骨性Ⅲ类错颌正畸治疗前行改良骨皮质切开术对矢状方向上牙齿移动模式的影响

Effect of Modified Bone Cortex Incision before Skeletal Class Ⅲ Orthodontic Treatment on Sagittal Direction Tooth Movement Pattern

目的探讨骨性Ⅲ类错颌正畸治疗前行改良骨皮质切开术对矢状方向上牙齿移动模式及牙周组织的影响。方法将2012年2月至2015年2月在湖北医药学院附属东风医院就诊的36例骨性Ⅲ类错颌患者依据随机数字表法分为研究组和对照组,各18例。研究组于牙列排齐后行改良骨皮质切开术,并于术区植入人工骨粉;对照组行常规正畸治疗。比较两组患者术前正畸时间、上颌中切牙与上颌第一磨牙矢状方向移动距离;并分别于手术前、手术后1、2、4、8周检测两组患者角化龈宽度。结果研究组关闭间隙时间及总时间显著短于对照组[(5.9±1.4)个月比(14.1±4.3)个月,(13±3)个月比(19±5)个月],差异有统计学意义(P<0.01)。两组患者手术后角化龈宽度开始增加,至术后1周达到高峰,随后逐渐降低,至术后8周恢复至术前水平,不同时点间差异有统计学意义(P<0.05),组间、组间·不同时点间交互作用差异无统计学意义(P>0.05)。结论骨性Ⅲ类错颌正畸治疗前行改良骨皮质切开术能显著缩短术前正畸时间,且对矢状方向上牙齿移动模式无明显影响,对牙周组织安全性高,值得临床推广。

Objective To explore the effect of modified bone cortex incision before skeletal class Ⅲorthodontic treatment on sagittal direction tooth movement pattern and periodontium. Methods A total of 36 cases of skeletal class Ⅲ orthodontic patients treated in Dongfeng Hospital Affiliated to Hubei University of Medicine from Feb. 2012 to Feb. 2015 were divided into a study group of 18 cases and a control group of 18 cases according to random number table method. The study group underwent modified bone cortex incision and implanted artificial bone after tooth column alignment,whiel the control group was treated with routine orthodontic treatment. The orthodontic time before surgery,maxillary central incisors and the maxillary first molar sagittal direction moving distance of the two groups were compared; the keratinized gingival width of the two groups were detected before surgery,and 1,2,4,8 weeks after surgery. Results Gap closing time and total time of the study group were significantly shorter than the control group [( 5. 9 ± 1. 4) months vs( 14. 1 ± 4. 3) months,( 13 ± 3) months vs( 19 ± 5) months],the differences were statistically significant( P < 0. 01). After operation,the keratinized gingival width began to increase,reached the peak at postoperative 1 week,then decreased gradually,recovered to preoperative levels at 8 weeks after operation,there was significant difference in different time points( P < 0. 05). Difference in groups and the interact in groups·time points was not statistically significant( P > 0. 05). Conclusion The bone cortex incision before skeletal class Ⅲ orthodontic treatment can shorten the orthodontic time significantly,and it has no obvious effect on tooth movement pattern in sagittal direction,and high safety of periodontal tissue,thus is worthy of clinical promotion.