青少年上牙弓前突患者拔牙矫治后上前牙区牙槽骨改建的CBCT随访研究

CBCT follow-up study on alveolar bone remodeling in the anterior teeth area of adolescent patients with anterior arch protrusion after tooth extraction correction

目的:研究青少年上牙弓前突患者拔牙治疗后以及经两年恢复期的上颌前牙区牙槽骨改建情况。方法:纳入15例青少年上牙弓前突患者,拔除上颌2颗第一前磨牙后利用种植体支抗结合滑动法关闭拔牙间隙。治疗前(T0),治疗后(T1),保持两年后(T2)拍摄CBCT片,用DophinImaging多平面重建后分别测量上颌中切牙、侧切牙、尖牙在各测量位点牙槽骨厚度(ABA),测量点分别为:釉-牙骨质界下3 mm(CEJ-3 mm)处、牙根颈部、中部、根尖部,分别记为TAC、TA1、TA2、TA3。各牙唇腭侧牙槽嵴顶到CEJ高度(BH)分别记为BCL、BCP,不同阶段间变化量记为Δ。经头颅标志点重叠后测量上颌中切牙水平内收量及垂直压低量,用IBM SPSS Statistics 25.0软件对数据进行分析。结果:T0-T1期,仅尖牙唇侧BH增加,余均减少。T1-T2期,中切牙及侧切牙腭侧有显著增加。T0-T2阶段,中切牙唇侧BH较治疗前增加。T0-T1阶段,各牙TA1、TA2减少,TA3增加。T1-T2期,中切牙及侧切牙TAC增加。T0-T2期,各牙TA1减少。T0-T1期,牙齿水平内收量与ΔBCP呈显著相关,其次是ΔTA3。T0-T2期,ΔBCP、ΔTA2、ΔTA3与牙齿水平内收量呈现低度负相关。T0-T1期,牙齿压低量与ΔTAC呈显著正相关,其次是与ΔTA3、ΔTA1呈低度相关。结论:青少年上牙弓前突患者在拔牙矫治期牙齿的垂直压低量和水平内收量与保持期牙根周围牙槽骨厚度及高度均呈显著正相关性,在保持期牙槽骨厚度增加,高度恢复。

Objective:To study the alveolar bone remodeling of maxillary anterior teeth after extraction treatment and 2-year recovery period in adolescent patients with maxillary an terior arch protrusion.Methods:15 adolescent patients with maxillary anterior arch protrusion were included,2 maxillary first premolars were extracted and implant anchorage combined with sliding method were used to close the extraction gap.CBCT images were taken before treatment(T0),after treatment(T1)and 2 years of recorvery period(T2),respectively.After multi-plane reconstruction with Dophin Imaging,the alveolar bone area(ABA)changes of maxillary central incisor,lateral incisor and canine at cementoenamel junction(CEJ-3 mm),root neck,central part,and root tip were measured and recorded as TAC,TA1,TA2 and TA3 respectively.The labial palatal alveolar crest to CEJ bone height(BH)of each tooth was recorded as BCL,BCP respectively.The data were analyzed by IBM SPSS statistics 25.0.Results:In T0-T2 phase,TA1 of each tooth was reduced.In T0-T1 phase,the horizontal adsorption of teeth was significan tly correlated withΔBCP,followed byΔTA3.In T0-T2 phase,ΔBCP,ΔTA2,ΔTA3 and the horizontal adsorption of teeth showed low negative correlation.In T0-T1 p hase,the vertical reduction of teeth was significantly positively correlated withΔTAC,followed by low correlation withΔTA3 andΔTA1.Conclusion:I n the treatment of anterior arch protrusion after extraction correction in adolescent patients the more the vertical reduction and horizontal adsorption of teeth in the treatment phase,the more the alveolar bone thickness and height around the tooth root in the maintenance phase,which were significantly positively correlated.Reasonable control of the vertical movement of teeth in the alveolar bone can improve the periodontal condition around the teeth to a certain extent.