无托槽隐形矫治配合正颌手术治疗骨性Ⅲ类偏颌的病例报道及文献回顾

Treatment of skeletal ClassⅢmalocclusion with mandibular lateral deviation by clear aligner therapy com⁃bined with orthognathic treatment:case report and literature review

目的 探讨无托槽隐形矫治配合正颌手术治疗骨性Ⅲ类偏颌的临床疗效。方法 对1例骨性Ⅲ类偏颌患者采用正畸正颌联合治疗,正畸治疗采用无托槽隐形矫治器,正颌术式为下颌升支矢状骨劈开术加颏成型,并结合文献回顾分析。结果 术中植入8颗种植钉配合数字化[牙合]板进行颌间牵引,术后通过垂直牵引使后牙咬合紧密;患者依从性良好,通过1套矫治器完成术前及术后正畸治疗,建立磨牙尖牙Ⅰ类关系及前牙正常覆覆盖,下颌前突及偏斜改善良好,术后1年稳定性良好。文献复习结果表明,无托槽隐形矫治配合正颌手术的应用已较为普遍,相较于传统的固定矫治器,无托槽隐形矫治数字化的特性使其与计算机辅助的正颌手术设计之间的配合更为紧密,可供探索的空间更广阔。结论 对依从性良好的患者,无托槽隐形矫治技术可高效完成正畸正颌联合治疗的简单病例,其数字化设计的优势具有良好的发展前景。

Objective To investigate the clinical efficacy of clear aligner therapy combined with orthognathic surgery in the treatment of skeletal Class Ⅲ mandible deviation.Methods A case of mandibular lateral deviation treated by combined orthodontic and orthognathic surgery was reported and analyzed in combination with the related literature.Clear aligner therapy was chosen for orthodontic treatment,and bilateral sagittal split ramus osteotomy and genioplasty were adopted to address the skeletal deformity.Results Eight intermaxillary fixation screws were inserted during surgery to fix the splint,and settling elastics were run to achieve better occlusion postsurgery.With good compliance of the patient,treatment was completed by the first set of aligners,Class Ⅰ canine and molar relationships were obtained,normal overbite and overjet were achieved,and mandibular deviation was addressed.The stability was good 1 year after treatment.The results of the literature review showed that clear aligner therapy in conjunction with orthognathic surgery has been widely used,but there are still some challenges in front.Compared with traditional orthodontics,the digital features of clear aligner therapy makes it fit more closely with computer-aided surgery,and there is more space for exploration.Conclusion For patients with good compliance,clear aligner therapy combined with orthognathic surgery can effectively complete the treatment of simple cases.The advantage of digital design equips clear aligner therapy with good prospects for development.