无托槽隐形矫治同时远中移动第一和第二磨牙的上颌牙列三维受力分析  

Three-dimensional analysis of force distribution on maxillary dentition while distalization of first and second molars simultaneously with clear aligners

作　　者：贺旭辉 杨泽轩 张夏雨 范亚杰 胡忆戎 顾泽旭 He Xuhui;Yang Zexuan;Zhang Xiayu;Fan Yajie;Hu Yirong;Gu Zexu(Department of Orthodontics,School of Stomatology,The Fourth Military Medical University,State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration,National Clinical Research Center for Oral Diseases,Shaanxi Clinical Research Center for Oral Diseases,Xi′an 710032,China)

机构地区：[1]第四军医大学口腔医院口腔正畸科、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,西安710032

出　　处：《中华口腔医学杂志》2024年第10期1037-1043,共7页Chinese Journal of Stomatology

基　　金：陕西省重点研发计划(2023-YBSF-229);空军军医大学第三附属医院临床新技术项目(LX2022-301);空军军医大学临床研究项目(2022LC2238)。

摘　　要：目的探究不同移位量设计下无托槽隐形矫治同时远中移动第一和第二磨牙时上颌牙列的三维受力情况,以期为临床合理设计磨牙远中移位量提供依据。方法设计无托槽隐形矫治同时推上颌双侧第一和第二磨牙远中移动,于第一、第二前磨牙和第二磨牙颊面中心设置矩形附件。根据磨牙移位量的不同分为A组(每步移位0.15 mm)、B组(每步移位0.20 mm)、C组(每步移位0.25 mm),使用0.76 mm厚度的聚对苯二甲酸乙二酯-聚乙二醇(PET-G)膜片制作矫治器,每组制作10个矫治器;使用无托槽隐形矫治器上牙列三维力学传感测力装置,以第一和第二磨牙为目标牙,除目标牙外的其余牙为支抗牙,测量3组矫治器各牙位牙齿的三维受力数据,并进行组间比较。结果近远中向上,3组切牙、侧切牙近远中向受力较小,总体差异均无统计学意义(P>0.05);3组尖牙、第一前磨牙、第二前磨牙、第一磨牙和第二磨牙受力的总体差异均有统计学意义(P<0.05)。B、C组第二磨牙远中向受力分别为(6.13±1.45)、(6.83±1.58)N,均显著大于A组[(3.51±1.01)N](P<0.05);C组第一磨牙远中向受力[(6.62±0.89)N]显著大于A、B组(P<0.05);B、C组第一、第二前磨牙近中反作用力均显著大于A组相应牙位(P<0.05),C组尖牙近中反作用力[(-2.98±1.33)N]显著大于A组[(-1.69±0.68)N](P<0.05),而B组与C组尖牙、第一前磨牙、第二前磨牙受力差异均无统计学意义(P>0.05)。唇(颊)腭向上,3组切牙、侧切牙唇向受力的总体差异均无统计学意义(P>0.05),3组尖牙、第二前磨牙、第二磨牙受力的总体差异均有统计学意义(P<0.05)。B组尖牙、第二前磨牙和第二磨牙唇(颊)腭向受力分别为(-0.56±0.54)、(-2.07±0.95)、(1.13±0.55)N,均显著大于A组相应牙位(P<0.05),但与C组差异均无统计学意义(P>0.05)。相比近远中向与唇(颊)腭向受力,3组目标牙和支抗牙的垂直向受力均较小。结论临床采用0.76 mObjective:To explore the force distribution on the maxillary dentition when the first and second molars distalized simultaneously with different step sizes using clear aligners in vitro in order to provide a theoretical basis for the rational design of molar distalization.Methods:Clear aligners were designed to simultaneously distalize the maxillary first and second molars bilaterally,with rectangular attachments placed on the buccal surfaces of the first and second premolars,as well as the second molars.Based on different step sizes,the aligners were divided into three groups:Group A(0.15 mm per step),Group B(0.20 mm per step),and Group C(0.25 mm per step).Ten aligners were fabricated for each group using 0.76 mm thick polyethylene terephthalate glycol(PET-G)sheets.A three-dimensional force measurement system was used to measure the forces exerted on each tooth by the aligners,the first and second molars served as the target teeth and the remaining teeth as anchorage teeth.The three-dimensional force data were compared among the three groups.Results:In the mesiodistal direction,the forces on the central and lateral incisors were relatively small among all three groups,with no statistically significant differences(P>0.05).However,significant differences were observed in the forces on the canines,first premolars,second premolars,first molars,and second molars(P<0.05).The distal forces on the second molars in Groups B and C were(6.13±1.45)N and(6.83±1.58)N,respectively,significantly higher than that in Group A[(3.51±1.01)N](P<0.05).The distal force on the first molars in Group C[(6.62±0.89)N]was significantly higher than that in Groups A and B(P<0.05).The mesial reactive forces on the first and second premolars in Groups B and C were significantly higher than those in Group A(P<0.05).The mesial reactive force on the canines in Group C[(-2.98±1.33)N]was significantly higher than that in Group A[(-1.69±0.68)N](P<0.05),while there were no significant differences between Groups B and C in the forces on the canine

关 键 词：正畸矫正器设计 正畸矫正器 可摘式 牙移动 力学 无托槽隐形矫治 

分 类 号：R783.5[医药卫生—口腔医学]