锥形束CT评价成人安氏Ⅱ~1类拔牙后上前牙内收前后牙槽骨变化
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摘要
背景:安氏Ⅱ类错患者临床上常采用拔牙矫治的方案以获得正常的覆、覆盖,改善患者面型及侧貌,此类型患者拔牙后矫治效果与前牙内收量及相应牙槽骨改建量有直接关系。目的:观察安氏Ⅱ~1类成人患者上前牙区内收前后牙槽骨变化。方法:选取30例安氏Ⅱ~1类成年拔牙患者,双颌排齐整平更换不锈钢方丝后稳定1个月(T_0期),采用Ⅱ类牵引滑动内收上前牙,调整前牙覆、覆盖至正常范畴后固定1个月(T_1期)。在T_0期、T_1期拍摄锥形束CT,对上前牙内收量、牙槽骨厚度及高度测量分析。结果与结论:①内收后,上中切牙冠根均舌向移动,内收量牙冠大于牙根;②除根尖区外,前牙区牙槽骨厚度在唇侧增大,腭侧减小(P <0.05),根尖区变化相反;③唇、舌侧牙槽嵴根向降低,腭侧差异有显著性(P <0.05);④结果说明,成人安氏Ⅱ~1类拔牙患者内收过程中上前牙做倾斜移动,内收时上前牙牙槽骨改建与牙齿移动并非一致,唇腭侧均发生活跃的骨改建,但总体表现为骨吸收大于骨增生。
BACKGROUND: Extraction is commonly used for class Ⅱ malocclusion to achieve normal cover and improve facial feature and lateral appearance, and the treatment efficacy is directly related to adduction degree of anterior teeth and alveolar bone reconstruction.OBJECTIVE: To investigate the alveolar bone change of the maxillary anterior region after retraction in adult patients with class Ⅱ~1 malocclusion. METHODS: Thirty adult patients with class Ⅱ~1 malocclusion were selected. After aligned and replaced with stainless steel square wire for 1 month(T_0 stage), the upper anterior teeth were retracted with type Ⅱ traction for 1 month(T_1 stage). Cone-beam CT was made before and at T_0 and T_1 stages. The upper anterior teeth volume, alveolar bone thickness and height were measured. RESULTS AND CONCLUSION:(1) After retraction, the crown of the upper middle incisor was moved lager than root in tongue direction.(2) The thickness of the alveolar bone significantly increased in the labial region except the apical region(P < 0.05), and the apical area changed inversely.(3) Both labial and palatal alveolar ridge decreased, and difference on the palatal side was significant(P < 0.05).(4) In summary, for adult patients with class Ⅱ~1, a tipping movement occurred in the process of anterior retraction. During retraction, the alveolar bone changes are not consistent with the movement of the teeth, and active bone remodeling occurred on both labial and palatal sides, but overall, bone resorption is greater than bone hyperplasia.
BACKGROUND: Extraction is commonly used for class Ⅱ malocclusion to achieve normal cover and improve facial feature and lateral appearance, and the treatment efficacy is directly related to adduction degree of anterior teeth and alveolar bone reconstruction.OBJECTIVE: To investigate the alveolar bone change of the maxillary anterior region after retraction in adult patients with class Ⅱ~1 malocclusion. METHODS: Thirty adult patients with class Ⅱ~1 malocclusion were selected. After aligned and replaced with stainless steel square wire for 1 month(T_0 stage), the upper anterior teeth were retracted with type Ⅱ traction for 1 month(T_1 stage). Cone-beam CT was made before and at T_0 and T_1 stages. The upper anterior teeth volume, alveolar bone thickness and height were measured. RESULTS AND CONCLUSION:(1) After retraction, the crown of the upper middle incisor was moved lager than root in tongue direction.(2) The thickness of the alveolar bone significantly increased in the labial region except the apical region(P < 0.05), and the apical area changed inversely.(3) Both labial and palatal alveolar ridge decreased, and difference on the palatal side was significant(P < 0.05).(4) In summary, for adult patients with class Ⅱ~1, a tipping movement occurred in the process of anterior retraction. During retraction, the alveolar bone changes are not consistent with the movement of the teeth, and active bone remodeling occurred on both labial and palatal sides, but overall, bone resorption is greater than bone hyperplasia.
引文
[1]傅民魁,张丁,王邦康,等.中国25392名儿童与青少年错合畸形患病率的研究[J].华口腔医学杂志, 2002,37(5):371-373.
[2]林久祥,许.赵.口腔正畸学[M].北京:人民卫生出版社,2011:177-178.
[3]Huang M, Hu Y, Yu J, et al.Cone-beam computed tomographic evaluation of the temporomandibular joint and dental characteristics of patients with Class II subdivision malocclusion and asymmetry. Korean J Orthod.2017;47(5):277-288.
[4]Janson G, Branco NC, Morais JF, et al.Smile attractiveness in patients with Class II division 1 subdivision malocclusions treated with different tooth extraction protocols.Eur J Orthod.2014;36(1):1-8.
[5]Schwab DT.The borderline patient and tooth removal. Am J Orthod.1971;59(2):126-145..
[6]Williams R, Hosila FJ. The effect of different extraction sites upon incisor retraction. Am J Orthod. 1976;69(4):388-410.
[7]de Castro N. Second-premolar extraction in clinical practice. Am J Orthod. 1974;65(2):115-137.
[8]Drobocky OB, Smith RJ. Changes in facial profile during orthodontic treatment with extraction of four first premolars. Am J Orthod Dentofacial Orthop. 1989;95(3):220-230.
[9]Makedonas D, Lund H, Hansen K. Root resorption diagnosed with cone beam computed tomography after 6 months and at the end of orthodontic treatment with fixed appliances. Angle Orthod. 2013;83(3):389-393.
[10]Hua Y, Nackaerts O, Duyck J,et al.Bone quality assessment based on cone beam computed tomography imaging. Clin Oral Implants Res.2009;20(8):767-771.
[11]刘映鸿,周泽渊,赵奎,等.青少年患者前牙内收过程中牙槽骨改建情况的锥形束CT研究[J].华西口腔医学杂志, 2016,1(34):78-84.
[12]Nauert K, Berg R.Evaluation of labio-lingual bony support of lower incisors in orthodontically untreated adults with the help of computed tomography. J Orofac Orthop. 1999;60(5):321-334.
[13]Vardimon AD, Graber TM, Voss LR,et al.Determinants controlling iatrogenic external root resorption and repair during and after palatal expansion. Angle Orthod.1991;61(2):113-122; discussion 123-124.
[14]Ahn HW, Moon SC, Baek SH. Morphometric evaluation of changes in the alveolar bone and roots of the maxillary anterior teeth before and after en masse retraction using cone-beam computed tomography.Angle Orthod. 2013;83(2):212-221.
[15]陈香,张向凤,黄倩倩,等.微种植体支抗辅助内收上切牙后牙槽骨改建的锥形束CT研究[J].上海口腔医学,2018,27(2):150-155.
[16]许天民,刘妍,江久汇,等.正畸内收上切牙对上颌牙槽骨改建的临床研究[J].实用口腔医学杂志,2004,20(4):431-433.
[17]Sarikaya S, Haydar B, Ci?er S,et al.Changes in alveolar bone thickness due to retraction of anterior teeth. Am J Orthod Dentofacial Orthop. 2002;122(1):15-26.
[18]Guo QY, Zhang SJ, Liu H, et al.Three-dimensional evaluation of upper anterior alveolar bone dehiscence after incisor retraction and intrusion in adult patients with bimaxillary protrusion malocclusion. J Zhejiang Univ Sci B. 2011;12(12):990-997.
[19]Marks SC Jr, Cahill DR, Wise GE. The cytology of the dental follicle and adjacent alveolar bone during tooth eruption in the dog. Am J Anat.1983;168(3):277-289.
[20]林薇薇,陈金武,成人前牙内收前后切牙牙槽骨高度变化的研究[J].实用口腔医学杂志, 2014. 30(6):823-826.
[21]Cobo J,Argüelles J,Puente M,et al.Dentoalveolar stress from bodily tooth movement at different levels of bone loss. Am J Orthod Dentofacial Orthop.1996;110(3):256-262.
[22]Tanne K,Nagataki T,Inoue Y,et al.Patterns of initial tooth displacements associated with various root lengths and alveolar bone heights.Am J Orthod Dentofacial Orthop.1991;100(1):66-71.
[23]姜若萍,傅民魁.正常汉族成年人前牙区牙槽宽度及根尖位置的研究[J].口腔正畸学,2008,15(1):16-19.
[24]杨雪,钱玉芬.上前牙内收过程中转矩控制的影像学研究[J].上海口腔医学,2016,25(4):469-474.
[2]林久祥,许.赵.口腔正畸学[M].北京:人民卫生出版社,2011:177-178.
[3]Huang M, Hu Y, Yu J, et al.Cone-beam computed tomographic evaluation of the temporomandibular joint and dental characteristics of patients with Class II subdivision malocclusion and asymmetry. Korean J Orthod.2017;47(5):277-288.
[4]Janson G, Branco NC, Morais JF, et al.Smile attractiveness in patients with Class II division 1 subdivision malocclusions treated with different tooth extraction protocols.Eur J Orthod.2014;36(1):1-8.
[5]Schwab DT.The borderline patient and tooth removal. Am J Orthod.1971;59(2):126-145..
[6]Williams R, Hosila FJ. The effect of different extraction sites upon incisor retraction. Am J Orthod. 1976;69(4):388-410.
[7]de Castro N. Second-premolar extraction in clinical practice. Am J Orthod. 1974;65(2):115-137.
[8]Drobocky OB, Smith RJ. Changes in facial profile during orthodontic treatment with extraction of four first premolars. Am J Orthod Dentofacial Orthop. 1989;95(3):220-230.
[9]Makedonas D, Lund H, Hansen K. Root resorption diagnosed with cone beam computed tomography after 6 months and at the end of orthodontic treatment with fixed appliances. Angle Orthod. 2013;83(3):389-393.
[10]Hua Y, Nackaerts O, Duyck J,et al.Bone quality assessment based on cone beam computed tomography imaging. Clin Oral Implants Res.2009;20(8):767-771.
[11]刘映鸿,周泽渊,赵奎,等.青少年患者前牙内收过程中牙槽骨改建情况的锥形束CT研究[J].华西口腔医学杂志, 2016,1(34):78-84.
[12]Nauert K, Berg R.Evaluation of labio-lingual bony support of lower incisors in orthodontically untreated adults with the help of computed tomography. J Orofac Orthop. 1999;60(5):321-334.
[13]Vardimon AD, Graber TM, Voss LR,et al.Determinants controlling iatrogenic external root resorption and repair during and after palatal expansion. Angle Orthod.1991;61(2):113-122; discussion 123-124.
[14]Ahn HW, Moon SC, Baek SH. Morphometric evaluation of changes in the alveolar bone and roots of the maxillary anterior teeth before and after en masse retraction using cone-beam computed tomography.Angle Orthod. 2013;83(2):212-221.
[15]陈香,张向凤,黄倩倩,等.微种植体支抗辅助内收上切牙后牙槽骨改建的锥形束CT研究[J].上海口腔医学,2018,27(2):150-155.
[16]许天民,刘妍,江久汇,等.正畸内收上切牙对上颌牙槽骨改建的临床研究[J].实用口腔医学杂志,2004,20(4):431-433.
[17]Sarikaya S, Haydar B, Ci?er S,et al.Changes in alveolar bone thickness due to retraction of anterior teeth. Am J Orthod Dentofacial Orthop. 2002;122(1):15-26.
[18]Guo QY, Zhang SJ, Liu H, et al.Three-dimensional evaluation of upper anterior alveolar bone dehiscence after incisor retraction and intrusion in adult patients with bimaxillary protrusion malocclusion. J Zhejiang Univ Sci B. 2011;12(12):990-997.
[19]Marks SC Jr, Cahill DR, Wise GE. The cytology of the dental follicle and adjacent alveolar bone during tooth eruption in the dog. Am J Anat.1983;168(3):277-289.
[20]林薇薇,陈金武,成人前牙内收前后切牙牙槽骨高度变化的研究[J].实用口腔医学杂志, 2014. 30(6):823-826.
[21]Cobo J,Argüelles J,Puente M,et al.Dentoalveolar stress from bodily tooth movement at different levels of bone loss. Am J Orthod Dentofacial Orthop.1996;110(3):256-262.
[22]Tanne K,Nagataki T,Inoue Y,et al.Patterns of initial tooth displacements associated with various root lengths and alveolar bone heights.Am J Orthod Dentofacial Orthop.1991;100(1):66-71.
[23]姜若萍,傅民魁.正常汉族成年人前牙区牙槽宽度及根尖位置的研究[J].口腔正畸学,2008,15(1):16-19.
[24]杨雪,钱玉芬.上前牙内收过程中转矩控制的影像学研究[J].上海口腔医学,2016,25(4):469-474.