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采用最小限度术前正畸治疗垂直III类错合伴严重骨性开牙合的手术治疗——病例报告

Surgical Management of Vertical Class III Malocclusion with Severe Skeletal Openbite Using Minimum Pre-surgical Orthodontics - A Case Report.

作者信息

Husain Seerab, Khan Nayeemullah, Parameswaran Anantanarayanan, Nagi Manini, Parameswaran Ratna

机构信息

Department of Orthodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India.

Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India.

出版信息

Ann Maxillofac Surg. 2025 Jan-Jun;15(1):128-132. doi: 10.4103/ams.ams_219_24. Epub 2025 May 28.

DOI:10.4103/ams.ams_219_24
PMID:40765883
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12321172/
Abstract

RATIONALE AND PATIENT CONCERNS

A 19-year-old male patient presented with a dentoalveolar Class III malocclusion on a Class III skeletal base with facial asymmetry, increased facial proportions, complicated by anterior open bite of 6.2 mm, unilateral posterior crossbite with Index of Orthognathic Functional Treatment Need score of 5.4.

DIAGNOSIS AND TREATMENT

The patient's maxillary arch was bonded initially and 4 months post alignment, pre-surgical intraoral scanning and full skull computed tomography were obtained and subjected to virtual surgical planning (NemoFAB Version 22, Nemotec, Madrid, Spain). Counterclockwise rotational bilateral sagittal split osteotomy setback and genioplasty was performed to close the open bite and correct the Class III skeletal discrepancy with the aid of intermaxillary fixation screws placed in the midline of upper and lower maxillary and mandibular arches for heavy elastic engagement post-surgery.

OUTCOME

Facial balance was restored, profile was improved, ideal overjet and overbite established.

TAKE-AWAY LESSONS: This approach combines the benefits of conventional three-phase surgery and surgery first orthognathic approach by meticulous planning of the intended transitional malocclusion to achieve a stable occlusion. Longer follow-ups in future studies can be investigated.

摘要

原理与患者担忧

一名19岁男性患者，表现为骨性III类错牙合伴牙性III类错牙合，面部不对称，面部比例增加，并发6.2毫米的前牙开牙合、单侧后牙反牙合，正颌功能治疗需求指数评分为5.4。

诊断与治疗

最初对上颌牙弓进行粘结，排齐4个月后，进行术前口内扫描和全颅骨计算机断层扫描，并进行虚拟手术规划（NemoFAB版本22，Nemotec，西班牙马德里）。采用逆时针旋转双侧矢状劈开截骨后退术和颏成形术，以关闭开牙合并借助置于上颌和下颌牙弓中线的颌间固定螺钉纠正III类骨骼差异，术后进行重度弹性牵引。

结果

面部平衡得以恢复，侧貌得到改善，建立了理想的覆盖和覆牙合。

经验教训

该方法通过精心规划预期的过渡性错牙合，结合了传统三相手术和手术优先正颌方法的优点，以实现稳定的咬合。未来研究可进行更长时间的随访。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/b9dc679c0446/AMS-15-128-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/6d862f1d3007/AMS-15-128-g001.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/ea345c156224/AMS-15-128-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/ce92057b0a9f/AMS-15-128-g004.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/b9dc679c0446/AMS-15-128-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/6d862f1d3007/AMS-15-128-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/f5ef0623c53b/AMS-15-128-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/ea345c156224/AMS-15-128-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/ce92057b0a9f/AMS-15-128-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/9cb40fe1f94a/AMS-15-128-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2624/12321172/b9dc679c0446/AMS-15-128-g006.jpg

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本文引用的文献

1
Systematic Review and Meta-Analysis of the Index of Orthognathic Functional Treatment Need for Detecting Subjects with Great Need for Orthognathic Surgery.正颌功能治疗需求指数用于检测极需正颌手术患者的系统评价与Meta分析
Cleft Palate Craniofac J. 2025 Mar;62(3):519-526. doi: 10.1177/10556656231216833. Epub 2023 Nov 30.
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One-year stability of the mandibular advancement and counterclockwise rotation for correction of the skeletal class II malocclusion and high mandibular plane angle: Dental and skeletal aspect.下颌前伸和逆时针旋转矫正骨性Ⅱ类错合和高下颌平面角的 1 年稳定性：牙颌和骨骼方面。
Biomed J. 2022 Feb;45(1):206-214. doi: 10.1016/j.bj.2021.02.005. Epub 2021 Feb 13.
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Miniplate removal in operated cases of maxillofacial region in a dental institute in Rajasthan, India.
印度拉贾斯坦邦一家牙科机构中颌面手术病例的微型钢板取出术。
Med Pharm Rep. 2019 Oct;92(4):393-400. doi: 10.15386/mpr-1195. Epub 2019 Oct 25.
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A Retrospective Analysis of Dentofacial Deformities and Orthognathic Surgeries.牙颌面畸形与正颌外科手术的回顾性分析
Ann Maxillofac Surg. 2017 Jan-Jun;7(1):73-77. doi: 10.4103/ams.ams_104_16.
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Surgery-first orthognathic approach case series: Salient features and guidelines.手术优先的正颌治疗病例系列：显著特征与指南
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