个性化舌侧矫正成人严重双颌前突的回顾性研究

A retrospective study of adults with severe bimaxillary protrusion treated with customized lingual orthodontics in

目的研究个性化舌侧矫治技术应用于成人严重双颌前突，评价所采用的数字化排牙，个性化舌侧矫治器、拔牙模式、支抗设计等，是否可以满意地改善侧貌的美观。方法纳入15例严重双颌前突病例，拔除四个第一前磨牙，应用横腭杆和腭部种植支抗，用统一的治疗设计进行舌侧矫正。其中14例女性，1例男性，平均（25.5±3.1）岁，平均疗程（28.9±3.3）个月。治疗前后X线进行传统头影测量，同一坐标系重叠CBCT图像进行3D测量，研究前牙的内收，牙槽骨的改建，牙长轴，牙弓宽度，面下1/3垂直向的改变等与面部美学有关的数据。结果治疗后头影测量结果显示U1-SN减小（－13.2±5.2）°，上下切牙切缘平均内收7.5、6.3 mm，上下唇突点平均内收4.0、6.3 mm，P〈0.01；上颌突度A点平均内收1.2 mm，P〈0.05。CBCT测量结果显示上颌中切牙切缘后移7.1～7.8 mm，尖牙牙尖后移6.4～6.6 mm，P〈0.05；切牙、尖牙根尖点后移3～4 mm，无显著性差异。磨牙0.5～1.0 mm近中移动、－0.2～0.6 mm垂直向移动以及宽度变化均无显著性差异。结论本研究为成人严重双颌前突个性化舌侧矫正的治疗模式和三维力系统提供临床参考数据，能够简单有效地大幅度内收前牙，有满意的垂直向和横向控制。

ObjectiveObjective To evaluate the treatment approach including 3D digital setup and eBrace customized lingual system, extraction pattern and anchorage design in adults with bimaxillary protrusion.MethodsFifteen Class I adults （1 men, 14 women; age, 25.5±3.1 years） treated with four first premolar extraction were included. Palatal miniscrews and transpalatal arch combined with customized lingual appliance were used. Lateral cephalometric radiographs and CBCT were obtained before and after treatment. The superimpositions of CBCT images were analyzed three-dimensionally for tooth position change.ResultsCephalometric analysis showed the upper and lower incisors were retracted by 7.5 mm and 6.3 mm, respectively. The average value of UI-SN decreased （-13.2±5.2）. Upper and lower lips were retracted by 4.0 mm and 6.3 mm, respectively. Mean point was retracted 1.2 mm. CBCT also showed significant retraction of incisor and canine crowns. Three-dimensional position change of maxillary molars showed no significant differences.ConclusionsThis study developed an approach of customized lingual orthodontics with the use of a customized transpalatal arch and anchorage design, which can be an effective modality for adults with severe bimaxillary protrusion.