锥形束CT三维体积测量评估骨性Ⅲ类错正畸正颌治疗后的牙根吸收

doi:10.19723/j.issn.1671-167X.2022.04.022

北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (4): 719-726. doi: 10.19723/j.issn.1671-167X.2022.04.022

锥形束CT三维体积测量评估骨性Ⅲ类错正畸正颌治疗后的牙根吸收

高娟^1,²,吕航苗¹,马慧敏¹,赵一姣³,李小彤^1,*()

1. 北京大学口腔医学院·口腔医院正畸科，国家口腔医学中心，国家口腔疾病临床医学研究中心，口腔生物材料和数字诊疗装备国家工程研究中心，口腔数字医学北京市重点实验室，国家卫生健康委员会口腔医学计算机应用工程技术研究中心，北京 100081
2. 贵阳市口腔医院正畸科，贵阳 550002
3. 北京大学口腔医学院·口腔医院口腔医学数字化研究中心，北京 100081

收稿日期:2021-05-12 出版日期:2022-08-18 发布日期:2022-08-11
通讯作者: 李小彤 E-mail:xiaotonglee@hotmail.com
基金资助:
北京大学口腔医院新技术新疗法基金(PKUSSNCT-19B04);国家重大疾病多学科合作诊疗能力建设项目(PKUSSNMP-201902);贵阳市科技计划项目：筑科合同([2019]9-7-9)

Evaluation of root resorption after surgical orthodontic treatment of skeletal Class Ⅲ malocclusion by three-dimensional volumetric measurement with cone-beam CT

Juan GAO^1,²,Hang-miao LV¹,Hui-min MA¹,Yi-jiao ZHAO³,Xiao-tong LI^1,*()

1. Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry, Beijing 100081, China
2. Department of Orthodontics, Guiyang Stomatological Hospital, Guiyang 550002, China
3. Digital Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing 100081, China

Received:2021-05-12 Online:2022-08-18 Published:2022-08-11
Contact: Xiao-tong LI E-mail:xiaotonglee@hotmail.com
Supported by:
the New Technology and New Therapy Fund of Peking University Stomatology Hospital(PKUSSNCT-19B04);the National Multi-disciplinary Collaborative Diagnosis and Treatment Capacity Building Project for Major Diseases(PKUSSNMP-201902);the Guiyang Science and Technology Project([2019]9-7-9)

摘要/Abstract

摘要：

目的: 探索运用锥形束CT(cone-beam computed tomography，CBCT)三维重建技术测量牙根体积的方法，研究骨性Ⅲ类错患者在正畸正颌联合治疗过程中，上下颌中切牙的牙根长度、牙根体积变化规律和牙根吸收的特点。方法: 选取20例因骨性Ⅲ类错行正畸正颌联合治疗的患者，于正畸去代偿治疗前1周内(T0)、正畸去代偿治疗后正颌手术前1周内(T1)及术后正畸治疗结束后1周内(T2)三个时间点拍摄CBCT，应用三维重建技术测量上下颌中切牙的牙根长度、牙根体积(包括牙根总体积、根颈部及根体部体积)，计算长度减小百分比和体积减小百分比，并测量正畸治疗前后牙齿移动的距离。数据用SPSS 20.0软件进行统计分析，服从正态分布的组间两两比较采用最小显著性差异法(least significant difference，LSD)，不服从正态分布的组间比较采用非参数检验。比较上下颌中切牙牙根长度和牙根体积变化的差异，分析其变化规律和牙根吸收的特点。结果: 骨性Ⅲ类错患者在正畸正颌联合治疗过程中，上下颌中切牙的牙根长度和牙根体积均明显减小(P < 0.05)，根颈部和根体部的牙根体积均明显减小(P < 0.05)，根体部牙根体积的减小量更加显著，上中切牙根体部牙根体积减小量百分比为(30.51±23.23)%，下中切牙为(23.24±11.96)%。与上中切牙相比，下中切牙牙根体积的减小量和减小量百分比均较小，且上中切牙根体部的体积减小量大于下中切牙，差异有统计学意义(P < 0.05)。术前正畸阶段去代偿治疗上颌中切牙以控根移动方式腭向移动，下颌中切牙移动方式为唇向倾斜移动。结论: 骨性Ⅲ类错患者在正畸正颌联合治疗过程中，上下颌中切牙的牙根长度和牙根总体积均减小，变化规律相似。牙根体积测量提示牙根根颈部也存在牙根吸收。上下颌中切牙牙根吸收量的差异可能与牙齿移动的距离和方式相关。利用CBCT三维重建体积测量评估牙根吸收可以弥补牙根长度测量的局限性。

关键词: ')">骨性Ⅲ类错, 正畸正颌治疗, 锥形束CT, 牙根吸收

Abstract:

Objective: To explore the method of measuring root volume with cone-beam computed tomography (CBCT) three-dimensional reconstruction technology, and to study root length and root volume of upper and lower central incisors in patients with skeletal Class Ⅲ malocclusion treated by surgical orthodontic treatment. Methods: Twenty patients with skeletal Class Ⅲ malocclusion undergoing surgical orthodontic treatment were selected. CBCT data at three time points, before decompensation treatment (T0), after decompensation treatment (before orthognathic surgery, T1), and the end of post-operative orthodontic treatment (T2) were collected. Three-dimensional reconstruction technology was used to measure the root length and root volume of the upper and lower central incisors (including total root volume, cervical root and apical root), calculate the percentage of reduction volume, and measure the distance of tooth movement after orthodontic treatment. Data were statistically analyzed by SPSS 20.0 software. Least significant difference (LSD) method was used for pair comparison between the groups subject to normal distribution, and non-parametric test was used for comparison between the groups not subject to normal distribution. The differences of root length and root volume of upper and lower incisors were compared, and the characteristics of root absorption were analyzed. Results: Root length and root volume of the upper and lower central incisors were reduced during the surgical orthodontic treatment (P < 0.05) in cases. Both the root volume of cervical root and apical root were significantly reduced (P < 0.05), the reduction of apical root was more significant. The percentage of root volume reduction of the upper central incisor was (30.51±23.23)%, and lower central incisor (23.24±11.96)%. Compared with the upper central incisor, the root volume reduction amount and percentage of the lower central incisor were smaller, and apical root volume reduction of the upper central incisor was greater than that of the lower central incisor, which was statistically significant (P < 0.05). During pre-surgical orthodontic treatment, maxillary central incisor palatal moving was in a controlled tipping manner, and the mandibular central incisor tipped labially. Conclusion: In patients with skeletal Class Ⅲ malocclusion, root length and total root volume of upper and lower central incisors decreased during surgical orthodontic treatment. Root volume measurement indicated that the cervical root also had root resorption. The difference in root resorption of the upper and lower central incisors might be related to the distance and direction of teeth movement. CBCT three-dimensional reconstruction will compensate for the limitation of root length measurement in evaluating root resorption.

Key words: Skeletal Class Ⅲ malocclusion, Surgical orthodontic treatment, Cone-beam computed tomography, Tooth root resorption

中图分类号:

R783.5

高娟,吕航苗,马慧敏,赵一姣,李小彤. 锥形束CT三维体积测量评估骨性Ⅲ类错正畸正颌治疗后的牙根吸收[J]. 北京大学学报（医学版）, 2022, 54(4): 719-726.

Juan GAO,Hang-miao LV,Hui-min MA,Yi-jiao ZHAO,Xiao-tong LI. Evaluation of root resorption after surgical orthodontic treatment of skeletal Class Ⅲ malocclusion by three-dimensional volumetric measurement with cone-beam CT[J]. Journal of Peking University (Health Sciences), 2022, 54(4): 719-726.

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参考文献 24

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Change parts	T0, $\bar x \pm s$	T1, $\bar x \pm s$	T2, $\bar x \pm s$	P	Comparison among groups
Upper central incisor
Root length/mm	10.47±2.13	9.41±2.36	8.95±2.37	< 0.001	T0>T1>T2
Total root volume/mm³	156.90±31.77	145.29±31.49	135.16±31.46	< 0.001	T0>T1>T2
Root apical volume/mm³	62.55±21.74	53.13±22.47	46.88±21.96	< 0.001	T0>T1>T2
Root cervical volume/mm³	94.34±15.16	92.15±15.83	88.27±15.41	0.001	(T0, T1)>T2
Under central incisor
Root length/mm	10.97±0.91	10.16±0.93	9.72±0.86	< 0.001	T0>T1>T2
Total root volume/mm³	98.07±15.18	89.04±17.10	82.69±16.37	< 0.001	T0>T1>T2
Root apical volume/mm³	43.71±8.95	37.72±9.28	33.72±9.25	< 0.001	T0>T1>T2
Root cervical volume/mm³	54.35±8.28	51.32±10.27	48.96±9.05	< 0.001	(T0, T1)>(T1, T2)

Items	Upper central incisor, $\bar x \pm s$	Under central incisor, $\bar x \pm s$	P
Root length/mm	1.51±1.34	1.24±0.70	0.41
Total root volume/mm³	21.73±13.81	15.38±7.78	0.08
Root apical volume/mm³	15.66±9.63	9.99±5.54	0.04
Root cervical volume/mm³	6.07±7.06	5.39±4.54	0.69
Percentage of root length/%	14.86±12.39	11.21±5.94	0.24
Volume percentage of total root/%	13.96±8.44	15.93±8.15	0.39
Volume percentage of root apical/%	30.51±23.23	23.24±11.96	0.15
Volume percentage of root neck/%	6.37±7.55	10.03±8.52	0.11

Items	Root neck, $\bar x \pm s$	Root body, $\bar x \pm s$	P
Upper central incisor
Volume change/mm³	6.07±7.06	15.66±9.63	< 0.001
Volume reduction percentage/%	6.37±7.54	30.51±23.23	< 0.001
Under central incisor
Volume change/mm³	5.39±4.53	9.99±5.54	0.005
Volume reduction percentage/%	10.02±8.51	23.23±11.96	< 0.001

Items	T0, $\bar x \pm s$	T1, $\bar x \pm s$	T1′, $\bar x \pm s$	T2, $\bar x \pm s$	ΔT1-T0, $\bar x \pm s$	ΔT2-T1′, $\bar x \pm s$	P1 (T1-T0)	P2 (T2-T1)
Upper central incisor
S-edge/mm	70.43±5.72	66.51±5.63	64.24±6.09	65.66±5.58	-3.92±1.78	1.42±2.73	< 0.001	0.048
V-edge/mm	76.14±3.72	77.26±3.54	75.24±3.67	74.11±3.21	1.12±1.63	-1.13±2.25	0.012	0.055
S-root/mm	57.75±5.54	56.31±6.00	57.55±4.79	56.82±4.77	-1.44±1.63	-0.73±1.42	0.002	0.050
V-root/mm	57.17±4.04	57.84±3.79	56.12±4.13	56.36±3.78	0.67±1.14	0.24±1.57	0.027	0.537
Under central incisor
S-edge/mm	71.44±7.72	74.61±8.45	61.81±6.17	62.49±5.67	3.16±1.97	1.06±2.79	< 0.001	0.151
V-edge/mm	77.16±5.07	78.06±4.49	74.36±3.84	72.25±3.54	0.89±1.82	-2.30±2.63	0.070	0.003
S-root/mm	64.79±8.09	64.42±9.03	53.18±6.33	54.57±5.81	-0.37±2.05	1.91±3.68	0.485	0.056
V-root/mm	96.76±4.02	95.55±3.95	91.32±3.70	89.55±3.82	-1.22±1.60	-1.84±2.31	0.011	0.006

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锥形束CT三维体积测量评估骨性Ⅲ类错正畸正颌治疗后的牙根吸收

Evaluation of root resorption after surgical orthodontic treatment of skeletal Class Ⅲ malocclusion by three-dimensional volumetric measurement with cone-beam CT

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