邻面去釉在成人牙周病正畸治疗中的应用

Use of interproximal enamel reduction in adult malocclusion patients with periodontitis

目的:探讨牙周病错患者正畸过程中,通过邻面去釉方法提供间隙的优势。方法:选取2004-2009年于本院口腔科治疗确诊为牙周病的错畸形患者34例,男9例,女25例,平均年龄25.4岁。治疗前,通过模型分析和头影测量分析,得到患者间隙需要量,将邻面去釉作为获得间隙的第一选择进行设计,确定邻面去釉牙位及去釉量,是否仍需减数拔牙以及支抗强度。经系统牙周治疗后,进行固定正畸治疗。排齐牙列后,用细金刚砂针均匀磨除邻面釉质0.25～0.5mm,抛光,涂氟化钠甘油防龋。正畸治疗完成后保持。结果:疗程6～24个月,牙周状况稳定,牙排列整齐,楔形间隙部分或全部消失,前牙覆、覆盖正常,后牙咬合关系良好。治疗后0.5～2a复查,去釉区未见新发龋。结论:邻面去釉用于牙周病错患者的正畸治疗具有明显优势,可以降低治疗难度和牙周风险,缩短疗程,改善牙龈美观,延长牙系统的使用寿命。

PURPOSE：To discuss the advantage of interproximal enamel reduction when it was applied to provide space needed in orthodontic treatment of malocclusion patients with periodontitis.METHODS：Thirty four patients were chosen from those seeking for orthodontic treatment at Stomatology Department of the Third Hospital of Peking University from 2004 to 2009, which includes 9 males and 25 females, the average age was 25.4 years.All of them were diagnosed with periodontitis to some extend.The needed space for orthodontic treatment was achieved for each patient through the procedure of plaster model analysis and cephalometric tracing, then the treatment plan was given on the premise that interproximal enamel reduction was the first choice for creating spaces, the sites and amount of enamel reduction, any still-needed further extraction and the corresponding anchorage were determined.The fixed orthodontic treatment began after systematic periodontal treatment.Needle-shaped fine diamond drill was used for cutting 0.25-0.5mm interproximal enamel after arch alignment, NaF glycerol was used after polishing to decrease caries risk.The result was retained after orthodontic treatment.RESULTS：After 6-24 months＇ orthodontic treatment, the teeth were aligned, the interdental embrasures were shrunk or disappeared, normal overbite, overjet and posterior occlusion were achieved, and periodontal conditions were stable.No new caries were found in the areas of enamel reduction at the 0.5-2 years follow-up examination.CONCLUSION：There is clear superiority to apply interproximal enamel reduction to create space for orthodontic treatment in those patients with periodontitis.By this method, the difficulty and periodontal risk of orthodontic treatment will decrease, the treatment duration will be shorten, the gingival aesthetics will be improved, and the live-span of dentition will be elongated.