摘要：

目的： 探索三维（three dimensions，3D）打印导板引导的微创骨皮质切开术辅助正畸治疗骨性Ⅱ类错牙合畸形的临床效果。方法： 选取就诊于我院的24例成人骨性Ⅱ类上颌前突患者，均需拔除上颌双侧第一前磨牙并使用种植体支抗内收上前牙，将其随机分为2组，对照组行常规正畸治疗，研究组在关闭间隙开始时实行3D打印导板引导下的微创骨皮质切开术，术后加力方式同对照组。分别对2组患者软硬组织变化相关指标和临床效果相关指标进行分析和比较。结果： 研究组U1-SN（上中切牙长轴与SN连线交角）的变化值为（-1.49±2.18）°，U1-NA（上中切牙长轴与NA连线交角）为（-5.63±3.39）°，NA-Apo（颌突角）为-4.10 (-4.60，-2.00）°，U1-Apo（上中切牙突距）为（-3.10±0.95） mm，与对照组相比，差异有统计学意义；研究组关闭拔牙间隙过程中牙齿的每月平均移动距离[（0.90±0.21） mm]显著大于对照组[(0.54±0.15) mm]，术后的牙根均未损伤，研究组与对照组治疗后牙根吸收程度、牙周探诊深度均无明显差异。结论： 在骨性Ⅱ类的错牙合畸形患者掩饰性治疗中，辅助3D打印引导下微创骨皮质切开术可有效实现上颌前牙的整体移动，缩短治疗时间，手术并发症较少，是骨性Ⅱ类患者掩饰性正畸治疗有效的辅助手段。

关键词: 骨性Ⅱ类, 3D打印, 骨皮质切开术, 正畸牙移动

Abstract:

Objective: To explore the clinical effect of Piezocision guided by three dimensions (3D) printing guide plate to assist skeletal Class Ⅱ malocclusion correction. Methods: Twenty-four patients with skeletal Class Ⅱ malocclusion were selected from our hospital. The treatment plan involved the extraction of the bilateral maxillary first premolars and anterior retraction by mini-implant anchorage in upper arch. The patients were randomly divided into two groups: The control group underwent conventional orthodontic treatment, while the research group underwent Piezocision guided by 3D printing guides at the beginning of the space-closing phase of the orthodontic treatment. The loading method was the same as that of the control group after the operation. The indexes related to the changes of hard and soft tissues and the treatment effects of the two groups were recorded for analysis and comparison. Results: In the research group, the change value of U1-SN was (-1.49±2.18)°，U1-NA was (-5.63±3.39)°，NA-Apo was -4.10 (-4.60, -2.00)°，U1-Apo was (-3.10±0.95) mm. There was significant difference comparing with the control group. The average speed of movement of the teeth in the research group during the process of space closure was (0.90±0.21) mm per month, which was significantly faster than that of the control group [(0.54±0.15) mm per month]. None of the roots were damaged after operation, and there was no significant difference in the degree of root resorption and the depth of periodontal probing between the research group and the control group after the treatment. Conclusion: In skeletal ClassⅡmalocclusion correction, 3D printing-guided Piezocision can effectively realize the overall movement of the maxillary anterior teeth, shorten the treatment time, and have fewer surgical complications, which can be viewed as an effective adjuvant treatment of patients with skeletal ClassⅡmalocclusion undergoing orthodontic treatment.

Key words: skeletal ClassⅡ, three dimensions printing, osteocorticotomy, orthodontic tooth movement

中图分类号: 

• R782