牙弓/牙槽骨弓的塑形矫治——基于牙弓形态发育不良的儿童错畸形诊断与阻断治疗

Dental alveolar bone and dental arch remodeling in children: orthodontic diagnosis and treatments based on individual child arch development

错畸形是颅面颌系统生长发育的异常,其产生是遗传、环境及特殊病因共同作用的结果。儿童错畸形的早期矫治是去除造成错畸形的病因,维持、恢复及矫正异常发育的颅面颌结构,矫正咬合关系异常;其主要目的就是要利用个体生长潜力,用较小的代价达到有效的稳定的矫治效果。错畸形早期矫治的范围很宽,包括口腔功能的早期矫治(口腔不良习惯早期矫治)、口周肌肉功能训练、牙替换的维护、牙发育不良的矫治、上下颌骨关系异常的矫治等等。从正畸学角度上看,牙错位的矫正称为"正牙"(orthodontics),上下颌骨发育关系异常的矫治称为"矫形"(orthopedics);而在牙弓/牙槽骨弓形态大小异常上的矫治,临床仍有进一步梳理和发展的空间。四川大学华西口腔医院儿童与口腔正畸科·儿童早期矫治专科在大量的临床实践中,总结了牙弓/牙槽骨弓发育的特点与规律,探索早期矫治异常牙弓发育的正畸临床思路与技术,在国内首次提出"牙弓/牙槽骨弓发育不良的塑形矫治"理论。把牙弓/牙槽骨弓发育不良的早期阻断矫治定义为"塑形"(remodeling),丰富除"正牙"与"矫形"等正畸治疗理论与技术外的错治疗方法,并用于指导错畸形早期矫治的临床工作,以期达到早期预防、阻断错畸形的发生发展,简化错复杂程度、降低错治疗难度的效果。本文从临床矫治的基础及儿童生长发育的角度,全面归纳分析"牙弓/牙槽骨弓发育不良的塑形矫治"的理论基础和临床思路,阐述该理论的可能性及必要性,希望借此促进儿童错畸形的早期预防与阻断矫治的理论与技术的发展。

The etiology of malocclusions basically involves both congenital and environmental factors. Malocclusion is the result of the abnormal development of the orofacial complex （including tooth, dental alveolar bone, upper and lower jaws） Early orthodontic interceptive treatments involve the elimination of all congenital and environmental factors that contribute to the malformation of the orofacial complex, as well as interrupt the deviated development of the orofacial complex and the occlusion. Early orthodontic interceptive treatments mainly aim to use children＇s growth potential to correct abnormal develop- ments of occlusions and orthodontically treat malocclusions more efficiently. The early orthodontic interceptive treatments include correcting the child＇s bad oral habits, training the abnormal functioned para-oral muscles, maintaining the normal eruptions of succeeding permanent teeth, applying interceptive treatments to the mal-developed teeth, and employing functional orthopedic treatments for abnormal growths of the upper and lower jaws. In orthodontics, correcting mal-positioned teeth is called orthodontic treatment, while rectifying the abnormal relationships of the upper and lower jaws is called functional orthopedic treatment. However, no clear definition is available as regards to the early orthodontic interceptive treatment of malocclusions caused by the deviated development of the dental alveolar bone. This new theory of＂early dental alveolar bone and dental arch remodeling technique＂ was proposed by Professor Li Xiaobing of the Department of Pediatric Dentistry, Faculty of Pediatric Dentistry and Orthodontics in West China Hospital of Stomatology through his clinical analyses and investigation of his early orthodontic interceptive treatments. He defined the early orthodontic corrections of abnormal growth of dental alveolar bone as ＂remodel＂. The ＂early dental alveolar bone and dental arch remodeling theory and technique＂ is proved useful in malocclusion diagnosis and treatment planning during early orthodontic interceptive treatment with malformed dental arch. With the development of the theory and technique, the author intended to prevent and intercept the malocclusion development more effectively and efficiently. This review presents the development and clinical usages of the theory which to provide a new vision in the analysis of malocclusions on the basis of the developmental mechanism of the alveolar bone and dental arch. With clinical case illustration, the author demonstrateshis successful orthodontic clinical practices with this theory, which may contribute to the development of contemporary orthodontic theories and techniques.