正畸治疗中“黑三角”发生的相关因素及应对策略  

The relevant factors and coping strategies for the occurrence of black triangles in orthodontic treatment

作　　者：郭冬会 高洁 王宪 徐悦蓉 金作林 Guo Donghui;Gao Jie;Wang Xian;Xu Yuerong;Jin Zuolin(State Key Laboratory of Oral&Marillo-facial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases&Shaanzi Clinical Research Center for Oral Diseases,Department of Orthodontics,School of Stomatology,Fourth Military Medical University,Xi'an 710032,China;Department of Stomatology,Joint Support Force 962 Hospital,Harbin 150086,China)

机构地区：[1]口颌系统重建与再生全国重点实验室,国家口腔疾病临床医学研究中心,陕西省口腔疾病临床医学研究中心,空军军医大学第三附属医院口腔正畸科,西安710032 [2]联勤保障部队第九六二医院口腔科,哈尔滨150086

出　　处：《中华口腔正畸学杂志》2024年第3期143-147,共5页Chinese Journal of Orthodontics

基　　金：国家口腔疾病临床医学研究中心项目(LCA202009,LCB202202);陕西省重点研发计划(2021SF-050;2022SF-227);中华口腔医学会青年临床科研基金(CSA-02022-01);空军军医大学新技术新业务(LX2022-401)。

摘　　要：正畸治疗过程中有很多美学风险出现,其中以牙周美学风险“黑三角”最为常见。如何预防和改善“黑三角”是正畸临床中医师和患者都很关注的问题。正畸过程中“黑三角”的发生可能是患者自身生理因素(牙齿的形态和牙龈生物型)、病理因素(菌斑控制不佳的牙周病)、医源性因素(切牙的过度唇倾过大的矫治力、托槽粘贴定位错误导致邻牙牙根不平行等)综合作用的结果。正畸治疗前,需充分检查及评估牙周情况,进行合理的正畸牙齿移动方式的设计,正畸治疗中需严格维护患者的牙周健康,避免使用过大的矫治力,特别是伸长力。正畸完成后也可采用复合树脂充填、贴面修复、义龈修复、牙周手术和局部注射的方法进一步改善“黑三角”。本文从“黑三角”的病因,预防和处理角度出发,对正畸治疗过程中“黑三角”发生的相关因素和应对策略做一综述,为临床工作中“黑三角”的预防和治疗提供一定的参考。There are many aesthetic risks in the process of orthodontic treatment,among which the“black triangles”of periodontal aesthetic risk is the most common.Both orthodontists and patients are very concerned about how to prevent and reduce the black triangle.The occurrence of black triangle during orthodontic treatment may result from the single or combined action of patients own physiological factors(teeth shape and gingival biotype),pathological factors(periodontitis patients with poor plaque control),iatrogenic factors(excessive labial inclination of incisors,excessive magnitude of force,non-parallel roots by incorrect bracket positions),etc.Before treatment,a thorough examination and evaluation of the periodontal condition are necessary,and a reasonable design for tooth movement pattern should be established.During treatment,it is crucial to strictly maintain the patient's periodontal health and to avoid using excessive magnitude of force,especially extrusive forces.After treatment,methods such as resin filling,veneer restoration,artificial gingiva restoration,periodontal surgery and local injections can be used to further reduce the black triangles.From the perspective of etiology,prevention and treatment of black triangles,this paper summarizes the relevant factors and coping strategies of black triangle in the process of orthodontic treatment,so as to provide some reference for the prevention of black triangles in clinical work.

关 键 词：“黑三角” 正畸治疗 牙槽骨高度 

分 类 号：R783.5[医药卫生—口腔医学]