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Ⅲ类错颌代偿性治疗中的垂直控制

Vertical control in the Class III compensatory treatment.

作者信息

Sobral Márcio Costa, Habib Fernando A L, Nascimento Ana Carla de Souza

机构信息

Federal University of Rio de Janeiro (UFRJ), Brazil.

出版信息

Dental Press J Orthod. 2013 Mar-Apr;18(2):141-59. doi: 10.1590/s2176-94512013000200026.

Abstract

INTRODUCTION

Compensatory orthodontic treatment, or simply orthodontic camouflage, consists in an important alternative to orthognathic surgery in the resolution of skeletal discrepancies in adult patients. It is important to point that, to be successfully performed, diagnosis must be detailed, to evaluate, specifically, dental and facial features, as well as the limitations imposed by the magnitude of the discrepancy. The main complaint, patient's treatment expectation, periodontal limits, facial pattern and vertical control are some of the items to be explored in the determination of the viability of a compensatory treatment. Hyperdivergent patients who present with a Class III skeletal discrepancy, associated with a vertical facial pattern, with the presence or tendency to anterior open bite, deserve special attention. In these cases, an efficient strategy of vertical control must be planned and executed.

OBJECTIVE

The present article aims at illustrating the evolution of efficient alternatives of vertical control in hiperdivergent patients, from the use, in the recent past, of extraoral appliances on the lower dental arch (J-hook), until nowadays, with the advent of skeletal anchorage. But for patients with a more balanced facial pattern, the conventional mechanics with Class III intermaxillary elastics, associated to an accentuated curve of Spee in the upper arch and a reverse curve of Spee in the lower arch, and vertical elastics in the anterior region, continues to be an excellent alternative, if there is extreme collaboration in using the elastics.

摘要

引言

代偿性正畸治疗,或简称为正畸掩饰治疗,是成年患者骨骼差异矫治中替代正颌手术的一种重要方法。需要指出的是,要成功实施该治疗,诊断必须详尽,以便具体评估牙齿和面部特征,以及差异程度所带来的限制。主要诉求、患者的治疗期望、牙周限度、面部形态和垂直控制等是确定代偿性治疗可行性时需探讨的部分项目。表现为Ⅲ类骨骼差异、伴有垂直面部形态、存在或有前牙开颌倾向的高角患者值得特别关注。在这些病例中,必须规划并执行有效的垂直控制策略。

目的

本文旨在阐述高角患者垂直控制有效替代方法的演变,从过去使用下颌牙弓的口外装置(J钩),到如今随着骨支抗的出现。但对于面部形态较为平衡的患者,如果能极其配合使用弹力牵引,那么采用Ⅲ类颌间弹力牵引的传统力学方法,结合上颌弓中明显的Spee曲线和下颌弓中的反Spee曲线,以及前部区域的垂直弹力牵引,仍然是一种极佳的选择。

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