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1、加快正畸牙齿移动的方法,南京大学医学院附属口腔医院正畸科 王天丛,研究的三个方向：,药物刺激 机械生理性刺激 手术加速,药物刺激,激素类药物：前列腺素（PG）、甲状旁腺素（PTH）、肾上腺皮质激素等 钙调节剂：骨钙素（OC）等 中药类：丹参、灯盏花等,机械生理性刺激,激光 磁场 超声波：选择了13 例对称拔牙正畸病例，实验侧局部给予超声波，10 mind14 d。结果实验侧尖牙移动速度比对照侧提高28.67%。 振动,手术加速,骨皮质切开术 corticotomy 牙周辅助加速成骨治疗 periodontally accelerated osteogenic orthodontics, PAO
2、O 牵张成骨 Dentoalveolar Distraction (DAD) 手术优先矫治 surgery first orthognathic approach,正畸力作用于牙齿，引起牙槽骨的改建，压力侧出现骨吸收，张力侧出现骨沉积，从而产生牙齿移动。理论上，凡能促进骨组织改建的外源性因素均可加速正畸牙齿移动。,A novel device in orthodontics,-AcceleDent,What is AcceleDent Aura?,A simple-to-use, hands-free device designed for faster orthodontic treatme
3、nt with only 20 minutes daily use.,Its Fast,Clinically proven to move teeth up to 50% faster in a US clinical trial.,AcceleDent is designed to work with all existing orthodontic appliances including fixed appliances and clear aligners.,Its Safe,Cleared by the United States Food and Drug Administrati
4、on (FDA) and available only by prescription from your orthodontist,Its Gentle,AcceleDent patients have reported reduced discomfort with their orthodontics.,AcceleDent Aura Components:,Activator The heart of AcceleDent Aura the small, lightweight Activator generates gentle micropulses to safely accel
5、erate bone remodeling. It includes a USB interface, whch can be plugged directly into a computer to view patient usage history via the FastTrac Report.,AcceleDent Aura Components:,Mouthpiece The Mouthpiece provides a comfortable fit snaps easily on and off the Activator for transport and cleaning.,A
6、cceleDent Aura Components:,USB extension cable with power adapter Allows for easy, convenient charging,AcceleDent Aura Components:,Travel Case The Travel Case keeps the components safe, clean and secure.,How AcceleDent Aura Works ?,SoftPulse Technology Part of the way that orthodontics works is by c
7、hanging or remodeling the bones surrounding your teeth. As this remodeling process is accelerated, your teeth move more quickly. SoftPulse Technology is designed to speed up bone remodeling, accelerating tooth movement,The device uses the application of cyclic forces to move teeth in bone faster thr
8、ough accelerated bone remodeling.,The applied force (0.2 Newtons or 20 grams) is intended to be barely noticeable and should not be uncomfortable. some researchers have theorised that the pulsing may actually decrease pain associated with standard ortho-dontic adjustments,SCIENTIFIC EVIDENCE,Suture
9、Growth Modulated by the Oscillatory Component of Micromechanical Strain,SCIENTIFIC EVIDENCE,SCIENTIFIC EVIDENCE,SCIENTIFIC EVIDENCE,SCIENTIFIC EVIDENCE,SCIENTIFIC EVIDENCE,SCIENTIFIC EVIDENCE,SCIENTIFIC EVIDENCE,SCIENTIFIC EVIDENCE,CLINICAL EVIDENCE,AcceleDent Increases the Rate of Orthodontic Tooth
10、 Movement: Results of a Randomized Controlled Clinical Trial,CLINICAL EVIDENCE,CLINICAL EVIDENCE,CLINICAL EVIDENCE,CLINICAL EVIDENCE,The perimeter was defined by tracing the labiolingual centers of each tooth from canine to canine.,CLINICAL EVIDENCE,CLINICAL EVIDENCE,CLINICAL EVIDENCE,CLINICAL EVIDE
11、NCE,CLINICAL EVIDENCE,CLINICAL EVIDENCE,The results of the randomized controlled clinical trial demonstrate that AcceleDent can increase the rate of tooth movement when used in conjunction with conventional orthodontics. Use of AcceleDent did not increase the risk of either root resorption,CASE REPO
12、RT,18 year old male Class III combination ortho & surgical case,CASE REPORT,CASE REPORT,9 Weeks,CASE REPORT,5 days post orthognathic surgery (9 months into treatment & 2 months of delay with travels and parents away),CASE REPORT,6.5 weeks post surgery 46 Weeks Total Treatment Time,corticotomy-assist
13、ed orthodontic treatment (CAOT),发展过程,1893年Bryan 提出骨皮质切开加速牙齿移动这一概念。 1959年Kole等首先应用了骨皮质首先应用了骨皮质切开术结合根尖下截骨术，证实能够有效加快正畸牙齿的移动。 2001年Wilcko等提出了牙周加速成骨正畸(periodontally accelerated osteogenic orthodontics, PAOO ) 的新理念，主要通过切开正畸牙牙根周围颊侧骨皮质至骨髓质深度，并在切开骨表面放置可吸收人工骨材料以增加骨量。,理论基础,骨块移动理论（bone block theory）：颌骨骨皮质切开加速正畸
14、牙齿移动的理论基础早期在手术中于牙齿近远中颊舌侧骨板进行骨皮质切开，保留骨松质的连续性，通过根尖下截骨术连接骨皮质切口以形成完整牙骨块， 他认为去除骨皮质阻力后，牙齿与周围骨块形成整体在正畸力作用下加速移动，即为骨块移动理论。,理论基础,局部骨加速现象（regional acceleratory phenomenond RAP ）被认为是骨皮质切开术加速牙齿移动的根本原因，而不是骨块移动理论。,理论基础,局部骨加速现象（regional acceleratory phenomenond RAP ）为术后局部骨质产生的暂时性脱矿与再矿化 表现为: 在骨组织创伤后术创附近的牙槽骨进入短暂可逆的骨质
15、减少状态，骨吸收及溶骨现象随即出现; 在这一分解代谢的过程中骨密度虽然降低，但牙槽骨骨量并没有减少; 正畸力施加使得牙根周围骨基质及骨胶原软组织基质随之移动; 在随后的再矿化过程中新骨沉积，类骨质基质再矿化，重新包绕牙根周围。,骨皮质切开术后一段时间可以加快正畸牙齿移动的速度，而该过程是基于引发现象后牙槽骨吸收和重建过程（RAP）.,临床应用,解除拥挤 矫正上前牙唇倾，加速前牙内收，改善前突面型 骨性 三类错合畸形下前牙舌倾的去代偿 个别牙齿的错合畸形也有很好的疗效，压低伸长磨，牵引埋伏牙，根骨黏粘牙齿 解除后牙反牙合,Lower Incisor Retraction with a Modif
16、ied Corticotomy Angle Orthodontist, Vol 76, No 5, 2006,In the current case report, the total orthodontic treat-ment time (16 months) was dramatically reduced whencompared with the average treatment time for extrac-tion therapy (31 months). In corticotomy-facilitatedorthodontics, the reduction of orthodontic treatmenttime by approximately 50% was observed.,
