查看更多>>摘要：术者诊断设计不当、矫治技术应用失误、正畸治疗后的复发以及患者依从性较差无法配合矫治等原因可导致患者对矫治结果不满意，寻求二次矫治。此类患者通常已减数，或伴牙周、关节、牙体或缺牙等问题，常需多学科联合治疗，二次矫治难度较大，可选方案受限。无托槽隐形矫治舒适美观，具备数字化精准化程度高、可个性化排牙模拟矫治后终末状态等特点，使其在失败病例的二次矫治中具有一定优势。本文通过展示无托槽隐形矫治在二次矫治病例中的应用实例，对矫治设计和监控细节进行讨论和总结。建议医师在接诊前利用无托槽隐形矫治难度评估工具对患者情况进行评估，接诊自身诊疗能力范围内的病例，以获得满意的矫治疗效。无托槽隐形矫治技术治疗减数病例的成功关键在于诊断正确，选对病例。在方案设计上，二次矫治应注意前牙转矩的恢复，利用推磨牙向后获得间隙，做好垂直向控制，改善后牙咬合关系。在无托槽隐形矫治中正确选择、谨慎纳入、合理设计，有望在二次矫治的疑难病例中获得牙排列整齐、尖窝交错、覆覆盖正常、牙周健康、牙根平行的矫治效果，达到美观、功能、稳定、健康的矫治目标。 Improper diagnosis and design, misusing orthodontic technique, relapse after orthodontic treatment, and poor patient compliance may lead to treatment failure, requiring orthodontic retreatment. While in such cases, patients usually have already had their teeth extracted, or are with periodontal, joint, and other dental problems, which often require multidisciplinary treatment. The retreatment of orthodontic patients is difficult, and the treatment options are limited. The characteristics of clear aligner treatment, such as comfortable and beautiful appearance, high degree of digital precision, and personalized tooth arrangement to simulate the final outcome, make it popular in the orthodontic retreatment. This article discusses and summarizes the details of orthodontic design, case monitoring, and the application of clear aligner in orthodontic retreatment of failed cases. Before starting treatment, the difficulty assessment tool (clear aligner treatment complexity assessment tool, CAT-CAT) can be used to evaluate the difficulty of clear aligner treatment. Orthodontists are recommended to treat orthodontic patients with clear aligners within their ability to avoid treatment failure. The key to the success of the extraction case treatment with clear aligner is to make the correct diagnosis and select the right cases. In the treatment planning, attention should be paid to the restoration of anterior tooth torque, making good use of molar distalization to obtain the space, vertical control, and improving posterior tooth relationship. Proper selection of cases and reasonable design in clear aligner treatment are expected to obtain tooth alignment, good intercuspation, normal overbite and overjet, periodontal health, parallel roots, and to achieve the goal of aesthetic, functional, stable, and healthy orthodontic treatment.
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