(2)牙弓病例设计前牙唇倾时若配合磨牙远移可增加唇倾效率,磨牙远移时若第二前磨牙缺失不利于缺牙区空间的打开。BACKGROUND:The reciprocal force generated by the molar distalization with clear aligners can lead to anchorage loss.The effect of arch shapes and missing second premolars on anchorage has not been reported.OBJECTIVE:To analyze the effect of arch shapes and missing second premolars on anchorage during molar distalization with clear aligners using the finite element method.METHODS:Cone-beam CT data from an adult male were acquired from the database to establish the maxilla-upper dentition-periodontium-rectangular attachment-clear aligner model.The distal movement amount designed on the bilateral second molars was set to 0.25 mm.First,there were two groups in the study:second premolar bilateral presence and absence groups.Then,four subgroups in each group were created:tapered arch,ovoid arch,square Class Ⅱ Division 1 arch,and Class Ⅱ Division 2 arch groups.The Ansys software was used to calculate the displacement of the anchorage tooth and the stress of the periodontal ligament.RESULTS AND CONCLUSION:Mesial tipping and extrusion of first molars and premolars,labial inclination and intrusion of anterior teeth occurred during the upper second molar distalization with clear aligners.When the bilateral second premolars were missing,the mesial displacement of first molars increased significantly while that of first premolars and anterior teeth decreased in all groups.The square Class Ⅱ Division 1 arch group showed the least anterior labial inclination,while the tapered arch group showed the most.There was no significant difference between the ovoid arch group and the tapered arch group.Moreover,the magnitude of tipping in the square Class II Division 2 arch group was slightly higher than that in the Class Ⅱ Division 1 arch group.The stress of the periodontal ligament of the anchorage teeth was concentrated on the cervical and apical regions of the teeth.And the lowest stress level was detected in the square arch group.Compared with the other groups,the stress on the labial cervical area of the periodontal ligamen

关 键 词：无托槽隐形矫治 磨牙远移 支抗 牙弓形态 第二前磨牙缺失 有限元 

分 类 号：R459.9[医药卫生—治疗学] R319[医药卫生—临床医学] R783.5