拔除病变第一磨牙矫治成人双颌前突的临床评价

Clinical study of the extraction of the unhealthy first molars in the treatment of bimaxillary protrusion adult cases

目的评价成人双颌前突错骀拔除病变第一磨牙正畸治疗的临床疗效，探讨拔除第一磨牙进行正畸治疗的可行性。方法通过回顾性研究，对临床已完成的10例由于病变需要拔除第一磨牙的成人双颌前突患者做矫治结果的临床分析。患者平均年龄25．5岁，均存在一颗或多颗第一磨牙严重病损或者早失。矫治设计拔除病损侧的第一磨牙而保留健康的双尖牙，已早失磨牙一侧不再减数，健康侧常规拔除第一前磨牙。所有病例均使用直丝弓矫治器，采用传统支抗技术。通过对10例患者的正畸治疗，总结该类患者的矫治要点并评价其疗效。结果10例患者平均疗程34．5±4．5月，磨牙拔牙间隙完全关闭。治疗后第三磨牙与对骀的第二或第三磨牙均建立良好的咬合关系，且第二磨牙与第三磨牙牙根平行状况良好。测量显示面凸角减小，上下唇角增加，反映出侧貌突度的减小。矫治后的硬组织改变主要为上下前牙的内收。结论：对于第一恒磨牙存在严重龋坏或过早缺失的成人双颌前突患者，非常规拔除第一磨牙，经过仔细的支抗设计和精心的临床操作，可以获得较满意的临床治疗效果。

Objective To investigate the clinical effects of the extraction of the unhealthy first molars in the treatment of bimaxillary protrusion adult. Methods A retrospective study of 10 bimaxillary protrusion adults cases were selected, mean age 25.5 years old, treated with the extraction of unhealthy first molars. The treatment effects were evaluated by pre-and post study casts, profile photos and panoramic and cephalometric films. Results The average treatment duration was 34.5-4. 5 months. Extraction spaces of first molars were closed in all cases, good ocelusal relationships were achieved , and soft tissue profile modified. The third molars moved into ocelusal contact, the roots of second molars and third molars were paralled. Mean values of Ns-Sn-Pos decreased, while angles of upper and lower lip increased. Upper and lower incisors retroclined. Conclusions For those bimaxillary protrusion adult cases, extraction of unhealthy first molars would obtain satisfactory results by careful anchorage design and proper clinical operation.