国际口腔医学杂志

国际口腔医学杂志 ›› 2024, Vol. 51 ›› Issue (2): 125-136.doi: 10.7518/gjkq.2024032

• 专家笔谈 •    下一篇

浅谈正畸临床矫治新技术——球托止动定位轻力5s系统

贺红1(),吉利2   

  1. 1.口颌系统重建与再生全国重点实验室 口腔生物医学教育部重点实验室 口腔医学湖北省重点实验室 武汉大学口腔医学院 武汉大学口腔医院正畸一科 武汉 430079
    2.中山大学附属第一医院口腔科 广州 510080
  • 收稿日期:2023-10-16 修回日期:2023-12-20 出版日期:2024-03-01 发布日期:2024-03-11
  • 通讯作者: 贺红
  • 作者简介:贺红，教授，博士，Email：drhehong@whu.edu.cn|贺红，博士，教授，主任医师，博士研究生导师，武汉大学口腔医学院正畸教研室主任，武汉大学口腔医院正畸一科主任。中华口腔医学会正畸专业委员会候任主任委员、中国医师协会睡眠医学专业委员会副主任委员，国际牙医师学院（International College of Dentists，ICD）院士、英国皇家爱丁堡牙外科学院正畸院士及考试委员会委员、世界正畸医师联盟理事、香港大学牙医学院名誉教授。主持国家自然科学基金5项及省部级科研项目7项，主编主译著作5部，参编参译著作10余部，以第一作者或通信作者发表相关学术论文130余篇。|吉利，硕士，中山大学副教授、中山大学附属第一医院副主任医师、硕士研究生导师。广东省民营牙科协会副会长、广东省口腔正畸工程技术研究中心主任、中华口腔正畸学会专业会员、中华口腔医学会会员，世界牙科正畸学会、RW（Roth-Williams）国际正畸学会会员。球面托槽发明人、止动定位正畸系统发明人，已申请包括美国和欧洲在内的国际国内专利136项。主持省部级基金项目6项，参编著作4部，以第一作者或通信作者在国内外学术期刊上发表论文20余篇。

Discussion of an innovating orthodontic technique: a spherical bracket, lock-hook and light force treatment system

Hong He1(),Li Ji2   

  1. 1.State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Dept. of Orthodontics 1, School & Hospital of Stomatology, Wuhan University, Wuhan 430079, China
    2.Dept. of Stomatology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2023-10-16 Revised:2023-12-20 Online:2024-03-01 Published:2024-03-11
  • Contact: Hong He

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摘要：

达成精确的转矩表达和稳定的支抗控制是正畸治疗的关键因素，患者在治疗过程中对口腔健康与矫治感受的重视程度日益增长，球面自锁托槽（球托）在一定程度上满足了这两个方面的需求。球面自锁托槽的球面结构可以降低因佩戴矫治器而引起口腔溃疡的概率，并能减少生物膜附着，降低牙龈和牙周疾病的发生概率。与方形托槽相比，球面自锁托槽的脱落率降低了95%。止动定位系统是球面自锁托槽的核心创新点，主要由螺纹系统、螺丝系统和弓丝系统组成。得益于止动定位系统，球面自锁托槽可以去除余隙角，精准表达转矩，使用止锁螺丝时可增强支抗稳定性。止动定位系统搭配了3种特制的细方丝（0.152 4 mm×0.635 0 mm、0.203 2 mm×0.584 2 mm、0.254 0 mm×0.558 8 mm），用轻力排齐的同时可以表达转矩，控制牙根。球托矫治器以黏膜刺激小、脱落率低、转矩表达精准、支抗保有率高、细方丝轻力矫治等特点引起了广泛关注。

关键词: 球面自锁托槽, 球托, 止动定位系统, 去除余隙, 控制支抗, 轻力矫治, 精准转矩表达

Abstract:

Precise torque expression and stable anchorage control are key points in orthodontic treatment. The concern of patients’ quality of life and oral health during orthodontic treatment is increasing. However, most orthodontic instruments cannot achieve the goals mentioned above. A spherical bracket exhibits advantages in these aspects and mitigates these problems to a certain extent. The spherical surface decreases the ulcer rate. Biofilm formation is inhibited, thereby reducing the probability of gum and periodontal disease occurrence. The bonding failure rate of the spherical bracket is lower than that of other self-ligating brackets by 95%. The lock-hook system is the most innovative aspect of the spherical bracket. The system contains thread, screw, and arch wire systems. The lock-hook system benefits torque expression because of its mitigating function. Furthermore, it improves the stability of anchorage when the lock screw is applied. The arch wire system containing three unique wires (0.152 4 mm×0.635 0 mm, 0.203 2 mm×0.584 2 mm, 0.254 0 mm×0.558 8 mm) can be used by orthodontist to control torque with light force during alignment. Therefore, the spherical bracket has gained increasing interest because of its outstanding performance such as comfort, low bonding failure rate, accurate torque expression, stable anchorage, and light force.

Key words: spherical bracket, obrace, lock-hook system, play mitigation, anchorage control, light force treatment, precise torque expression

中图分类号: 

  • R783.5

图1

球托5s矫治器与方形托槽的口内卫生状况"

图2

对比起其他自锁托槽，球托5s矫治器的外形线（橙色线）更短A：球托5s矫治器；B：Damon Q；C：Empower 2。"

图3

有限元实验分析方形自锁托槽（左）、结扎托槽（中）、球托5s矫治器（右）对口腔黏膜造成的应力Max：最大值；Min：最小值；单位：Pa。"

图4

有限元实验分析结扎托槽（左）和球托5s矫治器（右）在口腔黏膜上水平滑动1 mm对口腔黏膜造成的应力应变情况Max：最大值；Min：最小值；单位：Pa。"

图5

有限元实验分析结扎托槽（左）和球托5s矫治器（右）在口腔黏膜上垂直滑动2 mm对口腔黏膜造成的应力应变情况Max：最大值；Min：最小值；单位：Pa。"

图6

方形自锁托槽（蓝线）和球形托槽（绿线）在13个月中的存留曲线"

图7

其他自锁托槽（左）和球托5s矫治器（右）受到食物冲击力后二维平面上的静力力学分析"

图8

球托5s矫治器螺纹孔、牵引螺丝、定位螺丝以及螺纹系统专用扳手A、B：螺纹孔；C：定位螺丝；D：牵引螺丝；E：专用扳手。"

图9

“双重支抗”示意图第二前磨牙、第一磨牙、第二磨牙作为尖牙的第一重支抗，中切牙、侧切牙作为尖牙的第二重支抗；红圈示支抗；箭头示受力方向。"

图10

定位螺丝应力和弓丝受力的有限元分析左：定位螺丝锁死弓丝后，定位螺丝的应力应变情况；右：利用定位螺丝去除余隙时，弓丝的受力情况。"

图11

弓丝挠度曲线"

图12

细方丝排齐牙列左：初诊；中：拔除14、25牙；右：排齐3个月。"

图13

细方丝矫正扭转牙A：病例1排齐前；B：病例1排齐2个月；C：病例2排齐前；D：病例2排齐2.5个月。"

图14

定位扩弓A~E分别为初诊和第1、2、3、5个月时牙弓形态及测量值。"

图15

利用止动定位轻力5s系统内收尖牙（侧位照）左：右侧位照；右：左侧位照；上：牵引前；下：牵引6个月。"

图16

利用止动定位轻力5s系统内收尖牙对比图左：内收尖牙前（面照）；中：内收尖牙后（面照）；右：内收尖牙前后口扫模型对比，重叠平面为“上腭的第二皱襞”，灰色为刚拔除第一前磨牙时模型，橙色为内收尖牙后模型。"

图17

5s止动系统滑动法一步关闭拔牙间隙左：止锁前牙13—23，前牙支抗得到最大程度增强；右：止锁尖牙，前牙支抗得到一定程度增强。"

图18

利用定位螺丝止动表达转矩，控制牙根（口内照）左：初始状态；中：排齐唇倾后；右：止动表达后。"

图19

止锁前后上颌前牙CBCT上：止锁前；下：止锁后。"

图20

止锁前后的头测量重叠图黑色：内收前；红色：内收后。"

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