安氏Ⅱ类1分类患者前牙矫治过程中使用微种植体作支抗的效果研究

    吴渊 高杨

    

    

    [摘要]目的:對需要进行前牙矫治的安氏Ⅱ类1分类患者使用微种植体作为支抗,观察该种植体作为支抗对内收患者前牙的效果。方法:选取2015年5月-2018年5月笔者医院收治的需要行前牙矫治的61例安氏Ⅱ类1分类错牙合畸形患者为研究对象,按照随机数表法分为对照组30例[采用直丝弓矫治(MBT)系统+传统口外弓支抗]和微种植组31例(采用MBT+微种植体支抗)。观察比较两组矫治前后的前牙矫治效果。结果:微种植组的总矫治时间为(20.64±1.49)个月,明显低于对照组的(24.31±2.28)个月 (P<0.01);两组治疗后的上下齿槽座角(ANB)、牙合平面与SN平面夹角(OP-SN)、上唇突度(ULP)、下唇突度(LLP)、上中切牙切缘至NA连线垂直距离(U1-NA)及翼上颌裂后缘至上颌磨牙远中邻面垂直距离(Ptm-U6)水平均明显低于治疗前(均P<0.05),而两组治疗后的Z角度则明显高于治疗前(P<0.05);微种植组治疗后的OP-SN角度、ULP、LLP、U1-NA及Ptm-U6水平均明显低于对照组(均P<0.05),微种植组治疗后的Z角度则明显高于对照组(P<0.05)。结论:微型种植体不仅能为安氏Ⅱ类1分类错牙合畸形患者建立理想的咬合关系,增强支抗效果,还能缩短前牙矫治时间,使颜面部外侧貌更加美观,具有临床应用价值。

    [关键词]错牙合畸形:安氏Ⅱ类1分类;前牙矫治;微种植体;支抗

    [中图分类号]R783.5 ? ?[文献标志码]A ? ?[文章编号]1008-6455(2019)11-0096-03

    Abstract: Objective ?For patients with Class II division I who need anterior teeth treatment, micro-implants were used as anchorages and the effect of the implants as anchorages on the anterior teeth of patients was observed. Methods ?From May 2015 to May 2018, 61 patients with Angle classII division I malocclusion in our hospital who needed to be corrected for anterior teeth were selected as the main research objects.According to the method of random number, 30 cases of control group were divided into two groups using straight wire to treat traditional external arch Anchorage +(MBT) system and 31 cases in microimplant group (using MBT+ Microimplant Anchorage).Observation and comparison of the curative effect of anterior teeth in the two groups before and after orthodontic treatment. Results ?The total correction time of microimplant group was (20.64±1.49) months, significantly lower than the control group [(24.31±2.28) months,P<0.01];After the treatment, ?levels of upper and lower groove seat angle (ANB),the occlusal plane and SN plane angle (OP-SN), upper lip mutation(ULP), lower lip mutation(LLP),Vertical distance from upper incisor to NA line (U1-NA) and Vertical distance from the posterior edge of the pterygomaxillary fissure to the distal side of the maxillary molar (Ptm-U6) were significantly lower than those before the treatment (all P<0.05).The Z angle after treatment in both groups was significantly higher than that before treatment (P<0.05).The levels of OP-SN angle, ULP,LLP, U1-NA and Ptm-U6 in the microimplant group were significantly lower than those in the control group (all P<0.05).The Z angle of microimplant group was significantly higher than that of control group (P<0.05). Conclusion ?Micro-implants can not only establish an ideal occlusion relationship for patients with Class II division 1 malocclusion, but also enhance the effect of anchorage, shorten the anterior teeth treatment time, make the appearance of the facial appearance more beautiful, and have clinical application value.?

    本研究结果显示:微种植组矫治时间、治疗后的头影测量软硬及牙齿指标(OP-SN角度、ULP、LLP、Z角度、U1-NA及Ptm-U6)水平均优于对照组(均P<0.05)。国内研究[14]指出:与传统支抗相比,微种植体组SNA、SNB、OB、OL等指标改善程度均优于对照组,且其治疗效果也明显高于传统支抗组。可见与传统支抗比,微型种植能有效改善患者的前牙拥挤,最大程度改善患者的覆牙合、覆盖关系,为前牙内收提供足够的支抗力。其中,微种植组治疗時间及OP-SN角度均明显低于对照组(P<0.05)。国内也曾[15]报道称传统支抗会在错牙合矫治过程中可使牙合平面发生顺时针旋转,而微种植体支抗则更能有效控制牙合平面。提示与传统支抗相比,微种植体不仅可以通过加强支抗内收前牙,缩短矫正时间,有效控制牙合平面,满足内收前牙所需支抗力。而本研究结果还显示:两组治疗后的ANB、ULP、LLP,明显优于治疗前(P<0.05);且微种植组上述指标变化均明显优于对照组(P<0.05)。国内研究[16]也曾表明:微种植体可促进上下唇内收,鼻唇角加大,改善患者侧貌。反映出两种支抗均能够改善上、下唇突度,起到上切牙与上颌骨内收的效果。而微种植组上唇突度水平、下唇突度的降低水平更明显,说明微种植支抗更能促进前牙内收,保证颜面侧貌的外形美观,符合其他研究结果。本研究结果还显示:微种植组U1-NA及Ptm-U6水平均明显低于对照组。国内[17]研究也曾指出使用微型种植体支抗可以明显降低U6-Ptm,内收安氏Ⅱ类错牙合上切牙及上颌骨,改善颜面部突度及覆牙合覆盖关系。提示微种植组前牙内收效果更为理想,支抗作用更强,可使颜面部软组织侧貌恢复美观。同时微种植组上颌磨牙矢状方向移动较低,提示微种植组对于后牙的影响较小。

    综上所述,对安氏Ⅱ类1分类错牙合畸形患者使用微型种植体支抗的矫正效果理想,不仅能为患者建立良好的咬颌关系,还能有效控制牙合平面,缩短矫正时间,保证颜面部美观,具有临床应用价值。但本研究尚存不足,如研究样本较小,未深入分析不同的植入方式对支抗效果的影响等,以上内容均需进一步的大样本研究。

    [参考文献]

    [1]Wu XP,Xuan J,Liu H,et al.Morphological characteristics of the cranial base of early Angle's Class Ⅱ Division 1 Malocclusion in permanent teeth[J]. Int J Morphol, 2017,35(2):589-595.

    [2]Alnimri K,Abozomor M,Alomari S.Changes in mandibular position in treated Class Ⅱdivision 2 malocclusions in growing and non-growing subjects[J].Aust Orthod J, 2016,32(1):73-81.

    [3]田雪,韩俊,丁丽芳,等.CICE-下颌前移器矫治安氏Ⅱ类错牙合畸形最佳时机的探讨[J]. 口腔医学,2017,37(3):227-232.

    [4]Xu Y,Xie J.Comparison of the effects of mini-implant and traditional anchorage on patients with maxillary dentoalveolar protrusion[J].Angle Orthod, 2017,87(2):320-327.

    [5]Dler A,Hnd M,Seung-Hwan K,et al.Three-dimensional evaluation of tooth movement in ClassⅡ malocclusions treated without extraction by orthodontic mini-implant anchorage[J].Korean J Orthod,2016,46(5):280-289.

    [6]傅民魁,林久祥.口腔正畸学[M].北京:北京大学医学出版社,2005:257-261.

    [7]张晓波,尹燕飞,姚红梅,等.不同加载方式滑动法关闭双颌前突患者拔牙间隙的三维有限元分析[J].中华口腔医学杂志,2016,51(7):415-419.

    [8]赵岩,屈振宇,刘琳,等.锥形束CT用于骨性安氏Ⅱ类1分类错牙合畸形切牙区唇侧牙槽骨开窗及骨开裂的研究[J].中华口腔正畸学杂志,2016,23(1):2-7.

    [9]Janson G,Aliagadel CA,Niederberger A.Changes in apical base sagittal relationship in Class Ⅱ malocclusion treatment with and without premolar extractions: A systematic review and meta-? ? ? analysis[J].Angle Orthod,2016, 87(2):338-355.

    [10]孟秋菊,王磊昌,杜熹.成人双颌前突支抗控制中微种植与横腭杆临床疗效对比研究[J].中国实用口腔科杂志,2017,10(2):88-91.

    [11]陈敏,宣桂红.微型种植体支抗对青少年口腔正畸疗效及依从性的影响[J].中国现代医学杂志,2018,28(8):94-97.

    [12]Choi HW,Park YS,Chung SH,et al.Comparison of mechanical and biological properties of zirconia and titanium alloy orthodontic micro-implants[J].Korean J Orthod,2017,47(4):229-237.

    [13]Zheng X,Sun Y,Zhang Y,et al.Implants for orthodontic anchorage: An overview[J]. Medicine,2018,97(13):e0232.

    [14]Zhang R,Bai X,Zhang W,et al.Application and curative effect of micro-implant anchorage in orthodontics[J].Trop J Pharm? ? ? Res,2016,15(3):651-655.

    [15]李静平,徐学军,杨庆福,等.微型种植体支抗治疗安氏Ⅱ类1分类错牙合畸形的临床疗效观察[J].口腔医学,2012,32(2):88-91.

    [16]吴欣,刘国元.微种植体支抗矫治上颌前突15例的X线头影测量研究[J].口腔医学, 2015,35(10):842-845.

    [17]张靖,陈保成.微螺钉种植体和口外弓增强支抗矫治成人安氏Ⅱ类1分类错牙合畸形的临床疗效对比[J].中国美容医学,2016,25(6):90-91.

    [收稿日期]2019-02-11

    本文引用格式:吴渊,高杨.安氏Ⅱ类1分类患者前牙矫治过程中使用微种植体作支抗的效果研究[J].中国美容医学,2019,28(11):96-99.