上颌侧切牙过小不同正畸治疗方法疗效的美学评估

Aesthetic assessment of different orthodontic treatments of undersized maxillary lateral incisor

目的:评估拔牙和非拔牙配合修复2种不同的正畸方法矫治侧切牙过小错畸形的美学效果。方法:选取临床上颌侧切牙过小错畸形的病例16例,对9例采用拔除过小的上颌侧切牙减数后尖牙改形替代侧切牙的矫治方法,对7例用非拔牙配合修复的方法治疗,测量矫治前后模型,以及对正面相、微笑相进行观察评估。结果:侧切牙过小错畸形的患者前牙Bolton指数及全牙Bolton指数均不调,且大于正常值,矫治结束后均达正常值;2种方法矫治后正面观察微笑相分析显示,非拔牙组矫治后侧切牙与中切牙宽度的协调效果较好,其均值较拔牙组更接近黄金比例,而拔牙组矫治后上述指标均稍偏大;非拔牙组上中切牙与侧切牙间邻接区协调性较拔牙组好;牙龈的颜色以尖牙改形较冠修复为好,而龈缘的形状、微笑弧则以冠修复为好。对2种矫治方法的总体满意度为100%,而对牙齿颜色和色度的满意度冠修复者较高。结论:拔除过小的上颌侧切牙减数后尖牙改形替代侧切牙的矫治和非拔牙矫治配合修复的方法均可达到患者满意的矫治效果,从美学角度来说,非拔牙配合修复治疗要优于拔牙矫治尖牙改形。

Objective：To study the aesthetic effects of treatment of undersized maxillary lateral incisor by extraction and nonextraction orthodontic methods.Methods：16 patients with undersized maxillary lateral incisors were investigated.9 patients were treated with extraction of the deformed lateral incisors and substitution by canines,7 by prosthetic restoration of the lateral incisors without extraction.Results were evaluated based on dental casts,frontal and smile photographs.Results：The Bolton ratios of the 2 groups were both larger than the normal before treatment.After treatment,the Bolton ratios decreased and reached in the normal range.All patients were satisfied with the treatment.The nonextraction group showed better tooth width proportion,the harmony of connector between central and lateral incisor,gingival shape,contour,smile arc,tooth shade and color.Conclusion：Extraction and nonextration orthodontic methods both are effective in the treatment of undersized maxillary lateral incisor.From the aesthetic view,the nonextraction method is superior to the extraction method.