加快正畸牙齒移動(dòng)的方法第1頁(yè)/共69頁(yè)研究的三個(gè)方向：藥物刺激機(jī)械生理性刺激手術(shù)加速第2頁(yè)/共69頁(yè)

藥物刺激

激素類藥物：前列腺素（PG）、甲狀旁腺素（PTH）、腎上腺皮質(zhì)激素等鈣調(diào)節(jié)劑：骨鈣素（OC）等中藥類：丹參、燈盞花等第3頁(yè)/共69頁(yè)機(jī)械生理性刺激激光磁場(chǎng)超聲波：選擇了13例對(duì)稱拔牙正畸病例，實(shí)驗(yàn)側(cè)局部給予超聲波，10min／d×14d。結(jié)果實(shí)驗(yàn)側(cè)尖牙移動(dòng)速度比對(duì)照側(cè)提高28.67%。振動(dòng)第4頁(yè)/共69頁(yè)手術(shù)加速骨皮質(zhì)切開(kāi)術(shù)corticotomy牙周輔助加速成骨治療periodontallyacceleratedosteogenicorthodontics,PAOO牽張成骨DentoalveolarDistraction(DAD)手術(shù)優(yōu)先矯治surgeryfirstorthognathicapproach第5頁(yè)/共69頁(yè)正畸力作用于牙齒，引起牙槽骨的改建，壓力側(cè)出現(xiàn)骨吸收，張力側(cè)出現(xiàn)骨沉積，從而產(chǎn)生牙齒移動(dòng)。理論上，凡能促進(jìn)骨組織改建的外源性因素均可加速正畸牙齒移動(dòng)。第6頁(yè)/共69頁(yè)Anoveldeviceinorthodontics------AcceleDent?第7頁(yè)/共69頁(yè)第8頁(yè)/共69頁(yè)WhatisAcceleDent?Aura?

Asimple-to-use,hands-freedevicedesignedforfasterorthodontictreatmentwithonly20minutesdailyuse.第9頁(yè)/共69頁(yè)It’sFast

Clinicallyproventomoveteethupto50%fasterinaUSclinicaltrial.第10頁(yè)/共69頁(yè)AcceleDentisdesignedtoworkwithallexistingorthodonticappliancesincludingfixedappliancesandclearaligners.第11頁(yè)/共69頁(yè)It’sSafe

ClearedbytheUnitedStatesFoodandDrugAdministration(FDA)andavailableonlybyprescriptionfromyourorthodontist第12頁(yè)/共69頁(yè)It’sGentle

AcceleDentpatientshavereportedreduceddiscomfortwiththeirorthodontics.第13頁(yè)/共69頁(yè)AcceleDent?AuraComponents:

ActivatorTheheartofAcceleDentAurathesmall,lightweightActivatorgeneratesgentlemicropulsestosafelyaccelerateboneremodeling.ItincludesaUSBinterface,whchcanbepluggeddirectlyintoacomputertoviewpatientusagehistoryviatheFastTracReport.第14頁(yè)/共69頁(yè)AcceleDent?AuraComponents:MouthpieceTheMouthpieceprovidesacomfortablefitsnapseasilyonandofftheActivatorfortransportandcleaning.第15頁(yè)/共69頁(yè)AcceleDent?AuraComponents:USBextensioncablewithpoweradapter

Allowsforeasy,convenientcharging第16頁(yè)/共69頁(yè)AcceleDent?AuraComponents:TravelCase

TheTravelCasekeepsthecomponentssafe,cleanandsecure.第17頁(yè)/共69頁(yè)HowAcceleDentAuraWorks?SoftPulseTechnology?

Partofthewaythatorthodonticsworksisbychangingorremodelingthebonessurroundingyourteeth.Asthisremodelingprocessisaccelerated,yourteethmovemorequickly.

SoftPulseTechnology?isdesignedtospeedupboneremodeling,acceleratingtoothmovement

第18頁(yè)/共69頁(yè)Thedeviceusestheapplicationofcyclicforcestomoveteethinbonefasterthroughacceleratedboneremodeling.第19頁(yè)/共69頁(yè)Theappliedforce(0.2Newtonsor20grams)isintendedtobebarelynoticeableandshouldnotbeuncomfortable.someresearchershavetheorisedthatthepulsingmayactuallydecreasepainassociatedwithstandardortho-donticadjustments第20頁(yè)/共69頁(yè)SCIENTIFICEVIDENCE

SutureGrowthModulatedbytheOscillatoryComponentofMicromechanicalStrain第21頁(yè)/共69頁(yè)SCIENTIFICEVIDENCE第22頁(yè)/共69頁(yè)SCIENTIFICEVIDENCE第23頁(yè)/共69頁(yè)SCIENTIFICEVIDENCE第24頁(yè)/共69頁(yè)SCIENTIFICEVIDENCE第25頁(yè)/共69頁(yè)SCIENTIFICEVIDENCE第26頁(yè)/共69頁(yè)SCIENTIFICEVIDENCE第27頁(yè)/共69頁(yè)SCIENTIFICEVIDENCE第28頁(yè)/共69頁(yè)SCIENTIFICEVIDENCE第29頁(yè)/共69頁(yè)CLINICALEVIDENCEAcceleDent?IncreasestheRateofOrthodonticToothMovement:ResultsofaRandomizedControlledClinicalTrial第30頁(yè)/共69頁(yè)第31頁(yè)/共69頁(yè)CLINICALEVIDENCE第32頁(yè)/共69頁(yè)CLINICALEVIDENCE第33頁(yè)/共69頁(yè)CLINICALEVIDENCE第34頁(yè)/共69頁(yè)CLINICALEVIDENCETheperimeterwasdefinedbytracingthelabiolingualcentersofeachtoothfromcaninetocanine.第35頁(yè)/共69頁(yè)CLINICALEVIDENCE第36頁(yè)/共69頁(yè)CLINICALEVIDENCE第37頁(yè)/共69頁(yè)CLINICALEVIDENCE第38頁(yè)/共69頁(yè)CLINICALEVIDENCE第39頁(yè)/共69頁(yè)CLINICALEVIDENCE第40頁(yè)/共69頁(yè)CLINICALEVIDENCETheresultsoftherandomizedcontrolledclinicaltrialdemonstratethatAcceleDentcanincreasetherateoftoothmovementwhenusedinconjunctionwithconventionalorthodontics.UseofAcceleDentdidnotincreasetheriskofeitherrootresorption第41頁(yè)/共69頁(yè)CASEREPORT18yearoldmaleClassIIIcombinationortho&surgicalcase第42頁(yè)/共69頁(yè)CASEREPORT第43頁(yè)/共69頁(yè)CASEREPORT9Weeks第44頁(yè)/共69頁(yè)CASEREPORT5dayspostorthognathicsurgery(9monthsintotreatment&2monthsofdelaywithtravelsandparentsaway)第45頁(yè)/共69頁(yè)CASEREPORT6.5weekspostsurgery46WeeksTotalTreatmentTime第46頁(yè)/共69頁(yè)corticotomy-assistedorthodontictreatment

(CAOT)

第47頁(yè)/共69頁(yè)發(fā)展過(guò)程1893年Bryan提出骨皮質(zhì)切開(kāi)加速牙齒移動(dòng)這一概念。1959年Kole等首先應(yīng)用了骨皮質(zhì)首先應(yīng)用了骨皮質(zhì)切開(kāi)術(shù)結(jié)合根尖下截骨術(shù)，證實(shí)能夠有效加快正畸牙齒的移動(dòng)。2001年Wilcko等提出了牙周加速成骨正畸(periodontallyacceleratedosteogenicorthodontics,PAOO)的新理念，主要通過(guò)切開(kāi)正畸牙牙根周圍頰側(cè)骨皮質(zhì)至骨髓質(zhì)深度，并在切開(kāi)骨表面放置可吸收人工骨材料以增加骨量。第48頁(yè)/共69頁(yè)理論基礎(chǔ)骨塊移動(dòng)理論（boneblocktheory）：頜骨骨皮質(zhì)切開(kāi)加速正畸牙齒移動(dòng)的理論基礎(chǔ)早期在手術(shù)中于牙齒近遠(yuǎn)中頰舌側(cè)骨板進(jìn)行骨皮質(zhì)切開(kāi)，保留骨松質(zhì)的連續(xù)性，通過(guò)根尖下截骨術(shù)連接骨皮質(zhì)切口以形成完整牙骨塊，他認(rèn)為去除骨皮質(zhì)阻力后，牙齒與周圍骨塊形成整體在正畸力作用下加速移動(dòng)，即為骨塊移動(dòng)理論。第49頁(yè)/共69頁(yè)理論基礎(chǔ)局部骨加速現(xiàn)象（regionalacceleratoryphenomenondRAP）被認(rèn)為是骨皮質(zhì)切開(kāi)術(shù)加速牙齒移動(dòng)的根本原因，而不是骨塊移動(dòng)理論。第50頁(yè)/共69頁(yè)理論基礎(chǔ)局部骨加速現(xiàn)象（regionalacceleratoryphenomenondRAP）為術(shù)后局部骨質(zhì)產(chǎn)生的暫時(shí)性脫礦與再礦化表現(xiàn)為:在骨組織創(chuàng)傷后術(shù)創(chuàng)附近的牙槽骨進(jìn)入短暫可逆的骨質(zhì)減少狀態(tài)，骨吸收及溶骨現(xiàn)象隨即出現(xiàn);在這一分解代謝的過(guò)程中骨密度雖然降低，但牙槽骨骨量并沒(méi)有減少;正畸力施加使得牙根周圍骨基質(zhì)及骨膠原軟組織基質(zhì)隨之移動(dòng);在隨后的再礦化過(guò)程中新骨沉積，類骨質(zhì)基質(zhì)再礦化，重新包繞牙根周圍。第51頁(yè)/共69頁(yè)骨皮質(zhì)切開(kāi)術(shù)后一段時(shí)間可以加快正畸牙齒移動(dòng)的速度，而該過(guò)程是基于引發(fā)現(xiàn)象后牙槽骨吸收和重建過(guò)程（RAP）.第52頁(yè)/共69頁(yè)臨床應(yīng)用解除擁擠矯正上前牙唇傾，加速前牙內(nèi)收，改善前突面型骨性三類錯(cuò)合畸形下前牙舌傾的去代償個(gè)別牙齒的錯(cuò)合畸形也有很好的療效，壓低伸長(zhǎng)磨，牽引埋伏牙，根骨黏粘牙齒解除后牙反牙合第53頁(yè)/共69頁(yè)LowerIncisorRetractionwithaModifiedCorticoto