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36例下切牙先天缺失正畸治疗的临床体会
黄素华, 杨四维, 马晨博, 王 妤
( 泸州医学院附属口腔医院 正畸科, 四川 泸州 646000)
Clinical exper ience of or thodontic tr eatment on 36 cases with congenital lower incisor missing HUANG Su-
hua, YANG Si- wei, MA Chen- bo, WANG Yu.(Dept. of Orthodontics, Hospital of Stomatology, Luzhou Medical College,
Luzhou 646000, China)
[Abstr act] Objective To explore the treatment plan in patients with congenital lower incisor missing. Methods
Thirty - six patients with congenital lower incisor missing were included in the investigation. The missing location,
missing quantity, malocclusion type and treatment method were analyzed. Bolton index of two groups were analyzed.
The first group was congenital missing one lower incisor who treated by extracting two upper first premolars and one
lower first premolar. The second group was congenital missing two lower incisors who treated by exacting two upper
first premolars. Results The therapeutic effect of 36 cases were better. Overall ratio in two groups were 91.70%±
1.85% and 92.83% ±2.74% , anterior ratio were 81.69% ±2.12% and 85.46% ±2.39% , anterior tooth - size discrepancy
were(2.16±0.64)mm and(4.27±1.14)mm. There were no significance difference on overall ratio in two groups(P>0.05).
There were significance difference in anterior ratio and anterior tooth- size discrepancy(P<0.01). Conclusion For patients
with congenital missing one lower incisor who need extraction in upper and lower jaws, it is less affection on Bolton
index that extracting one premolar at non- missing side than extracting one center incisor in mandible.
[Key wor ds] lower incisor missing; treatment plan; Bolton index
矢状骨面型:Ⅰ类24例,Ⅱ类10例,Ⅲ类2例。 正常,但下中线不能居中;4)9例缺失1颗下中切牙、
垂直骨面型:均角型17例,高角型12例,低角型 拔除上颌2颗第一前磨牙和下颌1颗非缺牙侧第一前
7例。 磨牙的病例,7例达到了正常 ,2例前牙覆 覆盖
1.2 治疗 正常,但下中线有少许偏移;5)10例缺失2颗下切
36例伴下切牙先天缺失的错 畸形患者均采用 牙、拔除上颌2颗第一前磨牙的病例,9例达到了正
方丝弓或直丝弓矫治器进行治疗,根据患者面型、 常 ,1例成人下颌后缩病例拒绝手术,正畸治疗
牙弓突度、拥挤程度、下牙弓间隙、中线以及错 后达到了排齐上下牙列、改善前牙覆 覆盖的标
类型选择不同的治疗方法。 准。
缺1颗下切牙的21例患者中,1)3例上牙弓排列 两组不同类型先天缺牙和拔牙病例Bolton指数
基本整齐、面型欠丰满或较好、下颌发育不足、下 的测量结果见表1。从表1可见,两组拔牙病例之间
牙弓前段有间隙的低角和均角病例,均采用非拔牙 的Bolton指数全牙比无统计学差异(P>0.05),而前牙
矫治,排齐上下牙列,或扩大下牙弓,集中间隙义 比和前牙不调量有统计学差异(P<0.01)。
齿修复缺牙;2)7例下牙弓排列整齐无间隙、上牙弓 表 1 两 组 不 同 类 型 先 天 缺 牙 和 拔 牙 病 例 Bolton 指 数
比均大于中国人前牙比正常值(78.8%±1.72%),两 [3] Bolton WA. Disharmony in tooth size and its relation to the an-
alysis and treatment of malocclusion[J]. Angle Orthod, 1958, 28
组之间也有统计学差异﹙P<0.01), 4│4 或 4 │4 类 113- 130.
(2):
4│① ①│4
[4] Bolton WA. The clinical application of a tooth- size analysis[J].
型的Bolton比值不调小于 4 │ 4 类型,这提示在下
①│① Am J Orthod, 1962, 48(4):
504- 529.
切牙先天缺失1颗中切牙时,下颌选择拔除非缺牙 [5] 段培佳, 李志华, 赵 青, 等. 正畸拔牙后Bolton指数不调的多
因素分析[J]. 华西口腔医学杂志, 2003, 21(4):
289- 291.
侧1颗前磨牙比拔除1颗中切牙的Bolton指数不调量
DUAN Pei- jia, LI Zhi- hua, ZHAO Qing, et al. Logistic regression
要小。因此对下颌先天缺失1颗切牙且上下颌均需
model analysis on Bolton ratio of orthodontic extraction model[J].
拔牙者宜采用 4│4 或 4 │4 设计。 West China J Stomatol, 2003, 21(4):
289- 291.
4│① ①│4
[6] 王惠芸. 学[M]. 北京:人民卫生出版社, 1990:
231- 233.
下颌先天缺失2颗中切牙、上颌拔除2颗前磨牙
WANG Hui- yun. Occlusion[M]. Beijing:People′
s Medical Pub-
者,在矫治时下颌侧切牙、尖牙、第一前磨牙将前 lishing House, 1990:
231- 233.
移至前一牙位,在计算Bolton指数时,下颌第一前 [7] 罗颂椒. 当代实用口腔正畸技术与理论[M]. 北京:北京医科大
磨牙将纳入前牙量范畴。根据王惠芸 [6]统计,下颌 学中国协和医科大学联合出版社, 1995:
122.