侵袭性牙周炎患者正畸前后的咬合变化

Occlusal changes before and after orthodontic treatment in patients with aggressive periodontitis

目的:评价侵袭性牙周炎患者行唇侧固定矫治后咬合改善的有效性,探究咬合改善与炎症控制的关系。方法:将纳入的22例牙周-正畸联合治疗患者的牙合相与正畸模型匹配,使用3Shape R700激光扫描仪获得数字化三维模型,在OrthoAnalyzer软件中获得咬合分布图。从咬合分布与邻面接触两方面,对患者治疗前后的咬合变化进行评估。建立治疗后牙周探诊深度降低的多水平线性回归模型,筛选出对炎症控制有利的正畸方法。结果:在全牙列水平上,咬合分布评分在正畸治疗后显著提升(84.5±20.9 vs.105.3±22.6,P<0.001),邻面接触评分在正畸治疗后显著提升(68.9±9.1 vs.83.7±6.3,P<0.001)。在牙位水平上,正畸治疗后的咬合分布评分在上颌前牙区有显著提升(P<0.001),正畸治疗后的邻面接触评分在上下前牙区均有显著提升(P<0.01)。多水平线性回归模型表明年龄和性别与治疗后牙周探诊深度降低未见显著的相关关系(P>0.05)。初始牙周探诊深度、咬合分布评分改善值和邻面接触评分改善值与治疗后牙周探诊深度降低均呈正相关(P<0.001)。结论:正畸治疗后,侵袭性牙周炎患者的咬合力分布、邻面接触均有显著改善。咬合分布评分改善值及邻面接触评分改善值与牙周探诊深度降低呈正相关,提示侵袭性牙周炎患者的牙周-正畸联合治疗中,应改善牙齿的咬合力分布与邻面接触,以促进牙周炎症控制。

Objective:To evaluate the efficacy of occlusal improvement in the labial fixed orthodontic treatment in aggressive periodontitis patients and to explore the relationship between occlusal improvement and inflammation control.Methods:Twenty-two aggressive periodontitis patients who underwent combined periodontal-orthodontic treatment were included in this study.The patient’s photos were matched to the dental models and digital three dimentional models were acquired using 3Shape R700 laser scanner.The occlusal force distribution maps were generated in the OrthoAnalyzer software.The newly established occlusal force distribution score(OFDS)and proximal contact score(PCS)were used to evaluate the occlusal distribution changes before and after labial fixed orthodontic treatment for assessing the effectiveness of orthodontic treatment.The multi-level linear regression analysis was used to explore the relationship between the probing depth changes and OFDS or PCS changes to screen out the favorable orthodontic strategy for inflammation control,which would provide clinical strategy for combined periodontal-orthodontic treatment in aggressive periodontitis patients.Results:At the patient level,OFDS was improved significantly after orthodontic treatment compared with the score before orthodontic treatment(84.5±20.9 vs.105.3±22.6,P<0.001)and PCS was improved significantly after orthodontic treatment compared with the score before orthodontic treatment(68.9±9.1 vs.83.7±6.3,P<0.001).At the tooth level,the OFDS was significantly increased in the maxillary anterior teeth(P<0.001)while the PCS of the anterior teeth in both maxillary and mandible arches were significantly increased significantly(P<0.01).No significant changes were found in other tooth positions.The multi-level linear regression model showed that no significant correlation was found between age and gender and probing depth decrease(P>0.05).The baseline probing depth,OFDS improvements and PCS improvements(P<0.001)were positively correlated with probing depth decrease.Conclusion:This study showed that the distribution of occlusal force was more reasonable and the proximal contacts were more ideal in aggressive periodontitis patients.Orthodontic treatment was effective in improving occlusal force distribution by the above two ways.Especially,the OFDS and PCS improvements were both positively correlated with probing depth decrease,indicating that in the combined periodontal-orthodontic treatment for aggressive periodontitis patients,occlusal force distribution and proximal contact should be improved in order to facilitate periodontal improvement.