埋伏上切牙正畸牵引的临床分析

Clinical analysis of orthodontic traction of impacted upper incisors

目的 探讨埋伏阻生上切牙正畸牵引对牙根、牙周软硬组织的影响。方法 本研究已通过单位伦理委员会审查批准,并获得患者知情同意。选取2018年01月—2022年12月完成阻生上切牙正畸牵引的患者40例,选择对侧同名牙根尖孔未发育完成的为A组(23例),对侧同名牙根尖孔发育完成的为B组(17例)。利用锥形束CT(cone beam CT,CBCT)测量A、B组埋伏的上切牙牵引前后的牙根长度,比较患牙牵引后与对侧同名牙以及1年后患牙的牙槽骨(牙槽骨宽度、唇侧骨板厚度、牙槽骨高度)及角化龈宽度变化。结果 埋伏上切牙牵引后牙根长度较牵引前均有所增长(P<0.05);A组牵引后的牙槽骨宽度接近对侧同名牙牙槽骨宽度(P>0.05),而B组牵引后的牙槽骨宽度无法达到对侧同名牙厚度,差异具有统计学意义(P<0.05),A、B组牵引后的唇侧骨板均无法达到对侧同名牙的高度及厚度(P<0.05),角化龈宽度也显著小于对侧同名牙(P<0.05);但A组1年后的回访中,角化龈宽度显著增长(P<0.05)。结论 对埋伏上切牙牵引,有利于埋伏的上切牙牙根生长、牙槽骨的改建和角化龈的生长,但仍无法达到与对侧同名牙完全对称的状态。

Objective To study the effect of orthodontic traction on the roots and periodontal soft and hard tissues of buried obstructed upper incisors.Methods This study was reviewed and approved by the ethics committee,and in-formed consent was obtained from the patients.From January 2018 to December 2022,40 patients who underwent orth-odontic traction on impacted upper incisors were selected;those whose contralateral homonymous apical foramen was not developed were placed in group A(23 cases),and those whose contralateral homonymous apical foramen was devel-oped were placed in group B(17 cases).Software was used to measure the root length of the impacted upper incisors in groups A and B on cone beam CT(CBCT)images before and after traction and compare the changes in alveolar bone(al-veolar bone width,labral bone plate thickness,and horizontal height of alveolar bone)and keratinized gingival width be-tween each impacted upper incisor and the corresponding contralateral tooth immediately and one year after traction.Results The root length of the impacted upper incisors increased after traction compared to before traction(P<0.05).The width of the alveolar bone at the completion of traction in group A was similar to that of the contralateral homony-mous tooth(P>0.05),whereas the width of the alveolar bone at the completion of traction in group B did not reach that of the contralateral homonymous tooth,with a significant difference in width(P<0.05).Neither the labial bone plate height or width in group A or B reached that of the contralateral homonymous tooth after traction(P<0.05).The keratin-ized gingival width on the affected side was also significantly smaller than that on the contralateral side(P<0.05),but it was increased significantly in group A at the one-year follow-up visit(P<0.05).Conclusion Tooth traction is con-ducive to impacted upper incisor root growth,alveolar bone reconstruction and keratinized gingival growth but cannot produce complete symmetry with respect to the contralateral side.