种植体支抗配合片段弓技术推磨牙向后的临床研究
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摘要
目的：应用微型种植体支抗配合片段弓技术推磨牙向后,矫治安氏Ⅱ、Ⅲ类错合病例,并以磨牙推进器推磨牙向后作为对照,观察其疗效,为王畸临床提供依据。
方法：将47例患者根据年龄及错合类型为四组,Ⅰ组12例安氏Ⅱ类错合伴有前牙拥挤的患者,年龄12-14岁,不拔牙矫治,采用种植体支抗配合片段弓技术推上颌磨牙向后；Ⅱ组16例成人安氏Ⅱ类1分类错合患者,年龄18～32岁(其中10例为重新正畸治疗患者),拔除上颌第三磨牙或第二磨牙,种植体支抗配合片段弓推上颌磨牙向后；Ⅲ组6例安氏Ⅲ类亚类错合患者,年龄12～26岁,拔除下颌第三磨牙后,采用种植体支抗配合片段弓技术推单侧下颌磨牙向后;Ⅳ组13例安氏Ⅱ类错合患者,年龄10-13.5岁,采用磨牙推进器推上颌磨牙向后。以上各组病例矫治前、后拍摄头颅侧位片,进行头影测量分析；测量磨牙远移距离,评价颅颌面硬组织关系。
结果：在矫治过程中种植体保持稳定,无脱落。Ⅰ组上颌磨牙向远中平均移动4.27±0.36 mm(P<0.05)每月平均移动1.12±0.12 mm。头影测量分析：SNA、SNB、ANB、U1-NA mm、U1-NA、U1-L1、U1-SN、MP-SN、FH-MP、L6-PP mm、1.6-MP mm治疗前后均无差异(P>0.05)。Ⅱ组上颌磨牙平均远中移动距离4.80±0.30 mm,每月平均移动0.81±0.10 mm;ANB、SNA、SNB、U6-PP mm、L6-MP mm、FH-MP和SN-MP矫治前后的变化无显著性差异(P>0.05);U1-NA mm、U1-NA、L1-NB mm、L1 NB、U1-SN、L1-MP、治疗前后有显著性差异(P,<0.05)。Ⅲ组下领单侧磨牙平均向后移动3.24±0.25mm,每月平均移动0.72±0.14 mm;SNA、SNB、ANB、U1-NA mm、U1-NA、FH-MP和SN-MP矫治前后的变化无显著性差异(P>0.05);L1-NBmm、L1-NB、L1-MP治疗前后有显著性差异(P<0.05)。Ⅳ组上颌磨牙平均远中移动4.67±0.35 mm(P<0.05),每月平均移动1.40±0.14 mm。SNA、SNB、ANB、MP-SN、FH-MP、L6-MP、治疗前后均无差异(P>0.05),而U1-NA mm、U1-NA、U1-L1、U1-SN、U6-PP mm治疗前后具有显著性差异(P<0.05)。
结论：种植体支抗配合片段弓技术能有效地实现磨牙远移,与磨牙推进器相比,可减少或避免前牙唇倾。片段弓因应力中断避免了前牙唇倾及往返运动等不利影响,简化了治疗过程,施力比较明确,力值容易控制,避免了多种力的交织和相互抵消。片段弓丝采用0.46 mm×0.64 mm不锈钢方丝,在弓丝上弯制各类曲,能在三维方向调整磨牙的移动,而且复诊加力十分方便,减少了椅旁工作时间。种植体支抗联合片段弓技术推磨牙向后,对颅领面骨骼影响较小,拓展了不拔牙矫治的适应症范围。
Objective:To evaluate the treatment effects of mini-implant anchorage and sectional arch wire technique and to confirm the clinical usage of the application compared with molar distalization appliance in molar distalization used in Angle classⅡand Angle classⅢcases. To provide theoretical basis for orthodontic clinical research.
Methods:47 patients were divided into fourgroups according to age and the malocclusion. GroupⅠ,12 patients(ages,12-14 years) with Angle classⅡmalocclusion and anterior crowding were selected on a nonextraction basis. Then mini-implant anchorage and sectional arch wire technique were used to push maxillary molar distalization. GroupⅡ,16 adult patients(ages,18-32 years,10 were reorthodontic patients) with ClassⅡDivision 1 malocclusion were selected. After the second or third maxillary molars were extracted, mini-implant anchorage and sectional arch wire technique were used for maxillary molar distalization. GroupⅢ,6 patients (ages,12-26 years) of Angle classⅢsubdivision malocclusion were selected. After the mandibular third molars were extracted, mini-implant anchorage and sectional arch wire technique were used to push unilateral mandibular molars disterlization. GroupⅣ,13 Patients(ages,10-13.5 years) with Angle classⅡmalocclusion were selected. They were treated with maxillary molar distalization appliance for maxillary molar distalization. Lateral cephalometric radiographs were used to assess the alteration of molar position and craniofacial hard tissue relationship before and after molar distalization for all the groups.
Results:All the mini-implants were stable in groupⅠ-Ⅲ. In groupⅠ, maxillary molars were moved to the distal by 4.27±0.36 mm (P<0.05). The average distances of molar distalization were 1.12±0.12 mm per month. There were no significant difference in SNA,SNB,ANB,U1-NA mm,U1-NA,U1-L1,U1-SN,MP-SN.FH-MP,L6-MP mm and U6-PP mm before and after treatment. (P>0.05).In groupⅡ, maxillary molars were moved to the distal by 4.80±0.30 mm. The average distances of molar distalization were 0.81±0.10 mm per month. There were no significant difference in ANB、SNA、SNB、U6-PP mm、L6-MP mm、FH-MP and SN-MP before and after treatment. (P>0.05). While U1-NA mm、U1-NA、L1-NB mm、L1-NB、U1-SN and L1-MP were statistically significant (P<0.05). In groupⅢ. unilateral mandibular molars were moved to the distal by 3.24±0.25 mm. The average distances of molar distalization were 0.72±0.14 mm per month. There were no significant difference in SNA、SNB、ANB、U1-NA mm、U1-NA、FH-MP and SN-MP before and after treatment. (P>0.05). But L1-NB mm、L1-NB and L1-MP were statistically significant (P<0.05). In groupⅣ, maxillary molars were moved to the distal by 4.67±0.35 mm (P<0.05). The average distances of molar distalization were 1.40±0.14 mm per month. No significant difference was observed in SNA,SNB,ANB,MP-SN,FH-MP and L6-MP(P>0.05) before and after treatment. However, there were significant differences in U1-NA mm,U1-NA.U1-L1,U1-SN and U6-PP mm (P<0.05).
Conclusion:Mini-implant anchorage and sectional arch wire technique provide effective molar distalization. Compared with molar distalization appliance, the appliance can reduce or avoid insior proclination. The sectional arch wire can avoid the alternate motion of anterior teeth because of stress break. Also, it can simplify the treatment process and provide more reliable treatment effects. By using it, the force can be better controlled and it can avoid offsetting a variety of intertwined and mutual forces. In this study, the segmental arch wire was 0.46 mm×0.64 mm stainless steel rectangular wire. Various types of loop can be bent on the arch wires,. and adjust the movement of molars in three dimensions. Also, it is very convenient to apply force and reduce the chair side time. Mini-implant anchorage and sectional arch wire technique distalize molars effectively influencing maxillofacial skeletal structure little. The application expands the sutable region of non-extraction othodontic treatment.
方法：将47例患者根据年龄及错合类型为四组,Ⅰ组12例安氏Ⅱ类错合伴有前牙拥挤的患者,年龄12-14岁,不拔牙矫治,采用种植体支抗配合片段弓技术推上颌磨牙向后；Ⅱ组16例成人安氏Ⅱ类1分类错合患者,年龄18～32岁(其中10例为重新正畸治疗患者),拔除上颌第三磨牙或第二磨牙,种植体支抗配合片段弓推上颌磨牙向后；Ⅲ组6例安氏Ⅲ类亚类错合患者,年龄12～26岁,拔除下颌第三磨牙后,采用种植体支抗配合片段弓技术推单侧下颌磨牙向后;Ⅳ组13例安氏Ⅱ类错合患者,年龄10-13.5岁,采用磨牙推进器推上颌磨牙向后。以上各组病例矫治前、后拍摄头颅侧位片,进行头影测量分析；测量磨牙远移距离,评价颅颌面硬组织关系。
结果：在矫治过程中种植体保持稳定,无脱落。Ⅰ组上颌磨牙向远中平均移动4.27±0.36 mm(P<0.05)每月平均移动1.12±0.12 mm。头影测量分析：SNA、SNB、ANB、U1-NA mm、U1-NA、U1-L1、U1-SN、MP-SN、FH-MP、L6-PP mm、1.6-MP mm治疗前后均无差异(P>0.05)。Ⅱ组上颌磨牙平均远中移动距离4.80±0.30 mm,每月平均移动0.81±0.10 mm;ANB、SNA、SNB、U6-PP mm、L6-MP mm、FH-MP和SN-MP矫治前后的变化无显著性差异(P>0.05);U1-NA mm、U1-NA、L1-NB mm、L1 NB、U1-SN、L1-MP、治疗前后有显著性差异(P,<0.05)。Ⅲ组下领单侧磨牙平均向后移动3.24±0.25mm,每月平均移动0.72±0.14 mm;SNA、SNB、ANB、U1-NA mm、U1-NA、FH-MP和SN-MP矫治前后的变化无显著性差异(P>0.05);L1-NBmm、L1-NB、L1-MP治疗前后有显著性差异(P<0.05)。Ⅳ组上颌磨牙平均远中移动4.67±0.35 mm(P<0.05),每月平均移动1.40±0.14 mm。SNA、SNB、ANB、MP-SN、FH-MP、L6-MP、治疗前后均无差异(P>0.05),而U1-NA mm、U1-NA、U1-L1、U1-SN、U6-PP mm治疗前后具有显著性差异(P<0.05)。
结论：种植体支抗配合片段弓技术能有效地实现磨牙远移,与磨牙推进器相比,可减少或避免前牙唇倾。片段弓因应力中断避免了前牙唇倾及往返运动等不利影响,简化了治疗过程,施力比较明确,力值容易控制,避免了多种力的交织和相互抵消。片段弓丝采用0.46 mm×0.64 mm不锈钢方丝,在弓丝上弯制各类曲,能在三维方向调整磨牙的移动,而且复诊加力十分方便,减少了椅旁工作时间。种植体支抗联合片段弓技术推磨牙向后,对颅领面骨骼影响较小,拓展了不拔牙矫治的适应症范围。
Objective:To evaluate the treatment effects of mini-implant anchorage and sectional arch wire technique and to confirm the clinical usage of the application compared with molar distalization appliance in molar distalization used in Angle classⅡand Angle classⅢcases. To provide theoretical basis for orthodontic clinical research.
Methods:47 patients were divided into fourgroups according to age and the malocclusion. GroupⅠ,12 patients(ages,12-14 years) with Angle classⅡmalocclusion and anterior crowding were selected on a nonextraction basis. Then mini-implant anchorage and sectional arch wire technique were used to push maxillary molar distalization. GroupⅡ,16 adult patients(ages,18-32 years,10 were reorthodontic patients) with ClassⅡDivision 1 malocclusion were selected. After the second or third maxillary molars were extracted, mini-implant anchorage and sectional arch wire technique were used for maxillary molar distalization. GroupⅢ,6 patients (ages,12-26 years) of Angle classⅢsubdivision malocclusion were selected. After the mandibular third molars were extracted, mini-implant anchorage and sectional arch wire technique were used to push unilateral mandibular molars disterlization. GroupⅣ,13 Patients(ages,10-13.5 years) with Angle classⅡmalocclusion were selected. They were treated with maxillary molar distalization appliance for maxillary molar distalization. Lateral cephalometric radiographs were used to assess the alteration of molar position and craniofacial hard tissue relationship before and after molar distalization for all the groups.
Results:All the mini-implants were stable in groupⅠ-Ⅲ. In groupⅠ, maxillary molars were moved to the distal by 4.27±0.36 mm (P<0.05). The average distances of molar distalization were 1.12±0.12 mm per month. There were no significant difference in SNA,SNB,ANB,U1-NA mm,U1-NA,U1-L1,U1-SN,MP-SN.FH-MP,L6-MP mm and U6-PP mm before and after treatment. (P>0.05).In groupⅡ, maxillary molars were moved to the distal by 4.80±0.30 mm. The average distances of molar distalization were 0.81±0.10 mm per month. There were no significant difference in ANB、SNA、SNB、U6-PP mm、L6-MP mm、FH-MP and SN-MP before and after treatment. (P>0.05). While U1-NA mm、U1-NA、L1-NB mm、L1-NB、U1-SN and L1-MP were statistically significant (P<0.05). In groupⅢ. unilateral mandibular molars were moved to the distal by 3.24±0.25 mm. The average distances of molar distalization were 0.72±0.14 mm per month. There were no significant difference in SNA、SNB、ANB、U1-NA mm、U1-NA、FH-MP and SN-MP before and after treatment. (P>0.05). But L1-NB mm、L1-NB and L1-MP were statistically significant (P<0.05). In groupⅣ, maxillary molars were moved to the distal by 4.67±0.35 mm (P<0.05). The average distances of molar distalization were 1.40±0.14 mm per month. No significant difference was observed in SNA,SNB,ANB,MP-SN,FH-MP and L6-MP(P>0.05) before and after treatment. However, there were significant differences in U1-NA mm,U1-NA.U1-L1,U1-SN and U6-PP mm (P<0.05).
Conclusion:Mini-implant anchorage and sectional arch wire technique provide effective molar distalization. Compared with molar distalization appliance, the appliance can reduce or avoid insior proclination. The sectional arch wire can avoid the alternate motion of anterior teeth because of stress break. Also, it can simplify the treatment process and provide more reliable treatment effects. By using it, the force can be better controlled and it can avoid offsetting a variety of intertwined and mutual forces. In this study, the segmental arch wire was 0.46 mm×0.64 mm stainless steel rectangular wire. Various types of loop can be bent on the arch wires,. and adjust the movement of molars in three dimensions. Also, it is very convenient to apply force and reduce the chair side time. Mini-implant anchorage and sectional arch wire technique distalize molars effectively influencing maxillofacial skeletal structure little. The application expands the sutable region of non-extraction othodontic treatment.
引文
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