不同牵引位点及方向在隐形矫治器联合前方牵引时对上颌骨及上牙列的影响
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1.青岛大学口腔医学院;2.青岛大学附属医院口腔正畸科,青岛大学口腔医学院;3.青岛大学附属医院

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Impact of Traction Site and Direction on Maxillary and Upper Dentition in Clear Aligners Combined with Maxillary Protraction
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1.School of Stomatology, Qingdao University;2.Department of Orthodontics,Qingdao University Affiliated Hospital,School of Stomatology, Qingdao University;3.Qingdao University Affiliated Hospital

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    摘要:

    目的 通过三维有限元法研究,分析隐形矫治器联合前方牵引矫治上颌发育不足时不同牵引位点及方向对上颌骨及上牙列的影响,以指导临床医师在应用隐形矫治器联合前方牵引矫治骨性III类错??时,如何科学选择牵引位点及方向。方法 构建颧上颌复合体、上颌牙列及隐形矫治器的有限元模型,矫治器分为G1组(牵引扣位于侧切牙远中)及G2组(牵引扣位于尖牙远中),每组分别设置前牵引方向为与??平面呈向前下0°、10°、20°、30°的四组工况,并加载单侧500g的牵引力;分析加载工况后各组颌骨及牙列的应力及位移差异。 结果 1.当牵引方向为30°时,两组上颌骨均表现为向前向下的位移趋势,其余方向则有逆时针旋转趋势;相同牵引方向下,G2组上颌骨总位移及各方向位移均大于G1组(总位移:G1-30°:0.0073mm;G2-30°:0.0093mm)。2.G1组上中切牙表现舌向位移趋势,并随牵引角度的增加而增大;G2组上牙列则为向前的位移趋势,当牵引方向为30°时上牙列的总位移及矢状向位移最小(G2-30°组总位移为0.026mm,矢状向位移为-0.0245mm)。3.两组上颌骨应力主要集中于颧上颌缝和上前牙牙槽骨区域,并随牵引角度的增加而减小。结论 隐形矫治器联合前方牵引可应用于轻度上颌骨发育不足的骨性III类患者;当牵引位点位于尖牙远中、牵引方向为与??平面呈向前下30°时,上颌骨产生向前向下的位移趋势,且上前牙的唇向位移最小。

    Abstract:

    Objective Through a three-dimensional finite element method study, this research analyzes the effects of different traction sites and directions on the maxilla and upper dentition when using clear aligners combined with protraction, aiming to guide clinicians in scientifically selecting traction sites and directions when applying clear aligners combined with protraction for the treatment of skeletal Class III malocclusion. Methods Finite element models of the zygomaticomaxillary complex, maxillary dentition, and clear aligners were constructed. The models were divided into Group G1 (traction hook at the distal of lateral incisor) and Group G2 (traction hook at the distal of canine). Each group was analyzed under four loading conditions with protraction angles of 0°, 10°, 20°, and 30° relative to the occlusal plane. A unilateral protraction force of 500g was applied. The stress distribution and displacement of maxillary bone and dentition were analyzed. Results 1. When the protraction angle was 30°, both groups showed forward and downward displacement of the maxilla, while other angles resulted in counterclockwise rotation. Under the same protraction direction, Group G2 showed greater displacement than Group G1(total displacement: G1-30° : 0.0073mm; G2-30:0.0093mm). 2. The upper central incisors in Group G1 showed lingual displacement tendency, which increased with the protraction angle. The maxillary dentition in Group G2 showed forward displacement, with minimum total and sagittal displacement at 30° (G2-30° total displacement: 0.026mm, sagittal displacement: -0.0245mm). 3. Stress concentration was mainly observed in the zygomaticomaxillary suture and anterior alveolar bone regions in both groups, decreasing as the protraction angle increased. Conclusions Clear aligners combined with protraction can be applied to skeletal Class III patients with mild maxillary deficiency. When the protraction point is located at the distal of canine with a 30° downward and forward angle to the occlusal plane, the maxilla shows forward and downward displacement with minimal labial movement of upper anterior teeth.

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  • 收稿日期:2024-12-17
  • 最后修改日期:2025-03-08
  • 录用日期:2025-03-10
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