无托槽隐形矫治器施力于牙齿,使其恢复至正常的位置,最终牙齿在正确排列关系下建立平衡、稳定的咬合状态。咬合曲线是连接相关牙尖而形成的连续曲线,分为Spee曲线和Wilson曲线,是评价咬合和排齐整平效果的重要指标,但临床中缺乏准确、便捷的评价工具。近年来,口腔数字化已经覆盖了口腔诊疗的全流程,人工智能技术在信息分析中逐渐起到中流砥柱的作用,且正畸与人工智能呈现深度结合的趋势。本文将对咬合曲线的测量方法及目前无托槽隐形矫治后咬合曲线变化的研究现状进行综述。The clear aligner exerts force on the teeth, causing them to return to their normal positions, ultimately establishing a balanced and stable occlusion state for the teeth in the correct arrangement. The occlusal curve is a continuous curve formed by connecting the relevant cusps, and it is divided into the Spee curve and Wilson curve, which is an important indicator for evaluating occlusion and alignment, but there is a lack of accurate and convenient evaluation tools in clinical practice. In recent years, digitalization has covered the entire process of dental treatment, and artificial intelligence technology has played an increasingly pivotal role in information analysis, and there is a trend of deep integration between orthodontics and artificial intelligence. This paper will review the measurement methods of occlusal curves and the current research status of the changes in occlusal curves after clear aligner treatment.
目的·利用锥形束CT(cone-beam computed tomography,CBCT)比较上颌前牙倾斜性内收(retraction adjunct with tip,R&Tp)和控根性内收(retraction adjunct with torque,R&Tq)产生的牙槽骨改建反应差异。方法·选取40例符合纳入标准的安氏Ⅱ类1分类青少年患者,根据牙齿实际内收方式对纳入对象所有160颗上颌切牙进行标准化分组(分为倾斜内收组和控根内收组),利用CBCT影像结合三维测量软件对2组牙齿内收情况以及相关牙槽骨高度和厚度变化进行测量分析和比较。结果·2组前牙均实现较大范围内收和直立,倾斜内收组牙冠内收距离及内收角度均明显大于控根内收组(均P=0.000)。倾斜内收组L3、P1厚度显著减小(均P=0.000),控根内收组P1、P2厚度显著减小(均P=0.000)。倾斜内收组T1厚度减小(P=0.000),控根内收组各水平牙槽骨总厚度均减小(均P=0.000)。2组唇侧(P=0.000)、腭侧(P=0.000)牙槽嵴高度均下降,且腭侧牙槽嵴高度降低更显著。结论·安氏Ⅱ类1分类青少年患者上颌前牙在较大范围内收时,倾斜内收组唇侧根尖区、腭侧牙槽嵴区以及控根内收组腭侧牙根颈部及中部区域均为牙槽骨吸收高风险区。
目的·系统比较上颌骨LefortⅠ型截骨前移结合下颌骨后退术与单纯下颌后退术对骨性Ⅲ类错患者上气道的影响。方法·计算机检索Cochrane Library、EMBASE、Pub Med、CNKI、万方等中外文数据库中所有比较单纯下颌骨后退术与上颌骨LefortⅠ型截骨前移结合下颌骨后退术对骨性Ⅲ类错患者上气道影响的文献,包括随机对照试验和非随机对照试验,检索日期止于2016年2月29日。对纳入的研究进行质量评价,采用Rev Man 5.3软件对数据进行meta分析。结果·最终纳入6篇病例对照试验文献,共205例患者。meta分析结果显示:在2种术式对气道横截面积(CSA)的影响方面,鼻咽平面(后鼻棘平面)、会厌平面气道CSA改变的差异有统计学意义(P<0.05),软腭平面气道CSA改变的差异无统计学意义;在2种术式对气道容积的影响方面,鼻咽气道容积和上气道总容积改变的差异有统计学意义(P<0.05),口咽气道和喉咽气道容积的变化无统计学意义。结论·与单纯下颌骨后退术比较,上颌骨LefortⅠ型截骨前移术结合下颌骨后退术对骨性Ⅲ类错患者鼻咽、喉咽平面的横截面积及鼻咽气道、上气道总容积的影响更小;对于骨性Ⅲ类错患者,尤其有潜在呼吸问题的患者,上颌骨LefortⅠ型截骨前移结合下颌骨后退术的治疗更佳。
