牙周-正畸-正颌联合治疗骨性安氏Ⅲ类错畸形患者下前牙牙周表型的长期观察

doi:10.19723/j.issn.1671-167X.2023.01.008

北京大学学报（医学版） ›› 2023, Vol. 55 ›› Issue (1): 52-61. doi: 10.19723/j.issn.1671-167X.2023.01.008

牙周-正畸-正颌联合治疗骨性安氏Ⅲ类错畸形患者下前牙牙周表型的长期观察

潘孟乔¹,刘建¹,徐莉^1,*(),徐筱¹,侯建霞¹,李小彤^2,*(),王晓霞³

1. 北京大学口腔医学院·口腔医院牙周科, 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, 国家药品监督管理局口腔生物材料重点实验室, 北京 100081
2. 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, 国家药品监督管理局口腔生物材料重点实验室, 北京 100081
3. 北京大学口腔医学院·口腔医院口腔颌面外科, 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, 国家药品监督管理局口腔生物材料重点实验室, 北京 100081

收稿日期:2022-10-10 出版日期:2023-02-18 发布日期:2023-01-31
通讯作者: 徐莉,李小彤 E-mail:xulihome@263.net;xiaotonglee@hotmail.com
基金资助:
首都临床特色应用研究(Z181100001718111)

A long-term evaluation of periodontal phenotypes before and after the periodontal-orthodontic-orthognathic combined treatment of lower anterior teeth in patients with skeletal Angle class Ⅲ malocclusion

Meng-qiao PAN¹,Jian LIU¹,Li XU^1,*(),Xiao XU¹,Jian-xia HOU¹,Xiao-tong LI^2,*(),Xiao-xia WANG³

1. Department of Periodontology, 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 & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
2. 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 & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
3. Department of Oral and Maxillofacial Surgery, 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 & NMPA Key Laboratory for Dental Materials, Beijing 100081, China

Received:2022-10-10 Online:2023-02-18 Published:2023-01-31
Contact: Li XU,Xiao-tong LI E-mail:xulihome@263.net;xiaotonglee@hotmail.com
Supported by:
the Capital Characteristic Clinical Application Research Project(Z181100001718111)

摘要/Abstract

摘要：

目的: 观察牙周-正畸-正颌联合治疗后的骨性安氏Ⅲ类错畸形患者, 下前牙牙周表型(角化龈和牙槽骨)的变化。方法: 选择2017年3月至2022年6月于北京大学口腔医院正畸科和口腔颌面外科转诊至牙周科的骨性安氏Ⅲ类错畸形患者, 患者均因存在下颌前牙软硬组织不足问题行牙周组织再生结合骨皮质切开术并完成牙周-正畸-正颌联合治疗, 共纳入病例20例, 平均年龄(25.40±4.27)岁, 男6例、女14例, 平均随访(3.70±1.05)年, 共纳入119颗患牙(中切牙39颗, 侧切牙40颗, 尖牙40颗)。软组织采用角化龈宽度及牙周生物型评估, 牙槽骨厚度、面积及高度采用锥形束CT (cone-beam computed tomography, CBCT)测量, 软硬组织共同采用牙周表型描述。结果: 所有患牙治疗后角化龈宽度显著增加(P < 0.001), 中切牙、侧切牙、尖牙分别增加(1.82±1.57) mm、(2.03±1.48) mm、(2.05±1.27) mm。中切牙及侧切牙在治疗后厚龈型比例显著增加(P < 0.001), 尖牙无显著变化。牙周术后及联合治疗后所有下前牙唇侧牙槽骨厚度及面积均显著增加(P < 0.001), 颊舌侧总面积增加(P < 0.001);尖牙颊舌侧总面积基本不变。治疗后各牙位唇侧牙槽骨高度均增加(P < 0.001)。结论: 完成牙周-正畸-正颌系列治疗的骨性安氏Ⅲ类错畸形患者, 牙周表型改善, 长期效果稳定, 可降低牙周并发症风险。

关键词: 牙周表型, , 安氏Ⅲ类')">错, 安氏Ⅲ类, 长期观察, 锥形束CT

Abstract:

Objective: To evaluate the changes of periodontal phenotype (width of keratinized gingiva, thickness and height of alveolar bone) of lower anterior teeth in patients with skeletal class Ⅲ malocclusion before and after the periodontal-orthodontic-orthognathic combined treatment. Methods: In the study, 20 patients with skeletal class Ⅲ malocclusion (6 males and 14 females) completed the periodontal-orthodontic-orthognathic combined treatment were included from March 2017 to June 2022, with 39 central incisors, 40 lateral incisors and 40 canines. The mean age was (25.40±4.27) years (20-34 years). The mean follow-up time was (3.70±1.05) years from the beginning of periodontal corticotomy regenerative surgery (PCRS) to the end of the combined treatment. Cone-beam computed tomography (CBCT) was used to measure the thickness, area and height of alveolar bone by the same researcher, taken before the PCRS (T0), 6 months after the PCRS (T1), 12 months after the PCRS (T2), before the orthognathic surgery (T3), and after the periodontal-orthodontic-orthognathic combined treatment (T4). The periodontal clinical parameters were used to evaluate changes in the soft tissue by another researcher, measured before the PCRS (T0) and after the combined treatment (T4). Changes of soft and hard tissue were evaluated by the periodontal phenotype. Results: The width of keratinized gingiva increased significantly (all P < 0.001) in lower anterior teeth, the central incisors, lateral incisors and canines increased by (1.82±1.57) mm, (2.03±1.48) mm and (2.05±1.27) mm, respectively. The proportion of thick periodontal biotype in the central and lateral incisors increased significantly (all P < 0.001), while the changes of periodontal biotypes in the lower canines were not obvious. The thickness of labial alveolar bone of lower anterior teeth all increased significantly after periodontal corticotomy regenerative surgery and the combined treatment (all P < 0.001). The area of labial alveolar bone of lower anterior teeth also increased significantly after the combined treatment (all P < 0.001). The whole area of labial and lingual alveolar bone of central and lateral incisors increased (P < 0.001), while the whole area of canines remained the same. All The height of the alveolar bone increased (all P < 0.001) on the labial side after the treatment. Conclusion: The periodontal phenotypes of lower anterior teeth were significantly improved after the periodontal-orthodontic-orthognathic combined treatment in patients with skeletal Angle class Ⅲ malocclusion. The improvement was long-termly stable, and the periodontal risk was reduced.

Key words: Periodontal phenotypes, Malocclusion, Angle class Ⅲ, Long-term evaluation, Cone-beam computed tomography

中图分类号:

R783.5

潘孟乔,刘建,徐莉,徐筱,侯建霞,李小彤,王晓霞. 牙周-正畸-正颌联合治疗骨性安氏Ⅲ类错畸形患者下前牙牙周表型的长期观察[J]. 北京大学学报（医学版）, 2023, 55(1): 52-61.

Meng-qiao PAN,Jian LIU,Li XU,Xiao XU,Jian-xia HOU,Xiao-tong LI,Xiao-xia WANG. A long-term evaluation of periodontal phenotypes before and after the periodontal-orthodontic-orthognathic combined treatment of lower anterior teeth in patients with skeletal Angle class Ⅲ malocclusion[J]. Journal of Peking University (Health Sciences), 2023, 55(1): 52-61.

图/表 9

图1

表1

表2

图2

表3

表4

图3

图4

图5

参考文献 22

1	傅民魁, 林久祥. 口腔正畸学[M]. 北京: 北京大学医学出版社, 2014: 270- 271.
2	Kaya Y , Alkan Ö , Keskin S . An evaluation of the gingival biotype and the width of keratinized gingiva in the mandibular anterior region of individuals with different dental malocclusion groups and levels of crowding[J]. Korean J Orthod, 2017, 47 (3): 176- 185. doi: 10.4041/kjod.2017.47.3.176
3	毛铭馨, 徐莉, 靖无迪, 等. 骨性安氏Ⅲ类错畸形患者前牙唇侧牙槽嵴顶位置及相关因素分析[J]. 北京大学学报(医学版), 2020, 52 (1): 77- 82.
4	Guo R , Zhang L , Hu M , et al. Alveolar bone changes in maxillary and mandibular anterior teeth during orthodontic treatment: A systematic review and meta-analysis[J]. Orthod Craniofac Res, 2021, 24 (2): 165- 179. doi: 10.1111/ocr.12421
5	Lee KM , Kim YI , Park SB , et al. Alveolar bone loss around lower incisors during surgical orthodontic treatment in mandibular prognathism[J]. Angle Orthod, 2012, 82 (4): 637- 644. doi: 10.2319/081711-526.1
6	Ma H , Li W , Xu L , et al. Morphometric evaluation of the alveolar bone around central incisors during surgical orthodontic treatment of high-angle skeletal class Ⅲ malocclusion[J]. Orthod Craniofac Res, 2021, 24 (1): 87- 95. doi: 10.1111/ocr.12408
7	Jing WD , Jiao J , Xu L , et al. Periodontal soft- and hard-tissue changes after augmented corticotomy in Chinese adult patients with skeletal Angle class Ⅲ malocclusion: A non-randomized controlled trial[J]. J Periodontol, 2020, 91 (11): 1419- 1428. doi: 10.1002/JPER.19-0522
8	Xu X , Wu JQ , Jiang JH , et al. Periodontal effect of periodontally accelerated osteogenic orthodontics in skeletal Angle class Ⅲ: A nonrandomized, controlled trial[J]. Int J Periodontics Restorative Dent, 2020, 40 (4): e169- e177. doi: 10.11607/prd.4545
9	Wang B , Shen G , Fang B , et al. Augmented corticotomy-assisted surgical orthodontics decompensates lower incisors in Class Ⅲ malocclusion patients[J]. J Oral Maxillofac Surg, 2014, 72 (3): 596- 602. doi: 10.1016/j.joms.2013.08.021
10	Brugnami F , Meuli S , Caiazzo A , et al. Three-dimensional digital planning of class Ⅲ decompensation with clear aligners: Hard and soft tissue augmentation with concomitant corticotomy to stretch the limits of safe orthodontic treatment[J]. J Oral Biol Craniofac Res, 2021, 11 (2): 297- 302. doi: 10.1016/j.jobcr.2021.02.011
11	Malpartida-Carrillo V , Tinedo-Lopez PL , Guerrero ME , et al. Periodontal phenotype: A review of historical and current classifications evaluating different methods and characteristics[J]. J Esthet Restor Dent, 2021, 33 (3): 432- 445. doi: 10.1111/jerd.12661
12	Chapple ILC , Mealey BL , van Dyke TE , et al. Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions[J]. J Clin Periodontol, 2018, 45 (Suppl 20): S68- S77.
13	徐筱, 靖无迪, 侯建霞, 等. 牙周组织再生结合骨皮质切开术辅助骨性Ⅲ类错正畸-正颌治疗一例[J]. 中华口腔医学杂志, 2019, 54 (10): 686- 690.
14	韩烨, 苗莉莉, 靖无迪, 等. 牙周组织再生结合骨皮质切开术对骨性Ⅲ类错牙龈厚度影响的数字化评估[J]. 中华口腔医学杂志, 2020, (2): 73- 79. doi: 10.3760/cma.j.issn.1002-0098.2020.02.001
15	徐筱, 徐莉, 江久汇, 等. 改良骨皮质切开术对牙周组织影响的临床观察[J]. 中华口腔医学杂志, 2014, 49 (6): 343- 346. doi: 10.3760/cma.j.issn.1002-0098.2014.06.006
16	马慧敏, 张婕, 徐莉, 等. 骨性Ⅲ类错畸形患者正畸正颌联合治疗前后前牙区牙槽骨厚度的变化[J]. 中华口腔正畸学杂志, 2018, 25 (3): 121- 124.
17	Choi YJ , Chung CJ , Kim KH . Periodontal consequences of mandibular incisor proclination during presurgical orthodontic treatment in class Ⅲ malocclusion patients[J]. Angle Orthod, 2015, 85 (3): 427- 433. doi: 10.2319/021414-110.1
18	Sun L , Yuan L , Wang B , et al. Changes of alveolar bone dehiscence and fenestration after augmented corticotomy-assisted orthodontic treatment: A CBCT evaluation[J]. Prog Orthod, 2019, 20 (1): 7. doi: 10.1186/s40510-019-0259-z
19	Wang CW , Yu SH , Mandelaris GA , et al. Is periodontal phenotype modification therapy beneficial for patients receiving ortho-dontic treatment? An American Academy of Periodontology best evidence review[J]. J Periodontol, 2020, 91 (3): 299- 310.
20	Zweers J , Thomas RZ , Slot DE , et al. Characteristics of periodontal biotype, its dimensions, associations and prevalence: A systematic review[J]. J Clin Periodontol, 2014, 41 (10): 958- 971.
21	王高南, 焦剑, 周彦恒, 等. 正畸牙齿位置的移动对角化龈宽度的影响[J]. 北京大学学报(医学版), 2019, 51 (5): 931- 936.
22	Vlachodimou E , Fragkioudakis I , Vouros I . Is there an association between the gingival phenotype and the width of keratinized gingiva? A systematic review[J]. Dent J (Basel), 2021, 9 (3): 34.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Items	PLI, M(P₂₅, P₇₅)	PD/mm, $\bar x \pm s$	BI, M(P₂₅, P₇₅)	REC/mm, M(P₂₅, P₇₅)	WKG/mm, $\bar x \pm s$
Central incisors
T0	0.0(0.0, 1.0)	1.96±0.40	1.0(1.0, 2.0)	0.0(0.0, 0.0)	3.83±1.11
T4	0.0(0.0, 1.0)	1.86±0.48	1.0(1.0, 2.0)	0.0(0.0, 0.0)	5.65±1.32
t or Z value	-1.439^b	0.945^a	-0.762^b	-0.707^b	7.231^a
P value	0.150	0.350	0.446	0.480	< 0.001^*
Lateral incisors
T0	1.0(0.0, 1.0)	2.18±0.47	1.0(1.0, 1.0)	0.0(0.0, 0.0)	3.97±1.10
T4	0.0(0.0, 1.0)	1.98±0.48	1.0(1.0, 2.0)	0.0(0.0, 0.0)	6.00±1.29
t or Z value	-2.313^b	1.842^a	-1.428^b	-1.380^b	8.716^a
P value	0.021^*	0.073	0.153	0.168	< 0.001^*
Canines
T0	1.0(0.0, 1.0)	2.31±0.46	1.0(1.0, 1.0)	0.0(0.0, 0.0)	3.41±1.11
T4	0.0(0.0, 1.0)	2.16±0.51	1.0(1.0, 2.0)	0.0(0.0, 0.0)	5.47±1.48
t or Z value	-1.830^b	1.311^a	-1.795^b	-1.000^b	10.229^a
P value	0.067	0.198	0.073	0.317	< 0.001^*

Items	Central incisors	Lateral incisors	Canines
BA-4
T0	0.50±0.62	0.64±0.84	0.13±0.24
T1	2.05±1.71	1.83±1.64	1.26±1.15
T2	2.47±2.02	2.56±1.90	1.47±1.18
T3	2.54±2.08	2.65±2.02	1.40±1.30
T4	2.65±2.15	2.86±1.90	1.72±1.45
P value	< 0.001^*	< 0.001^*	< 0.001^*
Multiple comparison	T0 < T1, T2, T3, T4	T0 < T1 < T2, T3, T4	T0 < T1, T2, T3, T4
BA-6
T0	1.15±1.12	1.21±1.22	0.39±0.50
T1	4.37±2.80	4.13±2.46	2.52±1.65
T2	5.49±3.34	5.47±2.81	3.03±1.87
T3	5.66±3.54	5.60±2.88	2.93±2.03
T4	5.35±2.94	5.62±2.65	3.14±1.96
P value	< 0.001^*	< 0.001^*	< 0.001^*
Multiple comparison	T0 < T1, T2, T3, T4	T0 < T1 < T2, T3, T4	T0 < T1, T2, T3, T4
BA-8
T0	1.68±1.53	1.47±1.32	0.65±0.72
T1	7.88±4.47	7.51±3.44	4.06±2.22
T2	9.32±4.93	8.96±3.61	4.82±2.59
T3	9.50±4.84	9.30±3.80	4.64±2.74
T4	8.86±3.90	9.25±3.76	4.85±2.58
P value	< 0.001^*	< 0.001^*	< 0.001^*
Multiple comparison	T0 < T1, T2, T3, T4	T0 < T1 < T2, T3, T4	T0 < T1, T2, T3, T4
BA-a
T0	4.04±3.18	4.48±2.43	6.10±4.66
T1	14.97±6.85	16.88±6.19	11.86±6.73
T2	16.59±8.03	18.62±6.83	14.08±6.62
T3	16.68±7.57	18.82±7.11	15.14±7.29
T4	15.80±7.35	19.50±10.34	14.98±7.75
P value	< 0.001^*	< 0.001^*	< 0.001^*
Multiple comparison	T0 < T1, T2, T3, T4	T0 < T1, T2, T3, T4	T0 < T1, T2, T3, T4

Items	Central incisors	Lateral incisors	Canines
WA-4
T0	0.87±0.93	1.21±1.14	1.57±2.20
T1	2.37±1.95	2.25±2.01	2.88±2.83
T2	2.67±2.17	2.83±2.05	2.30±1.93
T3	2.78±2.50	2.91±2.24	2.31±2.44
T4	2.85±2.37	3.20±2.09	3.28±3.18
P value	< 0.001^*	< 0.001^*	0.038^*
Multiple comparison	T0 < T1, T2, T3, T4	T0 < T1, T2, T3, T4	T0 < T1, T4
WA-6
T0	2.37±2.05	2.72±2.34	4.19±5.12
T1	5.08±3.16	5.18±3.15	6.10±3.91
T2	5.91±3.55	6.04±3.04	5.29±3.64
T3	6.02±3.93	6.19±3.19	5.22±4.34
T4	5.79±3.25	6.48±3.13	6.55±5.18
P value	< 0.001^*	< 0.001^*	0.174
Multiple comparison	T0 < T1, T2, T3, T4	T0 < T1, T2, T3, T4	T0=T1, T2, T3, T4
WA-8
T0	4.35±3.39	4.30±3.72	7.34±6.91
T1	9.32±4.88	9.31±4.49	10.55±4.97
T2	10.03±5.14	9.90±3.95	9.11±4.90
T3	10.12±5.18	10.21±4.34	8.88±6.04
T4	9.66±4.35	10.70±4.47	10.47±7.12
P value	< 0.001^*	< 0.001^*	0.124
Multiple comparison	T0 < T1, T2, T3, T4	T0 < T1, T2, T3, T4	T0=T1, T2, T3, T4
WA-a
T0	13.71±8.30	15.53±8.66	29.53±15.91
T1	19.51±8.24	22.32±7.85	32.50±14.43
T2	18.58±8.58	21.37±7.85	29.51±14.40
T3	18.46±8.07	21.38±8.10	29.87±14.66
T4	18.01±8.91	22.93±11.59	30.81±17.84
P value	0.028^*	0.002^*	0.911
Multiple comparison	T0 < T1, T2, T3, T4	T0 < T1, T2, T3, T4	T0=T1, T2, T3, T4

[1]	薄士仕,高承志. 基于卷积神经网络实现锥形束CT牙齿分割及牙位标定[J]. 北京大学学报（医学版）, 2024, 56(4): 735-740.
[2]	章锦花,潘洁,孙志鹏,王霄. 不同根管内容物对口腔颌面锥形束CT诊断牙根纵裂准确性的影响[J]. 北京大学学报（医学版）, 2023, 55(2): 333-338.
[3]	叶佳学,梁宇红. 牙髓专科医师应用锥形束CT的现况调查[J]. 北京大学学报（医学版）, 2023, 55(1): 114-119.
[4]	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.
[5]	刘伟涛,王怡然,王雪东,周彦恒. 锥形束CT研究上颌反复扩缩前方牵引后上颌骨缝的三维变化[J]. 北京大学学报（医学版）, 2022, 54(2): 346-355.
[6]	孟圆,张丽琪,赵雅宁,柳登高,张祖燕,高岩. 67例上颌根尖周囊肿的三维影像特点分析[J]. 北京大学学报（医学版）, 2021, 53(2): 396-401.
[7]	曹畅,王菲,王恩博,刘宇. β-磷酸三钙用于下颌第三磨牙拔除术后骨缺损修复的自身对照研究[J]. 北京大学学报（医学版）, 2020, 52(1): 97-102.
[8]	谢晓艳,贾淑梅,孙志辉,张祖燕. 分辨率设置与锥形束CT检测牙根外吸收的可靠性[J]. 北京大学学报（医学版）, 2019, 51(1): 75-79.
[9]	赵一姣，刘怡，孙玉春，王勇. 一种基于曲率连续算法的冠、根三维数据融合方法[J]. 北京大学学报(医学版), 2017, 49(4): 719-723.
[10]	钟金晟, 欧阳翔英, 柳登高, 曹采方. 锥形束CT测量离体下颌磨牙Ⅱ°根分叉病变效果的评价[J]. 北京大学学报（医学版）, 2010, 42(1): 41-45.
[11]	刘怡, James MAH, 许天民. 锥形束计算机断层扫描中牙齿的分割精度[J]. 北京大学学报（医学版）, 2010, 42(1): 98-102.
[12]	王瑞永, 马绪臣, 张万林, 柳登高. 健康成年人颞下颌关节间隙锥形束计算机体层摄影术测量分析[J]. 北京大学学报（医学版）, 2007, 39(5): 503-506.

牙周-正畸-正颌联合治疗骨性安氏Ⅲ类错畸形患者下前牙牙周表型的长期观察

A long-term evaluation of periodontal phenotypes before and after the periodontal-orthodontic-orthognathic combined treatment of lower anterior teeth in patients with skeletal Angle class Ⅲ malocclusion

RICH HTML

PDF (PC)

摘要/Abstract

引用本文

使用本文

图/表 9

参考文献 22

相关文章 12

Metrics

本文评价

推荐阅读 0

Items	Central incisors	Lateral incisors	Canines
Thick BIO
T0	9	8	10
T4	21	22	24
Thin BIO
T0	30	32	30
T4	18	18	16
Z value	-3.207	-3.742	-1.897
P value	< 0.001	< 0.001	0.058