王欣 谢钦钦 古力巴哈·买买提力

[摘要]骨性Ⅲ类错牙合是常见的错牙合畸形之一，也是正畸医生临床上面临的一大挑战。现如今，针对早期骨性Ⅲ类错牙合患者较常用的治疗方案是快速扩弓结合前方牵引矫治技术，它不仅能影响颌骨的生长方向，也能影响治疗期间颌骨的增长程度。本文就前方牵引矫治技术的矫治原理、矫治时机、对骨性Ⅲ类错牙合的颅颌面疗效、微螺钉的联合运用以及治疗后的保持作一综述，意在加深对此矫治技术的认识和了解，为骨性Ⅲ类错牙合畸形的矫治提供参考。

[关键词]前方牵引;骨性Ⅲ类错牙合;种植支抗;正畸

[中图分类号]R783.5    [文献标志码]A    [文章编号]1008-6455（2020）09-0186-04

In Front of the Traction Correct Osseous Ⅲ Class or Wrong Tooth Deformity Progress of Clinical Application

WANG Xin，XIE Qin-qin，Gulibaha·MAIMAITILI

（Department of Stomatology，the Second Affiliated Hospital of Xinjiang Medical University，Urumqi 830000，Xinjiang，China）

Abstract： Skeletal class Ⅲ malocclusion is one of the common malocclusion， and orthodontists facing the big challenge today.According to the early patients with skeletal Class Ⅲ malocclusion is relatively commonly used treatment is rapidly expanding arch combined with anterior maxillary technology，it can not only affect the growth vector of maxillofacial， can also affect during treatment.In this paper， maxillary protraction appliance was reviewed about the orthodontic theory， correct timing，curative effect on maxillofacial and upper airway，combined application of microscrews and retain，to deepen the knowledge of the treatment technology and understanding， provide reference for skeletal class Ⅲ malocclusion treatments.

Key words： maxillary protraction;skeletal Class Ⅲ malocclusion; implant anchorage

骨性Ⅲ類错牙合畸形是临床上常见的错牙合畸形，此类错牙合畸形可能由上颌骨发育不良，下颌前突或两者结合引起。有文献报道，白种人骨性Ⅲ类错牙合畸形的发病率为1%～5%[1]，然而亚洲人的发病率高达14%[2]。骨性Ⅲ类错牙合严重影响患者颅颌面的生长发育，而且畸形可能会随着生长发育逐渐加重，严重影响患者的外貌及功能，甚至会影响患者的心理健康，产生自卑表现[3]。该类畸形与发育障碍、遗传基因、不良习惯等多种要素相关，且绝大多数患者具有显著家族史，颜面畸形严重[4]。骨性Ⅲ类错牙合是一种生长发育不良，其典型特点是前牙反牙合，主要原因为上颌骨发育不足或下颌骨生长过度对患者的侧貌美观影响较大[5]。有学者发现，因上颌发育不足引起的骨性Ⅲ类错牙合大约占60%，因此应用上颌前方牵引器增加上颌前移量，这有利于上颌骨生长发育、协调上下颌关系、阻碍畸形发展[5-6]。……