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中华口腔医学研究杂志(电子版)

中华口腔医学研究杂志(电子版) ›› 2017, Vol. 11 ›› Issue (05) : 278 -284. doi: 10.3877/cma.j.issn.1674-1366.2017.05.004

所属专题： 文献；

临床研究

无托槽隐形矫治扩弓治疗轻度牙列拥挤的疗效分析
李志芳1, 麦理想2,†()   
  1. 1. 514021　梅州，泽山口腔医院
    2. 510055　广州，中山大学光华口腔医学院·附属口腔医院，广东省口腔医学重点实验室
  • 收稿日期:2017-05-08 出版日期:2017-10-01
  • 通信作者: 麦理想

The study of clinical effects of Invisalign aided arch expansion in treating mild or moderate crowding

Zhifang Li1, Lixiang Mai2,†()   

  1. 1. Zeshan Stomatology Hospital, Meizhou 514021, China
    2. Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2017-05-08 Published:2017-10-01
  • Corresponding author: Lixiang Mai
  • About author:
    Corresponding author: Mai Lixiang, Email:
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引用本文：

李志芳, 麦理想. 无托槽隐形矫治扩弓治疗轻度牙列拥挤的疗效分析[J]. 中华口腔医学研究杂志(电子版), 2017, 11(05): 278-284.

Zhifang Li, Lixiang Mai. The study of clinical effects of Invisalign aided arch expansion in treating mild or moderate crowding[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2017, 11(05): 278-284.

目的

评价无托槽隐形矫治系统采用扩弓治疗轻度牙列拥挤患者的临床效果。

方法

选择11例骨性Ⅰ类安氏Ⅰ类错的成人患者，上颌轻度拥挤，下颌轻中度拥挤，侧貌良好，为直面型。采用Invisalign矫治系统行不拔牙矫治，治疗设计中，维持上中切牙矢状向位置，上颌扩弓治疗排齐牙列。对于治疗前后的头颅侧位片进行比较分析，同时测量治疗前、微调前及方案设计的上颌牙弓宽度，配对设计t检验分析矫治器的扩弓效率。

结果

11例患者均解除了拥挤，并维持上切牙唇倾度及上下唇突度。尖牙间、第一前磨牙间、第二前磨牙间及第一磨牙间的宽度（mm）均有增加，分别为（2.01 ± 1.31；t= 4.85，P= 0.001）、（4.12 ± 2.58；t= 5.04，P<0.001）、（4.68 ± 2.22；t= 6.66，P<0.001）、（3.13 ± 2.96；t= 3.34，P= 0.007），差异均有统计学意义。与设计方案比较，尖牙间宽度未达到治疗设计的宽度（-2.01±1.12；t= 5.67，P<0.001），但差异有统计学意义。

结论

以无托槽隐形矫治系统行扩弓治疗能有效解除牙列拥挤并维持上前牙突度，但在上尖牙区扩弓效果并不能达到方案设计的要求。

关键词: 牙弓，扩张, 牙列，拥挤, 隐形矫治
Objective

The purpose is to treat the mild crowding cases with Invisalign expansion protocol and to evaluate its clinical results.

Methods

Eleven adults with classⅠdental malocclusion, classⅠskeletal pattern and straight profile were enrolled into the study. The arches were mild crowding in maxilla and mild or moderate in mandible. All patients were treated with Invisalign non-extraction protocol. In the treatment planning, the central incisors were maintained in sagittal positions and the crowding was corrected by arch expansion. The cephalometry were measured and analyzed. Meanwhile, the upper canines width, first premolars width, second premolars widths, and first molars width were measured in the digital model to evaluate the expansion efficiency by paired-t tests.

Results

The crowding was corrected and the inclination of central incisor was maintained in eleven patients. The width (mm) of canines, first premolar, second premolar and first molar were increased by (2.01 ± 1.31; t= 4.85, P= 0.001) , (4.12 ± 2.58; t= 5.04, P<0.001) , (4.68 ± 2.22; t= 6.66, P<0.001) , (3.13 ± 2.96; t= 3.34, P= 0.007) , respectively, in which the significant differences were found. However, the expansion efficacy did not meet the treatment plans though with significant difference between post-treatment and pre-treatment (-2.01±1.12; t= 5.67, P<0.001) .

Conclusions

Mild crowding can be solved by expansion performed with Invisalign, maintaining the inclination of central incisor. The efficiency of upper canine expansion may not meet the treatment planning requirement.

Key words: Dental arch, expansion, Dentition, crowding, Invisalign
图1 牙弓内宽度测量示意图
图2 头颅定位侧位片测量示意图
表1 治疗前后头影测量指标配对t检验分析（±s）
测量项目 治疗前 治疗后 差值（治疗后-治疗前） t值 P值
SNA（°） 84.4 ± 2.7 83.9 ± 3.0 0.3 ± 0.5 1.86 0.092
SNB（°） 80.1 ± 1.7 80.8 ± 1.3 0.2 ± 0.8 0.84 0.416
ANB（°） 1.8 ± 1.4 2.1 ± 1.8 0.1 ± 0.8 0.48 0.641
MP-FH（°） 29.1 ± 4.7 30.6 ± 5.8 0.3 ± 0.6 1.87 0.091
U1-SN（°） 104.2 ± 4.3 102.8 ± 4.8 -0.3 ± 0.5 1.76 0.108
L1-MP（°） 91.4 ± 3.9 95.8 ± 3.9 3.8 ± 2.3a 5.18 <0.001
U1-LI（°） 121.2 ± 8.4 115.0 ± 6.9 -5.8 ± 3.9a 4.71 <0.001
Po-NB(mm) 0.2 ± 0.5 0.2 ± 10.5 0.1 ± 0.5 0.31 0.758
ULP(mm) 6.1 ± 3.9 6.3 ± 2.7 0.6 ± 1.1 1.68 0.122
LLP(mm) 5.3 ± 2.8 4.8 ± 2.8 -0.4 ± 1.2 1.17 0.265
表2 第一阶段治疗前后上颌牙弓宽度的测量指标配对t检验分析（mm，±s）
测量项目 治疗前(PR) 第一阶段治疗后(PT) 测量结果(PT-PR) t值 P值
CW 35.5 ± 1.7 37.6 ± 1.9 2.0 ± 1.3a 4.85 <0.001
FPMW 39.0 ± 3.2 43.6 ± 4.4 4.1 ± 2.6a 5.04 <0.001
SPMW 44.1 ± 3.7 48.9 ± 3.6 4.7 ± 2.2a 6.66 <0.001
FMW 52.8 ± 5.8 55.6 ± 4.7 3.1 ± 3.0a 3.35 0.007
表3 上颌牙弓宽度与治疗方案间差异的配对t检验分析（mm，±s）
测量项目 治疗后宽度(PT) 方案设计宽度(PL) 测量结果(PT-PL) t值 P值
CW 37.6 ± 1.8 39.8 ± 1.3 -2.0 ± 1.1a 5.67 0.000
FPMW 43.6 ± 4.4 44.1 ± 3.9 -0.6 ± 1.3 1.49 0.165
SPMW 48.8 ± 3.5 49.1 ± 2.9 -0.3 ± 0.9 1.16 0.269
FMW 55.6 ± 4.7 56.2 ± 5.2 0.1 ± 1.0 0.42 0.677
图3 安氏Ⅰ类错（前牙拥挤）、Ⅰ类骨型、均角型或者治疗前面相及口内像
图4 安氏Ⅰ类错（前牙拥挤）、Ⅰ类骨型、均角型或者治疗后患者面相及口内像
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