唇舌侧同期骨皮质切开植骨术疗效的前瞻性研究

Clinical and radiographic effect of simultaneously labial and lingual augmented corticotomy:a prospective case series study

目的:评价唇舌侧同期骨皮质切开植骨术的安全性、有效性及临床和影像学效果,为正畸过程中下前牙唇舌侧牙槽骨同时存在厚度不足情况时的手术干预措施提供依据。方法:选取2021年1月至2022年6月年于北京大学口腔医学院·口腔医院第四门诊部就诊、需要接受正畸-正颌联合治疗、治疗前或治疗中锥形束CT示下前牙唇舌侧骨板厚度均<0.5 mm的患者10例[男性2例,女性8例,年龄(26.2±3.1)岁,共60颗患牙],使用唇舌侧同期骨皮质切开植骨术进行治疗。比较患牙术前、术后2周及术后6个月的牙龈退缩情况、龈乳头指数差异,比较术前、术后即刻及术后6个月下前牙唇舌侧牙槽骨厚度差异。结果:术后6个月60颗患牙唇舌侧釉质牙骨质界(cemento-enamel junction,CEJ)根方4、8 mm及根尖水平唇侧[(1.02±0.39)、(2.22±0.89)、(4.87±1.35)mm]及舌侧骨板厚度[(1.07±0.46)、(2.31±1.04)、(3.91±1.29)mm]均显著高于术前[唇侧:(0.02±0.09)、(0.06±0.21)、(2.71±1.33)mm;舌侧:(0.14±0.29)、(0.40±0.52)、(2.13±1.02)mm](P<0.001)。其中在唇侧根尖水平及舌侧CEJ根方8 mm和根尖水平,中切牙[唇侧根尖水平:(2.53±1.20)mm,舌侧CEJ根方8 mm水平:(2.27±1.24)mm,舌侧根尖水平:(2.66±1.49)mm]及侧切牙[唇侧根尖水平:(2.42±1.30)mm,舌侧CEJ根方8 mm水平(2.28±0.92)mm,舌侧根尖水平(1.94±1.15)mm]牙槽骨厚度增加量均显著高于尖牙[唇侧根尖水平:(1.52±1.47)mm,舌侧CEJ根方8 mm水平:(1.17±1.09)mm,舌侧根尖水平:(0.74±1.37)mm](P<0.01)。唇舌侧牙龈退缩程度[术前唇侧:(0.72±0.88)mm,舌侧:(0.80±1.09)mm;术后6个月唇侧(0.72±0.81)mm,舌侧:(0.89±0.21)mm]及龈乳头指数[术前:1.00(0.75,2.00);术后6个月:1.00(1.00,2.00)]术前与术后6个月相比差异均无统计学意义(P>0.05),10例受试者均未出现严重并发症。结论:本组病例采用的唇舌侧同期骨皮质切开植骨术安全可行,该术式对下前牙唇舌侧骨板厚度均<0.5 mm患者正畸治疗中下前牙牙周组织的稳定具有积极的临床意义。

Objective To investigate soft-and hard-tissue changes after simultaneously labial and lingual augmented corticotomy in patients with insufficient alveolar bone thickness of lower anterior teeth both in labial and lingual side during orthodontic treatment.Methods From January 2021 to June 2022,10 patients[2 males and 8 females,(26.2±3.1)years old]who received orthodontic and orthognathic combined treatment from the Fourth Clinical Division,Peking University School and Hospital of Stomatology were selected.The alveolar bone thickness of lower anterior teeth both in labial and lingual side in these patients was less than 0.5 mm according to cone-beam CT examination before or during treatment,and 60 lower anterior teeth were included.The 10 patients were treated with simultaneously labial and lingual augmented corticotomy.The differences in gingival recession,papilla index and the differences in labial and lingual alveolar bone thickness of lower anterior teeth were compared.Results Six months after surgery,the alveolar bone thicknesses at the 4 mm under cemento-enamel junction(CEJ),8 mm under CEJ and at the apical level[labial side:(1.02±0.39),(2.22±0.89)and(4.87±1.35)mm;lingual side:(1.07±0.46),(2.31±1.04)and(3.91±1.29)mm]were significantly higher than that before surgery[labial side:(0.02±0.09),(0.06±0.21)and(2.71±1.33)mm];lingual side:(0.14±0.29),(0.40±0.52)and(2.13±1.02)mm](P<0.001),respectively.The increases in alveolar bone thickness of central incisors[apical level on labial side:(2.53±1.20)mm,8 mm under CEJ on lingual side:(2.27±1.24)mm,apical level on lingual side:(2.66±1.49)mm]and lateral incisors[apical level on labial side:(2.42±1.30)mm,8 mm under CEJ on lingual side:(2.28±0.92)mm,apical level on lingual side:(1.94±1.15)mm]were significantly higher than that of canines[apical level on labial side:(1.52±1.47)mm,8 mm under CEJ on lingual side:(1.17±1.09)mm,apical level on lingual side:(0.74±1.37)mm](P<0.01).There were no significant differences in the degree of gingival recession[labial side before surgery:(0.72±0.88)mm,lingual side before surgery:(0.80±1.09)mm;labial side 6 months after surgery:(0.72±0.81)mm,lingual side 6 months after surgery:(0.89±0.21)mm]and gingival papilla index[before surgery:1.00(0.75,2.00);6 months after surgery:1.00(1.00,2.00)]between pre-operation and 6 months after surgery(P>0.05).No serious complications occurred.Conclusions The method used in this article for simultaneously labial and lingual augmented corticotomy was safe and feasible.This surgery has positive clinical significance for the stability of the periodontal tissue in orthodontic treatment for patients with alveolar bone thickness less than 0.5 mm of lower anterior teeth both in labial and lingual side.