成年人个别牙早失伴错[牙合]畸形修复前正畸治疗的临床观察

目的：探讨成年人个别牙缺失伴错[牙合]患者,通过正畸治疗校正错牙合后,修复治疗的疗效情况。方法：对16例成年人个别牙缺失致前牙散在间隙或伴有反[牙合]夸患者,采用直丝弓矫治技术进行修复前正畸治疗。结果：16例成年人个别牙缺失伴错[牙合]畸形的患者经过修复前正畸治疗后。再进行牙列缺损修复治疗,获得了令患者较为满意的疗效,外貌也得到了改善。结论：通过正畸、修复相结合的口腔综合治疗,可以有效地使便利体获得更加完善的口腔功能及美观效果。     

牙缺损伴牙颌畸形的正畸与修复联合治疗效果分析

目的探讨牙缺损伴牙颌畸形的正畸与修复联合治疗效果。方法对牙缺损伴牙颌畸形患者采用正畸与修复联合治疗。结果 38例牙缺损伴牙颌畸形患者经过正畸与修复联合治疗,其中36例成功,成功率达94.74%。修复后牙排列整齐,咬合关系良好,基牙无松动、移位,患者对疗效满意。2例失败,占5.26%,表现为固定义齿有移位现象,出现不同程度的牙列间隙。结论正畸与修复联合治疗牙缺损伴牙颌畸形患者,克服了单一治疗方法的局限性,从根本上改变患者的面形和咬合关系,修复治疗效果良好。     

口腔正畸MIA技术对青少年安氏Ⅱ类错[牙合]畸形患者对龈沟液MMP-2表达水平的影响

目的:探讨口腔正畸微螺钉种植体支抗(Microscrew implant anchor,MIA)技术对青少年安氏Ⅱ类错[牙合]畸形患者对龈沟液基质金属蛋白酶(Matrix metalloproteinase,MMP)-2表达水平的影响。方法:2016年1月1日至2019年12月31日选择在本院诊治的青少年安氏Ⅱ类错[牙合]畸形患者86例,根据治疗方法把患者分为MIA组与对照组,各43例,对照组给予头帽口外弓支抗技术结合直丝弓矫治器治疗,MIA组给予MIA技术结合直丝弓矫治器治疗,检测龈沟液MMP-2表达水平变化情况。结果:MIA组正畸后6个月的总有效率为97.7%,显著高于对照组的81.4%(P<0.05)。两组正畸后6个月的SNA角、OB与OJ值低于正畸前,MIA组低于对照组(P<0.05),两组正畸前后SNB角在组内与组间对比差异都无统计学意义(P>0.05)。两组正畸后6个月的龈沟液MMP-2值低于正畸前,MIA组低于对照组(P<0.05)。结论:口腔正畸MIA技术在青少年安氏Ⅱ类错[牙合]畸形患者的应用能抑制龈沟液MMP-2的表达,有利于改善患者的头颅与牙齿的X线指标,从而促进提高治疗效果。     

口腔正畸治疗牙周病致前牙移位的临床疗效观察

目的:探究口腔正畸治疗牙周病致前牙移位的临床疗效,为牙周病治疗提供依据。方法:选择2011年8月~2013年8月间我院28例因牙周病致前牙移位患者(464颗)。所有患者均进行牙周病治疗,再行口腔正畸治疗,观察患者治疗前后的各项指标变化。结果:经治疗,有效率为67.24%(312/464);与治疗前相比,患者治疗后牙齿松动度、探诊出血率、前牙覆牙合值、前牙覆盖值及牙周袋深度明显减轻或降低,治疗前后比较差异均有统计学差异(均P0.05);牙槽骨高度改变无统计学意义(P0.05)。结论:通过口腔正畸治疗牙周病致前牙移位,不仅可有效减轻病患牙齿的松动度,改善病患的出血情况,还能有效纠正病患覆牙合覆盖关系以及降低病患的牙周袋深度。安全性好,值得临床推广。     

口腔种植修复与常规修复对牙列缺失患者生活质量及龈沟液细胞因子水平的影响

目的:研究口腔种植修复与常规修复对牙列缺失患者生活质量及龈沟液细胞因子水平的影响。方法:选择从2015年7月到2016年7月在我院接受治疗的牙列缺失患者108例作为研究对象。根据随机数字表法将患者分为对照组(n=54)和观察组(n=54),对照组实施常规修复,观察组给予口腔种植修复,随访3个月后,对比两组患者疗效、生活质量、治疗前及治疗3个月后龈沟液的细胞因子水平变化以及并发症情况。结果:观察组的总有效率较对照组明显升高(98.15%vs87.04%)(P0.05)。治疗后3个月两组的生理功能、情感功能以及社会功能评分均分别较治疗前升高,且观察组高于对照组(P0.05)。治疗后3个月两组患者的白细胞介素-6(IL-6)、白细胞介素-8(IL-8)以及肿瘤坏死因子-α(TNF-α)水平均分别高于治疗前,而观察组低于对照组(P0.05)。观察组患者并发症的总发生率较对照组明显降低(7.41%vs22.22%)(P0.05)。结论:牙列缺失患者经口腔种植修复方式治疗的效果更好,对于龈沟液细胞因子水平上升具有明显的抑制作用,减少并发症,值得关注及推广。     

正畸修复方案对正畸治疗疗效的影响

目的:探讨正畸联合修复方案对正畸治疗疗效的影响.方法:选择2007年3月～2012年5月来我院口腔科进行医治的牙列稀疏患者78例,将其随机分为治疗组(39例)和对照组(39例),治疗组先行正畸治疗,后进行修复治疗,对照组仅进行正畸治疗,比较两组治疗的总有效率和不良反应的发生情况.结果:78例患者均完成治疗,且无明显的不良反应,治疗组治疗后24例有效,12例显效,3例无者,总有效率为92.3％;对照组治疗后18例有效,8例显效,13例无效,总有效率为66.7％;治疗组总有效率显著高于对照组,差异有统计学意义(P＜0.05).结论:应用正畸联合修复治疗,可以达到患者对美观、舒适的要求,效果较单纯的正畸治疗明显,是一种理想、有效的治疗牙列稀疏、错颌畸形的方法.     

成人骨性Ⅲ类错治疗前后下切牙牙根吸收情况研究

目的:利用CBCT(Cone-Beam CT)三维重建技术评估成人骨性Ⅲ类错患者在正颌手术前的正畸治疗中,下切牙唇向移动后的牙根吸收情况。方法:对17名需要进行正颌手术的成人骨性Ⅲ类患者分别在矫治前及正颌手术前对下切牙区进行CBCT扫描,经软件处理进行三维重建,对每个牙根单独成像后分别测量其牙根体积。利用统计学方法比较治疗前后牙根体积量及吸收量百分比的变化。结果:①下切牙在唇向移动后牙根体积显著减小,具有统计学差异;②不同牙位间牙根吸收量百分比比较,无统计学差异。结论:成人骨性Ⅲ类错在术前正畸治疗移动下切牙的过程中,下切牙牙根发生了较为明显的吸收。在临床治疗中需要引起足够重视。     

钕铁硼永磁体与双阻板矫治器矫治Angle Ⅲ类错(牙合)

目的:观察双阻板矫治器基础上使用钕铁硼永磁体矫治AngleⅢ类错牙合的效果.方法:15例替牙及恒牙早期AngleⅢ类错牙合畸形患者,男6例,女9例.年龄9-13岁,平均11-25岁.在双阻板矫治器的上下阻板安放第三代高磁能积稀土永磁体钕铁硼,矫治过程中磁块间距的增加说明疗效,间距加1mm以上考虑加力.治疗前后头颅侧位片及常规头影方法进行分析.结果:与矫治前相比,矫治后ANB角,Ao-Bo距,NA-PA角均增大,差异有统计学意义(P<0.01).SNB角减小,差异有统计学意义(P<0.01).结论:磁力双阻板矫治器克服了传统矫形装置的缺点,从而能获得持续的矫形力,磁力调整易于控制,便于临床开展.     

侵袭性牙周炎伴错牙合畸形患者牙周-正畸联合治疗前后血清SAA、leptin的变化及与牙周指标和辅助性T细胞亚群的相关性分析

摘要 目的：探讨侵袭性牙周炎伴错牙合畸形患者牙周-正畸联合治疗前后血清淀粉样蛋白A（SAA）、瘦素（leptin）的变化及与牙周指标和辅助性T细胞（Th）亚群的相关性。方法：选择2020年6月-2022年8月解放军总医院京中医疗区黄寺门诊部口腔科收治的80例侵袭性牙周炎伴错牙合畸形患者（牙周炎组）和65例于口腔门诊检查的健康志愿者（对照组）。所有患者均接受牙周-正畸联合治疗,治疗前后分别检测血清SAA、leptin水平以及外周血中Th1、Th2、Th17细胞占比,并评估牙周指标变化。Pearson相关性分析血清SAA、leptin水平与牙周指标以及外周血中Th1、Th2、Th17细胞占比的相关性。结果：牙周炎组治疗前血清SAA、leptin水平,外周血Th1、Th17细胞占比,出血指数（SBI）、菌斑指数（PLI）、附着丧失（AL）、牙周探诊深度（PD）高于对照组（P＜0.05）,外周血Th2细胞占比低于对照组（P＜0.05）。牙周炎组治疗后血清SAA、leptin水平,外周血Th1、Th17细胞占比,PLI、SBI、AL、PD较治疗前降低（P＜0.05）,外周血Th2细胞占比较治疗前增高（P＜0.05）。牙周炎组血清SAA、leptin与PLI、SBI、AL、PD,外周血Th1、Th17细胞占比呈正相关,与外周血Th2细胞占比呈负相关（P＜0.05）。结论：侵袭性牙周炎伴错牙合畸形患者血清SAA、leptin水平增高,经牙周-正畸联合治疗后下降,高水平SAA、leptin与牙周组织破坏程度以及Th亚群紊乱有关,检测血清SAA、leptin水平可评估侵袭性牙周炎牙周组织破坏程度以及细胞免疫状态。     

微种植钉支抗压低伸长磨牙在牙列缺损修复中的临床应用

目的:评价以微种植钉为支抗压低伸长磨牙在牙列缺损修复中的临床应用效果.方法:选择2008年9月1日至2009年9月1日期间,11例修复空间不足,需要压低因对颌牙缺失而伸长的上颌第一磨牙患者,男5例,女6例,年龄18～40岁,平均26岁.9位患者下颌单侧第一磨牙缺失,2位患者下颌双侧第一磨牙缺失,上颌磨牙由于对颌牙长期缺失而伸长,咬舍于对颌牙槽嵴黏膜,妨碍牙列修复治疗.利用微种植钉作为支抗,使用弹力链牵引伸长的磨牙,产生根向压入力.治疗前后拍摄头颅侧位片和曲面断层片.结果:11例患者伸长的磨牙均成功压低,获得足够的义齿修复的垂直空间,伸长磨牙平均压入3mm,成功进行了种植义齿或固定义齿修复.治疗时间平均为6个月.结论:采用微种植钉作支抗,能有效压低伸长的上颌磨牙,创造足够的义齿修复空间,且方便、高效.     

安氏I类错合拔牙与非拔牙矫治对口唇形态影响的研究

目的:研究安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态的影响.方法:从直丝弓矫治的Angle Ⅰ类错合患者治疗前后的X线侧位片中随机选取拔除4个第一前磨牙患者15例(A组),非拔牙矫治患者15例(B组),经X线头影软组织测量分析比较矫治前后拔牙组与非拔牙组口唇形态的变化,对所得数据进行统计学处理.结果:拔牙矫治后上下唇的突度有明显改善,平均减少1.42和2.03 mm;上下唇的长度也平均增加0.51和1.58 mm;非拔牙矫治患者治疗后鼻唇角、下唇突度、上下唇长度均有增加,但矫治前后无统计学差异.结论:拔牙矫治有利于减小上下唇突度从而改善软组织侧貌.

Abstract：

Objictive: To investigate the effect of Angle Class Ⅰ malocclusion after orthodontic treatment, with and without extractions on lip position changes. Methods: 30 patients with Angle Class Ⅰ malocclusion were chosen. 15 patients were treated by 4 first-premolars extraction (Group A) and 15 patients were treated without extraction (Group B). The soft tissue X-ray cephalometric of the patients were measured before and after the treatment and compared statistically. Results: After the extraction treatment, the upper and lower projecting lip reduced by 1.42 mm and 2.03, mmrespectively. The length of the upper and lower lips increased by 0.51mm and 1.58mm, respectively. For the group B, the nasolabial angle, the lower lip protrusion, the length of upper and lower lips had been increased, though there had no statistical significance before and after treatment. Conclusions: After extraction treatment the upper and lower projecting lips decreased. The patients with extractment treatment had the facial aesthelics.     

金属桩与玻璃纤维桩对老年上颌前牙残根残冠修复的临床疗效比较

目的:探讨金属桩与玻璃纤维桩对老年上颌前牙残根残冠修复的临床疗效。方法:收集我院口腔科收治的上颌前牙残根残冠修复患者40例,随机分为玻璃纤维桩组和金属桩组,每组各20例,玻璃纤维桩组患者给予玻璃纤维桩进行残根残冠修复,金属桩组给予金属桩进行残根残冠修复,治疗结束后1年随访,对所有患者的牙龈指数(GI)、修复齿出血指数(SBI)、不良反应发生率、患者修复效果以及患者疗效进行检测并比较。结果:与治疗前相比,两组患者的牙龈指数(GI)以及修复齿出血指数(SBI)均下降(P0.05);与金属桩组相比,玻璃纤维桩组患者的牙龈指数(GI)以及修复齿出血指数(SBI)较低(P0.05),不良反应发生率较低(P0.05),颜色匹配率以及边缘适合率较高(P0.05),两组患者修复体完整例数百分率比较无明显差异(P0.05),玻璃纤维桩组患者的治疗成功率较高(P0.05)。结论:玻璃纤维桩在老年上颌前牙残根残冠修复的应用与金属桩组相比临床效果较好。     

Factors Predisposing to Maxillary Anchorage Loss: A Retrospective Study of 1403 Cases

Anchorage loss is very disturbing for orthodontists and patients during orthodontic treatment, which usually results in bad treatment effects. Despite the same treatment strategy, different patients show different tendencies toward anchorage loss, which influences the treatment results and should preferably be predicted before the treatment is begun. However, relatively little research has been conducted on which patients are more likely to lose anchorage. The mesial tipping of the first molar marks the onset of anchorage loss, and changes in the angulation of the first molar are closely related to anchorage loss. This cross-sectional study aimed to determine how the mesiodistal angulation of the upper first molars changes during general orthodontic treatment and to identify the individual physiologic factors leading to these changes in a large sample of 1403 patients with malocclusion. The data indicate that the upper first molars tend to be tipped mesially during orthodontic treatment, and this constitutes a type of anchorage loss that orthodontists should consider carefully. Compared to treatment-related factors, patients'' physiologic characteristics have a greater influence on changes in the angulation of the upper first molars during orthodontic treatment. The more distally tipped the upper first molars are before treatment, the more they will tip mesially during treatment. Mesial tipping of the upper first molars, and therefore, anchorage loss, is more likely to occur in adolescents, males, patients with class II malocclusion and patients who have undergone maxillary premolar extraction. This finding is of clinical significance to orthodontists who wish to prevent iatrogenic anchorage loss by tipping originally distally tipped upper molars forward, and provides a new perspective on anchorage during orthodontic treatment planning.     

A novel method for the three-dimensional (3-D) analysis of orthodontic tooth movement-calculation of rotation about and translation along the finite helical axis.

The purpose of this study was to establish a novel method for evaluating orthodontic tooth movement in three-dimensional (3-D) space. The present system consisted of the following procedures at a given treatment period: (1) 3-D tooth positions were measured with a 3-D surface-scanning system using a slit laser beam; (2) the 3-D shape data were registered automatically at the maxillary first molars, and the coordinate systems were normalized; (3) the rotation matrix and translation vector were calculated from the automatic registration of the two position data for a given tooth; (4) the finite helical axes of teeth were calculated as the locus of zero rotational displacement; and (5) tooth movement was presented as rotation about and translation along the finite helical axis. To test this system, a male patient (age 22 yr 2 months) with Angle Class III malocclusion and moderate crowding of the anterior teeth, who had been treated using a standard multi-bracket appliance, was used as a model case in this study. Impressions for a dental cast model were taken at five phases; immediately before and after application of the appliance, and 10 days, 1 month and 2 months after beginning treatment. The results demonstrated that the present analytical method can more simply describe the movement of a given tooth by rotation about and translation along the finite helical axis, and provides quantitative visual 3-D information on complicated tooth movement during orthodontic treatment.     

3D打印聚醚醚酮在先天性缺牙患者修复中的应用价值

目的:探讨3D打印聚醚醚酮在先天性缺牙患者修复中的应用价值。方法:2013年5月至2019年10月选择在本院诊治的先天性缺牙患者72例,根据随机数字表法把患者分为观察组与对照组各36例。对照组给予传统口腔修复治疗,观察组在对照组治疗的基础上给予3D打印聚醚醚酮修复治疗,记录与随访两组预后情况。结果:所有患者都顺利完成修复,治疗3个月观察组的总有效率为100.0%,显著高于对照组的88.9%(P<0.05)。两组治疗3个月的牙龈指数都低于治疗前,观察组也低于对照组(P<0.05)。治疗后3个月观察组的感染、刺激痛、出血、修复体脱落等并发症发生率为5.6%,显著低于对照组的27.8%(P<0.05)。治疗后3个月与4个月,观察组的美学评分都显著高于对照组(P<0.05)。结论:3D打印聚醚醚酮在先天性缺牙患者修复中的应用能够促进牙周清洁,减少并发症的发生,从而提高临床疗效与美学效果。     

Upper Airway Changes after Orthodontic Extraction Treatment in Adults: A Preliminary Study using Cone Beam Computed Tomography

Objective

Whether the orthodontic treatment with premolar extraction and maximum anchorage in adults will lead to a narrowed upper airway remains under debated. The study aims to investigate the airway changes after orthodontic extraction treatment in adult patients with Class II and hyperdivergent skeletal malocclusion.

Materials and Methods

This retrospective study enrolled 18 adults with Class II and hyperdivergent skeletal malocclusion (5 males and 13 females, 24.1 ± 3.8 years of age, BMI 20.33 ± 1.77 kg/m²). And 18 untreated controls were matched 1:1 with the treated patients for age, sex, BMI, and skeletal pattern. CBCT images before and after treatment were obtained. DOLPHIN 11.7 software was used to reconstruct and measure the airway size, hyoid position, and craniofacial structures. Changes in the airway and craniofacial parameters from pre to post treatment were assessed by Wilcoxon signed rank test. Mann-Whitney U test was used in comparisons of the airway parameters between the treated patients and the untreated controls. Significant level was set at 0.05.

Results

The upper and lower incisors retracted 7.87 mm and 6.10 mm based on the measurement of U1-VRL and L1-VRL (P < 0.01), while the positions of the upper and lower molars (U6-VRL, and L6-VRL) remained stable. Volume, height, and cross-sectional area of the airway were not significantly changed after treatment, while the sagittal dimensions of SPP-SPPW, U-MPW, PAS, and V-LPW were significantly decreased (P < 0.05), and the morphology of the cross sections passing through SPP-SPPW, U-MPW, PAS, and V-LPW became anteroposteriorly compressed (P <0.001). No significant differences in the airway volume, height, and cross-sectional area were found between the treated patients and untreated controls.

Conclusions

The airway changes after orthodontic treatment with premolar extraction and maximum anchorage in adults are mainly morphological changes with anteroposterior dimension compressed in airway cross sections, rather than a decrease in size.     

安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态影响的研究

目的：研究安氏Ⅰ类错合拔牙与非拔牙矫治对口唇形态的影响。方法：从直丝弓矫治的AngleⅠ类错合患者治疗前后的X线侧位片中随机选取拔除4个第一前磨牙患者15例（A组）,非拔牙矫治患者15例（B组）,经X线头影软组织测量分析比较矫治前后拔牙组与非拔牙组口唇形态的变化,对所得数据进行统计学处理。结果：拔牙矫治后上下唇的突度有明显改善,平均减少1.42和2.03mm;上下唇的长度也平均增加0.51和1.58mm;非拔牙矫治患者治疗后鼻唇角、下唇突度、上下唇长度均有增加,但矫治前后无统计学差异。结论：拔牙矫治有利于减小上下唇突度从而改善软组织侧貌。     

对比分析Lava Ultimate优韧瓷高嵌体与SonicFill声波树脂修复对根管治疗后大面积牙体缺损的修复效果

摘要 目的：比较Lava Ultimate优韧瓷高嵌体与SonicFill声波树脂修复对根管治疗后大面积牙体缺损的修复效果。方法：选择2019年1月至2022年1月期间我院收治的124例根管治疗后大面积牙体缺损患者作为研究对象,根据牙体修复方式分为A组（62例）和B组（62例）。A组采用Lava Ultimate优韧瓷高嵌体修复,B组采用SonicFill声波树脂修复。比较两组患者治疗后6个月、12个月时的临床疗效、牙龈指数（GI）和菌斑指数（PLI）以及并发症情况、患者修复满意度。结果：（1）A组和B组修复后6个月和修复后1年时的改良版USPHS标准中边缘密合度、修复体外形、修复体颜色、修复体折裂、基牙继发龋等分级比较无显著差异（P>0.05）;（2）A组和B组修复后6个月和修复后12个月时的GI和PLI均显著低于修复前（P<0.05）,但两组不同时间的GI、PLI分别比较无显著差异（P＞0.05）;（3）A组修复总满意度高于B组（P<0.05）;（4）A组和B组修复后并发症总发生率分别为3.23%和4.84%,两组间比较无显著差异（P＞0.05）。结论：Lava Ultimate优韧瓷高嵌体与SonicFill声波树脂修复对根管治疗后大面积牙体缺损治疗效果相当,都能有效保证牙体缺损外观恢复、密合程度和咬合,有利于牙周健康,但高嵌体满意度较高。     

牙周炎患者正畸治疗前后龈沟液中弹性蛋白酶的变化

摘要 目的：探讨牙周炎患者正畸治疗前后龈沟液中弹性蛋白酶的变化价值,希望为早期预测患者预后提供参考。方法：2016年12月到2019年10月选择在本院就诊的牙周炎患者68例作为研究对象,所有患者都给予正畸治疗,检测正畸治疗前后弹性蛋白酶、探诊深度(probing depth,PD)、出血指数(bleeding on probing,BOP)、附着丧失(attachment loss,AL)的变化,记录患者的病情变化、判定预后并进行相关性分析、影响因素分析。结果：所有患者完成治疗,对于正畸治疗的美观、固位、稳定性均满意。治疗后1个月与治疗后3个月患者的PD、BOP、AL都低于治疗前(P<0.05),治疗后3个月也低于治疗后1个月(P<0.05)。治疗后1个月与治疗后3个月患者的龈沟液弹性蛋白酶值都低于治疗前(P<0.05),治疗后3个月也低于治疗后1个月(P<0.05)。Spearman分析显示治疗前与治疗后3个月的龈沟液弹性蛋白酶变化差值与PD、BOP、AL变化差值存在显著正相关性(P<0.05)。多因素Logistic回归显示PD、BOP、AL变化差值作为影响龈沟液弹性蛋白酶变化差值的主要因素(P<0.05)。结论：牙周炎患者正畸治疗前后龈沟液中弹性蛋白酶水平显著下降,与患者的病情变化显著相关,也是反映与预测患者预后的重要指标。