锥形束CT在辅助微种植体支抗植入及评价成人安氏Ⅱ类1分类错(牙合)畸形患者矫治效果中的应用研究
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摘要
目的:探究锥形束计算机断层扫描(Cone-Beam Computed Tomography, CBCT)在辅助微种植体支抗植入及评价成人安氏Ⅱ类1分类错(牙合)畸形患者矫治效果中的应用价值。方法:选取2015年7月-2016年3月笔者医院正畸科收治的102例安氏Ⅱ类1分类错(牙合)畸形患者为研究对象。所有患者均在CBCT引导下进行微型种植体支抗拔牙矫治,并记录患者治疗前后CBCT扫描数据,观察患者牙槽骨开裂、开窗发生情况,比较治疗前后患者软组织和牙槽骨等各项指标的变化。结果:患者治疗后Ns-Sn-Pos、NLA等软组织指标均明显优于治疗前,有显著性差异,具有统计学意义(P<0.01),ULL、LLL优于治疗前,差异有统计学意义(P<0.05);UA、LA等牙槽骨指标明显优于治疗前,差异有统计学意义(P<0.01);上、下中切牙、侧切牙的牙根长度较治疗前明显缩短,有统计学意义(P<0.01),下颌尖牙牙根长度较矫治前稍有缩短,差异有统计学意义(P<0.05),上颌尖牙牙根长度较矫治前无明显变化,两组比较差异无统计学意义(P>0.05);患者矫治后均有前牙区牙槽骨开窗、开裂情况发生,但发生率较低,其中前牙区牙槽骨总开裂率为17.00%,总开窗率为7.76%。结论:CBCT在辅助微种植体支抗植入及评价成人安氏Ⅱ类1分类错(牙合)畸形患者矫治效果中作用显著,通过提高矫治方案的科学性、准确性有效提高了矫治效果,同时降低了患者牙槽骨开裂、开窗风险,值得临床推广使用。
Objective To investigate the value of Cone-Beam Computed Tomography(CBCT) in assisting micro-implant anchorage implantation and evaluating the correction effect of adult Class Ⅱ division 1 malocclusion. Methods A total of 102 patients with Class Ⅱ division 1 malocclusion were enrolled in the orthodontics department from July 2015 to March 2016. All patients underwent CBCT-guided micro-implant support for tooth extraction, and recorded CBCT scan data before and after treatment, and observed the occurrence of alveolar bone cracking and fenestration, and compared soft tissue and alveolar bone before and after treatment. The change. Results The soft tissue indexes of Ns-Sn-Pos and NLA were significantly better than those before treatment. The difference was statistically significant(P<0.01). ULL and LLL were better than before treatment,and the difference was statistically significant(P<0.05); the indexes of alveolar bone such as UA and LA were significantly better than those before treatment, and the difference was statistically significant(P<0.01). The length of roots of upper and lower incisors and lateral incisors was significantly shorter than that before treatment. The difference was statistically significant(P<0.01). The length of the mandibular canine was slightly shorter than that before the treatment. The difference was statistically significant(P<0.05). The length of the maxillary canine had no significant change before the correction. The difference was not statistically significant(P>0.05). After the correction, the anterior teeth alveolar bone fenestration and cracking occurred, but the incidence was low. The total cleavage rate of the alveolar bone in the anterior region was 17.00%.The window opening rate is 7.76%. Conclusion CBCT has a significant value in the application of micro-implant anchorage implantation and evaluation of the treatment of adult Class Ⅱdivision 1 malocclusion. It improves the correction and the accuracy and accuracy of the correction plan. The risk of alveolar bone cracking and window opening is worthy of clinical use.
Objective To investigate the value of Cone-Beam Computed Tomography(CBCT) in assisting micro-implant anchorage implantation and evaluating the correction effect of adult Class Ⅱ division 1 malocclusion. Methods A total of 102 patients with Class Ⅱ division 1 malocclusion were enrolled in the orthodontics department from July 2015 to March 2016. All patients underwent CBCT-guided micro-implant support for tooth extraction, and recorded CBCT scan data before and after treatment, and observed the occurrence of alveolar bone cracking and fenestration, and compared soft tissue and alveolar bone before and after treatment. The change. Results The soft tissue indexes of Ns-Sn-Pos and NLA were significantly better than those before treatment. The difference was statistically significant(P<0.01). ULL and LLL were better than before treatment,and the difference was statistically significant(P<0.05); the indexes of alveolar bone such as UA and LA were significantly better than those before treatment, and the difference was statistically significant(P<0.01). The length of roots of upper and lower incisors and lateral incisors was significantly shorter than that before treatment. The difference was statistically significant(P<0.01). The length of the mandibular canine was slightly shorter than that before the treatment. The difference was statistically significant(P<0.05). The length of the maxillary canine had no significant change before the correction. The difference was not statistically significant(P>0.05). After the correction, the anterior teeth alveolar bone fenestration and cracking occurred, but the incidence was low. The total cleavage rate of the alveolar bone in the anterior region was 17.00%.The window opening rate is 7.76%. Conclusion CBCT has a significant value in the application of micro-implant anchorage implantation and evaluation of the treatment of adult Class Ⅱdivision 1 malocclusion. It improves the correction and the accuracy and accuracy of the correction plan. The risk of alveolar bone cracking and window opening is worthy of clinical use.
引文
[1]梅银娥,吴湣,周昶,等.武汉市东西湖区高三学生口腔健康状况调查[J].临床口腔医学杂志,2015,31(11):688-689.
[2]Schloss T,Sonntag D,Kohli MR3,et al.A comparison of two-and threedimensional healing assessment after endodontic surgery using CBCTvolumes or periapical radiographs[J].J Endod,2017,43(7):1072-1079.
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[4]邓如平,张漫.基于CBCT对错牙合畸形切牙区牙槽骨形态的研究[J].口腔医学研究,2018,34(5):535-538.
[5]Walter C,Schmidt JC,Dula K,et al.Cone beam computed tomography(CBCT)for diagnosis and treatment planning in periodontology:asystematic review[J].Quintessence Int,2016,47(1):25-27.
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[7]肖遥,罗茂璇.CBCT评价儿童上后牙颊侧微种植体支抗植入部位的骨皮质厚度[J].重庆医学,2015,44(2):221-223.
[8]Luo JJ,Dong-Ni LI.Clinical effect of micro-implant anchorage technology in the treatment of dental orthodotics[J].Clin Res Pract,2017,76(4):325-332.
[9]Racvacsz P,Liktor B,Liktor B,et al.Comparative analysis of preoperative diagnostic values of HRCT and CBCT in patients with histologically diagnosed otosclerotic stapes footplates[J].Eur Arch Otorhinolaryngol,2016,273(1):63-72.
[10]刘洪,牟雁东,于晓光,等.口腔正畸治疗中微型种植体支抗的稳定和安全性[J].中国组织工程研究,2016,20(8):1159-1164.
[11]Ozbilek S,Gungor AY,Celik S.Effects of skeletally anchored ClassⅡelastics:a pilot study and new approach for treating ClassⅡmalocclusion[J].Angle Orthod,2017,87(4):108-113.
[12]徐筱,徐莉,江久汇,等.锥形束CT评判安氏Ⅲ类错牙合上前牙骨开裂与骨开窗的准确性分析[J].北京大学学报(医学版),2018,50(1):104-109.
[13]Kajii TS,Fujita T,Sakaguchi Y,et al.Osseous changes of the mandibular condyle affect backward-rotation of the mandibular ramus in Angle Class II orthodontic patients with idiopathic condylar resorption of the temporomandibular joint[J].Cranio,2018,17(1):1-8.
[14]史雨林,商洪涛,田磊,等.骨性Ⅲ类错牙合畸形患者双颌手术前后面部软组织变化的三维研究[J].中国修复重建外科杂志,2018,32(5):612-616.
[15]陈行素,周昕,朱零,等.微型种植体支抗在内收压低前牙中的应用[J].口腔医学,2017,37(5):470-473.
[16]Gamba TO,Alves MC,Haiterneto F.Mandibular sexual dimorphism analysis in CBCT scans[J].J Forensic Leg Med,2016,38(1):106-110.
[17]陈敏,宣桂红.微型种植体支抗对青少年口腔正畸疗效及依从性的影响[J].中国现代医学杂志,2018,28(8):94-97.
[18]Jiang XL,Yan GJ,Huang XY,et al.Clinical investigation of microimplant anchorage in the treatment of orthodontics[J].Progress Mod Biomed,2017,53(1):57-63.
[19]Wu XP,Xuan J,Liu H,et al.Morphological characteristics of the cranial base of early Angle's ClassⅡdivision 1 malocclusion in permanent teeth[J].Int J Morphol,2017,35(2):589-595.
[20]李琳,张敏,王桂子,等.安氏Ⅱ类2分类错牙合牙弓及牙槽骨弓宽度的特点分析[J].牙体牙髓牙周病学杂志,2017,27(1):41-44.
[2]Schloss T,Sonntag D,Kohli MR3,et al.A comparison of two-and threedimensional healing assessment after endodontic surgery using CBCTvolumes or periapical radiographs[J].J Endod,2017,43(7):1072-1079.
[3]夏文倩,顾永佳,高美琴.安氏Ⅱ类1分类和2分类错牙合畸形患者上中切牙区牙槽骨的三维形态分析[J].上海口腔医学,2016,25(1):68-71.
[4]邓如平,张漫.基于CBCT对错牙合畸形切牙区牙槽骨形态的研究[J].口腔医学研究,2018,34(5):535-538.
[5]Walter C,Schmidt JC,Dula K,et al.Cone beam computed tomography(CBCT)for diagnosis and treatment planning in periodontology:asystematic review[J].Quintessence Int,2016,47(1):25-27.
[6]赵岩,屈振宇,刘琳,等.锥形束CT用于骨性安氏Ⅱ类1分类错牙合畸形切牙区唇侧牙槽骨开窗及骨开裂的研究[J].中华口腔正畸学杂志,2016,23(1):2-7.
[7]肖遥,罗茂璇.CBCT评价儿童上后牙颊侧微种植体支抗植入部位的骨皮质厚度[J].重庆医学,2015,44(2):221-223.
[8]Luo JJ,Dong-Ni LI.Clinical effect of micro-implant anchorage technology in the treatment of dental orthodotics[J].Clin Res Pract,2017,76(4):325-332.
[9]Racvacsz P,Liktor B,Liktor B,et al.Comparative analysis of preoperative diagnostic values of HRCT and CBCT in patients with histologically diagnosed otosclerotic stapes footplates[J].Eur Arch Otorhinolaryngol,2016,273(1):63-72.
[10]刘洪,牟雁东,于晓光,等.口腔正畸治疗中微型种植体支抗的稳定和安全性[J].中国组织工程研究,2016,20(8):1159-1164.
[11]Ozbilek S,Gungor AY,Celik S.Effects of skeletally anchored ClassⅡelastics:a pilot study and new approach for treating ClassⅡmalocclusion[J].Angle Orthod,2017,87(4):108-113.
[12]徐筱,徐莉,江久汇,等.锥形束CT评判安氏Ⅲ类错牙合上前牙骨开裂与骨开窗的准确性分析[J].北京大学学报(医学版),2018,50(1):104-109.
[13]Kajii TS,Fujita T,Sakaguchi Y,et al.Osseous changes of the mandibular condyle affect backward-rotation of the mandibular ramus in Angle Class II orthodontic patients with idiopathic condylar resorption of the temporomandibular joint[J].Cranio,2018,17(1):1-8.
[14]史雨林,商洪涛,田磊,等.骨性Ⅲ类错牙合畸形患者双颌手术前后面部软组织变化的三维研究[J].中国修复重建外科杂志,2018,32(5):612-616.
[15]陈行素,周昕,朱零,等.微型种植体支抗在内收压低前牙中的应用[J].口腔医学,2017,37(5):470-473.
[16]Gamba TO,Alves MC,Haiterneto F.Mandibular sexual dimorphism analysis in CBCT scans[J].J Forensic Leg Med,2016,38(1):106-110.
[17]陈敏,宣桂红.微型种植体支抗对青少年口腔正畸疗效及依从性的影响[J].中国现代医学杂志,2018,28(8):94-97.
[18]Jiang XL,Yan GJ,Huang XY,et al.Clinical investigation of microimplant anchorage in the treatment of orthodontics[J].Progress Mod Biomed,2017,53(1):57-63.
[19]Wu XP,Xuan J,Liu H,et al.Morphological characteristics of the cranial base of early Angle's ClassⅡdivision 1 malocclusion in permanent teeth[J].Int J Morphol,2017,35(2):589-595.
[20]李琳,张敏,王桂子,等.安氏Ⅱ类2分类错牙合牙弓及牙槽骨弓宽度的特点分析[J].牙体牙髓牙周病学杂志,2017,27(1):41-44.