[Three-dimensional analysis of maxillary dentition during molar distalization with clear aligners under different movement designs: an in vitro experiment].

Objective: To investigate the three-dimensional force in the maxillary dentition under different movement designs for molar distalization with clear aligners Methods: Three groups were designed: simultaneous movement group (simultaneous distalization of maxillary first and second molars), second molar movement group (distalization of maxillary second molars) and first molar movement group (distalization of maxillary first molars). Ten clear aligners were made in each group, and the displacement was designed to be 0.2 mm. A force sensing device was established to measure the three-dimensional force on the upper dentition with the clear aligner. The device contained a model of the maxillary dentition consisting of 14 teeth, each tooth connected to an individual sensor. After the clear aligner was fitted, the data of 14 sensors were collected and analyzed using computer analysis software. The moving teeth were taken as the target teeth, and the rest of the teeth were anchorage. The data of the three-dimensional force in the three groups in each tooth position were measured and compared. Results: The sagittal forces on the first and second molars in the simultaneous movement group were (5.61±0.94) and (5.81±1.08) N, respectively, which were significantly smaller than those of the target teeth in the same position in other groups (P<0.05). The second molars in the first molar movement group received a sagittal reaction force, which was (-6.73±1.99) N. The anterior teeth in the three groups were all subjected to sagittal reaction force, and the force value was in a range of (-3.33 to 0.46) N. In the coronal direction, the second premolars of the simultaneous movement group received the reaction force in the palatal direction, and the force value was (-2.17±1.06) N. The first molars in the second molar movement group were also subjected to palatal reaction force of (-1.99±0.70) N. The second molars and second premolars in the first molar movement group were also subjected to palatal reaction force, which were (-2.85±0.57) and (-1.85±0.74) N, respectively. Compared with the sagittal and coronal forces, the target teeth and anchorage teeth in the three groups were less stressed in the vertical direction. Conclusions: The first and second molars distalized simultaneously, the correction force in the sagittal direction was relatively small. When first molar was moved distally alone, a greater reaction force in the sagittal direction was exerted on the second molar. Buccal displacement of the adjacent anchorage teeth should be designed to counteract the palatal reaction force on the anchorage teeth as the molars moved distally.目的： 通过体外实验探究无托槽隐形矫治磨牙远中移动不同设计方式下上颌牙列的三维受力，以期为临床设计合理的磨牙远中移动方案提供依据。 方法： 根据上颌磨牙远中移动方式，进行3种无托槽隐形矫治器设计：同时移动组设计上颌第一和第二磨牙同时远中移动；第二磨牙移动组设计上颌第二磨牙远中移动；第一磨牙移动组设计上颌第一磨牙远中移动；每组制作10个矫治器，移动量设计为0.2 mm。建立无托槽隐形矫治器上牙列三维力学传感测力装置，该装置包含14颗牙齿的上颌牙列模型，每颗牙齿与单独的传感器连接后将无托槽隐形矫治器戴入该上颌牙列模型，通过数据采集软件对14个传感器的数据进行采集。以移动牙为目标牙，除移动牙外的其余牙为支抗牙，测量3组无托槽隐形矫治器各牙位三维受力数据，并进行组间比较。 结果： 同时移动组第一和第二磨牙矢状向受力分别为（5.61±0.94）和（5.81±1.08）N，均显著小于其他组相同牙位目标牙（P<0.05）；第一磨牙移动组第二磨牙受到矢状向反作用力（-6.73±1.99）N；3组前牙均受到矢状向反作用力，力值大小为-3.33~0.46 N。冠状向上，同时移动组第二前磨牙受到腭向反作用力，力值为（-2.17±1.06）N；第二磨牙移动组第一磨牙同样受到腭向反作用力，力值为（-1.99±0.70）N；第一磨牙移动组第二磨牙、第二前磨牙也受到腭向反作用力，分别为（-2.85±0.57）和（-1.85±0.74）N。相比矢状向与冠状向受力，3组目标牙和支抗牙的垂直向受力均较小。 结论： 同时远中移动第一和第二磨牙时两者受到的矢状向矫治力较小；单独远中移动第一磨牙时第二磨牙受到较大的矢状向反作用力；磨牙远中移动时应设计相邻支抗牙的颊向位移以抵消支抗牙受到的腭向反作用力。.