Lai W L
Department of Orthodontics, West China Hospital of Stomatology, Sichuan University & State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, Chengdu 610041, China.
Zhonghua Kou Qiang Yi Xue Za Zhi. 2024 Apr 9;59(4):400-406. doi: 10.3760/cma.j.cn112144-20240109-00017.
Improper diagnosis and design, misusing orthodontic technique, relapse after orthodontic treatment, and poor patient compliance may lead to treatment failure, requiring orthodontic retreatment. While in such cases, patients usually have already had their teeth extracted, or are with periodontal, joint, and other dental problems, which often require multidisciplinary treatment. The retreatment of orthodontic patients is difficult, and the treatment options are limited. The characteristics of clear aligner treatment, such as comfortable and beautiful appearance, high degree of digital precision, and personalized tooth arrangement to simulate the final outcome, make it popular in the orthodontic retreatment. This article discusses and summarizes the details of orthodontic design, case monitoring, and the application of clear aligner in orthodontic retreatment of failed cases. Before starting treatment, the difficulty assessment tool (clear aligner treatment complexity assessment tool) can be used to evaluate the difficulty of clear aligner treatment. Orthodontists are recommended to treat orthodontic patients with clear aligners within their ability to avoid treatment failure. The key to the success of the extraction case treatment with clear aligner is to make the correct diagnosis and select the right cases. In the treatment planning, attention should be paid to the restoration of anterior tooth torque, making good use of molar distalization to obtain the space, vertical control, and improving posterior tooth relationship. Proper selection of cases and reasonable design in clear aligner treatment are expected to obtain tooth alignment, good intercuspation, normal overbite and overjet, periodontal health, parallel roots, and to achieve the goal of aesthetic, functional, stable, and healthy orthodontic treatment.
诊断与设计不当、正畸技术使用不当、正畸治疗后复发以及患者依从性差等情况可能导致治疗失败，需要进行正畸再治疗。而在此类情况下，患者通常已经拔过牙，或存在牙周、关节及其他牙齿问题，往往需要多学科联合治疗。正畸患者的再治疗难度较大，治疗选择有限。透明矫治器治疗具有外观舒适美观、数字化精准度高以及能个性化排牙以模拟最终效果等特点，使其在正畸再治疗中受到欢迎。本文探讨并总结了正畸设计细节、病例监测以及透明矫治器在正畸失败病例再治疗中的应用。在开始治疗前，可使用难度评估工具（透明矫治器治疗复杂性评估工具）来评估透明矫治器治疗的难度。建议正畸医生在自身能力范围内使用透明矫治器治疗正畸患者，以避免治疗失败。使用透明矫治器进行拔牙病例治疗成功的关键在于做出正确诊断并选择合适病例。在治疗计划中，应注意恢复前牙转矩，充分利用磨牙远移获取间隙，控制垂直向，改善后牙关系。在透明矫治器治疗中合理选择病例并进行合理设计，有望实现牙齿排齐、良好的牙尖交错、正常的覆合覆盖、牙周健康、牙根平行，并达到美观、功能、稳定和健康的正畸治疗目标。
