【作者】 徐波；

【导师】 刘丽；

【作者基本信息】 浙江大学 ， 口腔医学， 2001， 硕士

【摘要】 【研究目的】 临床正畸治疗是为了获得理想的上下颌间关系。普遍认为，如果上下牙大小不协调（tooth size discrepancy，TSD以下简称TSD），就很难获得良好的磨牙关系、覆盖、覆(牙合)。1958年，Bolton引入全牙比（OR）和前牙比（AR）两个概念，来表示上下总牙量及前部牙量之间的协调性。指出：两指数在相对小的变异范围内，能获得理想(牙合)；预测患者在正畸治疗后的正常(牙合)关系及美观效果，并且把该比率应用于正畸诊断和治疗计划中。按Bolton指数界定的TSD较普遍存在于正畸患者中。 本研究的目的：研究TSD对(牙合)的影响。（1）TSD是否影响(牙合)？（2）在正常(牙合)范围内牙的近远中及唇（颊）舌（腭）向的倾斜，即正常(牙合)范围内轴倾角及冠角的变化，是否可以解决TSD带来的问题？（3）验证正畸临床解决TSD问题的可行性，为TSD患者群制定较好治疗方案提供依据。 浙江大学医学院硕士学位论文【研究方法】 l．实验设计和统计分析采用正交试验设计及其方差分析，研究多因素 对PAR指标的影响。 2．以模拟实验的方法对已制备的TSD牙模进行人工排牙试验：磨牙 关系中性，通过正常范围内的牙的近远中及唇（颊）舌（胯）向倾 斜改变来获得较好的前牙覆盖、覆牙色 3．采用上海地区全牙比：90．99O土1．700，前牙比：78．36O士2．18o为标 准。引入趴以k盯地semem RaRahg艄标给模型记分：引入全牙比和 前牙比（A），覆盖（B），覆合（C），磨牙关系（D），全牙比 m）和前牙比（F） （以下分别称A因素月因素人因素刀因素，E因素＊因素X分别研 究A单独对PAR的影响；在牙轴代偿情况下，E，F对PAR的影响。【结果】1．TSD对 PAR影响的实验结果显示，PAR与 TSD的变化不同步；F＊5（。，18）＜．55，统计分析显示全牙比和前牙比、覆盖、磨牙关系均对邪液统计学意义上的影响0＜0刀5人2．牙轴代偿后TSD对PAR影响的实验结果显示，PAR与TSD的变化不同步；FO刀5o，4）－6．94，统计分析显示全牙比、前牙比两因素对牙合无明显的影响（P）0．05〕。3．实验结果表明，全牙比在ZSD范围内的患者群和全牙比超过ZSD范围同时前牙比在ZSD范围内的患者群，可以通过牙轴代偿的方法得到较小的PAR值。 3 浙江大学医学院硕士学位论文【结论】1．从TSD对邪舶单独影响角度考虑，TSD对韶是有影响的，TSD直接影响正畸疗效。2．在牙轴代偿情况下，TSD对济朝影响是有限的，特定的全牙比在ZSD范围内TSD患者群和全牙比超过ZSD范围同时前牙比在ZSD范围内的TSD患者群，可以通过选择牙轴代偿方法的治疗方案，取得较好的治疗效果。3．对非理想化指数范围的特定的TSD患者群的较佳治疗提供了理论依据，有助于正畸临床治疗水平的提高，具有临床实用价值。更多还原

【Abstract】 [Objection]The clinical orthodontic treatment is in order to obtain an excellent occlusion .It is claimed to be difficult to be obtain an excellent occlusion if the maxillary tooth size discrepancy (TSD) .In 1958 Bolton introduced overall and anterior tooth size ratios ,which were supposed to be helpful in diagnosis and treatment to express the coordinator of the mesiodistal tooth size of the maxillary and manidibular arch. Determined tooth size ratios may predict the excellent occlusion; may predict the functional and esthetic outcome of the case. TSD is general in orthodontic cases according to the Bolton ratios.The purposes of this experimental study are the following: to study the effect of TSD on occlusion, (l)Whether TSD always affect the final orthodontic treatment outcome, (2)Whether the change of the inclination and angulation of the teeth beyond normal can solute the question cased by TSD, (3) To test and verify the feasibility of resolving TSD issue in orthodontic clinic in order to offering the basis for the patient bevy with TSD for better plan of cure. (Material and Methods]1.The orthogonal experimental design and analysis of variance are used to study the effect of multiplex element on PAR.2.An attempt has been made to establish ideal setup situations. In cases with TSD can be made to compensate for the discrepancy. We have chosen to establish ideal occlusions in the buccal segment (Class I) > better anterior occlusion and compromise on the inclination and angulation of teeth.3. According to overall and anterior tooth size ratios in Shanghai, they are 90.99% + 1.70% and78.36%?.18%. The PAR index (Peer Assement Rating) was used to score the occlusion on setup. To study the effect of artificially created TSD on occlusion in setup, two part of the study were carried on. [Results]1. It is showed that the PAR ranking did not coincide with the TSD values as a result of the effect of TSD on PAR values; F005(2]18) =3.55, the analysis of statistically means no statisticallysignificant difference beaten overall > anterior tooth size ratios > overbitex the relationship of molar and occlusion (P^O.05) .2. It is showed that the PAR ranking did not coincide with the TSD values as a result of the effect of TSD on PAR scores after ; F005(2i4) =6.94, the analysis of statistically indicates statistically significant difference beaten overall -, anterior tooth size ratios > overbite^ the relationship of molar and occlusion (P^O.05) .3.The analysis of statistically means that the patient bevy whose overall tooth size ratios inside 2SD and overall tooth size ratios beyond 2SD with anterior tooth ratios inside 2SD can obtain less PAR score through compensation of tooth axes .[Conclusion]1. Only considering the effective of TSD on occlusion will be TSD the outcome of the final occlusion, it will affect on occlusion.2. On the occasion of compensation of tooth axes, the effect of TSD on occlusion appears to be limited. The differential TSD patient bevy whose overall tooth size ratios inside 2SD and overall tooth size ratios beyond 2SD but anterior tooth ratios inside 2SD can obtain better effective with selecting the compensation of tooth axes.3. The offering of academic basis for better treatment for the differential TSD patient bevy whose ratios beyond ideal, it ishelpful to advance the clinical orthodontic treatment, and plays a practical role in clinical orthodontic treatment.更多还原