【作者】 刘佳；

【导师】 刘红彦；

【作者基本信息】 大连医科大学 ， 口腔医学， 2015， 硕士

【摘要】 目的:观察分析用固定矫治技术治疗安氏Ⅱ类2分类青少年前突的临床效果,及软组织侧貌变化的临床分析。材料和方法:选取大连医科大学附属第一院口腔正畸科就诊的安氏Ⅱ类2分类前突患者一例。患者女性,12周岁,安氏Ⅱ类2分类;前突面型。模型分析:恒牙牙合;左侧磨牙关系为中性,右侧为磨牙远中尖对尖关系;深覆牙合Ⅱ°;深覆盖Ⅱ°;上下牙列均为Ⅰ°拥挤;Spee曲线较深,左侧深3mm,右侧深3.5mm。正面观:上牙列中线相对面中线正,下牙列中线向右侧偏2mm;面部放松时开唇露齿,闭口时上下唇肌紧张;面下1/3略长;口呼吸习惯;露龈笑。侧面观:侧貌前突,上颌稍前突下颌后缩;鼻唇颏关系不协调。头影测量分析:骨性Ⅱ类,高角;上颌骨相对颅底发育正常,下颌骨相对颅底发育不足且下颌骨长度较短;上切牙轴舌倾,下切牙轴唇倾;颏部后缩;全面高和上面高均较大;ODI提示深覆合趋势;APDI提示Ⅱ类趋势;EI提示拔牙;面型角FCA提示软组织侧貌呈凸面型;上下唇均位于审美平面外,Z角显示下唇明显过突;鼻唇角较钝;H角提示软组织颏部处于后缩位置,上唇过于前突。患者长期患有慢性鼻炎,未经有效治疗。患者经TWEED分析法分析总难度为174.86,为高难度病例。结果:矫治疗程共24个月,对比患者矫治前和后的头影测量分析及模型发现:EL-UL由4.5mm减小到0mm、EL-LL由7mm减小到1.5mm,说明上下唇相对审美平面回收;ULP由8mm减小至3.5mm,LLP由9mm减小至4mm均提示矫治后面型变平直;Z角由53°增大至66°,达到正常范围,也提示唇部形态改善;H角由23°减小为17°,鼻点-H线距离有7mm减小至0mm,鼻唇沟-H线由10mm减小至7mm,下唇突点-H线由4mm减小至2mm,颏唇沟-H线距离由1mm增加至2mm均说明面部软组织鼻唇颏关系明显变得相对协调,这与拔牙矫治和面部软组织的生长发育密切相关;FCA角由21.5°减小至19°,提示面部软组织整体突度变小,在矫治结束时获得的结果为面部软组织鼻唇颏关系变得相对协调,面型变平直,患者对侧貌改善效果满意。ANB角由8.5°减小至7°,Wits值由4mm减小至1mm提示上下颌骨矢状向位置变得相对协调;下切牙由唇倾变得直立。上、下面高所占全面高的比值变得协调。但是患者的慢性鼻炎未能得到有效治疗,所以口呼吸习惯仍存在,这对于处于生长发育期的该患者是非常不利的,同时会影响矫治疗效的保持,建议患者尽早到耳鼻喉科进行治疗。磨牙关系和尖牙关系双侧均为中性关系;上下中线与面中线对正;前牙覆盖、覆牙合基本正常。患者和家长对面型改善的治疗效果非常满意。结论:对于青少年骨性Ⅱ类高角面突患者,适当采取拔牙矫治能够获得理想的软组织侧貌改善。更多还原

【Abstract】 Objective: This study was designed to observe and analyze the effect of class Ⅱdivision 1 malocclosion, with protrusive face by using fixed appliance, as well as the cephalometric change of soft tissue.Methods: A patient with classⅡdivision 2 malocclusion and protrusive profile was selected from the Dental Division of The First Affiliated Hospital of Dalian Medical University as the object. The analysis of the model shows that the left molar relationship is normal the right molar relationship is class Ⅱ cusp to cusp. She is in permanent teeth stage.Anterior teeth was deep overbite Ⅱ°,deep over jet Ⅱ°.Both arch are mild crowding; the curve of Spee left is 3mm right is 3.5.Upper middle line is good,lower one is 2mm right.When lips are relax,anterior teeth could be seen.Her lower 1/3 facial height is big with mouth breathing and gummy smile.Maxillary protrusion and mandible retrusion lead to profile protrusion.Nose,lips and pogonion are not harmony.Cephalometric analysis shows that class Ⅱ skeletal pattern,high angle case 。 Maxillary development is good,mandible is retrusive and short.Upper incisor lingual tilts,lower incisor labial tilt.Full facial height and upper facial height are higher than the normal value.ODI implys deep bite tendency,APDI implys class Ⅱ tendency,EI implys teeth extraction.FCA shows soft tissue profile is convex.Both lips are over the E-line.Z angle shows upper lip is too protrusive.NLA is above the normal.H angle shows soft tissue pogonion is too retrusive,upper lis is too protrusive.She is a chronic nasitis patient without effective treatment.TWEED analysis shows C.F.Difficulty Total:140.51,Total Dntition Space Analysis:34.3,Total =C.F.+Space Analysis :174.86.This is a difficult case.Results:The course of orthodontic treatment requires 24 months.The changes of pre-and post-treatment:EL-UP from 4.5mm to 0mm,EL-LL from 7mm to 1.5mm,implyboth lip retraction to E-line.ULP from 8mm to 3.5,LLP from 9mm to 4mm,imply profile becomes straight.Z angle from 53°to 66°to the average level implies good lip pattern.H angle from 23°to 17°,nosepoint-H from 7mm to 0mm,nose lip sulcuse-H from10 mm to 7mm,LL-H from 4mm to 2mm,pogonion lip sulcus-H from 1mm to2 mm,imply that nose,lip,pogonion relationship becomes harmony.This effect is related to teeth extraction and soft tissue development.FCA from 21.5°to 19°implys that soft tissue profile conves is decreasing.ANB from 8.5°to7°,Wits from 4mm to 1mm,imply the anterior and posterior position of the maxillary and mandible becomes relatively better.Lower incisor position changes for good.Upper and lower facial height ratio changes to normal value.Chronic nasitis is not healed so mourth breathing still exist.We highly recommend the patient to treat nasitis. Both side molar relationship are slightly to distal.Upper and lower midline is perfect.Over bite and overjet is alomost perfect.Patient is satised with the change of the soft tissue profile.Conclusions:Proper teeth extraction could result in better soft tissue facial profile changes for growing class Ⅱ skeleton pattern high angle protrusion patient.更多还原