控根垂直曲辅弓在方丝弓矫治早期阶段对个别牙的控根移动应用(1)
[摘要]目的：介绍利用垂直曲控根辅弓在标准方丝弓矫治的牙列排齐整平阶段实现对牙齿转矩的有效控制。方法：选择18例安氏Ⅰ类中度或重度拥挤，具有明显异常冠转矩患牙的错牙合畸形病例。18例患者均在标准方丝弓矫治的第一阶段利用垂直曲控根辅弓对异常冠转矩患牙进行早期的转矩控制。治疗前留取记存模型，做常规模型测量分析。结果：治疗后，牙列建立中性咬合，目标患牙转矩控制良好。相比常规标准方丝弓矫治，矫治周期平均缩短2～3个月，跟踪随访2～5年，治疗效果稳定。结论：在标准方丝弓矫治的排齐整平阶段，针对具有异常冠转矩患牙的错牙合畸形，采用垂直曲控根辅弓，可以在一定程度上缩短矫治周期，后期保持效果稳定，托槽相关垂直曲控根辅弓为标准方丝弓矫治提供了新的思路。
[关键词]标准方丝弓矫治技术;排齐整平;早期阶段;垂直曲控根辅弓;转矩控制
[中图分类号]R783.5 [文献标志码]A [文章编号]1008-6455(2020)03-0122-03
Abstract： Objective The purpose of this study is to introduce the effective control of tooth torque by the vertical curved root auxiliary arch in the standard alignment of the dentition Methods 18 cases of moderate or severe crowding in the Angle's Class Ⅰwere selected with abnormal crown torque of teeth with malocclusion. In the first stage of standard square silk arch correction， the early torque control of abnormal crown torque was carried out by using the vertical curved root auxiliary arch in 18 patients. The memory model is retained before treatment， and the routine model measurement is analyzed. Results After treatment， the tooth column establishes the neutral occlusion， the target patient tooth torque control is good. Compared with conventional standard square silk arch correction， the correction period average shortened 2-3 months， followed up to 2-5 years， the therapeutic effect was stable. Conclusion In the standard square wire arch correction of the leveling stage， the use of vertical curved root auxiliary arch， aiming at abnormal crown torque teeth with malocclusion， can be a certain extent to shorten the orthodontic period， and maintain the stable effect in the later stage， and provide a new idea for the standard square wire arch correction with bracket-related vertical curved root auxiliary arch.
Key words： standard square wire arch correction technology; early stage; vertical curved root auxiliary arch; torque control
口腔正畸固定矯治技术种类繁多、体系完善、不同技术既相对独立又相互关联，治疗效果各有千秋。方丝弓矫治作为一种经典基础矫治技术仍长期存在。方丝弓矫治在牙列排齐与牙弓平整阶段，均以圆形弓丝作为矫治起始弓丝，圆丝与托槽的设计形态决定，单纯使用圆丝该阶段很难对错位牙齿转矩进行有效控制。但在临床工作中转矩异常患牙却很常见。方丝弓矫治要经过牙列排齐与整平阶段，当托槽居于较为一致水平时，才为使用方丝和进行牙齿控根移动创造条件。此时虽然托槽基本处于一致水平，但如果患牙存在明显异常转矩，会造成以下问题：①局部方丝入槽困难;②个别患牙受力过大导致存在牙创伤、牙根吸收等风险[1]。有研究在正畸治疗12个月后，如果发生牙根吸收超过lmm即可定义为有临床意义的根吸收[2]，也有将正畸治疗早期阶段发生2度及以上根吸收作为临床上诊断发生了根吸收[3];③患牙控根调整时间长，导致正畸治疗周期整体延长;④转矩明显异常患牙复发倾向明显[4]。本文利用一种垂直曲控根辅弓，对具有此类错位牙齿的安氏Ⅰ类错牙合畸形病例进行早期的转矩控制。从而使正畸治疗周期缩短，而且患牙控根效果稳定。对异常转矩患牙进行早期控根调整获得比较满意的疗效，现将结果报道如下。
1 资料和方法
1.1 临床资料：入选标准：①临床诊断为安氏Ⅰ类错牙合畸形，ANB角0～5°，上下颌相对位置正常。中度拥挤(拥挤度在6～8mm)或重度拥挤病例(拥挤度>8mm)设计拔除上下颌第一双尖牙;②牙列中存在明显异常转矩增加患牙，依手腕骨X线片判断生长发育期为生长发育高峰期或高峰前期。, http://www.100md.com(战金辉 米慧 米斐)
[关键词]标准方丝弓矫治技术;排齐整平;早期阶段;垂直曲控根辅弓;转矩控制
[中图分类号]R783.5 [文献标志码]A [文章编号]1008-6455(2020)03-0122-03
Abstract： Objective The purpose of this study is to introduce the effective control of tooth torque by the vertical curved root auxiliary arch in the standard alignment of the dentition Methods 18 cases of moderate or severe crowding in the Angle's Class Ⅰwere selected with abnormal crown torque of teeth with malocclusion. In the first stage of standard square silk arch correction， the early torque control of abnormal crown torque was carried out by using the vertical curved root auxiliary arch in 18 patients. The memory model is retained before treatment， and the routine model measurement is analyzed. Results After treatment， the tooth column establishes the neutral occlusion， the target patient tooth torque control is good. Compared with conventional standard square silk arch correction， the correction period average shortened 2-3 months， followed up to 2-5 years， the therapeutic effect was stable. Conclusion In the standard square wire arch correction of the leveling stage， the use of vertical curved root auxiliary arch， aiming at abnormal crown torque teeth with malocclusion， can be a certain extent to shorten the orthodontic period， and maintain the stable effect in the later stage， and provide a new idea for the standard square wire arch correction with bracket-related vertical curved root auxiliary arch.
Key words： standard square wire arch correction technology; early stage; vertical curved root auxiliary arch; torque control
口腔正畸固定矯治技术种类繁多、体系完善、不同技术既相对独立又相互关联，治疗效果各有千秋。方丝弓矫治作为一种经典基础矫治技术仍长期存在。方丝弓矫治在牙列排齐与牙弓平整阶段，均以圆形弓丝作为矫治起始弓丝，圆丝与托槽的设计形态决定，单纯使用圆丝该阶段很难对错位牙齿转矩进行有效控制。但在临床工作中转矩异常患牙却很常见。方丝弓矫治要经过牙列排齐与整平阶段，当托槽居于较为一致水平时，才为使用方丝和进行牙齿控根移动创造条件。此时虽然托槽基本处于一致水平，但如果患牙存在明显异常转矩，会造成以下问题：①局部方丝入槽困难;②个别患牙受力过大导致存在牙创伤、牙根吸收等风险[1]。有研究在正畸治疗12个月后，如果发生牙根吸收超过lmm即可定义为有临床意义的根吸收[2]，也有将正畸治疗早期阶段发生2度及以上根吸收作为临床上诊断发生了根吸收[3];③患牙控根调整时间长，导致正畸治疗周期整体延长;④转矩明显异常患牙复发倾向明显[4]。本文利用一种垂直曲控根辅弓，对具有此类错位牙齿的安氏Ⅰ类错牙合畸形病例进行早期的转矩控制。从而使正畸治疗周期缩短，而且患牙控根效果稳定。对异常转矩患牙进行早期控根调整获得比较满意的疗效，现将结果报道如下。
1 资料和方法
1.1 临床资料：入选标准：①临床诊断为安氏Ⅰ类错牙合畸形，ANB角0～5°，上下颌相对位置正常。中度拥挤(拥挤度在6～8mm)或重度拥挤病例(拥挤度>8mm)设计拔除上下颌第一双尖牙;②牙列中存在明显异常转矩增加患牙，依手腕骨X线片判断生长发育期为生长发育高峰期或高峰前期。, http://www.100md.com(战金辉 米慧 米斐)