微螺钉种植体支抗在成人双颌前突矫治中的应用研究
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摘要
目的：研究微螺钉种植体在成人双颌前突中的临床应用，评价微螺钉种植体作为正畸强支抗的有效性。
方法：收集青岛大学医学院口腔正畸科就诊的成人双颌前突患者24例，年龄18—32岁，患者表现为牙列轻中度拥挤，前牙唇倾，轻度开唇露齿，侧貌呈凸面型，尖牙及磨牙关系为安氏Ⅰ类。患者随机分为两组，即应用微螺钉种植体的研究组和传统强支抗方法的对照组，两组患者均拔除4颗第一前磨牙，分别采用微螺钉种植体与传统方法加强支抗。研究组种植体分别植入到上下颌第一磨牙与第二前磨牙颊侧根尖部的牙槽间隔；对照组采用传统强支抗方法，上下颌第一第二磨牙均上带环，同时上颌配合口外弓或J钩下颌以舌弓加强支抗。两组均以每侧50—150g力组牙滑动关闭间隙，通过术前术后X线头影测量，评价2种支抗方法在切牙位置、磨牙位置、硬组织以及软组织的变化。
结果：①研究组12例患者共计48枚微螺钉种植体在拔牙间隙关闭过程中有1枚脱落，3枚松动，其它保持了稳定；②有2例患者种植体周围的软组织发生增生并盖过种植体头端，其他患者种植体周围的软组织健康，无感染、肿胀发生。所有患者均未感不适，能极好配合治疗。③研究组的切牙均明显直立和内收，软组织侧貌得到明显改善，上颌切牙切端向腭侧平均移动6.74mm，对照组向腭侧平均移动5.53mm，两组变化有高度显著性差异，P＜0.01；研究组下颌切牙切端向舌侧平均移动5.46mm，对照组向舌侧平均移动4.04mm,两组变化有极高度显著性差异，P＜0.001。④研究组的上下颌第一磨牙牙冠分别向近中移动0.36mm和0.67mm，对照组上下颌第一磨牙牙冠明显近中移动，分别向近中移动1.92mm和2.48mm，两组变化有极高度显著性差异，P＜0.001。⑤研究组的SNA角平均减少0.42°，对照组SNA角平均减少0.24°，两组变化有显著性差异，P＜0.05；研究组的SNB角平均增加0.32°，对照组SNB角平均增加0.27°，两组变化无显著性差异，P＞0.05；研究组的ANB角平均减少0.74°，对照组ANB角平均减少0.51°，两组变化有高度显著性差异，P＜0.01。⑥研究组的上下唇突度分别减少了4.27mm和4.58mm，对照组上下唇突度分别减少了3.90mm和4.11mm，两组变化有高度显著性差异，P＜0.01；研究组Z角平均增加了9.41°，对照组Z角平均增加了9.07°，两组变化有显著性差异，P＜0.05。
结论：①应用微螺钉种植体支抗矫治成人双颌前突，与传统强支抗相比具有显著的优势，完全可以满足对正畸支抗的需要。②采用微螺钉种植体作为强支抗，其价格适中，对美观无影响，无需患者配合。③微螺钉种植体植入部位灵活，操作简单，可即刻负载，具有良好的临床应用前景。
Objective: The purpose of this study is to evaluate the efficiency of mini-implant in adultpatients with bimaxillary protrusion.
Methods: Based on the selective criteria, 24 patients with bimaxillary protrusion wereselected and divided into 2 groups: Experimental group(used by mini-implantanchorage)and control group(used by strong anchorage). Upper and lower first premolarson both left and right were extracted and mini-implants were inserted into buccal alveolarbone between second premolar and first molar in experimental group, meanwhilehead-gear and lingual holding arch in control group. Sliding mechanics with 50-150gforce was used to retract anterior teeth(from canine to canine). The cephalometric filmsbefore and after treatments were measured.
Results:①Mini-implants remained stable during treatment except one losing and threeloosen.②The soft tissue around implant remained healthy except two cases in whichhyperplasia of soft tissue happened. All patients had good adaptability.③In experimentalgroup, dental protrusion and facial profile were improved significantly. The average oflingual movements of upper and lower incisors were 6.74 and 5.46mm in experimentalgroup respectively and 5.53 and 4.04mm in control group respectively, and there werestatistically significant differences between the two groups(p＜0.01, p＜0.001 respectively).The average of mesial movements of upper and lower first molars were 0.36 and 0.67mmin experimental group respectively, and 1.92 and 2.48mm in control group respectively,and there were statistically significant differences between the two groups(p＜0.001).④The average of reduction of Angle SNA and Angle ANB were 0.42°and 0.74°inexperimental group respectively,and 0.24°and 0.51°in control group respectively,and there were statistically significant differences between the two groups(p＜0.05, p＜0.01respectively). The average of increasing of Angle SNB was 0.32°in experimentalgroup, and 0.27°in control group, and there were no statistically significant differences between the two groups(p＞0.05).⑤The average of reduction of UL—E Plane、and LL—E Plane were 4.27 and 4.58mm in experimental group respectively and 3.90 and 4.11mmin control group respectively, and there were statistically significant differences betweenthe two groups(p＜0.01).
Conclusion: Mini-implant can provide enough anchorage to retract the anterior teeth foradult bimaxillary protrusion; meanwhile, it can create clinically superior results whencompared with traditional strong anchorage systems.
方法：收集青岛大学医学院口腔正畸科就诊的成人双颌前突患者24例，年龄18—32岁，患者表现为牙列轻中度拥挤，前牙唇倾，轻度开唇露齿，侧貌呈凸面型，尖牙及磨牙关系为安氏Ⅰ类。患者随机分为两组，即应用微螺钉种植体的研究组和传统强支抗方法的对照组，两组患者均拔除4颗第一前磨牙，分别采用微螺钉种植体与传统方法加强支抗。研究组种植体分别植入到上下颌第一磨牙与第二前磨牙颊侧根尖部的牙槽间隔；对照组采用传统强支抗方法，上下颌第一第二磨牙均上带环，同时上颌配合口外弓或J钩下颌以舌弓加强支抗。两组均以每侧50—150g力组牙滑动关闭间隙，通过术前术后X线头影测量，评价2种支抗方法在切牙位置、磨牙位置、硬组织以及软组织的变化。
结果：①研究组12例患者共计48枚微螺钉种植体在拔牙间隙关闭过程中有1枚脱落，3枚松动，其它保持了稳定；②有2例患者种植体周围的软组织发生增生并盖过种植体头端，其他患者种植体周围的软组织健康，无感染、肿胀发生。所有患者均未感不适，能极好配合治疗。③研究组的切牙均明显直立和内收，软组织侧貌得到明显改善，上颌切牙切端向腭侧平均移动6.74mm，对照组向腭侧平均移动5.53mm，两组变化有高度显著性差异，P＜0.01；研究组下颌切牙切端向舌侧平均移动5.46mm，对照组向舌侧平均移动4.04mm,两组变化有极高度显著性差异，P＜0.001。④研究组的上下颌第一磨牙牙冠分别向近中移动0.36mm和0.67mm，对照组上下颌第一磨牙牙冠明显近中移动，分别向近中移动1.92mm和2.48mm，两组变化有极高度显著性差异，P＜0.001。⑤研究组的SNA角平均减少0.42°，对照组SNA角平均减少0.24°，两组变化有显著性差异，P＜0.05；研究组的SNB角平均增加0.32°，对照组SNB角平均增加0.27°，两组变化无显著性差异，P＞0.05；研究组的ANB角平均减少0.74°，对照组ANB角平均减少0.51°，两组变化有高度显著性差异，P＜0.01。⑥研究组的上下唇突度分别减少了4.27mm和4.58mm，对照组上下唇突度分别减少了3.90mm和4.11mm，两组变化有高度显著性差异，P＜0.01；研究组Z角平均增加了9.41°，对照组Z角平均增加了9.07°，两组变化有显著性差异，P＜0.05。
结论：①应用微螺钉种植体支抗矫治成人双颌前突，与传统强支抗相比具有显著的优势，完全可以满足对正畸支抗的需要。②采用微螺钉种植体作为强支抗，其价格适中，对美观无影响，无需患者配合。③微螺钉种植体植入部位灵活，操作简单，可即刻负载，具有良好的临床应用前景。
Objective: The purpose of this study is to evaluate the efficiency of mini-implant in adultpatients with bimaxillary protrusion.
Methods: Based on the selective criteria, 24 patients with bimaxillary protrusion wereselected and divided into 2 groups: Experimental group(used by mini-implantanchorage)and control group(used by strong anchorage). Upper and lower first premolarson both left and right were extracted and mini-implants were inserted into buccal alveolarbone between second premolar and first molar in experimental group, meanwhilehead-gear and lingual holding arch in control group. Sliding mechanics with 50-150gforce was used to retract anterior teeth(from canine to canine). The cephalometric filmsbefore and after treatments were measured.
Results:①Mini-implants remained stable during treatment except one losing and threeloosen.②The soft tissue around implant remained healthy except two cases in whichhyperplasia of soft tissue happened. All patients had good adaptability.③In experimentalgroup, dental protrusion and facial profile were improved significantly. The average oflingual movements of upper and lower incisors were 6.74 and 5.46mm in experimentalgroup respectively and 5.53 and 4.04mm in control group respectively, and there werestatistically significant differences between the two groups(p＜0.01, p＜0.001 respectively).The average of mesial movements of upper and lower first molars were 0.36 and 0.67mmin experimental group respectively, and 1.92 and 2.48mm in control group respectively,and there were statistically significant differences between the two groups(p＜0.001).④The average of reduction of Angle SNA and Angle ANB were 0.42°and 0.74°inexperimental group respectively,and 0.24°and 0.51°in control group respectively,and there were statistically significant differences between the two groups(p＜0.05, p＜0.01respectively). The average of increasing of Angle SNB was 0.32°in experimentalgroup, and 0.27°in control group, and there were no statistically significant differences between the two groups(p＞0.05).⑤The average of reduction of UL—E Plane、and LL—E Plane were 4.27 and 4.58mm in experimental group respectively and 3.90 and 4.11mmin control group respectively, and there were statistically significant differences betweenthe two groups(p＜0.01).
Conclusion: Mini-implant can provide enough anchorage to retract the anterior teeth foradult bimaxillary protrusion; meanwhile, it can create clinically superior results whencompared with traditional strong anchorage systems.
引文
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12．曾祥龙．正畸种植体支抗的发展、类型与应用．口腔正畸学，2005，12(1)：44-48
13．朱胜吉，荣起国，周彦恒．微型种植体支抗长度及直径对应力分布影响的三维有限元研究．口腔正畸学，2006，13(2)：49-52
14．吴晶，白玉兴，王邦康等．微型种植体的长度及直径对生物力学的影响．口腔正畸学，2006，13(2)：53-55
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42.Carano A, Velo S , Leone P , et al. Clinical applications of the miniscrew anchorage system. J Clin Orthod , 2005 , 39(1) : 9-24
43．丁寅．正畸临床合面倾斜的预防与治疗．实用口腔医学杂志,2004,20(2):250-251
44.Kyung SH , Hong SG, Park YC. Distalization of maxillary molars with a midpalatal miniscrew. J Clin Orthod , 2003 ,37(1) : 22-26
45.Kyung SH , Choi J H , Park YC. Miniscrew anchorage used to protract lower second molars into first molar extraction sites. J Clin Orthod, 2003,37(10) : 575-579
46. Glancotti A, Muzzi F. Miniscrew treatment of ectopic mundibular molars. J Clin Orthod, 2003,37 (7) : 380-383
47. Wehrbein H, Merz B, Hammerle C, et al. Bone to implant contact of orthodontic implants in humans subjacted to horizontal loading. J Clin Oral Impl Res, 1998, 9 (4): 348-353
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21. Melsen B, Lang NP. Biological reactions of alveolar bone to orthodontic loading of oral implants. Clin Oral Implants Res, 2001, 12: 144-152
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40. Schlegel KA , Kinner F , Schlegel KD. The anatomic basisfor palatal implants in orthodontics. Int J Adult Orthodon Orthognath Surg ,2002,17( 2) : 133 -139
41. Miyawaki S , Koyama I , Inoue M,et al . Factors associated with the stability of titanium screws placed in the posterior region for orthodontic anchorage. Am J Or thod Dentofacial Orthop , 2003 ,124 : 373-378
42.Carano A, Velo S , Leone P , et al. Clinical applications of the miniscrew anchorage system. J Clin Orthod , 2005 , 39(1) : 9-24
43．丁寅．正畸临床合面倾斜的预防与治疗．实用口腔医学杂志,2004,20(2):250-251
44.Kyung SH , Hong SG, Park YC. Distalization of maxillary molars with a midpalatal miniscrew. J Clin Orthod , 2003 ,37(1) : 22-26
45.Kyung SH , Choi J H , Park YC. Miniscrew anchorage used to protract lower second molars into first molar extraction sites. J Clin Orthod, 2003,37(10) : 575-579
46. Glancotti A, Muzzi F. Miniscrew treatment of ectopic mundibular molars. J Clin Orthod, 2003,37 (7) : 380-383
47. Wehrbein H, Merz B, Hammerle C, et al. Bone to implant contact of orthodontic implants in humans subjacted to horizontal loading. J Clin Oral Impl Res, 1998, 9 (4): 348-353
48．李平，陈卫民，毛靖等．微型种植体增强后牙支抗的初步临床研究．临床口腔医学杂志，2005，21(6)：369-371