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中华口腔医学研究杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 174 -179. doi: 10.3877/cma.j.issn.1674-1366.2022.03.007

病例分析

骨性Ⅱ类错非对称拔牙掩饰性正畸治疗一例
程钰迅1, 刘旭琳1, 金作林1, 秦文1,()   
  1. 1. 军事口腔医学国家重点实验室,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
  • 收稿日期:2022-04-09 出版日期:2022-06-01
  • 通信作者: 秦文

Camouflage orthodontic treatment with asymmetric tooth extraction for a skeletal Class Ⅱ malocclusion patient

Yuxun Cheng1, Xulin Liu1, Zuolin Jin1, Wen Qin1,()   

  1. 1. State Key Laboratory of Military Stomatology & National Clinical Research Center for Oral Diseases & Shaanxi Clinical Research Center for Oral Diseases, Department of Orthodontics, School of Stomatology, Fourth Military Medical University, Xi′an 710032, China
  • Received:2022-04-09 Published:2022-06-01
  • Corresponding author: Wen Qin
  • Supported by:
    National Natural Science Foundation of China(82001079); New Technology and New Business of the Third Affiliated Hospital of Air Force Military Medical University in 2021(LX2021-322)
引用本文:

程钰迅, 刘旭琳, 金作林, 秦文. 骨性Ⅱ类错非对称拔牙掩饰性正畸治疗一例[J]. 中华口腔医学研究杂志(电子版), 2022, 16(03): 174-179.

Yuxun Cheng, Xulin Liu, Zuolin Jin, Wen Qin. Camouflage orthodontic treatment with asymmetric tooth extraction for a skeletal Class Ⅱ malocclusion patient[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2022, 16(03): 174-179.

患者,女,初诊时21周岁,主诉为上牙前突。正面观左侧软组织较丰满,闭唇紧张,侧面观凸面型,颏肌紧张;口内见36残根,46大面积龋补,16、26伸长,38、48未完全萌出,双侧尖磨牙远中关系。X线测量分析该患者属于骨性Ⅱ类错畸形,上颌前突,下颌后缩。该病例矫治策略为拔除14、24、36、46。采用Damon Q自锁托槽排齐整平上、下牙列,上颌植入2枚种植钉,以进行上颌前牙的内收和磨牙垂直向控制。目标为建立磨牙远中关系及前牙正常覆覆盖,促使下颌骨逆旋,最大程度改善面型。整个疗程约为28个月,治疗结束后患者咬合关系良好,面型改善较大。

The female patient was 21 years old at the time of initial diagnosis, complaining of protrusion of the upper anterior teeth. The soft tissue on the left side is plump, the lip is tense from the front view, and the lateral view shows that the face shape is convex, the mental muscle is tense; there were residual roots of 36, extensive caries filling of 46, elongation of 16 and 26, incomplete eruption of 38 and 48, distally relation of bilateral molars. X-ray analysis showed that the patient was skeletal Class Ⅱ with maxillary protrusion and mandibular retraction. The treatment strategy for this case was extacting 14, 24, 36, 46. Damon Q self-locking brackets were used to straighten the upper and lower teeth, and two screws were implanted in the upper jaw to control the adduction of the maxillary anterior teeth and the vertical direction of the molars. The objective is to establish the Class Ⅱ molar relationship between the molars and the normal overbite and overjet of the anterior teeth, promote the inverse rotation of the mandible, and improve the facial shape to the greatest extent. The whole course of treatment lasted about 28 months. After the treatment, the occlusal relationship was normal and the facial shape improved greatly.

图1 骨性Ⅱ类错畸形患者非对称拔牙掩饰性正畸治疗前图像资料 A:正面像;B:微笑像;C:侧面像;D:口内右侧位像;E:上牙列像;F:口内覆覆盖像;G:口内左侧位像;H:下牙列像;I:口内正面像;J:全颌曲面断层片;K:头颅侧位片。
图2 头影测量标志点及相关角度示意图 1. SNA角;2. SNB角;3. ANB角;4. U1-NA角;5. U1-NB角;6. U1-L1;7. FMIA;8. FMA;9. IMPA;a. U1-NA(mm);b. L1-NB(mm);c. Wits值。
表1 牙性、功能性及骨性Ⅱ类错畸形的鉴别诊断
图3 鞋拔曲示意图及鞋拔曲在患者口中放置位置 A:红圈所示为鞋拔曲;B:箭头所示为鞋拔曲在本病例患者口内放置位置。
图4 骨性Ⅱ类错畸形患者矫治18个月面像及口内照 上颌植入2枚种植体支抗,配合17、27改良横腭杆压低16、26;尖牙近中添加长牵引钩,使得施加于种植体上的颌内牵引力高于前牙的阻抗中心,实现上前牙的压低内收。上颌应用高转矩托槽,对抗Ⅱ类牵引对上颌前牙的垂直向影响。A:正面像;B:微笑像;C:侧面像;D:口内右侧位像;E:上牙列像;F:口内覆覆盖像;G:口内左侧位像;H:下牙列像;I:口内正面像。
图5 骨性Ⅱ类错畸形患者矫治26个月面像及口内照 上颌应用种植钉内收关闭剩余间隙,下颌37、47舌侧增加舌钮,纠正由于长时间近中移动产生的磨牙近中扭转。A:正面像;B:微笑像;C:侧面像;D:口内右侧位像;E:上牙列像;F:口内覆覆盖像;G:口内左侧位像;H:下牙列像;I:口内正面像。
表2 骨性Ⅱ类错畸形患者矫治前、后头影测量值
图6 骨性Ⅱ类错畸形患者矫治后面像、口内照及X线片 A:正面像;B:微笑像;C:侧面像;D:口内右侧位像;E:上牙列像;F:口内覆覆盖像;G:口内左侧位像;H:下牙列像;I:口内正面像;J:全颌曲面断层片;K:头颅侧位片。
图7 骨性Ⅱ类错畸形患者矫治前、后头颅侧位重叠图 A:以SN平面为基准的重叠图;B:以PP平面为基准的重叠图;C:以下颌平面为基准的重叠图;黑色为治疗前;红色为治疗后。
图8 骨性Ⅱ类错畸形患者矫治前、后数字化牙列模型 A:矫正前数字化模型上颌牙列像;B:矫正后数字化模型上颌牙列像;C:矫正前数字化牙列模型下颌牙列像;D:矫正后数字化牙列模型下颌牙列像。
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