姜杉 刘超 白明海

[摘要] 骨性Ⅲ类错 是一种以上下颌骨发育不调、咬合关系紊乱、前牙反 为特征的错颌畸形。其畸形因素更多源于颌骨，单纯通过正畸手段移动牙齿难以取得较好矫治效果，临床上常选择正畸-正颌联合治疗方式从根本上纠正颅颌面畸形。传统正畸-正颌联合治疗因其疗程长、治疗环节复杂，易出现偏差导致术后效果不佳、术后反 复发等不良影响。本文报道1例数字化技术辅助正畸-正颌联合治疗骨性Ⅲ类患者的案例，结合其治疗过程及治疗效果探讨数字化技术在正畸-正颌联合治疗中的应用并文献回顾。

[关键词] 隐形矫治;正颌手术;去代偿;数字化医疗;骨性Ⅲ类

[中图分类号] R783.5          [文献标识码] C          [文章编号] 1673-9701（2021）07-0166-05

Digital orthodontics combined with orthognathic treatment for one case of skeletal class Ⅲ and literature review

JIANG Shan1   LIU Chao1   BAI Minghai2

1.The affiliated Stomatological Hospital of Hu′nan University of Chinese Medicine， Changsha   410208， China; 2.Department of Orthodontics， Changsha Stomatological Hospital， Changsha   410004， China

[Abstract] Skeletal Class Ⅲ malocclusion is a malocclusion deformity characterized by irregular development of the upper and lower jaws， disordered occlusal relationship， and anterior crossbite. The deformity factors are more derived from the jaws， and it is difficult to achieve better correction results by simply moving the teeth through orthodontic methods. Clinically， the combined orthodontic-orthognathic treatment is often used to fundamentally correct craniomaxillofacial deformities. Traditional orthodontic-orthognathic combined treatment is prone to easy deviations resulting in poor postoperative results， postoperative recurrence of malocclusion due to its long treatment course， and complicated treatment procedures. This article reports a case of digital technology-assisted orthodontics-orthognathic combined treatment of skeletal class Ⅲ patients， discusses the application of digital technology in orthodontic-orthognathic combined treatment， and reviews the literature based on the treatment process and therapeutic effect.

[Key words] Invisible correction; Orthognathic surgery; Decompensation; Digital medicine; Skeletal class Ⅲ

骨性Ⅲ類错 是对颜面部及功能影响较大的一类错 畸形，成年患者通常ANB角小，侧貌不佳，牙槽骨厚度不足，通过正畸掩饰治疗仅能纠正覆合覆盖关系，无法改善侧貌，且正畸后稳定性不佳[1];临床多选择正畸-正颌手术联合治疗，在纠正咬合的同时能够极大改善骨面型，有利于牙周健康及治疗后的稳定[2-3]。近年来数字化技术飞速发展，在正畸治疗中可以使牙齿移动更精准高效;在正颌手术中，精确控制手术移动量更是取得良好术后效果的关键[4]。本文通过1例使用无托槽隐形矫治技术结合数字化正颌手术联合治疗案例，探讨数字化在正畸正颌联合治疗中的应用及相关影响因素。

1 病例资料

1.1 病史摘要

患者，女，17岁，2018年7月9日接诊于长沙市口腔医院正畸科，主诉前牙反 11年，近年来自觉影响咀嚼功能及美观，要求矫治。……