加速正畸牙齿移动的辅助干预措施

正畸治疗周期通常为2~3年,较长的治疗周期常伴随着较高的并发症发生风险,对患者预后产生不利影响。因此,缩短治疗周期,探索安全有效的辅助干预措施加速正畸牙齿移动具有非常重要的临床意义。目前,加速正畸牙齿移动的辅助干预措施较多,主要可以分为手术干预和非手术干预两大类。但是,尚无一种干预措施得到公认,为正畸临床所常规采用。本文旨在针对目前常见的加速正畸牙齿移动的辅助干预措施作一综述,以期指导临床,缩短治疗周期,改善患者预后。     

骨皮质切开术辅助正畸治疗的研究进展

近年来,寻求正畸治疗的成年患者数量日益增多,如何加速正畸牙齿移动、缩短正畸疗程,并同时降低与正畸治疗时间较长相关的牙体、牙周疾病风险成为医生和患者共同关注的焦点。目前已报道的加速牙齿移动的方法中,经基础和临床研究证实,骨皮质切开术可有效加速正畸牙移动、缩短疗程并减少与正畸时间相关的牙体、牙周疾病,且其术式也随着临床操作、手术设备、计算机技术的更新和进步而变得更加微创、简便、精确、有效。文章就骨皮质切开术辅助正畸治疗的历史起源与发展、加速正畸牙齿移动的原理、术式变化、适应证与禁忌证、临床应用等方面做一综述。     

牙槽骨微穿孔术加速正畸牙齿移动的研究进展

牙槽骨微穿孔术(micro-osteoperforations,MOPs)是一种创伤小、操作安全、费用低,正畸医生可以独自在椅旁完成的辅助正畸牙齿移动的干预措施。其理论基于区域加速现象(regional accelerated phenomenon,RAP),手术破坏骨组织导致术区周围骨密度降低,创伤刺激细胞调节机制使骨重建加速,达到加快正畸牙齿移动的目的。目前大部分研究验证其能够有效加速牙齿移动且可重复操作,但效果仍然存在争议,与其他加速正畸牙齿移动干预措施相比有其优缺点,本文就牙槽骨微穿孔术的提出、生物学反应、应用现状、目前可能出现的副作用作一综述,为该技术的最新发展及临床应用提供科学参考。     

骨皮质切开术及其辅助正畸牙齿垂直向控制研究进展

成人患者多伴有牙周、关节等问题,正畸治疗机制复杂、疗程较长,患者不仅对疗效要求高,对正畸治疗的疗程也颇为关注。骨皮质切开术,通过切开牙齿周围的骨皮质,辅助加速牙齿移动,缩短疗程,为成人正畸提供了一种新的治疗理念与思路。术中辅助植骨,可减轻治疗风险,同时可改善患者的牙周状况。骨皮质切开术日趋成熟,作为一种牙周辅助快速正畸技术在国外已应用于临床。本文将对骨皮质切开术在正畸牙齿垂直向控制中的临床应用、发展、优缺点以及一般临床程序等做一综述。     

骨皮质切开术辅助正畸治疗的临床研究

目的探讨骨皮质切开术辅助正畸治疗的临床应用。方法研究临床接受骨皮质切开术辅助治疗的正畸患者48例,男14例,女34例。骨皮质切开术应用于正畸临床:辅助扩弓,拔牙患者的前牙内收,修复前正畸治疗的磨牙前移、残冠牵引,根骨粘连牙齿的移动等。结果在正畸治疗中,辅助骨皮质切开术可以解除骨皮质阻力,加速正畸牙齿移动,增加牙周支持组织及骨覆盖,减少牙根吸收。结论骨皮质切开术辅助正畸治疗不仅可以加速牙齿移动,而且能够有效解决正畸临床的一些疑难问题。     

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成人患者多伴有牙周、关节等问题,正畸治疗机制复杂、疗程较长,患者不仅对疗效要求高,对正畸治疗的疗程也颇为关注。骨皮质切开术,通过切开牙齿周围的骨皮质,辅助加速牙齿移动,缩短疗程,为成人正畸提供了一种新的治疗理念与思路。术中辅助植骨,可减轻治疗风险,同时可改善患者的牙周状况。骨皮质切开术日趋成熟,作为一种牙周辅助快速正畸技术在国外已应用于临床。本文将对骨皮质切开术在正畸牙齿垂直向控制中的临床应用、发展、优缺点以及一般临床程序等做一综述。     

加速正畸牙齿移动的生物学方法

正畸治疗的平均疗程在两年以上,较长的正畸治疗周期可能增加牙周、牙体并发症发生的风险。因此科学有效地加速牙齿移动,缩短正畸周期具有重要的临床意义。目前加速牙齿移动的方法主要有两大类：一类是外科手术法,包括截骨术、皮质切开术、压电皮质切开术、微骨手术等;另一类是非手术理化刺激法,包括低能激光辐照疗法、低强度脉冲超声、共振震动、脉冲电磁场、低频脉冲疗法、化学物质局部注射等。本文对以上方法的研究进展作一综述,以期为临床医生选择加速牙齿移动的方法提供参考。     

加速正畸牙齿移动的生物学方法

正畸治疗的平均疗程在两年以上，较长的正畸治疗周期可能增加牙周、牙体并发症发生的风险。因此科学有效地加速牙齿移动，缩短正畸周期具有重要的临床意义。目前加速牙齿移动的方法主要有两大类：一类是外科手术法，包括截骨术、皮质切开术、压电皮质切开术、微骨手术等；另一类是非手术理化刺激法，包括低能激光辐照疗法、低强度脉冲超声、共振震动、脉冲电磁场、低频脉冲疗法、化学物质局部注射等。本文对以上方法的研究进展作一综述，以期为临床医生选择加速牙齿移动的方法提供参考。     

牙周辅助加速成骨正畸治疗技术

加速牙齿移动是近年来正畸医生关注的焦点之一。其中牙周辅助加速成骨正畸治疗（periodontally accelerated osteogenic orthodontics,PAOO）技术被证实可有效加速牙齿移动。该技术以局部加速现象为理论基础发展而来,术式在其发展的几年间也几经改良。目前认为PAOO技术可以加速牙齿移动,缩短疗程,减少牙根吸收,增加牙槽骨量,可获得差异性牙齿移动,同时增强术后稳定性。本文阐述PAOO技术的发展历史及加速牙齿移动机制,介绍其目前临床研究和临床应用的现况,可让读者对PAOO技术有较全面的了解和认识。     

超声波对兔牙加速移动的研究

为缩短正畸治疗的疗程,学者们尝试了许多方法来加速正畸牙齿的移动,其中包括局部或全身应用某些药物;物理刺激如局部微电流、脉冲电磁场等来刺激牙周骨细胞体系,促进牙周组织的改建与正畸牙齿的移动。本文通过动物实验观察超声波对正畸牙齿移动的影响。结果表明:局部超声波作用能够加速兔正畸牙齿的移动。     

Efficacy of piezocision on accelerating orthodontic tooth movement: A systematic review

Objectives:The aim of this systematic review was to evaluate the effect of piezocision as an adjunctive procedure to accelerate orthodontic tooth movement.Materials and Methods:Randomized controlled trials and controlled clinical trials that investigated the effectiveness of piezocision on accelerating orthodontic tooth movement were identified through electronic and manual searches. The literature search, study inclusion, risk of bias assessment, and data extraction were performed by two reviewers independently.Results:Four eligible studies were included in this review. All studies reported accelerated tooth movement after piezocision, and three reported a significant reduction of treatment duration in the piezocision group. No deleterious effects on periodontal status, pain perception, satisfaction, root resorption, or anchorage control were reported in any studies.Conclusion:Based on currently available information, weak evidence supports that piezocision is a safe adjunct to accelerate orthodontic tooth movement, at least in the short term. More high-quality clinical trials to determine the long-term effects and optimal protocol for piezocision are needed to draw more reliable conclusions.     

Efficacy and safety of different interventions to accelerate maxillary canine retraction following premolar extraction: A systematic review and network meta-analysis

Decreasing orthodontic treatment duration is at the forefront of innovation for clinical orthodontics. This network meta-analysis aimed to determine the relative efficacy and safety of treatments for accelerated orthodontic tooth movement (OTM) in patients undergoing extraction of maxillary first premolars followed by canine retraction in any orthodontic setting. MEDLINE, EMBASE, Cochrane CENTRAL, CINAHL and SCOPUS were searched (from inception to 20 April 2020). Study selection and data extraction were performed in duplicate. Eligible randomized controlled trials (RCTs) were meta-analysed to estimate the rate of tooth movement, 95% credible interval and surface under the cumulative ranking curve (SUCRA) in the first 3 months following the application of the adjunctive accelerative method. Eligible RCTs were assessed by Cochrane risk of bias tool, and quality of evidence was assessed by GRADE approach, obtained from CINeMA web application. Interventions were ranked for efficacy and reviewed for safety. Nineteen studies pertaining to eight interventions, with data from 415 patients were included. Quality of evidence was very low to moderate. Very low-to low-quality evidence suggests that corticotomy is an efficacious and safe adjunctive treatment to accelerate OTM in comparison with conventional treatment in the first 2 months of treatment. Low-quality evidence suggests that piezocision and micro-osteoperforations (MOP) are efficacious and safe adjunctive treatments only in the first month of treatment. Frequent MOP in conjunction with low-level laser therapy appeared to be an efficacious and safe adjunctive treatment only in the first month following its initial application but not thereafter.     

正畸骨皮质切开术加速牙移动机制的研究进展

正畸骨皮质切开术作为一种外科手段，可在正畸治疗过程中通过安全有效的方法加速牙移动，对健康正畸有着重要的临床意义。在微创前提下有效加速牙移动是目前临床热点之一。该文就正畸骨皮质切开术的起源、临床进展、正畸牙移动的生物学基础以及其加速牙移动的机制进行综述。     

低水平激光治疗促进正畸牙齿移动的研究进展

低水平激光治疗（low-level laser therapy ,LLLT）是被FDA批准应用于临床的一种安全、无创的治疗方法,可通过使用600-1000nm的单色可见红光或近红外光对细胞和组织产生光生物刺激作用。目前,LLLT广泛应用于促进伤口愈合,缓解疼痛,减少炎症,再生医学等领域。现有研究认为,LLLT的分子和细胞机制主要与线粒体电子呼吸链有关,通过促进ATP的生成,调节细胞新陈代谢。大量研究表明,LLLT可通过促进牙周膜和牙槽骨的生理性改建,加速牙齿移动,进而缩短正畸治疗时间。由于LLLT的光生物刺激作用、非侵入性方式等特点使其在加速正畸牙齿移动方面有广泛的应用前景。本文就LLLT的作用机制,生物学效应及对正畸治疗中牙齿移动的促进作用进行探讨。     

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??In recent years??with the development of orthodontic technology??domestic and foreign scholars have done a lot of research on how to accelerate the orthodontic tooth movement. Here we review multiple important factors accelerating the speed of orthodontic tooth movement that has been confirmed??such as hormones and drugs??electromagnetic laser and surgical methods??in order to offer the reference for future clinical treatment.     

Effects of drugs and systemic factors on orthodontic treatment.

Orthodontic tooth movement and bone remodeling activity are dependent on systemic factors such as nutritional factors, metabolic bone diseases, age, and use of drugs. Therefore, a comprehensive review of the effects of these factors on orthodontic tooth movement is attempted in this article. Systemic hormones such as estrogen, androgen, and calcitonin are associated with an increase in bone mineral content, bone mass, and a decrease in the rate of bone resorption. Consequently, they could delay orthodontic tooth movement. On the contrary, thyroid hormones and corticosteroids might be involved in a more rapid orthodontic tooth movement during orthodontic therapy and have a less stable orthodontic result. Drugs such as bisphosphonates, vitamin D metabolites, and fluorides can probably cause a reduction of tooth movement after the orthodontic force is applied. Nonsteroidal anti-inflammatory drugs have also been shown to reduce bone resorption. Long-term administration of these drugs may therefore delay the necessary bone response to respective tooth-borne pressure and should not be administered for long periods of time to patients undergoing orthodontic tooth movement. Attention has also been focused on the effects of prostaglandins and leukotrienes in orthodontic tooth movement. It seems that they might have future clinical applications that could result in enhanced tooth movement. The use of the above drugs should be considered by every dentist in evaluating the treatment time and in planning treatment when tooth movement is attempted.