天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (7): 726-733.doi: 10.11958/20220702

• 临床研究 • 上一篇    下一篇

隐形矫治器结合种植体支抗治疗拔牙患者的垂直向变化研究

刘伟涛，孙佳，戚琳，邹冰爽，周绍楠，周彦恒   

  1. 1北京赛德阳光口腔临床研究院（邮编100022）；2北京大学基础医学院；3英属哥伦比亚大学牙医学院正畸科；4北京大学口腔医学院·口腔医院正畸科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔数字化医疗技术和材料国家工程实验室
  • 收稿日期:2022-05-12 修回日期:2022-05-27 出版日期:2022-07-15 发布日期:2022-07-15
  • 基金资助:
    国家自然科学基金面上项目（62076011）

Vertical changes of extraction cases with clear aligners and miniscrews

LIU Weitao, SUN Jia, QI Lin, ZOU Bingshuang, ZHOU Shaonan, ZHOU Yanheng   

  1. 1 Institute for Clinical Research and Application of Sunny Dental, Beijing 100022, China; 2 School of Basic Medical Sciences, Peking University; 3 Division of Orthodontics, Faculty of Dentistry, the University of British Columbia; 4 Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology
  • Received:2022-05-12 Revised:2022-05-27 Published:2022-07-15 Online:2022-07-15

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摘要： 目的　探索无托槽隐形矫治器结合种植体支抗治疗拔牙患者的垂直向变化与相关影响因素。方法　选取32例使用隐形矫治器配合上颌种植体支抗进行拔牙矫治的患者，平均年龄（27.1±4.3）岁，收集相关临床资料进行回顾性研究。通过对锥形束计算机断层扫描（CBCT）影像的测量，分析患者治疗前后上、下颌前牙和后牙以及颏下（Me）点的三维方向变化；通过对三维转化头颅侧位片的测量，分析患者治疗前后下颌平面角（MP-SN角）、[ ]平面角（OP-SN角）及下面高（ANS-Me距）的变化。采用配对t检验比较治疗前后各牙性及骨性指标变化情况，对影响下颌平面角变化的有关因素进行相关性分析。结果　治疗后患者的上前牙内收（6.76±1.75）mm，压低（1.57±1.54）mm；下前牙内收（5.56±1.37）mm，压低（2.94±1.15）mm；上磨牙近中移动（1.65±1.21）mm，压低（1.21±0.79）mm；下磨牙近中移动（1.30±0.84）mm，伸长（0.36±0.92）mm。Me点向前、向上移动，下颌平面逆时针旋转1.10°±0.99°，[ ]平面顺时针旋转，下面高减小。相关指标治疗前后差异均有统计学意义（P＜0.05）。下磨牙垂直向位置（r=0.731，P＜0.01）、上磨牙垂直向位置（r=-0.485，P＜0.01）、OP-SN角（r=0.437，P＜0.05）、下前牙矢状向位置（r=0.405，P＜0.05）及上前牙垂直向位置（r=-0.380，P＜0.05）均与下颌平面角变化相关。结论　隐形矫治器配合上颌种植体支抗可在内收前牙的同时逆旋下颌平面。下颌平面旋转可能与上下颌后牙和上前牙垂直向位置及下前牙矢状向位置相关。

关键词: 正畸学, 矫正, 正畸支抗, 拔牙, 锥束计算机体层摄影术, 隐形矫治, 垂直向变化, 种植支抗钉

Abstract: Objective　To explore dentoskeletal changes and factors that correlated with vertical control effect in extraction cases treated with clear aligner appliances and miniscrews. Methods　Thirty-two patients (mean age, 27.1±4.3 years), who were extracted 4 premolars followed by Invisalign treatement with upper miniscrews for retraction of anterior teeth, were retrospectively selected. Cone-beam computed tomography (CBCT) images were taken before and after treatment. Treatment changes in the position of the anterior and posterior teeth, menton, mandibular plane angle (MP-SN), occlusal plane angle (OP-SN) and lower face height (ANS-Me) were measured on the CBCT and cephalometric radiographs generated from CBCT and counted using paired-comparison test. The correlations of significant variables with mandibular plane angle were evaluated using correlation analysis. Results　After treatment, the upper incisors showed significant retraction (6.76±1.75) mm and intrusion (1.57±1.54) mm, and the lower incisors were also significantly retracted (5.56±1.37) mm and intruded (2.94±1.15) mm. The mean vertical change in upper molars was a (1.21±0.79) mm intrusion, while a (0.36±0.92) mm extrusion in lower. Regarding the anteroposterior (AP) dimension, there was a significantly mesial movement in both upper (1.65±1.21 mm) and lower (1.30±0.84 mm) molars. The mean changes in mandibular plane angle was a 1.10°±0.99° of counterclockwise rotation with a anterosuperior movement in menton and a decrease in lower face height, whereas the occlusal plane angle was clockwise rotated. The changes above were all statistically significant (P＜0.05). The changes of mandibular plane angle was significantly correlated with the vertical position of lower molars (r=0.731，P＜0.01), upper molars (r=-0.485，P＜0.01) and upper incisors (r=-0.380, P＜0.05), the AP position of lower incisors (r=0.405，P＜0.05), and the changes of OP-SN angle (r=0.437，P＜0.05). Conclusion　Except retracted upper anterior teeth, extraction cases treated with Invisalign and upper miniscrews appear to have a relatively good vertical control with a decreased mandibular plane angle, which might be associated with the vertical position of upper and lower molars, vertical position of upper incisors, and the AP position of lower incisors.

Key words: orthodontics, corrective, orthodontic anchorage procedures, tooth extraction, cone-beam computed tomography, clear aligner, vertical changes, miniscrews