不同矢状骨面型高角成年女性上颌磨牙区牙槽骨复合体的研究

A morphological study on upper molar dental-alveolar complex in high-angle adult females with different sagittal skeletal patterns

目的通过锥形束CT比较高角成年女性不同矢状骨面型的上颌磨牙区牙槽骨复合体在三维方向上的差异,探究不同矢状骨面型与上颌磨牙区牙槽骨复合体形态的相关性。方法本回顾性研究选取90例高角成年女性作为研究对象,按ANB分为骨性Ⅰ类30例,骨性Ⅱ类30例,骨性Ⅲ类30例。拍摄锥形束CT并使用三维影像测量分析软件测量上颌磨牙区牙槽骨复合体的相关指标,采用独立样本t检验、单因素方差分析比较三组间上颌磨牙区牙槽骨复合体的形态特点。结果骨性Ⅲ类高角患者的第一恒磨牙牙槽弓宽度[(60.24±4.86) mm]较骨性Ⅰ类[(62.63±2.45) mm]和Ⅱ类[(63.22±3.07) mm]更窄(P=0.005),基骨弓宽度[(62.55±4.17) mm]分别小于骨性Ⅰ类[(64.97±3.89) mm]和Ⅱ类[(64.21±3.09) mm](P=0.042),磨牙转矩(98.05°±5.82°)较骨性Ⅰ类[(94.80°±5.38°)]和Ⅱ类[(93.04°±5.45°)]更加颊倾(P=0.003),且腭侧骨板(101.83°±5.31°)较骨性Ⅰ类[(104.78°±7.13°)]和Ⅱ类[(106.39°±6.78°)]更加更直立(P=0.025),远颊根根尖骨厚度[(4.25±1.18) mm]较骨性Ⅰ类[(4.81±1.33) mm]和Ⅱ类[(4.77±1.23) mm]更薄(P=0.017),腭根根尖骨厚度[(3.46±0.96) mm]也较骨性Ⅰ类[(3.85±1.05) mm]和Ⅱ类[(4.11±1.14) mm]更薄(P=0.049)。此外,骨性Ⅲ类的腭高度[(20.97±2.37) mm]小于骨性Ⅰ类[(22.78±2.21) mm]和Ⅱ类[(22.11±2.61) mm](P=0.016)。矢状向上,骨性Ⅲ类和Ⅱ类上颌第一恒磨牙与腭平面的后下夹角分别为83.89°±6.52°、77.65°±5.37°,骨性Ⅱ类上颌第一恒磨牙更为远中倾斜(P<0.001)。牙弓宽度、牙弓后段的牙槽骨长度、上颌第二恒磨牙近远中向倾斜度等三组间差别则无统计学意义。结论在高角成年女性患者中,不同矢状骨面型的上颌磨牙区牙槽骨复合体在三维方向上存在差异,提示临床正畸治疗中要注意高角患者牙齿移动的生理边界。

Objective To compare the three-dimensional differences of upper molar dental-alveolar complex with different sagittal skeletal patterns in adult female with high angle by cone beam CT,and to explore the correlation between different sagittal skeletal patterns and the morphology of dental-alveolar complex in maxillary molar regions.Methods The retrospective study selected 90 adult females with high angle,and divided them into three groups according to the ANB angle,which are groups skeletal ClassⅠ,Ⅱ,andⅢ,with each group comprised of 30 cases.Cone beam CTs were taken,and the indexes were reconstructed and measured by using 3D image measurement analysis software.And the characteristics of the alveolar bone complex among the three groups were compared by independent sample t test and one-way ANOVA analysis of variance.Results The alveolar arch width of the maxillary first molars with high angle skeletal classⅢ[(60.24±4.86)]mm was narrower than that in patients with skeletal classⅠ[(62.63±2.45)mm]and classⅡ[(63.22±3.07)mm](P=0.005),and the basal arch width[(62.55±4.17)mm]was smaller than that in patients with skeletal classⅠ[(64.97±3.89)mm]and classⅡ[(64.21±3.09)mm]respectively(P=0.042).The molar torque[(98.05°±5.82°)]was more buccal than that in patients with skeletal classⅠ[(94.80°±5.38°)]and classⅡ[(93.04°±5.45°)](P=0.003).And paletal bone plate were more upright[(101.83±5.31)]°than that in patients with skeletal classⅠ[(104.78°±7.13°)]and classⅡ[(106.39°±6.78°)](P=0.025).The distal buccal apical bone thickness[(4.25±1.18)mm]was thinner than skeletal classⅠ[(4.81±1.33)mm]and classⅡ[(4.77±1.23)mm](P=0.017),and the palatal apical bone thickness[(3.46±0.96)mm]was thinner than skeletal classⅠ[(3.85±1.05)mm]and classⅡ[(4.11±1.14)mm](P=0.049).In addition,the palate height of skeletal classⅢ[(20.97±2.37)mm]was lower than that of classⅠ[(22.78±2.21)mm]and classⅡ[(22.11±2.61)mm]respectively(P=0.016).The skeletal classⅢmaxillary first molars were mesially tilted[(83.89°±6.52°)],while the skeletal classⅡwere distally inclined[(77.65°±5.37°)](P<0.001).There were no significant differences in arch width,posterior alveolar length,mesial and distal inclination of maxillary second molars.Conclusions In adult females with high angle,there are three-dimensional morphological differences in upper molar dental-alveolar complex among different sagittal skeletal types.It is suggested that we should pay attention to the physiological boundary of tooth movement in patients with high angle in clinical orthodontics.