成人双颌前突患者正畸前后上颌切牙区唇腭侧牙槽骨的变化  

Changes of Labial-palatal Alveolar Bone in Maxillary Incisor Region in Adult Patients with Bimaxillary Protrusion Before and After Orthodontic Treatment

作　　者：杨安迪 毛慧敏 雷浪[1] YANG Andi;MAO Huimin;LEI Lang(Department of Orthodontics,Nanjing Stomatological Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院南京市口腔医院正畸科,江苏南京210008

出　　处：《口腔医学研究》2021年第1期48-52,共5页Journal of Oral Science Research

基　　金：南京市医学科技发展项目(编号:QRX17081)。

摘　　要：目的:分析成人双颌前突患者治疗前后上颌切牙区唇腭侧牙槽骨的变化,为正畸治疗中在牙槽骨内的安全移动牙齿提供参考依据。方法:纳入23例成人双颌前突的患者,拔除4颗第一前磨牙,采用直丝弓矫治技术一步法整体内收上下前牙。患者治疗前后均拍摄锥体束CT片,测量上颌切牙区唇腭侧牙槽骨厚度(alveolar bone thickness,ABT)、釉牙骨质界-牙槽嵴顶的高度(alveolar bone height,ABH)和牙槽骨面积(alveolar bone area,ABA)。结果:治疗后上颌切牙区唇侧的ABT在根中和根尖部水平显著升高,而腭侧的ABT在颈部、根中和根尖3个水平上均下降(P<0.05);中切牙在颈部和根中两个水平上总ABT显著减少(P<0.05),而侧切牙在颈部、根中和根尖处总ABT均减少(P<0.05);正畸治疗后,切牙区腭侧ABA减少,而唇侧ABA增加(P<0.05);上颌中切牙和侧切牙腭侧的ABH和上颌侧切牙唇侧的ABH显著增加(P<0.01)。结论:正畸治疗会导致成人双颌前突患者的切牙区腭侧的牙槽骨发生显著吸收,减少整个切牙区的牙槽骨量,需关注其对牙周组织的长期影响。Objective:To analyze the changes of labial-palatal alveolar bone in the maxillary incisor region in patients with bimaxillary protrusion,and to provide potential reference for a safe orthodontic tooth movement.Methods:Twenty-three adult patients who were diagnosed with bimaxillary protrusion were enrolled in the study.All patients were treated with straight wire appliances after extraction of four first premolars.Sliding mechanics with en masse retraction were utilized in the all subjects.CBCT images were taken before and after treatment.Following variables were measured to analyze the alveolar bone remodeling in the maxillary incisor region:(1)alveolar bone thickness(ABT);(2)labial and palatal cementoenamel junction-alveolar bone crest height(ABH);(3)labial and palatal alveolar bone area(ABA).Results:The labial ABT at mid-root and apical levels increased significantly in both central and lateral incisors(P<0.05),while the palatal ABT at all three levels consistently decreased after treatment(P<0.05).Regarding the changes of total ABT,significant reduction was observed in central incisors at the crestal and mid-root levels,and in lateral incisors at all three levels(P<0.05).ABA consistently reduced on the palatal side and increased on the labial side after treatment(P<0.05).Significant increase in the palatal ABH was observed at both central and lateral incisors after treatment,while an increase in the labial ABH was found at lateral incisors(P<0.01).Conclusion:Retraction of maxillary incisors in bimaxillary protrusion patients reduced periodontal bone support on the palatal side,leading to less alveolar bone in the maxillary incisor region.Potential risks of reduced alveolar bone on the periodontal sequalae should be further evaluated in the long term.

关 键 词：双颌前突 正畸牙移动 牙槽骨改建 牙周 

分 类 号：R78[医药卫生—口腔医学]