隐形与固定矫治后上前牙区牙槽骨改建的对比研究  

A comparative study of alveolar bone remodeling in anterior region:clear aligner vs.fixed appliance

作　　者：张瑞洁 秦文 郭子煜 张明欣 金作林 Zhang Ruijie;Qin Wen;Guo Ziyu;Zhang Mingxin;Jin Zuolin(Department of Orthodontics,State Key Laboratory of Oral&Maxillofacial Reconstruction and Regeneration&National Clinical Research Center for Oral Diseases&Shaanxi Clinical Research Center for Oral Diseases,Department of Orthodontics,School of Stomatology,Fourth Military Medical University,Xi’an 710032,China)

机构地区：[1]口颌系统重建与再生全国重点实验室、国家口腔疾病临床医学研究中心、陕西省口腔疾病临床医学研究中心、第四军医大学口腔医院正畸科,西安710032

出　　处：《中华口腔正畸学杂志》2024年第1期26-30,共5页Chinese Journal of Orthodontics

摘　　要：目的研究固定矫治和隐形矫治治疗拔牙患者内收上前牙后,上前牙区牙槽骨改建情况。方法本回顾研究选取2017至2022年在空军军医大学口腔医院就诊的骨性Ⅰ类成人患者55例,年龄18~35岁,其中固定组30例接受唇侧固定拔牙矫治(男性3例,女性27例),隐形组25例接受无托槽隐形拔牙矫治(男性1例,女性24例)。采集治疗前后的锥形束CT影像,测量正畸治疗前、后上前牙区唇腭侧牙槽骨高度及沿牙长轴方向距离釉牙骨质界3 mm、6 mm、9 mm处唇腭侧牙槽骨厚度(S1、S2、S3),以分析上前牙区牙槽骨改建情况。配对t检验用于分析固定组、隐形组治疗前后不同牙位牙槽骨改建情况;成组t检验用于分析两组间不同牙位牙槽骨改建量的差异,P<0.05为有统计学差异。结果拔牙病例大量内收前牙后,腭侧牙槽骨高度均明显降低:固定组上颌中切牙降低(0.94±1.54)mm(P<0.001),上颌侧切牙降低(2.71±2.79)mm(P<0.001),上颌尖牙降低(1.29±1.33)mm(P<0.001);隐形组上颌中切牙降低(1.51±2.06)mm(P<0.001),上颌侧切牙降低(2.53±3.19)mm(P<0.001),上颌尖牙降低(1.07±1.42)mm(P<0.001),但固定组和隐形组之间没有统计学差异。隐形组上颌中切牙唇侧牙槽骨高度增加(0.32±0.44)mm(P<0.001),而固定组此处牙槽骨高度降低(0.05±0.55)mm(P>0.05),两组间有统计学差异(P<0.001)。内收前牙后唇侧牙槽骨普遍变厚,腭侧牙槽骨普遍变薄。隐形组上颌中切牙S1水平唇侧牙槽骨变厚(0.35±0.38)mm高于固定组(0.11±0.58)mm(P<0.05);隐形组上颌侧切牙S1水平唇侧牙槽骨变厚(0.23±0.52)mm高于固定组(0.03±0.66)mm(P<0.05);隐形组上颌尖牙S3水平腭侧牙槽骨变厚(0.41±1.31)mm高于固定组(0.23±1.56)mm(P<0.05),提示隐形矫治前牙内收容易发生倾斜移动,测量固定组治疗后上颌中切牙冠舌向倾斜9.22°±9.51°(P<0.001),隐形组治疗后上颌中切牙冠舌向倾斜12.85°±6.78°(P<0.001),与前述结果相符。结论正�Objective To evaluate the alveolar bone remodeling in the upper anterior region with clear aligner and fixed appliance treatment.Methods ClassⅠadult patients(18~35 years old)treated between 2017 and 2022 at Air Force Medical University were selected in this retrospective study;thirty patients were treated with orthodontic extraction treatment with fixed appliances(3 males and 27 females)and 25 patients(1 male and 24 females)treated with orthodontic extraction treatment with clear aligners.Cone-beam computed tomography images before and after treatment were collected to measure alveolar bone height in the anterior region and the alveolar bone thickness at 3,6,9 mm from cementum(S1,S2,S3),so as to evaluate the alveolar bone remodeling in the anterior region.Paired-t test was used to analyze alveolar bone remodeling before and after treatment.Group-t test was used to compare the alveolar bone remodeling between the two groups at different dental positions.P<0.05 is considered statistically significant.Results The palatal bone height decreased significantly after orthodontic extraction treatment with a substantial amount of anterior retraction:in fixed appliance group,the palatal bone height decreased(0.94±1.54)mm(P<0.001)at central incisor,(2.71±2.79)mm(P<0.001)at lateral incisor,(1.29±1.33)mm(P<0.001)at canine;in clear aligner group,the palatal bone height decreased(1.51±2.06)mm(P<0.001)at central incisor,(2.53±3.19)mm(P<0.001)at lateral incisor,(1.07±1.42)mm(P<0.001)at canine.However,there was no significant difference between the two groups.The labial bone height at the maxillary central incisor increased by(0.32±0.44)mm(P<0.001)in the clear aligner group,whereas it decreased by(0.05±0.55)mm(P>0.05)in the fixed appliance group.There was significant difference between the two groups(P<0.001).After the anterior tooth retraction,labial bone was generally thickened and palatal bone was generally thinned.The amount of labial bone thickening of central incisors at S1 in the clear aligner group(0.35±0.38)mm w

关 键 词：无托槽隐形矫治 锥形束CT 牙槽骨改建 

分 类 号：R783.5[医药卫生—口腔医学]