Ntu 2: Cov Kev Sib Tw Dab Tsi yog Qhov Ua Tau Zoo thiab qhov twg tsis yog / Dab tsi yog qhov yooj yim, nruab nrab lossis nyuaj kho

By Dr. Geoffrey Hall

Xyoo 1946 Kesling thawj zaug tau qhia txog lub tswv yim ntawm cov cuab yeej siv kho hniav kom tshem tau cov hniav tsis zoo. Thawj qhov xwm txheej yog me me los yog qhov sib txawv. Nrog rau kev txhim kho ntawm cov khoom siv thiab lub computer tsim ntawm cov hniav txav, qhov taw qhia ntawm cov aligners meej tau nthuav dav heev. 

Ntau tus kws tshawb fawb tau tshaj tawm cov xwm txheej ua tau zoo los ua pov thawj tias cov kev sib raug zoo niaj hnub no tau tuaj yeem kho yuav luag txhua yam ntawm me me mus rau qhov hnyav malocclusions. Cov kws kho mob uas muab cov kev kho mob kom meej meej yuav tsum nkag siab txog cov yam ntxwv ntawm biomechanical, paub thaum twg yuav kho thiab muaj peev xwm kwv yees tau txais kev kho mob thiab npaj tshwj xeeb los ntawm kev kho mob orthodontic.

Clear aligners yog yooj yim nyob rau hauv me me mus rau nruab nrab neeg coob coob los yog diastema, posterior expansion, intrusion ntawm ib los yog ob tug hniav, txo incisor extraction mob, thiab distal tipping ntawm molars. Cov kev txav xws li extrusion, kho cov kev sib hloov loj heev, molar uprighting thiab kaw ntawm qhov chaw rho tawm yog paub tias yuav nyuaj rau ua kom tiav nrog cov aligners. Txawm li cas los xij, incisor extrusion, molar hloov pauv, thiab kaw qhov chaw rho tawm tuaj yeem ua tau nrog kev siv cov ntawv txuas hauv qhov tseeb aligner system.

Indications thiab contraindications ntawm Clear Aligners rau General kws kho hniav

Qhov cuam tshuam ntawm ntau yam hniav txav raws li kev txheeb xyuas cov ntaub ntawv

1. Djeu et al. (NWS 2005) tau ua thawj qhov kev tshawb fawb rov qab los ntawm qhov kev ua tau zoo ntawm cov aligners meej thiab tau tshaj tawm tias lawv muaj txiaj ntsig zoo rau hauv qhov chaw kaw, qhov sib npaug ntawm cov npoo npoo npoo thiab, cov hauv paus sib dhos; Txawm li cas los xij, cov aligners yog qhov tsis txaus hauv kev kho ntawm anteroposterior discrepancies, muab kev sib cuag occlusal, thiab posterior torque. 

2. Kravitz et al. (NWS 2009)soj ntsuam qhov tseeb ntawm cov hniav txav tau los ntawm cov kab ke aligner thiab tshaj tawm tias tsuas yog 41% ntawm kev kwv yees cov hniav txav tau tiav. Qhov kev txav tau zoo tshaj plaws yog lingual constriction (47.1%), qhov tsawg tshaj plaws yog extrusion (29.6%), thiab tsuas yog 33% ntawm kev kwv yees kev hloov kho tau tiav.

3. Kassas et al. (2013)tau tshaj tawm hais tias qhov tseeb aligner system muaj txiaj ntsig zoo hauv kev sib tw thiab ua kom cov arches nyob rau hauv cov mob me thiab nruab nrab thiab hauv kev kho cov kab mob buccolingual zoo, txawm li cas los xij, nws tsis txaus rau kev muab kev sib cuag occlusal zoo tagnrho. Lub deterioration nyob rau hauv occlusal hu yog tshwm sim los ntawm lub thickness ntawm aligners, uas cuam tshuam nrog kev daws teeb meem ntawm lub dav hlau occlusal.

4. Buschang et al. (UA 2014) & Rossini thiab cov npoj yaig (AO 2015)pom tau hais tias aligners tau zoo nyob rau hauv:

• tswj anterior intrusion 
• posterior buccolingual inclination, 
• nyob rau hauv tsim txog 1.5 hli lub cev txav ntawm maxillary molars.

Tsis siv rau hauv:

• tswj anterior extrusion, 
• anterior buccolingual inclination, 
• rotations ntawm rounded hniav.

5. Kho hniav arch qhov ntev

Pavoni et al (2011) pom tias braces ua tau ntau dua transverse dento-alveolar dav ntawm maxillary intercanine thiab interpremolar thiab ntau perimeter ntawm maxillary koov dav.

tshaj li qhov tseeb aligners tau ua, thiab nce intermolar dav thiab maxillary arch tob nrog aligners.

Grunheid et al (AO 2016) pom tias cov aligners ntshiab tended nce mandibular intercanine

dav thaum lub sij hawm sib dhos nyob rau hauv sib piv rau braces thiab cuam tshuam rau nce intemolar dav thiab maxillary arch tob nrog aligners.

6. Qhib tom / Deep Bite

• Qhib tom yog ib qho nyuaj malocclusion los kho, nrog rau qhov tshwm sim siab ntawm kev rov qab los.
• Extrusion yog qhov tsawg kawg yog cov hniav txav los ua nrog Clear aligners thiab nws tuaj yeem ua rau muaj qhov sib txawv loj dua piv rau lwm qhov txav.
• Qhov tsis muaj qhov ua tau zoo no tuaj yeem yog vim qhov nyuaj ntawm cov khoom siv hauv kev tsim kom muaj zog txaus los extrude cov hniav hauv txoj hauv kev tseem ceeb. Raws li ob peb cov ntaub ntawv, CAT tsis pom zoo los kho qhov qhib tom.

Khosravi et al (AJO 2017), qhia tau hais tias cov aligners meej kho me me mus rau nruab nrab qhib tom feem ntau los ntawm incisor extrusion, tsis yog posterior intrusion, thiab relieves sib sib zog nqus tom feem ntau los ntawm proclination ntawm lub mandibular incisors.

7. Labiolingual zog

Grunheid et al (AO 2016), pom tau hais tias kev kho mob nrog braces ho txo ​​qis proclination ntawm mandibular canines nyob rau hauv sib piv rau kev kho mob nrog ntshiab aligners uas tended nce lub intercanine dav es tsis txhob txo inclination. Cov tsiaj qis yog cov hniav uas nyuaj tshaj plaws los tswj.

Hennessy et al (AO 2016), pom tias braces tsim ntau mandibular incisor proclination

thaum alignment dua aligners.

Yildirim et al. (2013) tshawb xyuas qhov ua tau zoo ntawm cov hniav txav thiab txiav txim siab tias kev rov qab tau pom tias yog qhov tseeb tshaj plaws tau txais cov hniav txav tom qab los ntawm kev sib hloov, kiv cua-hom expansion, thiab protrusion feem. 

Retrusion ntawm mandibular central incisors yog suav tias yog qhov tseeb tshaj plaws ntawm ib tus hniav txav, qhov kev sib hloov ntawm mandibular canine yog qhov tsawg tshaj plaws yog qhov txav.

Kravitz et al (AJO 2009) qhia tau hais tias lingual crown tip (53%) yog qhov tseeb ntau dua li labial crown tip (38%), tshwj xeeb tshaj yog rau maxillary incisors.

8. Mesiodistal txav

Clear aligners tuaj yeem tsim ob qho kev tswj tsis tau thiab tswj tau tipping txav. Kev tswj tsis tau tipping nyob rau hauv kaw qhov chaw extraction thiab qhov tsawg tshaj plaws tshwm sim nyob rau hauv tipping canines qhia hais tias cov hniav uas muaj cov hauv paus hniav loj yuav muaj teeb meem ntau dua kom ua tiav mesiodistal txav.

Baldwin et al (AJO 1996) pom qhov kev hloov pauv hauv radiographic thiab kho hniav cast interdental

lub kaum sab xis ntawm 17º tom qab Clear aligner kho.

Kravitz et al (AJO 2009), ua kev tshawb fawb ntawm cov hniav anterior thiab pom qhov tseeb qhov tseeb ntawm 41% rau mesiodistal tipping, uas qhov tseeb tshaj plaws tau ua tiav los ntawm maxillary (43%) thiab mandibular (49%) lateral incisors. Cov maxillary (35%) thiab mandibular (27%) canines thiab maxillary central incisors (39%) muaj qhov raug qis tshaj.

9. Kev sib hloov

Nguyen thiab Chen (2006), xaus lus tias incisors ua tiav 60% ntawm qhov kwv yees kev sib hloov, thaum canines thiab premolars muaj qhov raug qis tshaj (39%). Yog li, cov hniav nrog cov kab sib npaug zoo li nyuaj rau tig nrog cov aligners meej.

Kravitz et al (AO 2008) ntsuam xyuas qhov tseeb qhov tseeb rau canine rotation ntawm 36%. Canines uas tau txais kev txo qis (IPR) tau tshaj tawm qhov siab tshaj qhov ntsuas qhov tseeb (43%).

Kravitz et al (AJO 2009) pom qhov tseeb ntawm kev sib hloov rau maxillary canines yog 32%, qis dua li ntawm maxillary central incisors (55%) thiab mandibular lateral incisors (52%). Qhov tsawg tshaj plaws raug kuaj pom rau mandibular canine (29%). Rau kev sib hloov ntau dua

15º qhov tseeb ntawm maxillary canine txav tau txo qis. 

10. Vertical txav

Kravitz et al (AJO 2009), qhia tias,

Intrusion- Qhov tseeb tshaj plaws ntawm kev nkag tau ua tiav los ntawm maxillary (45%) thiab mandibular (47%) hauv nruab nrab incisors. Qhov qis tshaj qhov tseeb ntawm kev nkag mus tau tiav los ntawm maxillary lateral incisors (33%). Qhov nruab nrab tus nqi ntawm qhov tseeb intrusion sim yog 0.72 hli.

Extrusion- Nws yog qhov tsawg kawg ntawm cov hniav txav tau tiav nrog cov aligners meej (30% ntawm kev kwv yees). Cov maxillary (18%) thiab mandibular (25%) hauv nruab nrab incisors muaj qhov raug qis tshaj. Qhov nruab nrab ntawm extrusion sim yog 0.56 hli. 

Charalampakis et al (AJO 2018), qhia txog qhov tseeb tshaj plaws txav uas tuaj yeem ua tiav nrog yog incisor intrusion thiab canine rotation.

11. Qhov chaw kaw / rho tawm

Weihong et al. (2015) soj ntsuam cov kev ua tau zoo ntawm qhov tseeb aligner system ntawm me me mus rau nruab nrab cov neeg mob kho nrog premolar extractions thiab muab piv rau cov kev kho mob tau txais nrog taag khoom. Lawv cov txiaj ntsig tau tshaj tawm tias ob lub tshuab tuaj yeem siv tau rau hauv kev kho mob ntawm cov ntaub ntawv rho tawm, thiab cov hauv paus angulation tau txais nrog cov aligners meej yog tsim nyog thaum siv cov ntawv txuas kom raug.

Ib daim ntawv ntsuam xyuas los ntawm Best et al (AO2017) thiab D'Appuzo el al (2019) tau xaus lus tias muaj qhov sib txawv tseem ceeb ntawm cov kws kho hniav thiab kws kho hniav nyob rau hauv cov ntaub ntawv xaav, ob pawg kho feem ntau yog Class I spacing thiab coob coob, nrog ntau orthodontists kho Class Kuv qhib-tom case.

Cov kws kho hniav dav dav txaus siab los kho cov teeb meem nyuaj nrog kev kho kom zoo nkauj nkaus xwb, thaum cov kws kho hniav muaj peev xwm tshaj qhia cov neeg mob txog qhov nyuaj ntawm lawv cov teeb meem thiab ntawm qhov yuav tsum tau siv cov koom haum nrog cov aligners meej.

Zuag qhia tag nrho, qhov feem pua ​​​​siab dua ntawm ob tus kws kho hniav thiab kws kho hniav dav dav tau tshaj tawm tias lawv muaj kev ntseeg siab dua kho cov chav kawm kuv kev kho hniav kev sib raug zoo thiab malocclusions nrog me me-rau-mob neeg coob coob.

xaus

Clear aligner tuaj yeem pom zoo rau kev kho cov malocclusions yooj yim nrog lub teeb overbite tsis sib xws. Kev ua tau zoo ntawm kev txav chaw orthodontic tau qhia tias cov aligners tau ua tiav hauv kev tswj cov kab mob ntsug. Nws yuav tsum nco ntsoov tias kev kho cov ntaub ntawv rho tawm yuav tsum muaj kev paub dhau los thiab kev paub dav dav ntawm qhov system. Lawv ua tau zoo nyob rau hauv aligning thiab leveling lub arches nyob rau hauv cov kev kawm tsis loj hlob.

Kev kho mob nrog aligners tsis yog nyob ntawm aligners ib leeg. Nws yuav tsum tau siv cov auxiliaries (txuas ntxiv, interarch elastics, IPR, altered aligner geometries) los txhim kho qhov kev kwv yees ntawm orthodontic txav.

Yog li ntawd, ntxiv rau kev paub txog cov kev txwv kom meej meej thiab cov txheej txheem xaiv cov ntaub ntawv, kev npaj kho mob muaj tswv yim thiab kev tau txais kev paub dhau los thiab kev txawj ntse yog qhov tseem ceeb tom qab qhov kev kawm thawj zaug. Kev tsim nyog ntawm kev txav mus los thiab kev siv cov txheej txheem pabcuam tuaj yeem ua rau muaj txiaj ntsig zoo thiab muaj txiaj ntsig zoo.

References

• Ke et al. Kev sib piv ntawm kev kho mob tau zoo ntawm qhov tseeb aligner thiab kho cov cuab yeej kho mob BMC Oral Health (2019) 19:24
• d'Apuzzo et al. Clear aligner kho mob: sib txawv kev pom ntawm orthodontists thiab cov kws kho hniav dav dav. Kev kawm hauv Orthodontics (2019) 20:10
• Park et al, Aligner Corner, JCO 2021 
• Rossini et al, Kev ua tau zoo ntawm cov aligners meej hauv kev tswj cov hniav txav ntawm cov hniav: Kev tshuaj xyuas qhov systematic, Angle Orthodontist, Vol 85, No 5, 2015
• Tamer et al. Kev Kho Mob Orthodontic nrog Clear Aligners thiab Kev Tshawb Fawb Txog Kev Muaj Peev Xwm Tom Qab Lawv Kev Lag Luam: Kev Tshawb Xyuas Cov Ntawv Sau, Turk J Orthod 2019; 32(4): 241-6
• T. Wier, Clear aligners in orthodontic treatment, Australian Dental Journal 2017; 62: 1–58 : kuv