RW(牙合)板对伴颞下颌关节紊乱病的安氏Ⅱ类错(牙合)患者颌位及咬合关系的影响

目的探讨RW[牙合]板(RW-splint)对伴颞下颌关节紊乱病(temporomandibular disorder,TMD)的安氏Ⅱ类错[牙合]患者颌位及咬合关系的影响,以期为此类患者的诊断及设计提供参考。方法收集15例伴有TMD的安氏Ⅱ类错[牙合]患者,采用RW-splint治疗8个月后,通过髁突移位测量仪记录治疗前后髁突在正中关系位(centric relation,CR)和正中[牙合]位(centric occlusion,CO)时颌位(∠ANB,∠SN-MP,S-G0/N-Me)及咬合关系(磨牙、尖牙位移及前牙覆[牙合]覆盖值)的变化值。结果 RW-splint治疗后,15例患者∠ANB值(t=4.971,P=0.001)、∠SN-MP值(t=9.895,P <0.01)均显著增加,S-G0/N-Me变小(t=5.342,P=0.005)。15例患者下颌左右侧第一磨牙相对上颌第一磨牙远中移动均值分别为(1.57±0.79)mm,(1.69±1.29)mm;下颌左右侧尖牙均向远中移动均值分别为(1.54±0.50)mm,(1.51±1.08)mm;前牙覆[牙合]减小,覆盖增加,其均值分别为(1.16±0.60)mm,(1.99±0.85)mm。结论经RW-splint治疗后伴TMD的安氏Ⅱ类患者下颌皆发生顺时针旋转,磨牙及尖牙相对位置均有明显改变。     

骨性Ⅲ类错（牙合）牙弓、基骨弓宽度及协调性分析

目的 探讨骨性Ⅲ类错（牙合）患者牙弓、基骨弓宽度及二者协调性,为临床诊断和治疗提供理论依据.方法 选择骨性Ⅲ类错（牙合）患者33例为实验组,47例个别正常（牙合）为对照组,利用锥形束CT扫描颌面部,将扫描后图像导入Mimics10.01图像处理软件分别测量牙弓宽度、基骨弓宽度,并计算上下颌对应宽度之差,对测量结果进行独立样本t检验.结果 骨性Ⅲ类错（牙合）组上颌牙弓宽度与个别正常（牙合）组比较无显著性差异,但下颌牙弓宽度大于正常（牙合）,其中下颌第一磨牙处平均宽度正常（牙合）为（56.26±3.09）mm,骨型Ⅲ类患者为（57.78±3.22）mm,差异有统计学意义（P＜0.05）;骨性Ⅲ类错（（牙合）上颌基骨弓宽度测量值均小于对照组,其中在上颌第二前磨牙处正常（骀）为（59.11±5.97）mm,骨型Ⅲ类患者为（56.23±5.28）mm,有统计学差异（P＜0.05）,下颌基骨弓宽度均大于对照组,其中在前磨牙及第一磨牙处分别为（47.44±2.96）mm、（59.81±3.87）mm和（76.20±4.20）mm,与正常（牙合）相比差异显著（P＜0.05）.骨性Ⅲ类错（牙合）上下颌基骨弓宽度差值均小于正常（牙合）（P＜0.01）,而牙弓宽度差值仅在尖牙处差异显著（P＜0.05）,其余牙位测量项目无统计学差异.结论 ①骨性Ⅲ类错（牙合）组上颌基骨宽度发育不足,下颌基骨宽度发育过度.②骨性Ⅲ类错（牙合）的宽度不协调表现在基骨水平,牙弓对基骨弓宽度不调有代偿.     

中国人群个别正常牙合牙弓与基骨弓在三维空间的匹配性研究

目的 对个别正常牙合者的牙弓与基骨弓匹配性进行研究,以期指导临床治疗. 方法 选取30例个别正常牙合患者并拍摄锥形束CT,将牙弓与基骨弓标志点坐标进行数学处理,并通过统计学分析建立上下颌牙弓匹配的数学方程,以及牙弓与基骨弓的匹配数学方程. 结果 上下颌牙弓在尖牙区及第二磨牙区的宽度、深度有很强的相关性(r尖牙深度 =0. 967,r尖牙宽度 =0. 949,r磨牙深度 =0. 948,r磨牙宽度 =0. 942),上下颌基骨弓在尖牙区的深度与宽度匹配关系较弱(r上颌尖牙深度 =0. 922,r上颌尖牙宽度 =0. 701,r下颌尖牙深度 =0. 971,r下颌尖牙宽度 =0. 629),在第二磨牙区的宽度与深度有很强的相关性(r上颌磨牙深度 =0. 973,r上颌磨牙宽度 =0. 988,r下颌磨牙深度 =0. 971,r下颌磨牙宽度 =0. 976). 结论 上下颌牙弓、基骨弓在尖牙区及第二磨牙区的宽度、深度存在匹配关系.     

成人安氏Ⅰ类错(牙合)正畸前、后髁突形态的变化

目的:运用锥形束CT(CBCT)分析成人安氏Ⅰ类错(牙合)正畸治疗前、后髁突形态在三维方向上的变化.方法:选取25例临床无口腔颞下颌关节紊乱症状的成人安氏Ⅰ类错(牙合)患者(男5例,女20例)正畸治疗前、后双侧颞下颌关节的CBCT影像,应用Mimics10.01软件对CBCT影像进行三维重建,测量正畸治疗前、后髁突的高度、最大轴位平面和最大矢状位平面的面积及骨密度,三维髁突及上部三维髁突的体积及骨密度,采用SPSS 19.0软件包对数据进行统计学分析.结果:最大轴位平面和最大矢状位平面的面积和骨密度值较治疗前显著降低(P＜0.05);三维髁突体积及骨密度和上部三维髁突骨密度较治疗前显著降低(P＜0.05).结论:成人安氏Ⅰ类错(牙合)正畸治疗前、后髁突发生适应性的改建.     

维吾尔族错(牙合)畸形患者髁突位置及颞下颌关节形态的锥形束CT研究

目的:运用锥形束CT(CBCT)探讨维吾尔族错(牙合)畸形成年患者髁突位置及颞下颌关节形态特征及其差异,为临床诊治提供依据.方法:对64例维吾尔族安氏Ⅰ类和安氏Ⅱ类1分类错(牙合)畸形成年患者的颞下颌关节CBCT图像进行分析测量,采用SPSS17.0软件包对颞下颌关节窝间隙、髁突相关指标进行统计学分析,比较安氏Ⅰ类和安氏Ⅱ类1分类颞下颌关节形态之间的差异.结果:安氏Ⅰ类和安氏Ⅱ类1分类成年维吾尔族患者髁突在颞下颌关节窝内的位置无性别差异(P＞0.05);安氏Ⅱ类1分类患者的颞下颌关节窝前间隙、上间隙及深度均大于安氏Ⅰ类患者,后间隙小于安氏Ⅰ类患者;髁突的内外径及前后径在不同矢状骨面型患者中存在显著差异.结论:维吾尔族安氏Ⅰ类患者的髁突位置及颞下颌关节形态与安氏Ⅱ类1分类患者存在差异,临床诊治过程中应予以重视.     

基于CBCT分析正畸前后单侧后牙正锁牙合的髁突变化

目的采用锥形束CT(CBCT)分析单侧后牙正锁牙合患者的双侧髁突在关节窝内位置及其形态,探讨其对患者髁突位置及形态的影响和改善情况。方法选择2012年2月至2015年8月间我院收治的15例单侧后牙正锁牙合患者为实验组,选择同期符合安氏Ⅰ类轻度拥挤错牙合患者15例为对照组。所有研究对象均进行面部锥形束CT拍摄,对双侧髁突运用3D Exam vision软件进行三维重建,对7个不同测量值进行统计学分析。结果正畸治疗前,对照组两侧在关节窝内的位置及髁突形态比较,差异均无统计学意义(P>0.05);实验组中的正锁牙合侧关节窝深度、髁突高度均大于非锁牙合侧,差异具有统计学意义(P<0.01)。解除正锁牙合矫正稳定3个月后,实验组正锁牙合侧关节前间隙变化明显小于治疗前,关节后间隙明显大于治疗前,差异具有统计学意义(P<0.05);实验组非锁牙合侧治疗前后髁突形态及位置差异均无统计学意义(P>0.05);实验组正锁牙合侧与非锁牙合侧相比,关节窝深度和髁突高度差异具有统计学意义(P<0.01)。结论单侧后牙正锁牙合可影响髁突形态及其位置的改变,矫治正锁牙合并稳定保持3个月后,锁牙合侧关节有向前下移动的趋势,但髁突形态变化不明显。     

不同拔牙模式正畸矫治对成年女性牙弓宽度和软组织正貌的影响

目的：研究不同拔牙模式对安氏Ⅱ1错牙合成年女性治疗前后牙弓宽度和面部软组织正貌的影响。方法：将40例安氏Ⅱ1错牙合需拔牙矫治的成年女性患者随机分为两组。 A组拔除上颌2颗第一前磨牙,下颌拔除2颗第二前磨牙,B组拔除4颗第一前磨牙。分析比较两组病例治疗前后牙弓宽度和面部软组织正貌指标的变化。结果：正畸治疗后,组内比较显示两组病例上下颌尖牙间宽度均增加,上下颌第一磨牙间宽度均减小,差异有统计学意义（P＜0.05）;组间比较仅下颌尖牙和下颌第一磨牙间宽度变化有统计学意义（P＜0.05）,B组下颌尖牙宽度增加量大于A组,B组下颌第一磨牙牙弓宽度减小量小于A组。治疗前后比较,两组病例在面宽、口裂宽、下颌角间宽、容貌面长和鼻下颏下距的差异均无统计学意义（P＞0.05）。Pearson相关性分析显示牙弓宽度与软组织正貌指标之间无相关关系（P＞0.05）。结论：安氏Ⅱ1错牙合病例正畸矫治后成年女性软组织正貌的变化不受拔牙模式影响,不同拔牙模式仅影响矫治后牙弓宽度的变化。     

安氏Ⅱ类亚类错牙合颅颌面结构三维形态分析

目的    从三维影像分析安氏Ⅱ类亚类错牙合畸形的颅颌面结构,阐明安氏Ⅱ类亚类错牙合畸形的发生机制,为制定临床矫治方案提供依据。方法    选取2011年7月至2013年10月佛山市第一人民医院正畸科收治的安氏Ⅱ类亚类错牙合畸形患者17例为研究组。同期选取在校大学生个别正常牙合志愿者16名为对照组。应用三维测量软件Mimics10.01对两组研究对象进行下颌骨、牙牙合相关项目测量。结果    （1）安氏Ⅱ类亚类错牙合下颌骨除髁突高度外,其余测量项目左右侧差异均无统计学意义（均P＞0.05）;（2）安氏Ⅱ类亚类错牙合中性关系侧与正常牙合相比在升支长度、体部长度、髁突高度、髁突顶点高度等方面差异有统计学意义（均P＜0.05）;（3）安氏Ⅱ类亚类错牙合远中关系侧与正常牙合相比在升支长度、体部长度、下颌角点宽度、乙状切迹点宽度、髁突内外径、髁突顶点高度、髁突顶点宽度等方面差异均有统计学意义（均P＜0.05）。（4）研究组两侧上、下颌第一磨牙的位置差异均有统计学意义（均P＜0.05）,表现为远中关系侧的上颌第一磨牙近中错位和下颌第一磨牙远中错位,且该侧磨牙位置与对照组比较差异均有统计学意义（均P＜0.05）。结论    安氏Ⅱ类亚类错牙合畸形除乙状切迹点位置外,下颌骨左右侧对称,其升支长度和体部长度较正常牙合偏短。远中关系侧的升支有向内旋转的趋势,牙牙合表现为该侧的上颌第一磨牙近中错位和下颌第一磨牙远中错位。     

伴口呼吸习惯安氏Ⅱ~1类错患者正畸治疗后牙颌面横向结构的改变

目的 :探讨正畸治疗对伴口呼吸习惯安氏Ⅱ1类错牙合患者硬组织横向结构的影响。方法 :对 12例伴口呼吸习惯安氏Ⅱ1类错牙合病例用联冠式快速扩弓联合Tip Edge差动直丝弓技术进行治疗 ,拍摄治疗前后X线头颅后前位片 ,进行治疗前后牙颌面横向结构测量分析。结果 :矫治后上、下磨牙间距分别增加 3 .73mm和 3 .65mm ,与治疗前比较变化有显著性差异 (P <0 .0 1) ;上颌基骨宽度及骨性鼻腔宽度也发生增大 ;与上磨牙冠根同时被扩宽相比 ,下磨牙间距的改变主要发生于牙冠部。结论 :利用联冠式快速扩弓矫治器联合Tip Edge差动直丝弓技术 ,可明显增加上颌基骨、上下牙弓及骨性鼻腔的宽度 ,可有效改善伴口呼吸习惯安氏Ⅱ1类错牙合患者横向发育不足畸形     

片段弓技术矫治安氏Ⅱ类1分类错

目的 :评价应用片段弓技术治疗安氏 类 1分类错牙合的效果。方法 :应用片段弓技术对 7例安氏 类 1分类患者 ,通过拔除上颌第一前磨牙及下颌第二前磨牙 ,使下颌第一磨牙较快地向近中移动 ,纠正磨牙 类错牙合关系。结果 :X线头影测量分析显示本方法能够有效改善面部侧貌 ,控制下面部高度 ,控制牙合平面角及下颌平面角 ,使下前牙直立于下颌骨基骨之上 ,促进下颌骨向有利的方向生长。结论 :片段弓技术对于安氏 类 1分类患者是一种操作简单、有效、可推广运用的方法。     

下颌第二磨牙错位相关因素研究

目的:探讨下颌第二磨牙错位的类型及相关因素,为口腔正畸诊断和治疗提供参考。方法:随机抽取100例符合条件的正畸患者,男27例,女73例,平均年龄17.68±1.24岁(12.0~37.5岁)。在记存模型上评估下颌第二磨牙的错位情况,测量Spee曲线曲度和下颌牙槽弓在第二磨牙处的宽度,结合X线曲面断层片测量下颌后段牙弓拥挤度,对测量值进行统计分析。结果:下颌第二磨牙错位发生率约为45%,其中舌侧倾斜占70%。下颌第二磨牙错位与安氏Ⅱ类错牙合、第二磨牙处的下颌牙槽弓宽度存在高度显著相关性(P<0.01),而与后段牙弓拥挤度和Spee曲线曲度无明显相关性(P>0.05)。结论:下颌第二磨牙错位发生率高,且以舌向倾斜多见,应常规纳入治疗计划。下颌第二磨牙错位可能与第二磨牙处的下颌局部牙槽弓宽度有关,而与后段牙弓拥挤度无关。     

青少年下颌后缩患者颅颌面硬组织结构特征的Delaire头影测量初步分析

目的采用Delaire头影测量法分析重庆地区青少年下颌后缩患者颅颌面硬组织特征及其补偿机制,为进一步诊断、治疗设计及预后分析提供参考。方法选取重庆地区11～14岁下颌后缩患者56例及正常青少年40例为研究对象,拍摄头颅侧位片,采用传统头影测量法和Delaire头影测量法分析其颅颌面硬组织结构特征。结果传统头影测量法分析发现,与正常相比,下颌后缩患者∠SNB、Co-Go、Co-Pog、U1-L1减小,∠ANB、∠SN-MP、L1-MP增大,∠SNA、Go-Pog无统计学差异。Delaire头影测量法分析发现,下颌后缩患者∠1、∠5、（Cp-Oi）/C2减小,∠2、（M-Cp）/C2、∠3、∠4增大,C3/C2、NP-F1无统计学差异;Me-F1为-8.70 mm±2.48 mm,Me-Met为5.74 mm±2.58 mm。结论Delaire头影测量法可较直观地定量评估下颌后缩患者颅颌面骨骼结构特征及其补偿机制,下颌后缩畸形主要由下颌骨相对后移及下颌骨发育不足所致。     

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??Objective    To evaluate the mandibular and dentoalveolar asymmetry in a group of patients with class??subdivision malocclusion??and to investigate its mechanism in order to provide evidence for clinical treatment. Methods     Seventeen patients with class?? subdivision malocclusion and sixteen patients with normal occlusion underwent cone-beam CT evaluation. Mandibular and dentoalveolar asymmetry measurements were performed on these images using Mimics10.01 software. The independent samples t-test and paired t-test were used in statistical analysis. Results          No statistically significant differences existed in the right and left sides of class??subdivision malocclusion group except for condylar height. There were significant differences between the class??side of class??subdivision malocclusion group and normal occlusion group in ramal length?? mandibular body length??condylar height and the height of the highest point of condyle. Significant differences were found between the class ??side of class?? subdivision malocclusion group and normal occlusion group in ramal length??mandibular body length??the width of gonion and incisura mandibulae??condylar width??and the width and height of the highest point of condyle. Significant differences existed between the right and left sides of class??subdivision malocclusion group in the position of maxillary and mandibular first molar. Conclusion    Except for condylar height??class??subdivision malocclusion patients have symmetrical mandibular. The length of mandibular body and ramus is shorter when compared to normal occlusion samples. The ramus in class??side of class?? subdivision malocclusion has the trend of rotating inward. The maxillary first molar is in the mesial position and the mandibular first molar is in the distal position in class??side of class?? subdivision malocclusion.     

Unilateral expansion of a narrow mandibular dental arch combined with bimaxillary osteotomies in a patient with hypoglossia

A 23-year-old female with hypoglossia, who had a narrow mandibular dental arch, was treated using the gradual expansion technique. Three lower incisors were missing and the right molar occlusion showed a scissor bite. Her speech was acceptable. Gradual unilateral expansion of the mandibular alveolar bone was performed. Orthodontic tooth alignment was performed prior to surgical treatment. A tooth-borne expander was devised using a hyrax-type screw to move the inclined right alveolar bone into an upright position. Alveolar bone osteotomies were performed under general anesthesia and the expander was placed in the mandibular dental arch. After a 5-day latency period, the screw was activated for 21 days. After expansion, the width of the mandibular dental arch increased by 10 mm at the first molar region and the right molars were moved to an upright position. After a consolidation period of 7 days, simultaneous two-jaw surgery that combined Le Fort I osteotomy and intraoral vertical ramus osteotomies was performed to obtain a stable occlusion. After post-surgical orthodontic and prosthodontic treatment, her occlusion improved without deterioration of her speech. The results indicate that this technique is useful for unilateral expansion of distorted mandibular alveolar process.     

A case report of bilateral Brodie bite in early mixed dentition using bonded constriction quad-helix appliance

Brodie bite is a comparatively rare type of malocclusion found in primary and mixed dentition. It not only adversely affects chewing and muscle functions, but also impairs normal growth and development of the mandible. This report describes the therapeutic results of a patient with bilateral Brodie bite in early mixed dentition after using a bonded constriction quad-helix appliance. The patient, a boy aged 9 years and 2 months, first visited our hospital after occlusal abnormality in the molar region was detected at a local dental clinic. Case analysis resulted in a diagnosis of bilateral Brodie bite with slight mandibular retrognathism. Treatment objectives were to reduce the arch width of the maxillary dentition and expand the mandibular arch in order to establish and stabilize molar occlusion and to achieve a Class I molar relation and appropriate overbite and overjet. Treatment comprised covering the occlusal surface of the maxillary molars with resin and attaching a bonded constriction quad-helix appliance joined with a 0.040-inch quad-helix wire. A bi-helix appliance was also fixed to the mandibular dentition. Brodie bite visibly improved after 5 months. Cervical headgear was then fitted and the patient observed until eruption of the permanent dentition was complete. Class I molar relation was achieved after 2 years and 6 months, although spacing remained in the maxillary and mandibular dentitions. Treatment of bilateral Brodie bite in mixed dentition by means of a bonded constriction quad-helix appliance attached to the maxillary dentition enabled effective bite opening and reduction in the width of maxillary arch independent of the patient's cooperation, providing good therapeutic outcome in a short time period.     

骨性Ⅲ类与Ⅰ类错患者基骨及牙弓宽度的比较研究

目的：评价骨性Ⅲ类错合与骨性I类个别正常合上下颌第一磨牙区基骨及牙弓宽度差异。方法：选取骨性Ⅲ类错合患者与骨性I类个别正常合样本各30例。测量CBCT数据中上颌骨颧弓点和下颌第一磨牙阻抗中心对应的颊侧骨皮质点间的距离作为基骨宽度；测量模型上下颌第一磨牙中央窝之间的距离作为牙弓宽度。使用SPSS 22.0独立样本t检验。结果：上颌基骨宽度Ⅲ类组（63.96±3.78mm）小于I类组（65.67±2.76mm）；下颌基骨宽度Ⅲ类组（62.26±3.12mm）大于I类组（60.29±3.15mm）；基骨宽度差为Ⅲ类组（2.31±2.41mm）小于I类组（5.38±1.24mm）。差异均有统计学意义（P<0.05）。Ⅲ类组与I类组上下颌牙弓宽度均无组间差异（P>0.05）。结论：骨性Ⅲ类患者存在上下颌基骨横向发育不调及上下颌磨牙的颊舌向代偿。     

Extraction treatment of a Class II division 2 malocclusion with mandibular posterior discrepancy and changes in stomatognathic function

This case report describes the successful extraction treatment of a Class II division 2 malocclusion with mandibular posterior discrepancy and a congenitally missing maxillary lateral incisor on the left side. The posterior space in the mandibular arch was small, and the mandibular second molars were impacted, with distal tipping. The discrepancies in the maxillary and mandibular arches were resolved by extraction of the maxillary lateral incisor on the right side and the mandibular second premolars on both sides. The mesial movement of the mandibular first molars occurred appropriately, with the second molars moving into an upright position. A lip bumper was used with a preadjusted edgewise appliance in the maxillary dentition to reinforce molar anchorage and labial movement of the retroclined incisors. Despite the extraction treatment, a deep bite could be corrected without aggravation as a result of the lip bumper and utility arch in the mandibular dentition. Thus, an Angle Class I molar relationship and an ideal overbite were achieved. The occlusal contact area and masticatory muscle activities during maximum clenching increased after treatment. The maximum closing velocity and the maximum gape during chewing increased, and the chewing pattern changed from the chopping to grinding type. The findings in the present case suggest that the correction of a deep bite might be effective for improving stomatognathic function.     

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目的    探讨改良全牙列牙合垫在第二磨牙正锁牙合矫治中的应用。方法    选择2005年5月至2009年12月在中国医科大学口腔医学院正畸科就诊的伴有第二恒磨牙正锁牙合的错牙合畸形患者21例,采用改良全牙列牙合垫矫治第二磨牙正锁牙合并观察效果。结果    21例患者第二磨牙的正锁牙合关系均得到纠正,矫治时间2.5～4.5个月,平均3.3个月。结论    对于第二磨牙正锁牙合,尤其是锁牙合较严重的患者,采用改良全牙列牙合垫进行矫治是一种值得推广的好方法。     

Maxillary and mandibular mesiodistal tooth sizes among different malocclusions in a sample of the Turkish population

The purpose of this study was to establish normative data for mesiodistal tooth crown dimensions with respect to malocclusions and gender differences in Turkish sample. The subjects were randomly selected and assigned to three malocclusion groups according to Angle's classification. Each group consisted of 100 individuals between the ages of 13 and 18 years with the following distribution: Class I, 42 males and 58 females; Class II, 52 males and 48 females; and Class III, 51 males and 49 females. An electronic digital calliper was used to measure the mesiodistal tooth width from the right second permanent molar to the left second permanent molar on both upper and lower study casts. For statistical evaluation, one- and two-way analyses of variance and post hoc Tukey's honestly significant difference (HSD) tests were performed. There were statistically significant differences for the maxillary canine (P < 0.001), first premolar (P < 0.05), second molar (P < 0.05), and mandibular canine (P < 0.01) for males, and for all maxillary teeth and the mandibular central (P < 0.05), canine (P < 0.001), and first premolar (P < 0.05) teeth in females among the malocclusion groups. When Angle's classification was evaluated, significant differences were determined, except for the first and second mandibular molars. All mesiodistal widths were also found to be statistically different according to gender dimorphism. A significant relationship was found between mesiodistal tooth size, Angle's classification, and gender. Therefore, tooth dimensions may play a crucial role in treatment planning and in achieving satisfactory interdigitation of the upper and lower dentition following the completion of orthodontic treatment.