正畸治疗对青少年和成人牙髓体积影响的比较研究

Comparison of the impact of orthodontic treatment on pulp volume in adolescents and adults

目的探讨正畸治疗对青少年和成人牙髓体积影响的差异,以期更好地控制正畸临床治疗风险。方法回顾性收集2019年1月至2022年3月于重庆医科大学附属口腔医院正畸科接受正畸治疗的62例错畸形患者的锥形束CT数据。按年龄将患者分为2组(每组31例):青少年组,年龄13~17岁,其中男性17例,女性14例;成人组,年龄21~25岁,其中男性12例,女性19例。使用锥形束CT数据对正畸治疗前后双侧上颌第一磨牙(UM1)和下颌中切牙(L1)的牙髓及牙体组织进行重建,并测量UM1及L1的牙髓体积(UM1 P和L1 P)、UM1髓室体积(UM1 PC)和根管体积(UM1 RC)、L1根长(L1 RL)、UM1近中颊根长度(UM1 RL),以及UM1中央窝融合处至髓室顶(H1)、髓室底(H2)、根部分离最近点(H3)及根部分离最远点(H4)水平的距离及髓室高度(H5)。计算两组正畸治疗前后各指标变化量及其绝对值,使用配对样本t检验比较同组各指标正畸治疗前后差异,使用独立样本t检验比较两组各指标变化量绝对值的差异。采用Pearson相关性分析评估H5、根长与牙髓体积变化量之间的潜在相关性。结果正畸治疗前后,成人组L1 P差异无统计学意义(t=-0.03,P=0.975),UM1 P、UM1 PC、UM1 RC差异均有统计学意义(t=9.98,P<0.001;t=9.04,P<0.001;t=6.69,P<0.001)。正畸治疗前后,青少年组L1 P、UM1 P差异均有统计学意义(t=2.25,P=0.029;t=6.30,P<0.001)。两组UM1 P、UM1 PC、L1 P变化量绝对值[青少年组分别为(19.75±9.58)、(15.07±7.65)和(1.89±6.29)mm^(3);成人组分别为(13.33±9.41)、(9.16±7.05)和(0.02±4.66)mm^(3)]差异均有统计学意义(t=3.77,P<0.001;t=4.48,P<0.001;t=2.34,P=0.048)。两组UM1 RC变化量绝对值的差异无统计学意义(t=0.86,P=0.391)。青少年组与成人组L1 RL、H1及H5变化量绝对值[青少年组分别为(0.54±0.41)、(0.38±0.27)和(0.71±0.33)mm;成人组分别为(0.78±0.62)、(0.26±0.20)和(0.57±0.28)mm]差异均有统计学意义(t=-2.43,P=0.017;t=2.96,P=0.004;t=2.57,P=0.011),而两组UM1 RL、H2、H3及H4变化量绝对值差异均无统计学意义(t=-0.85,P=0.400;t=0.43,P=0.669;t=-0.50,P=0.619;t=1.46,P=0.148)。此外,H5和UM1 RL变化量与UM1 P变化量呈弱相关和极弱相关(r=0.35,P<0.001;r=0.19,P=0.030),而L1 RL变化量与L1 P变化量不相关(r=0.11,P>0.05)。结论正畸治疗对青少年和成人牙髓体积的影响存在差异。

Objective To compare the impact of orthodontic treatment on pulp volume in adolescents and adults.Methods Cone-beam CT data of 62 patients undergoing orthodontic treatment at the Department of Orthodontics,Stomatological Hospital of Chongqing Medical University,from January 2019 to March 2022 were collected.Patients were divided into two age groups(31 patients in each group):adolescent group(aged 13-17,17 males and 14 females)and adult group(aged 21-25,12 males and 19 females).Pre-and post-treatment reconstructions of the pulp and dental tissues of upper first molars(UM1)and lower central incisors(L1)were performed.Measurements included pulp volume for UM1(UM1 P)and L1(L1 P),pulp chamber volume(UM1 PC)and root canal volume(UM1 RC)for UM1,root length for L1(L1 RL),and mesiobuccal root length for UM1(UM1 RL),as well as chamber heights at specific landmarks[the lengths from the central fossa fusion site to the roof of the pulp chamber(H1),the floor of the pulp chamber(H2),the nearest point of root divergence as well as crown-root bifurcation(H3),the farthest point of root divergence(H4),and the pulp chamber height(H5)]in UM1.Changes in these indices were calculated and analyzed using paired and independent sample t-tests for within-group and between-group differences,respectively.Pearson correlation was used to assess potential associations among H5,root length,and pulp volume changes.Results Before and after orthodontic treatment,no significant difference was observed in the adult group for L1 P(t=-0.03,P=0.975),while significant differences were noted for UM1 P,UM1 PC,and UM1 RC(t=9.98,P<0.001;t=9.04,P<0.001;t=6.69,P<0.001).In the adolescent group,significant differences were found for both L1 P and UM1 P(t=2.25,P=0.029;t=6.30,P<0.001).After orthodontic treatment,the absolute value changes of UM1 P,UM1 PC,and L1 P in the adolescent group were(19.75±9.58),(15.07±7.65)and(1.89±6.29)mm^(3),respectively,and in the adult group were(13.33±9.41),(9.16±7.05)and(0.02±4.66)mm^(3),respectively(t=3.77,P<0.001;t=4.48,P<0.001;t=2.34,P=0.048).There was no significant absolute difference in the amount of UM1 RC between the two groups after orthodontic treatment(t=0.86,P=0.391).Before and after orthodontic treatment,the absolute value changes of L1 RL,H1 and H5 in the adolescent group were(0.54±0.41),(0.38±0.27)and(0.71±0.33)mm,respectively,and the absolute value changes in the adult group were(0.78±0.62),(0.26±0.20)and(0.57±0.28)mm,respectively(t=-2.43,P=0.017;t=2.96,P=0.004;t=2.57,P=0.011).Whereas no significant differences were observed for UM1 RL,H2,H3,and H4(t=-0.85,P=0.400;t=0.43,P=0.669;t=-0.50,P=0.619;t=1.46,P=0.148).Additionally,significant correlations were found between changes in H5 and UM1 RL with UM1 P(r=0.35,P<0.001;r=0.19,P=0.030),but not between Changes in L1 RL and L1 P(r=0.11,P>0.05).Conclusions The effect of orthodontic treatment on pulp volume in adolescents and adults were different.