头帽－颏兜矫洽乳前牙反合

本文介绍了笔者运用头帽－颏兜矫治乳牙期和替牙早期的前牙反病例的体会。分析了乳前牙反矫治后复发的因素;探讨了头帽－颏兜牵引矫治下颌前移型乳前牙反　的机理;提出了乳牙期前牙反　可分牙型和下颌前移型。强调尽可能在乳牙期矫治前牙反　,以阻断颌骨畸形的发展,诱导儿童颅、颌、面的正常发育。介绍了运用布替代自凝塑料制作颏兜的具体方法。     

下颌垫配合头帽牵引矫治替牙期前牙反16例的临床观察

目的探讨下颌垫矫治器配合头帽颏兜牵引矫治替牙期前牙反的机制。方法选择临床16例替牙期前牙反患者,使用下颌垫矫治器配合头帽颏兜牵引。结果经过6～11个月的治疗,下颌垫矫治器配合头帽颏兜牵引,16例替牙期前牙反解除。L1-NB、IMPA、SNB减小,有统计学差异(P<0.01),Y-axis、MP-SN、Co-S增加,有统计学差异(P<0.01)。结论下颌垫矫治器配合头帽颏兜牵引,矫治替牙期前牙反的机制是内收下前牙,下颌向后移动及顺时针旋转,同时释放了上颌及上前牙向前的生长力。     

下颌(牙合)垫配合头帽牵引矫治替牙期前牙反(牙合)16例的临床观察

目的 探讨下颌(牙合)垫矫治器配合头帽颏兜牵引矫治替牙期前牙反(牙合)的机制.方法 选择临床16例替牙期前牙反(牙合)患者,使用下颌(牙合)垫矫治器配合头帽颏兜牵引.结果 经过6～11个月的治疗,下颌(牙合)垫矫治器配合头帽颏兜牵引,16例替牙期前牙反(牙合)解除.L1-NB、IMPA、SNB减小,有统计学差异(P＜0.01),Y-axis、MP-SN、Co-S增加,有统计学差异(P＜0.01).结论 下颌(牙合)垫矫洽器配合头帽颏兜牵引,矫治替牙期前牙反(牙合)的机制是内收下前牙,下颌向后移动及顺时针旋转,同时释放了上颌及上前牙向前的生长力.     

头帽颏兜在前牙反治疗中的应用

头帽颏兜用于矫正前牙反已有一个多世纪的历史 ,是临床上常用的治疗前牙反的矫形方法 ,但长期以来 ,人们对头帽颏兜的疗效充满争议 ,影响了它的合理使用 ,下文将就头帽颏兜的疗效进行综述 ,以帮助临床医生建立合理的使用方法。1 头帽颏兜对颅底、上下颌、牙、颞下颌关节的影响1 1头帽颏兜对颅底、上颌和上牙列的影响通常认为头帽颏兜对颅底、上颌的矢状发育无影响[1-5] ,但也有作者认为头帽颏兜的作用力可通过上下牙列的咬传递到面中部 ,导致面中部出现生长改良[6] 。就垂直向而言 ,当力的方向朝向颞下颌关节时 ,尚未见抑制上颌垂直向…     

头帽颏兜在前牙反治疗中的应用

头帽颏兜用于矫正前牙反已有一个多世纪的历史,是临床上常用的治疗前牙反的矫形方法,但长期以来,人们对头帽颏兜的疗效充满争议,影响了它的合理使用,下文将就头帽颏兜的疗效进行综述,以帮助临床医生建立合理的使用方法.1.头帽颏兜对颅底、上下颌、牙、颞下颌关节的影响1.1头帽颏兜对颅底、上颌和上牙列的影响通常认为头帽颏兜对颅底、上颌的矢状发育无影响[1-5],但也有作者认为头帽颏兜的作用力可通过上下牙列的咬传递到面中部,导致面中部出现生长改良[6].就垂直向而言,当力的方向朝向颞下颌关节时,尚未见抑制上颌垂直向发育的报道,而当力的方向朝向S点时,头帽颏兜可明显抑制上颌前后部的垂直向生长发育,且对后部的抑制大于前部,使面中部及上颌顺时针旋转[6].对上牙而言,头帽颏兜常使其前倾[1,3,5].     

头帽—颏兜矫治乳前牙反He

本文介绍了笔者运用头帽－颏兜矫治乳牙期和替牙早期的前牙反Ｙｅ病例的体会，分析了乳前牙反Ｙｅ矫治后复发的因素，探讨了头帽－颏兜牵引矫治下颌前移型乳前牙反Ｙｅ的机理；提出了乳牙期前牙反Ｙｅ可分牙型和合颌前移型，强调尽可能在乳牙期矫治前牙反Ｙｅ，以阻断颌骨畸形的发展，诱导儿童，颌，面的正常发育，介绍了运用布替代自凝塑料制作刻兜的具体方法。     

用口外前牵引及颏兜矫治骨性Ⅲ类错He

临床上对骨性前牙反Ｈｅ的治疗早期要通过抑制下颌生长，用上凳前牵引来调整上下颌骨的矢状不调。成人的骨性反Ｈｅ则通过正颌外科的方法解决。但对于恒牙列早期患者，ＢＭＩ为８０－９０％的前牙骨性反Ｈｅ患者是等待手术呢？还是用积极的措施调动其生长发育的潜力：本文用口外前牵引及颏兜治疗７例患者，均收到很好的治疗效果。     

FR—1型功能矫治器矫治安氏Ⅱ类1分类错He的牙弓测量

目的 了解ＦＲ－１型矫治器矫治安氏Ⅱ类１分类错Ｈｅ的牙Ｈｅ变化，方法 对２３例生长发育快速期的安氏Ⅱ类，分类错Ｈｅ患者采用ＦＲ－１型矫治器矫治，并对治疗前后模型进行牙弓测量，结果 １．上颌牙弓宽度增加，长度减小；２．下颌牙弓宽度增加，长度增加，Ｓｐｅｅ’ｓ曲线变平，３．前牙覆Ｈｅ，覆盖减小，结论 ＦＲ－１型矫正器，能使上牙弓长，宽，高三维关系发生明显变化，有效地改善安氏Ⅱ类１分类错Ｈｅ。     

FR3矫治乳牙期,替牙期前牙反He的头影测量对比研究

目的 为观察ＦＲ３矫治前牙反Ｈｅ的效果，尤其是矫治疗后颅面形态的改变。方法 采用ＦＲ３对１７例乳牙期和１０例替牙期前牙反Ｈｅ患者进行矫治，通过头影响测量分析其矫治前后的变化及矫治后与正常值的差异。结果 ＦＲ３能促进上颌生长发育，唇倾上切牙；使下颌后退，有效地改善异常的Ｈｅ间关系，乳牙期反Ｈｅ矫治后，除下切牙舌倾、颏角尖锐外、基本恢复Ⅰ类骨面型，矫治效果好。替牙期反Ｈｅ由于骨骼异常较严重，因而矫治后     

前牙反He矫治的He与颌位探讨

通过对４２例前牙反Ｈｅ反应ＦＲⅢ型功能矫治器、上颌Ｈｅ垫矫治器及方丝弓矫治器的矫治，探讨其功能特点和矫治原则，得出：（１）功能性反Ｈｅ者ＩＣＰ前移，骨性反Ｈｅ者ＩＣＰ正常，两者的临床鉴别不能单纯看下颌能否后退至对刃位；（２）前牙反Ｈｅ矫治的咬合重建，不能以后退接触位为基准，只有在肌位建Ｈｅ才是最符合生理的；（３）固定矫治对反覆Ｈｅ小于３ｍｍ者可不加Ｈｅ垫，固定矫治反覆Ｈｅ大于３ｍｍ者及活动矫治应加     

固定功能矫治器前伸大鼠下颌后髁突适应性生长改建特征的计算机辅助图像分析

目的：探讨持续性前伸大鼠下颌条件下髁突后部的适应性生长改建特征。方法：模拟临床固定功能矫治器,引导大鼠下颌前伸,制取相应的组织切片,采用ＬｅｉｃａＱ５５０ＩＷ计算机辅助图像分析系统进行精确定量分析。结果：对照组各层细胞面积随生长发育过程而变化,除生发层外,各层变化基本稳定。实验组和对照组进行比较,纤维层面积无显著性差异,其余各层都存在显著性差异,最能体现生长改建活跃程度的生发层及移行层有较剧烈的变动。结论：大鼠下颌持续性前伸引发了髁突软骨内各细胞层面积的变化,从而引起髁突从软骨到骨的改建,为临床上采用固定功能矫治器提供了实验依据。     

正畸治疗中磨牙的拔除和保留（五十三）——利用骨钉矫治生长发育期上颌后缩下颌前突型反

目的：评价骨钉前方牵引治疗对生长发育期上颌后缩下颌前突型反[牙合]病例的矫治效果。方法：选择替牙晚期和恒牙早期骨性Ⅲ类错病例8例,男2例,女6例,年龄11～14岁,平均12.2岁。均为上颌发育不足并伴有下颌、下牙弓轻度前突的凹面型,在双侧上颌颧牙槽嵴区植入骨钉,骨钉与牵引面罩的牵引钩相连,与[牙合]平面成向前下30°夹角,力值维持在350g左右,每日戴用时间为10～12h。有3例恒牙早期病例因牙列拥挤或下牙弓前突,设计对称拔除了上、下颌第二或第三磨牙,植入下颌磨牙骨钉以牵引排齐内收下牙弓。结果：8例患者前方牵引5～10个月,平均7个月,均有效解除前牙反[牙合]。结论：应用骨钉做前方牵引,牵引力通过上颌骨阻力中心,不会致颌骨出现异常旋转。牵引力完全作用在颌骨上,避免了对牙齿产生副作用。骨钉还可用于牵引上下颌牙列远中移动,减少上前牙唇倾并增强前方牵引对下牙弓的矫治作用。     

Postoperative changes in mandibular prognathism surgically treated by intraoral vertical ramus osteotomy

This study investigated short- and long-term postoperative skeletal changes following intraoral vertical ramus osteotomy (IVRO) for mandibular prognathism, as determined from lateral cephalograms. The subjects were 20 patients with mandibular prognathism who had undergone surgical orthodontic treatment combined with IVRO. Lateral cephalograms were taken at six time points: 1 month before surgery, and 1 day, 3 months, 6 months, 1 year, and approximately 2 years after surgery. Intermaxillary fixation (IMF) with four monocortical screws was maintained for 1 week in all patients. Mean posterior movement of the menton (Me) was 5.9 mm at surgery. 3 months after surgery, the FMA and FH-CorMe angles had increased 6.3 and 6.2 degrees, respectively, indicating clockwise rotation of the distal segment of the mandible. This rotation was observed in all 20 patients, suggesting that postoperative rotation of the mandible in the postoperative short term is likely to occur after IVRO and could be considered an adaptation of the mastication system newly established by surgery. In the long term after IVRO, Me had moved anteriorly by only 0.9 mm and the relapse ratio was 15.3%. These findings suggest the excellent long-term stability of surgical orthodontic treatment combined with IVRO in patients with mandibular prognathism.     

Morphological and positional asymmetries of young children with functional unilateral posterior crossbite.

This prospective clinical study evaluated the morphological and positional mandibular asymmetry of young patients with functional unilateral posterior crossbite. The sample included 9 girls and 6 boys (8.8 +/- 1.0 years of age), evaluated at the initiation of treatment and approximately 6 months after the retention phase (1.1 +/- 0.2 years after initiation of treatment). Each patient had a complete unilateral posterior crossbite involving 3 or more posterior teeth, a functional shift from centric relation-intercuspal position, and no signs or symptoms of temporomandibular disorder. A bonded palatal expansion appliance was used to rapidly expand the maxilla (1 month) and retain the treatment changes (6 months). Zonograms were used to assess articular joint spaces, and submental vertex radiographs were used to assess morphological and positional asymmetry. The results showed that the mandible was significantly longer on the noncrossbite side than it was on the crossbite side. The asymmetry was most evident for the ramus and involved both the condylar and the coronoid processes. The posterior and superior joint spaces were larger on the noncrossbite side than they were on the crossbite side. After treatment and retention, the mandible showed no significant morphological asymmetries. Mandibular growth was greater on the crossbite side than it was on the noncrossbite side, and the mandible had been repositioned; the crossbite side had rotated forward and medially toward the noncrossbite side. We concluded that unilateral posterior crossbites produce morphological and positional asymmetries of the mandible in young children, and that these asymmetries can be largely eliminated with early expansion therapy.     

成人双侧唇腭裂前牙反牙合的非手术治疗

目的：在成人双侧Ⅲ度唇腭裂患者前牙反牙合治疗中应用小型下颌双侧后退位牙合板,适度后退下颌骨,评价其矫治前牙反牙合的临床效果。方法：应用小型下颌双侧后退位牙合板治疗48例成人双侧Ⅲ度唇腭裂术后前牙反牙合患者。在打开咬合的同时后退下颌骨,亦可同时侧方调位下颌骨,并同时粘固上下颌牙列托槽进行牙列的排齐整平。正畸治疗结束后进行缺牙区义齿修复。结果：患者侧貌在戴用后退位牙合板后明显改善,下颌骨整体后退,反牙合矫治时间较普通牙合板明显缩短。使患者避免了正颌手术。随访2年以上疗效稳定。结论：小型下颌双侧后退位牙合板适用于下颌可适度后退的成人双侧唇腭裂术后前牙反牙合患者。下颌骨整体地有效后退缩短了矫治时间,也使上颌扩弓的难度明显减少。该牙合板结构小巧不影响上下颌牙列托槽的粘固,是较固定反式TBA更为理想的装置。     

小型下颌后退位（牙合）板在前牙反（牙合）矫治中的应用

目的：在前牙反（牙合）矫治中应用一种小型下颌后退位（牙合）板后退下颌,评价其矫治AngleⅢ类功能性-轻、中度骨性前牙反（牙合）病例的临床应用效果.方法：应用小型下颌后退位（牙合）板治疗反（牙合）328例.在打开咬合的同时后退下颌,同时粘固上下颌托槽进行排齐整平.结果：患者侧貌在戴用后退位（牙合）板后明显改善,下颌的有效后退使反（牙合）的矫治变得简单化,治疗时间较传统矫治明显缩短.远期随访疗效肯定.结论：小型下颌后退位（牙合）板适用于下颌可适度后退的前牙反（牙合）病例,可快速矫治前牙反（牙合）.是较固定反式TBA联合前牵引更为理想的装置,结构更小巧,制作更简便,更适用于临床应用.     

改良固定斜面导板矫治安氏Ⅱ类畸形伴后牙锁牙合的临床研究

[摘要] 目的 观察应用改良固定斜面导板在矫治安氏Ⅱ类1分类伴第二磨牙正锁牙合中的临床效果。方法 临床应用改良固定斜面导板,通过术前、术后X线头影测量分析和测量临床牙冠高度,对18例上颌第二磨牙正锁牙合伴安氏Ⅱ类1分类患者进行研究,男7例,女11例,年龄13～16岁,平均14.5岁。结果 经过3～4个月的矫治,上颌第二磨牙正锁牙合解除,前面高增加(2.67±0.56)mm,后面高增加(1.64±0.26)mm,矢状关系改善,覆盖减小,上下前磨牙均有显著萌长,下颌多于上颌。下磨牙亦明显萌长,上磨牙萌长不明显。结论改良固定斜面导板是一种简单有效的矫治上颌第二磨牙正锁牙合的口内装置,并能快速打开咬合,前移下颌,尤其适用于安氏Ⅱ类1分类短面型低角患者。     

Skeletal components of class III malocclusions and compensation mechanisms

Summary  The aim of this retrospective study was to assess the skeletal characteristics of sagittal maxillary and mandibular discrepancies resulting in class III malocclusions and compensation mechanisms in one Caucasian European population (Croatian). The study sample included 107 patients (63 females and 44 males), aged between 11 and 18 years of age (mean age 14·6 ± 2·2), with a class III malocclusion. Forty-three angular and linear measurements were assessed from the pre-treatment lateral cephalographs of each subject. anova , Tukey post hoc and t -test were used for statistical analysis. The most common differential skeletal type was mandibular prognathism with a normal maxilla (43%), followed by maxillary retrognathism with a normal mandibular position (19·6%), while the combination of maxillary retrognathism and mandibular prognathism was found to be rare (<5%). Subjects with maxillary retrognathia, appeared to also have a vertical facial pattern, suggesting a tendency towards vertical growth as a possible compensation mechanism. Those with mandibular prognathia tended to exhibit a horizontal facial growth pattern and typically included more pronounced dento-alveolar compensation, that is, proclination of maxillary and retroclination of mandibular incisors. There were no differences observed in gender, overjet or soft tissue profiles between different sagittal skeletal types. Dominant protrusive mandible in Croatians can be related to European Caucasian ancestry, where this entity is historically described as 'Habsburg jaw'.     

Transitional joint effusion in the mandibular prognathic surgery patient: intraoral vertical ramus osteotomy versus sagittal split ramus osteotomy.

PURPOSE: The purpose of this study was to examine the cause of joint effusion (JE) appearing postoperatively in the temporomandibular joint (TMJ) of patients with mandibular prognathism on T2-weighted magnetic resonance (MR) images. PATIENTS AND METHODS: MR imaging was performed before and after surgery in 30 TMJs of 15 subjects with mandibular prognathism who underwent intraoral vertical ramus osteotomy (IVRO) and in 20 TMJs of 10 subjects with mandibular prognathism who underwent sagittal split ramus osteotomy (SSRO). The preoperative MR imaging was performed 1 month before surgery, and postoperative MR imaging was performed during maxillomandibular fixation. RESULTS: Preoperatively, none of SSRO and IVRO groups had JE. Postoperatively, 12 TMJs (40%) of the IVRO group and only 1 TMJ (5%) of the SSRO group had JE. As for the TMJs in the IVRO group, on MR imaging, the degree of downward movement of the condyle after surgery was larger in TMJs with JE (3.8 +/- 2.3 mm) than in TMJs without JE (1.8 +/- 1.6 mm). JE diminished within about 4 months after removal of the maxillomandibular fixation. CONCLUSION: JE appearing postoperatively in the TMJ of patients with mandibular prognathism might be relation to the degree of downward movement of the condyle.     

上颌四眼簧扩弓纠正早期功能性下颌偏斜的髁突位置变化研究

目的:通过颞下颌关节断层片测量,探讨上颌四眼簧扩弓纠正单侧后牙反(牙合),改善早期功能性下颌偏斜后髁突位置的变化.方法:混合牙列或早期恒牙列,单侧后牙反(牙合)伴有或不伴有前牙反(牙合),下颌功能性偏斜患者16例,采用上颌Quad-Helix扩弓法,对矫治前后颞下颌关节断层片进行测量分析.结果:单侧后牙反(牙合)矫正后,偏斜侧T1期与T2期髁突位置变化无统计学意义(P＞0.05).对侧髁突向后移动,即治疗后,对侧关节腔前间隙增大,上间隙和后间隙比治疗前减小(p＜0.05).结论:混合牙列或早期恒牙列,上颌四眼簧扩弓器纠正单侧后牙反(牙合),使髁突与关节窝关系发生改变,两侧髁突运动逐渐对称.