Wang Shi-Zhe, Pan Xiao-Gang, Zhou Ke-Tuo
Shanghai Jiao Tong University School of Medicine. Shanghai 200025, China. E-mail:
Shanghai Kou Qiang Yi Xue. 2019 Jun;28(3):264-267.
This study analysed the mechanical features of the extraction space closure in clear aligners through mechanical research.
A patient with four first premolars extraction was chosen as sample, and four plans with clear aligners for space closure were designed, including anterior retraction entirely, anterior retraction dispersedly, posterior movement mesially and posterior movement dispersedly. Finite element analysis was performed separately.
In anterior retraction, when there was no anterior space, the force acted on them more evenly, and the posteriors needed to provide more anchorage; when anterior space existed, the force acted on the central incisors first and largely, and the posteriors needed to provide less anchorage. In posterior anchorage, when the posteriors moved entirely with mesial movement, it might help to protect second premolar's anchorage while molars would receive more mesial force; when the posteriors moved separately without designed movement, the second premolar would undertake more anchorage and more tendency to incline mesially; when the posteriors moved entirely without designed movement, the anchorage would distribute more evenly.
Selection of the way of retracting anteriors should be based on the difference of stress distribution in different ways in addition to individual discrepancy and clinical facts. Selection of the way of moving posteriors should be based on the distribution of anchorage as well as avoiding posterior open bite. Less amount of correction in each step has better axial control.
本研究通过力学研究分析了透明矫治器中拔牙间隙关闭的力学特征。
选取一名拔除四颗第一前磨牙的患者作为样本,设计了四种使用透明矫治器关闭间隙的方案,包括前牙整体后移、前牙分散后移、后牙近中移动和后牙分散移动。分别进行有限元分析。
在前牙后移中,无前牙间隙时,力作用更均匀,后牙需提供更多支抗;存在前牙间隙时,力首先较大地作用于中切牙,后牙需提供的支抗较少。在后牙支抗方面,后牙整体近中移动时,可能有助于保护第二前磨牙的支抗,而磨牙会受到更大的近中力;后牙无设计移动而单独移动时,第二前磨牙会承担更多支抗且有更大的近中倾斜趋势;后牙无设计移动而整体移动时,支抗分布更均匀。
前牙后移方式的选择除个体差异和临床实际情况外,还应基于不同方式下应力分布的差异。后牙移动方式的选择应基于支抗分布以及避免后牙开 。每一步较小的矫正量具有更好的轴向控制。