微植体支抗高牵引钩个性化舌侧系统矫治成人双颌前突硬组织变化初步研究

A study of hard tissue changes in adults with bimaxillary protrusion treated with customized lingual appliance system plus micro-implant and lever-arm

目的探讨微植体支抗高牵引钩个性化舌侧系统矫治成人双颌前突硬组织的变化情况。方法选择8例符合纳入标准的成人双颌前突患者为研究对象。应用e-Brace个性化舌侧系统进行矫治，拔除4颗第一前磨牙，于上颌第一磨牙与第二磨牙之间的腭侧牙槽骨植入微种植体，植入高度距牙槽嵴顶约6 mm。在侧切牙远中的弓丝上安放高度为6 mm的高牵引钩，微种植体与牵引钩间加力进行前牙的内收治疗。在正畸治疗前后分别拍摄头颅侧位片，将两次头影测量的数据应用SPSS 22.0软件进行配对样本t检验，分析各测量指标的变化情况。结果8例患者矫治结束后，磨牙和尖牙关系中性，覆覆盖正常。头影测量结果显示SN-OP（°）增大、U1-SN（°）、U1-PP（°）、U1-NA（mm）、L1-NB（mm）、L1-MP（mm）、OB（mm）减小，U1-L1（°）增大差异有统计学意义（P〈0.05），其余项目差异无统计学意义。结论运用微植体支抗高牵引钩个性化舌侧系统可以内收前牙，改善硬组织突度，临床疗效较为确切，是矫治成人双颌前突的有效手段之一。

ObjectiveThe purpose of this study is to investigate hard tissue changes in adults with bimaxillary protrusion treated with customized lingual appliance system plus micro-implant and lever-arm.MethodsThe sample comprised 8 adults with bimaxillary protrusion who fulfil the inclusion criteria. An e-Brace customized lingual appliance was applied after extraction of four first premolars. Micro-implant was placed on the palatal side of alveolar bone between the second premolar and first molar on maxilla, 6mm above alveolar bone crest. Lever-arm with 7mm in length was placed in the distal of lateral incisors. Elastic chain was tied between micro-implant and lever-arm for later retraction of the anterior teeth. Pre- and post-treatment cephalometric radiographs were measured by hand. Hard tissue changes were analyzed with one-sample T test （SPSS 22.0）.ResultsAfter treatment, molar and canine relationships of 8 patients were Class I and normal overjet and overbite were established. These changes of SN-OP（°）、U1-SN（°）、U1-PP（°）、U1-NA（mm）、L1-NB（mm）、L1-MP（mm）、OB（mm）and U1-L1（°）were statistically significant.ConclusionsCustomized lingual appliances system combined with micro-implants and lever-arm could retract anterior teeth and modify hard tissue protrusion with good outcomes, which could be used as one of the efficient methods to correct bimaxillary protrusion in adults.