无托槽隐形矫治联合牙周组织再生术治疗重度牙周炎伴Ⅱ类错颌畸形患者的临床疗效

Clinical effect of invisible correction without brackets combined with guided tissue regeneration in the treatment of severe periodontitis with class Ⅱ malocclusion

目的:探讨无托槽隐形矫治联合牙周组织再生术(Guided tissue regeneration,GTR)在重度牙周炎伴Ⅱ类错颌畸形矫治患者中的应用价值。方法:选取浚县人民医院2018-09至2022-012022-12收治的130例重度牙周炎伴Ⅱ类错颌畸形患者,随机分为无托槽隐形矫治组和常规矫治组,各65例。常规矫治组在GTR术基础上进行金属直丝弓托槽矫治,无托槽隐形矫治组在GTR术基础上联合无托槽隐形矫治。矫治6m后,比较两组临床疗效、疼痛介质(P物质、前列腺素E_(2)(Prostaglandin E_(2),PGE_(2))、降钙素基因相关肽(Calcitonin gene-related peptide,CGRP))、龈沟液炎性因子(细胞间黏附因子-1(Intercellular cell adhesion molecule-1,ICAM-1)、白细胞介素-1β(Interleukin-1β,IL-1β)、基质金属蛋白酶8(Matrix metalloproteinase-8,MMP8))、牙周改善情况(牙周探诊深度(Periodontal depth,PD)、龈沟出血指数(Sulcus bleeding index,SBI)、牙菌斑指数(Plaque index,PLI)、牙龈指数(Gingivalindex,GI))、牙齿功能(咬合力、咀嚼效率)及不良反应情况。结果:矫治6m后,无托槽隐形矫治组总有效率高于常规矫治组(P<0.05);与矫治前相比,矫治6 m后,两组龈沟液P物质、PGE_(2)、CGRP、ICAM-1、IL-1β、MMP8水平、PD、SBI、PLI、GI均降低,咬合力、咀嚼效率均升高,且无托槽隐形矫治组改善程度更为显著(P<0.05);无托槽隐形矫治组不良反应发生率低于常规矫治组(P>0.05)。结论:无托槽隐形矫治联合GTR术用于重度牙周炎伴Ⅱ类错颌畸形患者可提高矫治效果,减轻龈沟液炎性程度,改善牙周状况,有助于减轻患者疼痛,增强牙齿功能,且具有较好安全性。

Objective:To evaluate the clinical value of invisible correction without brackets combined with guided tissue regeneration(GTR)in the treatment of severe periodontitis with class Ⅱ malocclusion.Methods:130 cases of severe periodontitis with class Ⅱ malocclusion treated in Xunxian People's Hospital from 2018-09 to 2022-012022-12 were randomLy divided into the non-bracket invisible treatment group and conventional correction group,65 cases in each group.The conventional treatment group was treated with metal straight wire arch bracket based on GTR,while the non-bracket invisible treatment group was treated with non-bracket invisible correction based on GTR.After 6 months of correction,the clinical efficacy,pain mediator(substance P,prostaglandin E_(2)(PGE_(2)),calcitonin gene-related peptide(CGRP)),gingival fluid inflammatory factor(intercellular cell adhesion molecule-1(ICAM-1),interleukin-1β(IL-1β),matrix metalloproteinase-8(MMP8)),periodontal improvement(periodontal depth(PD),sulcus bleeding index(SBI),plaque index(PLI),gingival index(GI)),dental function(bite force,mastication efficiency)and adverse reactions were compared between the two groups.Results:After 6 months of treatment,the total effective rate of non-bracket invisible treatment group was higher than that of conventional treatment group(P<0.05).Compared with before treatment,after 6 months of treatment,substance P,PGE_(2),CGRP,ICAM-1,IL-1β,MMP8 levels,PD,SBI,PLI and GI of gingival crevicular fluid were decreased in both groups,and biting force and masticatory efficiency were increased,and the improvement was more significant in the non-bracket invisible treatment group(P<0.05).The incidence of adverse reactions in the non-bracket invisible treatment group was lower than that in the conventional correction group(P>0.05).Conclusion:The invisible correction without brackets combined with GTR in patients with severe periodontitis with class II malocclusion can improve the therapeutic effect,reduce the degree of gingival creviculmonary fluid inflammation,improve the periodontal status,help to reduce the pain of patients,enhance the function of teeth,and have good safety.