伴错畸形的侵袭性牙周炎患者牙周-正畸联合治疗的临床评价

Clinical evaluation of periodontal-orthodontic treatment in patients with aggressive periodontitis and malocclusion

目的:评价伴错畸形的侵袭性牙周炎(aggressive periodontitis,Ag P)患者行牙周-正畸联合治疗的临床疗效及安全性。方法:纳入25名就诊于北京大学口腔医院牙周科并完成牙周-正畸治疗的Ag P患者,回顾性评价初诊(T0)、正畸治疗前(T1)、正畸治疗完成后(T2)的探诊深度(probing depth,PD)、出血指数(bleeding index,BI)、探诊后出血比率(percentage of sites with bleeding on probing,BOP%),通过根尖片评价正畸前后剩余牙槽骨高度(residual alveolar bone height,RBH)的变化及牙根吸收发生状况。结果:(1)在牙周治疗后、正畸治疗前(T1)及正畸治疗完成后(T2),PD、BI、BOP%以及PD>3 mm位点的百分比均有显著降低(P<0.001)。(2)T0时全口RBH均值为68.37%±15.60%,牙周-正畸治疗后RBH为70.27%±14.23%,差异有统计学意义,其中上切牙[T0为58.79%±16.71%,T2为65.54%(55.74%,78.13%)]、上尖牙[T0为77.62%(66.06%,87.17%),T2为79.57%(69.75%,86.52%)]及上磨牙[T0为74.30%(61.69%,84.45%),T2为76.76%(68.12%,85.09%)]在正畸治疗后RBH增高明显(P<0.05)。(3)正畸治疗后人均有23.94%±13.45%的牙发生牙根吸收,其中以下切牙及上切牙的发生率最高,总发生率分别为68.48%和65.31%。结论:伴错畸形的Ag P患者,在规范的牙周治疗后,正畸治疗不会引起牙周炎症加重或牙槽骨吸收;约2/3的上、下切牙可发生轻度的牙根吸收。

Objective： To evaluate the clinical effect and safety of periodontal-orthodontic treatment in patients with aggressive periodontitis（ Ag P） and malocclusion. Methods： A retrospective analysis was conducted in 25 Ag P patients,who had received periodontal-orthodontic treatment in Peking University School and Hospital of Stomatology. Clinical indexes,including probing depth（ PD）,bleeding index（ BI） and percentage of sites with bleeding on probing（ BOP%） were evaluated at three time points：Baseline（ T0）; active periodontal treatment finished and before orthodontic treatment（ T1）; and after orthodontic treatment（ T2）. Also changes of ratio of the residual alveolar bone height（ RBH） and the occurrence of root resorption were evaluated by periapical radiographs. Results：（ 1） Compared with T0,all the clinical parameters including PD,BI,BOP% and percentage of sites with PD 3 mm were significantly improved（ P 〈0. 001）.（ 2） Significant difference was observed in the average RBH between T0（ 68. 37% ± 15. 60% and T2（ 70. 27% ± 14. 23%）. RBH in upper incisors [（ 58. 79% ± 16. 71% at T0,65. 54%（ 55. 74%,78. 13%） at T2 ],upper canines [77. 62%（ 66. 06%,87. 17%） at T0,79. 57%（ 69. 75%,86. 52%） at T2] and upper molars [74. 30%（ 61. 69%,84. 45%） at T0,76. 76%（ 68. 12%,85. 09%） at T2] showed significant increase（ P 〈0. 05）.（ 3） After orthodontic treatment,varying degrees of root resorption occurred in（ 23. 94% ± 13. 45%） of teeth per capita,among which the lower and upper incisors showed the highest incidence（ 68. 48% and 65. 31% in homogeneous teeth,respectively）. Conclusion： After active periodontal treatment,orthodontic treatment in Ag P patients had not aggravated inflammation and alveolar bone resorption; root resorption occurred in two-thirds of incisors approximately.