正畸支抗之“惑”

70多年以前，正畸学先驱Tweed医师考虑到牙弓唇颊侧的边界，提出了拔牙矫治的概念；今天，当种植钉支抗风靡全球之际，当正畸医师有能力将前牙无限内收之时，难道不该问一句：“牙弓的舌侧有没有边界？”

上：治疗后头颅侧位片；下：治疗后口内像。

图3  治疗后下颌切牙根尖突出于牙槽突舌侧骨皮质之外

Fig 3  Lower incisor apex stick out of lingual alveolar bone after orthodontic treatment

上：上颌中切牙根尖从牙槽突唇侧突出于骨皮质之外，而牙根舌侧颈1/2处的骨皮质影像消失；下：下颌中切牙牙根从牙槽突舌侧突出于骨皮质之外。

图4  治疗后牙根移出至牙槽突之外的锥形束CT影像

Fig 4  CBCT images show incisor roots being moved out of alveolar bone

正畸治疗的目标是功能、美观、稳定和健康，过分强调美观而忽略其他3个要素不符合医学的基本原则，而正畸支抗控制在协调这四者之间的关系中扮演着重要的角色。正畸学者应该围绕这些根本的临床问题展开基础及临床研究，避免盲从，从而走出中国正畸学自己的路。

【参考文献】

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