上后牙区微种植钉支抗改善露龈笑的回顾性研究

A retrospective study of micro-implant anchorage in the upper posterior region to improve gummy smiles

摘要

目的 分析上后牙区植入微种植钉支抗对露龈笑患者唇齿软硬组织的改善效果，为临床提供参考。方法 本研究已通过单位伦理委员会审查批准，并获得患者知情同意。对使用上颌后牙区高位植入微种植钉治疗前突伴露龈笑的年轻女性患者30例进行回顾性研究，其中种植钉植入于上颌第一、二前磨牙根间的患者18例（A组），种植钉位于上颌第二前磨牙与第一磨牙根间且术中配合使用摇椅弓患者12例（B组），治疗前、后分别拍摄头颅侧位片并测量两组术前、术后上中切牙切端至上唇下点距离（U1-Stms）、上中切牙切端至腭平面垂直距离（U1-PP）、牙槽缘点至腭平面垂直距离（Spr-PP）、上中切牙切端至牙槽缘点距离（U1-Spr）、上颌第一磨牙近中颊尖点至腭平面垂直距离（U6-PP）等相关指标，拍摄微笑照片测量微笑时上前牙区软硬组织暴露量及最大露龈量。结果 两组患者矫治后唇齿关系均明显改善，差异有统计学意义（P<0.05），A组U1-Stms平均减小2.6 mm，U1-PP平均减小2.4 mm，Spr-PP平均减小1.4 mm，U1-Spr平均减小0.9 mm；B组U1-Stms平均减小2.3 mm，U1-PP平均减小1.6 mm，Spr-PP平均减小1.4 mm，U1-Spr平均减小0.2 mm；两组治疗前后U6-PP差异均无统计学意义（P>0.05）。A组∆U1-PP、∆U1-Spr大于B组，差异有统计学意义（P<0.05），两组∆U1-Stms、∆Spr-PP差异无统计学意义（P>0.05）。两组患者术后微笑时上前牙区软硬组织暴露量、最大露龈量均减小，A组治疗后上前牙区软硬组织暴露量平均降低至治疗前的70.19%，最大露龈量平均减少至治疗前的24.12%，B组治疗后上前牙区软硬组织暴露量平均降低至术前的76.12%，最大露龈量平均减少至治疗前的31.88%。两组之间的比值差异无统计学意义（P>0.05）。结论 对于前突伴露龈笑患者，微种植钉植入于上颌前磨牙根间可有效压低内收前牙改善唇齿关系，从而减少微笑露龈量，微种植钉植入于上颌第二前磨牙与第一磨牙根间配合使用摇椅弓亦可取得良好疗效。

Abstract

Objective To analyze the ability of micro-implant nails placed in different locations in the posterior region to improve the hard and soft tissues of the labiodental region in patients with gummy smiles to provide a reference for clinicians. Methods This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Thirty young female patients with anterior tooth protrusions and gummy smiles were included in the retrospective study; 18 patients had micro-implant nails implanted between the premolars (group A), and 12 patients had implant nails placed between the roots of the premolar and the molar and an intraoperatively placed rocking-chair archwire (group B). The preoperative and postoperative distances from the incisal end of the upper mesial incisors to the lower point of the upper lip (U1-Stms), the vertical distance from the incisal end of the upper mesial incisors to the palatal plane (U1-PP), the vertical distance from the point of the alveolar ridge to the palatal plane (Spr-PP), the distance from the incisal end of the upper mesial incisors to the point of the alveolar margin (U1-Spr), and the vertical distance from the point of the proximal middle buccal cusp of the maxillary first molar to the palatal plane of the maxillary first molar (U6-PP) were measured in the cephalometric lateral radiographs of the two groups; additionally, the amount of hard and soft tissues of the upper anterior region exposedduring smiling and the maximum amount of gingiva exposed during smiling were assessed from the smile photograph. Results After correction, the lip-dentition relationship improved significantly in both groups, with an average reduction of 2.6 mm in U1-Stms, 2.4 mm in U1-PP, 1.4 mm in Spr-PP, and 0.9 mm in U1-Spr in Group A. In group B, the U1-Stms was reduced by an average of 2.3 mm, the U1-PPs by an average of 1.6 mm, the Spr-PPs by 1.4 mm, and the U1-Spr by 0.2 mm. The difference between pre- and postoperative U6-PP in both groups was not significant (P>0.05). Group A had greater ∆U1-PP and ∆U1-Spr changes than group B(P<0.05). There was no difference between the two groups in terms of ∆U1-Stms or ∆Spr-PP (P>0.05). The amount of soft and hard tissue exposed and maximum amount of gingiva exposed in the upper anterior region of the smile were reduced in 30 patients postoperatively, with group A having anaverage reduction of 70.19% of the preoperative amount of soft and hard tissue exposed in the upper anterior region and an average reduction of 24.12% of the preoperative maximum amount of gingiva exposed, and group B having an average reduction of 76.12% of the preoperative amount of hard and soft tissue exposed in the upper anterior region and an average reduction of 31.88% of the preoperative maximum gingiva exposed after the operation. The difference in the ratio between the two groups was not statistically significant (P>0.05). Conclusion For patients with proptosis and gummy smiles, placing micro-implant nails between the roots of maxillary premolars can effectively lead to retraction and intrusion of anterior teeth to improve the lip-dentition relationship and improve gummy smile, and placing micro-implant nails between the roots of the maxillary second premolar and the first molar together with the use of rocking chair arches can also achieve a good therapeutic effect.

关键词

露龈笑 / 凸面型 / 微种植钉 / 摇椅弓 / 压低移动 / 直丝弓 / 唇齿关系 / 头影测量

Key words

gummy smile / convex profile / micro-implant nail / rocking-chair archwire / intrusion movement / straight wire / lip and teeth relationship / cephalometric measurements

Author summay

周迎，住院医师，硕士研究生，Email:[e-mail]