慢性牙周炎的减数正畸治疗

Extraction-orthodontic treatment on patients with chronicperiodontitis: a preliminary study

目的:探讨减数正畸治疗对慢性牙周炎患者牙周组织的影响。方法:纳入33名已完成减数正畸治疗的慢性牙周炎患者,通过牙周检查大表和曲面体层片评价减数正畸治疗前(T0)、治疗后(T1)减数牙邻牙(teeth adjacent to extraction sites,TAES)和非减数牙邻牙(non-teeth adjacent to extraction sites,NTAES)的牙周探诊深度(probing depth,PD)和剩余牙槽骨高度(residual alveolar bone height,RBH)的变化。结果:T0时,TAES和NTAES的PD差异无统计学意义[(2.40±0.51)mm vs.(2.42±0.55)mm,P>0.05],T1时,PD差异无统计学意义[(2.70±0.67)mm vs.(2.67±0.64)mm,P>0.05],治疗后PD分别增加0.3 mm[(2.40±0.51)mm vs.(2.70±0.67)mm,P<0.01]和0.25 mm[(2.42±0.55)mm vs.(2.67±0.64)mm,P<0.01],两者变化值差异无统计学意义[(0.30±0.64)mm vs.(0.25±0.58)mm,P>0.05]。T0时,TAES比NTAES的RBH要小0.02(0.74±0.16 vs.0.76±0.16,P<0.05),T1时,两者的RBH差异无统计学意义(0.78±0.14 vs.0.79±0.12,P>0.05);相比治疗前,TAES的RBH显著增加了0.04(0.74±0.16 vs.0.78±0.14,P<0.05),NTAES的RBH显著增加了0.02(0.76±0.16 vs.0.79±0.12,P<0.05),但RBH变化值差异无统计学意义(0.04±0.11 vs.0.02±0.08,P>0.05)。T0时,TAES近减数侧的RBH与远离减数侧的RBH差异无统计学意义(0.73±0.17 vs.0.74±0.16,P>0.05),T1时,近减数侧的RBH显著增加了0.04(0.73±0.11 vs.0.77±0.11,P<0.05),远离减数侧的RBH也显著增加了0.04(0.74±0.11 vs.0.78±0.11,P<0.05),但RBH变化值差异无统计学意义(0.04±0.11 vs.0.04±0.11,P>0.05)。结论:在牙周炎症控制和口腔卫生良好维护的前提下,正畸治疗不会导致慢性牙周炎患者牙周组织进一步的丧失,减数区域的牙槽骨也未见降低。

Objective:To retrospectively evaluate clinical and radiographic records of chronic periodontitis patients who underwent extraction-orthodontic treatment,in order to determine the effect of the treatment on probing depth,alveolar bone height of teeth adjacent to the extraction sites.Methods:In the study,33 chronic periodontitis patients who had finished extraction-orthodontic treatment were selected,the periodontal examination system tables and panoramic tomography were recorded before treatment(T0)and after treatment(T1),and the periodontal probing depth(PD),residual alveolar bone height(RBH)of the teeth adjacent to extraction sites(TAES)and the non-teeth adjacent to extraction sites(NTAES)were measured at T0 and T1.Results:There was insignificant difference in PD of TAES and NTAES at T0[(2.40±0.51)mm vs.(2.42±0.55)mm,P>0.05],neither was that at T1[(2.70±0.67)mm vs.(2.67±0.64)mm,P>0.05];From T0 to T1,PD of TAES and NTAES had mean increases of 0.3 mm[(2.40±0.51)mm vs.(2.70±0.67)mm,P<0.01]and 0.25 mm[(2.42±0.55 mm vs.(2.67±0.64)mm,P<0.01],respectively.And PD of TAES and NTAES increased from T0 to T1 statistically in the same degree[(0.30±0.64)mm vs.(0.25±0.58)mm,P>0.05];at T0,RBH of TAES was 0.024 smaller than that of NTAES(0.74±0.16 vs.0.76±0.16,P<0.05),but there was no difference in RBH between the TAES and NTAES at T1(0.78±0.14 vs.0.79±0.12,P>0.05);From T0 to T1,RBH of TAES and NTAES had mean increases of 0.04(0.74±0.16 vs.0.78±0.14,P<0.05)and 0.02(0.76±0.16 vs.0.79±0.12,P<0.05),respectively.And the change of RBH between TAES and NTAES from T0 to T1 had no statistical difference(0.04±0.11 vs.0.02±0.08,P>0.05)RBH of TAES in the side close to extraction sites was as the same as that of TAES in the side away from the extraction sites at T0(0.73±0.17 vs.0.74±0.16,P>0.05).From T0 to T1,RBH of both sides of TAES had mean increases of 0.04(0.73±0.11 vs.0.77±0.11,P<0.05)and 0.04(0.74±0.11 vs.0.78±0.11,P<0.05),respectively.But for both sides of TAES,from T0 to T1,there was no significant difference in change of RBH(0.04±0.11 vs.0.04±0.11,P>0.05).Conclusions:With strict control of periodontal inflammation and maintenance of oral hygiene,orthodontic treatment preserves the periodontal conditions in patients with chronic periodontitis,and the extraction-orthodontic treatment can preserve the bone height of the teeth adjacent to extraction sites.