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【摘要】 目的 总结、分析口腔正畸-正颌外科联合矫治下颌前突畸形的治疗经验，以指导临床工作。方法 对40例年龄为17～38岁的下颌前突患者经口腔正畸与正颌外科联合矫治的资料进行分析。结果 40例下颌前突患者平均术前正畸治疗时间9个月(2～25个月)，术后正畸治疗时间7.6个月(2～15个月)。整个治疗过程平均16个月(4～41个月)。术前正畸治疗的目标为排齐上下牙列，完成切牙和磨牙的去代偿治疗，整平牙列，协调上下牙弓宽度。术后正畸的目标为关闭残余间隙，伸长后牙以纠正后牙区开，平行移动牙齿，调整关系。结论 术前术后正畸治疗是正颌外科手术矫正下颌前突畸形不可缺少的步骤和取得良好效果的保证。
Pre-and post surgical orthodontic treatment of mandibular prognathism
ZHOU Yanheng, HU Wei, FU Minkui, et al.
School of Stomatology, Beijing Medical University，Beijing 100081
【Abstract】 Objective To analyze the patients we treated in clinic through combined orthodontic-orthognathic surgery, and get some guidance for the future clinical work.Methods All 40 skeletal Class III malocclusion patients we analyzed were from joint clinic of our hospital. They aged from 17 to 38.Results The duration for presurgical orthodontic treatment was 9 months on average (2～25 months)，and for postsurgical orthodontic treatment about 7.6 months on average (2～15 months). The duration for whole active treatment was 16 months on average (4～41 months). The objectives of presurgical orthodontic are: Alignment of dental arches, decompensation of anterior and posterior teeth, leveling of arches, and coordination of the width of the upper and lower arches. After presurgical orthodontic treatment, most of the patients could be treated by one piece surgery, which could simplify the surgical procedure and reduce the relapse rate of surgery. During the surgery, we modified the intermaxilary fixation wires. We used rigid rectangular stainless steel wires with Edgewise appliances as the fixation wires instead of conventional canine and molar bands with multiloop wires. The aims of the postsurgical orthodontic treatment are : closing residual spacing, extrusion of posterior teeth for correction of local openbite in premolars region, paralleling of the teeth, and adjustment of occlusion.Conclusion Pre-and post-ssurgical orthodontic treatment is essential to the surgical treatment for mandibular prognathism.
【Key words】 Malocclusion Mandible Orthognathic surgery
下颌前突畸形是一种严重的颌面骨骼畸形，临床较常见，仅用单纯的正畸治疗难以矫正。对于那些处于生长发育期的患者，尚可通过生长改形治疗予以矫正，但生长发育已经结束的成年患者，唯一的治疗途径为口腔正畸与正颌外科的联合矫治［1］。对下颌前突畸形的正颌手术治疗始于本世纪初，但限于手术技术条件，正颌外科发展缓慢。直至60年代，Trauner 和Obsweger发明了下颌升支矢状劈开截骨术，正颌外科学才得到迅速的发展。现代正颌外科治疗下颌前突畸形，始于70年代的口腔正畸与正颌外科手术相结合的治疗［2］。我国学者也是在70年代初，开始采用正颌外科与口腔正畸联合的方法矫治下颌前突畸形［3］。随着固定矫正器在国内的应用和普及，口腔正畸与正颌外科的结合日益紧密。我们总结、分析了采用口腔正畸-正颌外科联合矫治方法，对40例下颌前突畸形患者的治疗体会，旨在为临床工作提供参考。
责任编辑：韩晓炜 | 
