成人正畸下前牙矢状向内收对牙周硬组织影响的研究  

Effect of Sagittal Retraction of Mandibular Anterior Teeth on Periodontal Hard Tissue in Adult Orthodontics.

作　　者：杨舒 湛渝 任雪峰 马宇 林建 赵沛 张明珠[2] YANG Shu;ZHAN Yu;REN Xuefeng;MA Yu;LIN Jian;ZHAO Pei;ZHANG Mingzhu(Department of Orthodontics,Kunming Stomatological Hospital,Kunming 650011,China;Department of Periodontics,The Affiliated Stomatology Hospital of Kunming Medical University,Kunming 650106,China.)

机构地区：[1]昆明市口腔医院正畸科,云南昆明650011 [2]昆明医科大学附属口腔医学院牙周科,云南昆明650106

出　　处：《口腔医学研究》2024年第12期1091-1097,共7页Journal of Oral Science Research

基　　金：2022年度昆明市卫生健康委员会卫生科研课题项目基金(编号:2022-08-03-003);中青年学术和技术带头人后备人才项目张明珠(编号:202405AC350001)。

摘　　要：目的:观察下前牙矢状向内收的成人正畸患者,在正畸不同时期牙周硬组织的变化,分析下前牙唇舌向倾斜度的变化量与唇侧骨开裂发生率的相关性,为成人正畸治疗中硬组织增量时机选择提供参考依据。方法:选取正畸过程中下前牙需矢状向内收的成人患者20例,在正畸前(T0)、正畸10个月(T1)和正畸20个月(T2)时,进行影像学数据采集。影像学检查:(1)釉牙骨质界(cemeto-enamel junction,CEJ)根方3 mm、5 mm、7 mm处的唇侧牙槽骨厚度(labial bone thickness,LBT);(2)术中骨开裂(dehiscence,DEH)情况与下前牙唇舌向倾斜度(L1-mandibular plane,L1-MP)变化量的相关性分析。对3个时间点进行数据对比分析,探讨下前牙矢状向内收对牙周组织的影响。结果:影像学检查结果:正畸过程中,CEJ根方3 mm、5 mm、7 mm处的LBT先减少后增加,T1比T0,LBT减少(P<0.05);T2比T1,LBT增加(P<0.05),表明正畸前期比后期骨丧失量显著;T1时,中切牙CEJ根方3 mm处LBT减少显著(P<0.05),表明正畸前期中切牙根颈部骨丧失量最显著;T0及T2时,倾斜度变化量与唇侧骨开裂发生率呈正相关;尖牙在正畸过程中骨开裂发生率最高。结论:(1)成人正畸下前牙矢状向内收早期对牙周硬组织的影响较大,会导致唇侧牙槽骨厚度变薄以及骨开裂发生率增高等。(2)牙周组织也具有一定代偿能力,正畸后期变薄的唇侧牙槽骨在正畸后期逐步增厚,但是通过对比不同时期的各项研究指标表明牙周组织的代偿能力远不足以弥补正畸治疗带来的损害。(3)成人正畸下前牙矢状向内收过程中下切牙根颈部骨丧失量最大,尖牙骨开裂发生率最高,对于这些潜在风险较大的位点,应进行牙周实时监控,适时通过控根及牙周软、硬组织增量等措施预防和减少牙周组织的丧失。Objective:Observe the changes of periodontal hard tissue in adult orthodontic patients with sagittal retraction of mandibular anterior teeth at different stages of orthodontic treatment,and to analyze the correlation between the change of labial and lingual inclination of mandibular anterior teeth and the incidence of labial bone dehiscence.Methods:Twenty adult patients with sagittal retraction of mandibular anterior teeth during orthodontic treatment were selected,imaging data were collected before orthodontic treatment(T0),10 months of orthodontic treatment(T1),and 20 months of orthodontic treatment(T2).Imaging examination measured:(1)labial bone thickness(LBT)at 3mm,5mm,and 7mm of the root of cemeto-enamel junction(CEJ);(2)Correlation analysis between intraoperative dehiscence(DEH)and the change of L1-mandibular plane(L1-MP).The data at the three time points were compared and analyzed to reveal the effect of sagittal retraction of mandibular anterior teeth on periodontal tissue.Results:Our imaging examination showed that during orthodontic treatment,LBT at 3 mm,5 mm and 7 mm of CEJ root decreased first and then increased,where LBT was lower at T1 than at T0(P<0.05),and higher at T2 than T1(P<0.05),indicating that the amount of bone loss in the early stage of orthodontic treatment was significantly higher than that in the late stage.At T1,LBT at 3mm of CEJ root of central incisor decreased significantly(P<0.05),indicating that bone loss of central incisor root neck was the most significant in the early orthodontic treatment.At T0 and T2,the change of inclination was positively correlated with the incidence of labial bone dehiscence.The incidence of canine dehiscence was the highest during orthodontic treatment.Conclusion:(1)The early sagittal retraction of anterior teeth under adult orthodontics has a greater impact on periodontal hard tissue,which will lead to a decrease in the thickness of the labial alveolar bone and an increase in the incidence of bone dehiscence.(2)Periodontal tissue also has certain compe

关 键 词：成人 正畸 下前牙 矢状向 牙周组织 

分 类 号：R783.5[医药卫生—口腔医学]