伴错[牙合]畸形的侵袭性牙周炎患者牙周-正畸联合治疗长期疗效的影响因素分析

Influential factors related to the long-term effect of periodontal-orthodontic treatment in patients with aggressive periodontitis and malocclusion

目的分析侵袭性牙周炎(aggressive periodontitis,AgP)患者牙周-正畸联合治疗长期疗效的相关影响因素。方法纳入2002年1月至2010年9月于北京大学口腔医学院·口腔医院牙周科就诊,并完成牙周-正畸治疗的AgP患者25例,收集初诊(T0)、正畸治疗完成后(T1)、正畸结束3年以上末次复查(T2)时的全口根尖X线片,通过根尖X线片评价患者根形态异常情况、正畸前后剩余牙槽骨高度(residual alveolar bone height,RBH)的变化。评价根形态异常对牙周-正畸治疗的影响,并进行多因素分析,评价与正畸后长期牙槽骨高度变化相关的牙和个体水平因素。结果T0、T1时统计25例患者的693颗牙,T2期随访14例患者,共观测368颗牙。牙周-正畸治疗前后,牙槽骨高度变化的主要影响因素为根形态异常(估计值为-2.392)、牙位(上颌牙vs.下颌牙估计值为3.139;前牙vs.后牙估计值为?3.469)和T0期的牙槽骨高度变化(估计值为-0.391)(P<0.05)。根形态异常、下颌牙、前牙以及T0时牙槽骨高度高,都是牙槽骨增加的不利因素。正畸后长期观察,牙槽骨高度变化的主要影响因素为牙位(上颌牙vs.下颌牙估计值为3.735;前牙vs.后牙估计值为-5.318)、T0时探诊深度(估计值为-1.594)和T0时牙槽骨高度(估计值为-0.498)(P<0.05)。下颌牙、前牙、T0时牙槽骨高度增加和T0探诊深度增加,都是正畸后长期牙槽骨增加的不利因素。结论多因素分析显示,正畸治疗结束时,牙槽骨高度变化的主要影响因素为根形态异常、牙位和T0时牙槽骨高度;正畸后3年以上复查,牙槽骨高度变化的主要影响因素为牙位、T0时的探诊深度和T0时牙槽骨高度。

Objective To investigate the influential factors related to the long-term effect of periodontal-orthodontic treatment in patients with aggressive periodontitis(AgP).Methods A retrospective analysis was conducted in 25 AgP patients,who have received periodontal-orthodontic treatment in Peking University School and Hospital of Stomatology.Changes in the ratio of the residual alveolar bone height(RBH)was measured at three time points:baseline(T0),post orthodontic treatment(T1),and the last re-visit 3 years after orthodontic treatment(T2).Root abnormity was evaluated by observing periapical radiographs,and its relationship with alveolar bone loss after orthodontic treatment was analyzed.A multi-level analysis on factors related to the clinical outcome(alveolar bone height change)was performed.Results Totally 693 teeth of 25 patients at T0 and T1 and 368 teeth of 14 patients at T2 were investigated.During the periodontal-orthodontic treatment,the RBH was mainly influenced by root abnormity(estimation value?2.392),tooth position(estimation value for upper teeth vs.lower teeth 3.139,and anterior teeth vs.posterior teeth?3.469)and the baseline RBH at T0(estimation value?0.391)(P<0.05).Teeth with root abnormity,teeth in mandibular and anterior area,and teeth with higher RBH showed less change in T1-T0 RBH values.In the long-term follow-up,RBH was mainly influenced by tooth position(estimation value for upper teeth vs.lower teeth 3.735,and anterior teeth vs.posterior teeth?5.318),the baseline RBH and probing depth(PD)at T0.Teeth in mandibular and anterior area,teeth with higher RBH(estimation value-0.498)and PD(estimation value-1.594)(P<0.05)showed less change in T0-T2 RBH values.Conclusions During orthodontic treatment,teeth with abnormal root,lower teeth,anterior teeth,and teeth with high RBH were unfavorable factors for bone gain.In the long-term observation,lower teeth,anterior teeth,teeth with high RBH and PD at first visit were unfavorable factors for bone gain.