国际口腔医学杂志

国际口腔医学杂志 ›› 2022, Vol. 49 ›› Issue (4): 373-379.doi: 10.7518/gjkq.2022082

• 专家笔谈 •    下一篇

基于治疗方案和牙移动方式的无托槽隐形矫治难度评估

赵志河()   

  1. 口腔疾病研究国家重点实验室 国家口腔疾病临床医学研究中心四川大学华西口腔医院正畸科 成都 610041
  • 收稿日期:2022-04-10 修回日期:2022-05-03 出版日期:2022-07-01 发布日期:2022-06-28
  • 通讯作者: 赵志河
  • 作者简介:<named-content content-type="corresp-name">赵志河</named-content>，博士，四川大学二级教授，博士生导师，四川大学华西口腔医学院教授委员会主任，口腔正畸国家临床重点专科学术带头人，享受国务院政府特殊津贴专家，国家卫生计生委有突出贡献中青年专家，全国宝钢优秀教师奖获得者，中华口腔医学会口腔医学科技创新人物，中国科学技术协会全国口腔正畸学首席科学传播专家，四川省学术和技术带头人，四川省卫生健康首席专家，世界正畸联盟（World Federation of Orthodontists，WFO） 会员， 国际牙医师学院（InternationalCollege of Dentists，ICD） 院士（Fellow）。现任中国医师协会口腔医师分会副会长，中华口腔医学会常务理事、口腔正畸专业委员会委员，四川省医学会口腔专业委员会主任委员，四川省口腔医学会常务委员、计算机及数字化口腔医学专业委员会主任委员。《中华口腔正畸学杂志》副总编，《国际口腔医学杂志》副主编，《中华口腔医学杂志》《华西口腔医学杂志》等核心期刊编委，SCI收录期刊Internitional Journal of Oral Sciences 编委，《中国口腔医学信息》主编。全国百篇优秀博士论文导师，“国家级精品课程”、“国家级精品资源共享课”、“国家级一流本科线上课程”《口腔正畸学》负责人，中国医学教育慕课联盟口腔规划课程《口腔正畸学》第一主讲人，教育部国家卫生计生委全国高等学校五年制本科口腔医学专业“十三五”国家级规划教材《口腔正畸学》主编，全国高等学校研究生规划教材、卫生部“十二五”规划教材《口腔正畸学》副主编，主编专业著作9 部，参编9部、主译1 部。主持了包括重点项目在内的8 项国家自然科学基金研究项目，主持了6 项省部级科研项目。发表专业论文230 余篇，其中被SCI 收录110 余篇。主持研究的“口腔正畸牙移动生物力学机制基础及临床应用的系统化研究”获教育部进步奖一等奖，主持研究的“加快牙移动提高正畸效率的基础探索和临床应用”获四川省科技进步一等奖，另外获省部级科技进步二等奖2 项。从事正畸临床工作30 余年，擅长儿童及成人疑难病例的正畸治疗。现为四川大学华西口腔医院口腔正畸“首席专家”，曾获得四川大学华西口腔医院“十佳岗位能手”荣誉称号，入选“妙手仁心·首届成都好医生口碑榜”前100 强好医生，荣获全国第4届“国之名医、优秀风范”荣誉称号。

Difficulty assessment of invisible orthodontic treatment based on treatment plan and tooth movement pattern

Zhao Zhihe.()   

  1. State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2022-04-10 Revised:2022-05-03 Online:2022-07-01 Published:2022-06-28
  • Contact: Zhihe. Zhao

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摘要：

建立基于治疗方案和牙移动方式的错𬌗畸形无托槽隐形矫治难度评估原则，对提高我国隐形矫治水平和促进医疗资源合理分配有现实意义和社会价值。错𬌗畸形是三大口腔疾病之一，我国的正畸医疗资源需求巨大。过去以传统的固定矫治技术为主，但是随着我国经济社会的发展和无托槽隐形矫治技术的进步，隐形矫治的需求逐年增大。如何在术前合理评估错𬌗畸形无托槽隐形矫治方案的实施难度，辅助方案设计决策，促进正畸分级医疗，已成为口腔正畸亟待解决的临床问题。笔者将隐形矫治难度评估的研究进展及笔者的临床经验进行归纳总结，基于无托槽隐形矫治器的材料力学特点，遵循临床医师主导方案设计的原则，探讨拔牙病例和非拔牙病例在矢状向、垂直向、水平向三维方向的难度评估要点以及其他影响矫治难度的因素。希望本文能够引导我国无托槽隐形矫治的临床诊疗，促进建立科学规范的分级诊疗，吸引更多医师和研究者参与到隐形矫治的创新工作中，促进我国隐形矫治学术与技术水平的进步。

关键词: 隐形矫治, 错𬌗畸形, 治疗, 难度评估

Abstract:

The establishment of principles for assessing the difficulty in bracketless invisible orthodontic treatment for malocclusion based on the treatment plan and tooth movement patterns has practical significance and social value for improving the level of invisible orthodontic treatment in China and for promoting the rational distribution of medical resources. Malocclusion is one of three major oral diseases. China has a large demand for orthodontic medical resources, which used to be dominated by traditional fixed orthodontic technology. However, with the economic and social development of China and the advancement of invisible orthodontic technology, the demand for invisible orthodontic treatment is increasing. A reasonable assessment of the difficulty of implementing invisible orthodontic treatment plans to assist in clinical treatment plan decisions and to implement orthodontic tiered medical services has become a clinical problem that must be urgently solved. The author summarizes the research progress and individual clinical experience about the difficulty in assessment of invisible treatment. On the basis of the material mechanics of clear aligners and the principle of clinician-led treatment planning, the present paper discusses the key factors of assessment difficulty from the sagittal, vertical, and horizontal directions in extracted cases and non-extracted cases, as well as other factors that affect the difficulty of invisible orthodontic treatment. The author hopes that this paper can guide the clinical diagnosis and treatment of invisible orthodontics in China, promote the establishment of scientific and standardized tiered treatment, attract more clinicians and researchers to participate in the innovation of invisible orthodontic technology, and promote both academic and clinical levels of invisible orthodontics in China.

Key words: invisible orthodontics, malocclusion, therapy, difficulty assessment

中图分类号: 

  • R 783.5
1 傅民魁, 张丁, 王邦康, 等. 中国25 392名儿童与青少年错𬌗畸形患病率的调查[J]. 中华口腔医学杂志, 2002, 37(5): 371-373.
Fu MK, Zhang D, Wang BK, et al. The prevalence of malocclusion in China: an investigation of 25 392 children[J]. Chin J Stomatol, 2002, 37(5): 371-373.
2 Kesling HD. The philosophy of the tooth positio-ning appliance[J]. Am J Orthod Oral Surg, 1945, 31(6): 297-304.
3 Graf I, Puppe C, Schwarze J, et al. Evaluation of effectiveness and stability of aligner treatments using the peer assessment rating index[J]. J Orofac Orthop, 2021, 82(1): 23-31.
4 Ke Y, Zhu Y, Zhu M. A comparison of treatment effectiveness between clear aligner and fixed applian-ce therapies[J]. BMC Oral Health, 2019, 19(1): 24.
5 Gu JF, Tang JS, Skulski B, et al. Evaluation of Invi-salign treatment effectiveness and efficiency compared with conventional fixed appliances using the peer assessment rating index[J]. Am J Orthod Dentofacial Orthop, 2017, 151(2): 259-266.
6 Borda AF, Garfinkle JS, Covell DA, et al. Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in a teenage population with mild malocclusions[J]. Angle Orthod, 2020, 90(4): 485-490.
7 Linjawi AI, Abushal AM. Adaptational changes in clear aligner fit with time[J]. Angle Orthod, 2022, 92(2): 220-225.
8 Rossini G, Parrini S, Castroflorio T, et al. Efficacy of clear aligners in controlling orthodontic tooth mo-vement: a systematic review[J]. Angle Orthod, 2015, 85(5): 881-889.
9 Richmond S, Shaw WC, Roberts CT, et al. The PAR index (peer assessment rating): methods to determine outcome of orthodontic treatment in terms of improvement and standards[J]. Eur J Orthod, 1992, 14(3): 180-187.
10 Daniels C, Richmond S. The development of the index of complexity, outcome and need (ICON)[J]. J Orthod, 2000, 27(2): 149-162.
11 Long H, Wu ZQ, Yan XY, et al. An objective system for appraising clear aligner treatment difficulty: clear aligner treatment complexity assessment tool (CAT-CAT)[J]. BMC Oral Health, 2020, 20(1): 312.
12 Eslami S, Faber J, Fateh A, et al. Treatment decision in adult patients with class Ⅲ malocclusion: surgery versus orthodontics[J]. Prog Orthod, 2018, 19(1): 28.
13 Chambers DW, Thakkar D. Consistency of orthodontists’ clinical decisions: a systematic review, meta-analysis, and theory development[J]. Am J Orthod Dentofacial Orthop, 2022, 161(4): 497-509.e4.
14 Ravera S, Castroflorio T, Garino F, et al. Maxillary molar distalization with aligners in adult patients: a multicenter retrospective study[J]. Prog Orthod, 2016, 17: 12.
15 Krieger E, Seiferth J, Marinello I, et al. Invisalign® treatment in the anterior region: were the predicted tooth movements achieved[J]. J Orofac Orthop, 2012, 73(5): 365-376.
16 Galan-Lopez L, Barcia-Gonzalez J, Plasencia E. A systematic review of the accuracy and efficiency of dental movements with Invisalign® [J]. Korean J Orthod, 2019, 49(3): 140-149.
17 Pavoni C, Lione R, Laganà G, et al. Self-ligating versus invisalign: analysis of dento-alveolar effects[J]. Ann Stomatol (Roma), 2011, 2(1/2): 23-27.
18 Zhou N, Guo J. Efficiency of upper arch expansion with the Invisalign system[J]. Angle Orthod, 2020, 90(1): 23-30.
19 Chisari JR, McGorray SP, Nair M, et al. Variables affecting orthodontic tooth movement with clear aligners[J]. Am J Orthod Dentofacial Orthop, 2014, 145(4 ): S82-S91.
20 Kravitz ND, Kusnoto B, Agran B, et al. Influence of attachments and interproximal reduction on the accuracy of canine rotation with Invisalign. A prospective clinical study[J]. Angle Orthod, 2008, 78(4): 682-687.
21 Simon M, Keilig L, Schwarze J, et al. Treatment outcome and efficacy of an aligner technique: regarding incisor torque, premolar derotation and molar distalization[J]. BMC Oral Health, 2014, 14: 68.
22 Cortona A, Rossini G, Parrini S, et al. Clear aligner orthodontic therapy of rotated mandibular round-shaped teeth: a finite element study[J]. Angle Orthod, 2020, 90(2): 247-254.
23 Grünheid T, Loh C, Larson BE. How accurate is Invisalign in nonextraction cases? Are predicted tooth positions achieved[J]. Angle Orthod, 2017, 87(6): 809-815.
24 Al-Nadawi M, Kravitz ND, Hansa I, et al. Effect of clear aligner wear protocol on the efficacy of tooth movement[J]. Angle Orthod, 2021, 91(2): 157-163.
25 王丽颖, 金作林. 锥形束CT及其在口腔正畸学中的应用[J]. 国际口腔医学杂志, 2013, 40(2): 181-184.
Wang LY, Jin ZL. The application of cone beam computer tomography in orthodontics[J]. Int J Stomatol, 2013, 40(2): 181-184.
26 Liu W, Shao JH, Li SF, et al. Volumetric cone-beam computed tomography evaluation and risk factor analysis of external apical root resorption with clear aligner therapy[J]. Angle Orthod, 2021, 91(5): 597-603.
27 宋欣羽, 钱玉芬. 正畸治疗对颞下颌关节影响的锥形束CT研究进展[J]. 中国实用口腔科杂志, 2021, 14(4): 482-487.
Song XY, Qian YF. Research progress of CBCT in the effect of orthodontic treatment on temporomandibular joint[J]. Chin J Pract Stomatol, 2021, 14(4): 482-487.
28 Jiang T, Wang JK, Jiang YY, et al. How well do integrated 3D models predict alveolar defects after treatment with clear aligners[J]. Angle Orthod, 2021, 91(3): 313-319.
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