Comparison of Torsional Control of Anterior Molars by Bracket Type in Extraction of Premolars
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摘要:
目的 对比研究Ormco传统双翼直丝弓托槽、Tip-Edge Plus差动力直丝弓托槽与标准转矩Damon被动自锁托槽在正畸拔牙矫治中对上颌前牙的转矩控制情况，为临床应用上选择合适的矫治器和矫治技术提供参考依据。 方法 患者40例选取于2016年1月至2019年12月在南京大学医学院附属口腔医院正畸科和昆明市延安医院口腔科就诊者，且为中度牙列拥挤需拔除上下颌第1前磨牙的安氏I类错（）畸形，其中采用Ormaco传统双翼直丝弓托槽矫治器患者10例、Tip-Edge plus差动力直丝弓托槽矫治器患者10例和标准转矩Damon被动自锁托槽矫治器患者20例。比较矫治前和矫治完成时反映颅颌面关系、软组织形态等20项测量项目。 结果 3组患者矫治前均提示突面相，上前牙前突。矫治后3种矫治器及相应的矫治技术都改善了上前牙突度，∠U1-L1较治疗前均增大，∠U1-NA较治疗前均减小。在软组织方面，矫治后3组UL-EP、LL-EP均发生了减小，Z角增大，接近正常值，提示侧貌前突也得到改善。矫治前和矫治后3组患者间的上下颌骨在矢状向位置、垂直向位置、前牙突度，以及软组织4个方面均未见明显差异（P > 0.05）。 结论 研究结果显示Damon双翼托槽矫治器、Tip-Edge plus托槽矫治器和标准转矩Damon被动自锁托槽矫治器3种矫治器，在改善前牙突度方面都有着一定的效果，矫治完成后对照的3组数值均接近正常值，说明标准转矩的Damon自锁托槽、Tip-Edg plus差动力直丝弓托槽以及Ormco传统双翼托槽在拔牙病例中都能有效的控制前牙转矩，且3种托槽在控制转矩方面没有明显差异。 -
关键词:
- 拔牙矫治 /
- 转矩 /
- Ormco传统双翼托槽矫治器 /
- Tip-Edge plus差动力直丝弓托槽矫治器 /
- Damon标准转矩自锁托槽矫治器
Abstract:Objective To compare the torque control of upper teeth with 3 appliances （Damon double wings bracket, Tip-Edge Plus bracket and Damon self-ligating bracket） in the extraction cases, and to provide the reference basis for the comprehensive consideration of the patient’s condition and the selection of the best appliance and correction technique. Methods A total of 40 patients were selected from the Orthodontics Department of Stomatology Hospital affiliated to Nanjing University School of Medicine and The Stomatology Department of Kunming Yan’an Hospital from January 2016 to December 2019. The patients were moderate dentition congestion with Angle type I malocclusion requiring extraction of the first maxillary premolars. Among them, 10 patients were treated with Ormaco traditional double-wing straight wire arch bracket orthodontic device, 10 patients with TIP-EDGE Plus differential dynamic straight wire arch bracket orthodontic device and 20 patients with Damon passive self-locking orthodontic device with standard torque. Twenty measurement items reflecting cranio-maxillofacial relationship and soft tissue morphology were compared before and after treatment. Results In the three groups, the anterior protrusion of the anterior teeth was presented before the treatment, and the side appearance was in the protrusive state. After treatment of three kinds of orthodontic techniques, the anterior teeth protrusion improved, ∠U1-L1 increased than before treatment, while ∠U1-NA decreased.In the soft tissue, the three groups of UL-EP and LL-EP reduced, and the Z angle increased, which was close to the normal value, suggesting that the side front process was also improved. There was no significant difference among the three groups in the 4 aspects of sagittal, vertical, anterior dental protrusion and soft tissue before and after correction （P > 0.05）. Conclusion The results of this study showed that Damon double wings bracket, Tip-Edge Plus bracket and Damon self-ligating bracket have a certain effect on improving anterior teeth protrusion. After treatment, the measured values were closed to normal numerical value. The standard torque Damon self-ligating bracket and Tip-Edg plus bracket as well as Damon double wings bracket can effectively control the anterior teeth torque in the extraction cases. Three kinds of brackets have no obvious difference in the control torque. -
表 1 治疗前各组患者颅颌面结构测量结果（
$\bar x \pm s $ ）Table 1. Pretreatment cephalometric analysis （
$\bar x \pm s $ ）指标 TP组 Damon双翼托槽组 Damon自锁托槽组 F P 矢状向 SNA（°） 78.44 ± 3.75 79.82 ± 6.29 79.09 ± 2.70 0.284 0.755 SNB（°） 75.76 ± 3.94 77.05 ± 6.46 77.19 ± 3.53 0.357 0.702 ANB（°） 3.00 ± 2.02 2.78 ± 1.56 2.66 ± 1.31 0.161 0.852 垂直向 MP-SN（°） 41.64 ± 4.50 39.76 ± 10.75 37.27 ± 5.30 1.425 0.253 MP-FH（°） 33.47 ± 5.10 31.59 ± 9.34 29.28 ± 6.29 1.291 0.287 S-Go/N-Me（%） 60.70 ± 4.24 62.97 ± 7.72 60.38 ± 14.62 1.765 0.414 ANS-Me/N-Me（%） 53.99 ± 2.94 54.14 ± 2.40 53.54 ± 2.72 0.193 0.825 前牙突度 U1-L1（°） 115.99 ± 6.34 117.45 ± 13.02 118.40 ± 7.92 0.405 0.817 U1-SN（°） 110.67 ± 5.20 111.34 ± 11.26 111.86 ± 6.33 1.116 0.572 U1-NA（mm） 32.22 ± 6.95 31.53 ± 9.81 32.78 ± 5.87 0.431 0.806 L1-NB（mm） 29.13 ± 6.65 28.26 ± 5.74 26.93 ± 5.34 0.523 0.597 L1-MP（°） 91.75 ± 5.66 91.47 ± 7.02 92.48 ± 5.37 0.115 0.892 软组织 UL-EP /mm 2.85 ± 1.45 1.57 ± 2.50 1.60 ± 2.05 1.422 0.254 LL-EP /mm 4.13 ± 2.45 2.75 ± 2.81 2.32 ± 2.29 1.807 0.178 Z 角（°） 59.60 ± 5.83 64.52 ± 7.76 65.00 ± 12.74 0.975 0.387 面角（°） 87.53 ± 3.87 86.33 ± 5.92 89.30 ± 6.01 1.035 0.365 软组织侧貌（°） 163.07 ± 3.30 160.04 ± 4.87 163.31 ± 5.94 1.448 0.248 
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表 2 矫治前后上下颌骨矢状向位置的变化（
$\bar x \pm s $ ）Table 2. The changes of the maxilla and mandible in sagittal direction （
$\bar x \pm s $ ）治疗时期 SNA（°） SNB（°） ANB（°） Damon矫治前 79.82 ± 6.29 77.05 ± 6.46 2.78 ± 1.56 Damon矫治后 77.69 ± 4.01 74.41 ± 4.48 3.26 ± 2.18 t 1.868 2.350 −0.977 P 0.095 0.430 0.354 TP矫治前 78.44 ± 3.75 75.76 ± 3.94 3.00 ± 2.02 TP矫治后 78.71 ± 3.91 76.17 ± 3.89 2.95 ± 2.20 t −0.468 −0.749 0.179 P 0.651 0.473 0.862 Damon自锁矫治前 79.09 ± 2.70 77.19 ± 3.53 2.66 ± 1.31 Damon自锁矫治后 78.97 ± 2.93 76.38 ± 3.43 2.73 ± 1.25 t 0.223 1.627 −0.305 P 0.826 0.120 0.763
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表 3 矫治前后垂直向位置的变化（
$\bar x \pm s $ ）Table 3. The changes of the maxilla and mandible in vertical direction（
$\bar x \pm s $ ）治疗时期 MP-SN（°） MP-FH（°） S-Go/N-Me（%） ANS-Me/N-Me（%） Damon矫治前 39.76 ± 10.75 31.59 ± 9.34 62.97 ± 7.72 54.14 ± 2.40 Damon矫治后 39.96 ± 8.97 31.65 ± 9.04 63.34 ± 5.50 54.21 ± 2.11 t −0.199 −0.066 −0.311 −0.106 P 0.847 0.949 0.763 0.918 TP矫治前 41.64 ± 4.50 33.47 ± 5.10 60.70 ± 4.24 53.99 ± 2.94 TP矫治后 41.25 ± 6.30 33.77 ± 5.80 61.04 ± 5.38 53.60 ± 2.35 t 0.399 −0.307 −0.390 0.690 P 0.699 0.766 0.706 0.508 Damon自锁矫治前 37.27 ± 5.30 29.28 ± 6.29 60.38 ± 14.62 53.54 ± 2.72 Damon自锁矫治后 36.90 ± 4.09 30.05 ± 5.54 64.18 ± 3.30 53.69 ± 1.70 t 0.514 −1.064 −1.156 −0.347 P 0.613 0.301 0.262 0.733
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表 4 矫治前后上下前牙突度的变化 （
$\bar x \pm s $ ）Table 4. The changes of the upper and lower incisors （
$\bar x \pm s $ ）治疗时期 U1-L1（°） U1-SN（°） U1-NA（mm） L1-NB（mm） L1-MP（°） Damon矫治前 117.45 ± 13.02 111.34 ± 11.26 31.53 ± 9.81 28.26 ± 5.74 91.47 ± 7.02 Damon矫治后 126.31 ± 9.11 99.88 ± 9.80 22.16 ± 9.10 28.26 ± 5.11 93.81 ± 8.84 t −1.797 2.689 2.044 −0.309 −0.971 P 0.106 0.025* 0.071 0.761 0.357 TP矫治前 115.99 ± 6.34 110.67 ± 5.20 32.22 ± 6.95 29.13 ± 6.65 91.75 ± 5.66 TP矫治后 130.57 ± 7.71 100.32 ± 7.55 21.63 ± 8.13 25.26 ± 6.45 87.87 ± 9.42 t −5.027 4.763 4.356 1.600 1.365 P 0.001* 0.001* 0.002* 0.144 0.205 Damon自锁矫治前 118.40 ± 7.92 111.86 ± 6.33 32.78 ± 5.87 26.93 ± 5.34 92.48 ± 5.37 Damon自锁矫治后 129.30 ± 10.98 99.56 ± 4.74 20.56 ± 4.33 27.50 ± 8.22 94.22 ± 8.58 t 5.143 9.246 9.706 −0.309 −0.928 P 0.000* 0.000* 0.000* 0.761 0.365 *P < 0.05。
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表 5 矫治前后软组织的变化（
$\bar x \pm s $ ）Table 5. The changes of the soft tissue （
$\bar x \pm s $ ）治疗时期 UL-EP（mm） LL-EP（mm） Z 角（°） 面角（°） 软组织侧貌（°） Damon矫治前 1.57 ± 2.50 2.75 ± 2.81 64.52 ± 7.76 86.33 ± 5.92 160.04 ± 4.87 Damon矫治后 0.65 ± 3.55 1.85 ± 4.25 64.17 ± 10.79 84.58 ± 5.22 159.64 ± 4.01 t 0.953 0.773 0.144 1.625 0.261 P 0.366 0.459 0.888 0.139 0.800 TP矫治前 2.85 ± 1.45 4.13 ± 2.45 59.60 ± 5.83 87.53 ± 3.87 163.07 ± 3.30 TP矫治后 0.14 ± 2.74 0.97 ± 2.36 68.18 ± 6.72 88.32 ± 4.30 163.42 ± 5.16 t 6.676 5.006 −4.061 −0.912 −0.233 P 0.000* 0.001* 0.003* 0.386 0.821 Damon自锁矫治前 1.60 ± 2.05 2.32 ± 2.29 65.00 ± 12.74 89.30 ± 6.01 163.31 ± 5.94 Damon自锁矫治后 −0.26 ± 2.85 0.67 ± 2.15 68.11 ± 9.53 88.00 ± 5.10 164.62 ± 5.50 t 4.660 3.976 −1.623 1.506 −1.394 P 0.000* 0.001* 0.121 0.148 0.180 *P < 0.05。
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表 6 治疗后各组患者颅颌面结构测量结果 （
$\bar x \pm s $ ）Table 6. Post-treatment cephalometric analysis （
$\bar x \pm s $ ）测量项目 TP组 Damon双翼托槽组 Damon自锁托槽组 F P 矢状向 SNA（°) 78.71 ± 3.91 77.69 ± 4.01 78.97 ± 2.93 0.463 0.633 SNB（°) 76.17 ± 3.89 74.41 ± 4.48 76.38 ± 3.43 0.935 0.402 ANB（°) 2.95 ± 2.20 3.26 ± 2.18 2.73 ± 1.25 0.301 0.742 垂直向 MP-SNV 41.25 ± 6.30 39.96 ± 8.97 36.90 ± 4.09 1.929 0.160 MP-FHV 33.77 ± 5.80 31.65 ± 9.04 30.05 ± 5.54 1.063 0.356 S-Go/N-Me /% 61.04 ± 5.38 63.34 ± 5.50 64.18 ± 3.30 1.657 0.205 ANS-Me/N-Me /% 53.60 ± 2.35 54.21 ± 2.11 53.69 ± 1.70 0.296 0.745 前牙突度 U1-L1（°) 130.57 ± 7.71 126.31 ± 9.11 129.30 ± 10.98 0.508 0.606 U1-SN（°) 100.32 ± 7.55 99.88 ± 9.80 99.56 ± 4.74 0.039 0.962 U1-NA(mm) 21.63 ± 8.13 22.16 ± 9.10 20.56 ± 4.33 0.602 0.740 L1-NB(mm) 25.26 ± 6.45 28.26 ± 5.11 27.50 ± 8.22 0.493 0.615 L1-MP（°) 87.87 ± 9.42 93.81 ± 8.84 94.22 ± 8.58 1.833 0.174 软组织 UL-EP/mm 0.14 ± 2.74 0.65 ± 3.55 −0.26 ± 2.85 0.358 0.701 LL-EP/mm 0.97 ± 2.36 1.85 ± 4.25 0.67 ± 2.15 0.288 0.866 Z 角（°) 68.18 ± 6.72 64.17 ± 10.79 68.11 ± 9.53 0.811 0.667 面角（°) 88.32 ± 4.30 84.58 ± 5.22 88.00 ± 5.10 1.933 0.159 软组织侧貌（°) 163.42 ± 5.16 159.64 ± 4.01 164.62 ± 5.50 3.219 0.051
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