正畸治疗中前牙牙槽骨唇侧骨性凸起1例报道及文献回顾  

Labial protuberances of anterior alveolar bone in orthodontic treatment:a case report and literature review

作　　者：周伟[1] 汤雅 肖健平[1] 郝静[3] 谭葆春[1] ZHOU Wei;TANG Ya;XIAO Jianping;HAO Jing;TAN Baochun(Department of Periodontology,Nanjing Stomatological Hospital,Affiliated Hospital of Medical School,Research Institute of Stomatology,Nanjing University,Nanjing 210008,China;The Second Outpatient Department,Nanjing Stomatological Hospital,Affiliated Hospital of Medical School,Research Institute of Stomatology,Nanjing University,Nanjing 210008,China;Department of Orthodontics,Nanjing Stomatological Hospital,Affiliated Hospital of Medical School,Research Institute of Stomatology,Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属口腔医院牙周病科,南京市口腔医院,南京大学口腔医学研究所,江苏南京210008 [2]南京大学医学院附属口腔医院第二门诊部,南京市口腔医院,南京大学口腔医学研究所,江苏南京210008 [3]南京大学医学院附属口腔医院口腔正畸科,南京市口腔医院,南京大学口腔医学研究所,江苏南京210008

出　　处：《口腔疾病防治》2025年第5期393-400,共8页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家重点研发计划项目(2022YFC2504200);南京大学医学院附属口腔医院2015学科带头人后备人才资助项目(JSDW202246)。

摘　　要：目的探讨正畸治疗中前牙牙槽骨唇侧骨性凸起的影响因素、形成机制及治疗方法,为临床提供参考。方法报道1例上前牙11、21缺失,12、22倾斜移动内收后导致唇侧骨性凸起、牙龈增生,进而进行牙周骨成形手术及牙龈成形术治疗的病例,并结合相关文献分析前牙内收时牙槽骨的具体变化及其改建特点,总结正畸患者唇侧骨凸形成的影响因素、机制以及预防和治疗方法。结果牙周术后半年随访,12、22牙龈色形质良好,唇侧牙槽骨基本正常,效果稳定;患者对唇侧牙龈及骨外形满意。文献复习显示,唇侧骨性凸起多见于成年正畸患者,前牙内收的距离(>4 mm)和移动速度与其形成相关,主要机制可能是牙槽骨的差异改建。成年患者牙槽骨中活性成骨细胞和破骨细胞减少,代谢活性和总体细胞活性下降,降低了牙槽骨的反应性,导致前牙内收后,唇侧骨吸收不足。此外,牙槽间隔缺乏机械应力介导的牙周膜,该区域骨改建刺激减少,导致上前牙唇侧牙槽骨增厚。骨皮质和骨松质改建速率不一致,唇侧靠近牙根表面的松质骨增生活跃,而靠近外表面的皮质骨吸收缓慢,最终表现为唇侧牙颈部骨厚度增加。本研究病例分析表明,该病例上前牙内收距离约为6 mm,11、21缺失处牙槽骨因缺少牙周膜刺激,骨改建和吸收较少,表现为增生。唇侧骨性凸起的预防主要是控制前牙内收的速度和距离。体积较小的唇侧骨性凸起一般无需治疗,影响功能及美观的唇侧骨性凸起可采取牙周骨成形手术。结论正畸内收前牙后,唇侧牙槽骨有时会出现明显、坚硬的骨性凸起,这可能是唇侧不同区域牙槽骨改建效率差异所致。对于影响美观或功能的骨性凸起,可采取牙周骨成形手术。Objective This study aims to explore the influencing factors,formation mechanisms,and treatment methods of labial protuberance in the anterior maxilla during orthodontic treatment,providing a reference for clinical practice.Method This study reports a case where the absence of upper anterior teeth 11 and 21,and the retraction tilting movement of teeth 12 and 22,resulted in labial protuberance and gingival hyperplasia.Alveolar osteoplasty and gingivoplasty were performed.The specific changes in the alveolar bone during the retraction of the anterior teeth and the characteristics of its remodeling were analyzed.Combined with relevant literature,the factors influencing the formation of labial protuberance in orthodontic patients,mechanisms,and methods for prevention and treatment were summarized.Results After periodental surgery follow-up for 6 months,the gingival color and shape of teeth 12 and 22 were good,the labial alveolar bone was normal,and the overall condition was stable.A review of the literature showed that labial protuberance is more common in adult orthodontic patients,and the distance(>4 mm)and speed of retraction of anterior teeth are related to its formation,with the main mechanism likely being differential remodeling of the alveolar bone.In adult patients,the number of active osteoblasts and osteoclasts in the alveolar bone decreases,along with a reduction in metabolic activity and overall cellular activity,which diminishes the reactivity of the alveolar bone.After treatment of anterior teeth retraction,there is insufficient labial bone resorption.Moreover,the lack of mechanical stressmediated periodontal ligament in the interdental space leads to reduced bone remodeling stimulation in this area,resulting in thickening of the labial alveolar bone of the upper anterior teeth.The remodeling rates of cortical and trabecular bone differ,with active trabecular bone proliferation near the tooth root surface and slow cortical bone resorption near the outer surface,which ultimately results in increased bone

关 键 词：唇侧骨性凸起 骨疣 正畸治疗 内收前牙 内收距离 骨改建 牙槽骨 牙龈成形术 牙槽骨修整术 

分 类 号：R78[医药卫生—口腔医学]