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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (1): 77-82. doi: 10.19723/j.issn.1671-167X.2020.01.012

• 论著 • 上一篇    下一篇

骨性安氏Ⅲ类错牙合畸形患者前牙唇侧牙槽嵴顶位置及相关因素分析

毛铭馨1,徐莉1,△(),靖无迪2,徐筱1,侯建霞1,李小彤3,△(),王晓霞4   

  1. 1. 北京大学口腔医学院·口腔医院,牙周科　国家口腔疾病临床医学研究中心　口腔数字化医疗技术和材料国家工程实验室　口腔数字医学北京市重点实验室,北京　100081
    2. 北京协和医院口腔科,北京　100032
    3. 北京大学口腔医学院·口腔医院正畸科,北京　100081
    4. 北京大学口腔医学院·口腔医院口腔颌面外科,北京　100081
  • 收稿日期:2019-10-10 出版日期:2020-02-18 发布日期:2020-02-20
  • 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)

Alveolar crest and relevant analysis of labial side of anterior teeth on skeletal Angle class Ⅲ patients

Ming-xin MAO1,Li XU1,△(),Wu-di JING2,Xiao XU1,Jian-xia HOU1,Xiao-tong LI3,△(),Xiao-xia WANG4   

  1. 1. Department of Periodontology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Department of Periodontology, Peking Union Medical College Hospital, Beijing 100032, China
    3. Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing 100081, China
    4. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing 100081, China
  • Received:2019-10-10 Online:2020-02-18 Published:2020-02-20
  • Contact: Li XU,Xiao-tong LI E-mail:xulihome@263.net;xiaotonglee@hotmail.com
  • Supported by:
    Supported by the Capital Characteristic Clinical Application Research Project(Z181100001718111)

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摘要：

目的:直视下评估骨性安氏Ⅲ类错牙合畸形患者前牙唇侧牙槽嵴顶位置,即釉牙骨质界(cemento-enamel junction,CEJ)到牙槽嵴顶(aleolar crest,AC)距离,并进行相关因素分析。方法:纳入46名骨性安氏Ⅲ类错牙合畸形需牙周手术骨增量的患者,平均年龄23.65岁,男10例、女36例,67个颌位(27个上颌、40个下颌), 共400颗牙,其中161颗上前牙(切牙、侧切牙、尖牙各54、53、54颗)和239颗下前牙(切牙、侧切牙、尖牙各79、80、80颗)。术中用Williams牙周探针直视下测量CEJ到AC距离(CEJ-AC),每颗牙测量近中、中央、远中三个位点,并进行多元回归及分析。结果:前牙唇侧CEJ-AC平均为(2.21±1.48) mm;下前牙CEJ-AC平均为(2.54±1.60) mm,大于上前牙(1.72±1.13) mm,差异有统计学意义(P<0.05)。尖牙CEJ-AC平均为(2.42±1.78) mm,大于中切牙(2.06±1.27) mm或侧切牙(2.16±1.32) mm,差异有统计学意义(P<0.05)。中央CEJ-AC平均为(3.04±2.01) mm,大于近中(1.79±0.86) mm或远中(1.81±0.89) mm,差异有统计学意义(P<0.05)。存在CEJ-AC>2 mm的位点的前牙为233颗,占总数58.25%;存在骨开裂的前牙为117颗,占总数29.25%。多元回归显示,年龄、颌位、牙位、位点与牙槽嵴顶位置相关。结论:行唇侧骨增量的骨性安氏Ⅲ类错牙合畸形患者前牙牙槽嵴顶位置低于一般人群,去代偿正畸过程中存在牙周风险,年龄大、下颌、尖牙及唇侧中央位点风险尤明显。

关键词: 错牙合, 安氏Ⅲ类, 釉牙骨质界, 牙槽嵴顶

Abstract:

Objective: To measure the distance from cemento-enamel junction (CEJ) to alveolar crest (AC) of labial side of anterior teeth on skeletal Angle class Ⅲ patients under direct vision during periodontal bone augmentation surgery and to make relevant analysis to find the relevant factors. Methods: In the study, 46 skeletal Angle class Ⅲ patients (10 males and 36 females) received periodontal bone augmentation surgery of anterior teeth were included, with 67 jaws (27 maxillae and 40 mandibles) and 400 anterior teeth (161 maxillary anterior teeth and 239 mandibular anterior teeth). The mean age was 23.65 years. Maxillary anterior teeth consisted of 54 central incisors, 53 lateral incisors and 54 canines. Mandibular anterior teeth consisted of 79 central incisors, 80 lateral incisors and 80 canines. CEJ-AC was measured in three sites (mesial sites, central sites and distal sites) by Williams periodontal probes during periodontal bone augmentation surgery under direct vision by the same researcher. Results: The average CEJ-AC of 400 anterior teeth was (2.21±1.48) mm. The average CEJ-AC of maxillary anterior teeth was (1.72±1.13) mm, more than (2.54±1.60) mm of mandibular anterior teeth (P<0.05). The average CEJ-AC of canines was (2.42±1.78) mm, more than (2.06±1.27) mm of central incisors or (2.16±1.32) mm of lateral incisors (P<0.05). The average CEJ-AC of central sites was (3.04±2.01) mm, more than (1.79±0.86) mm of mesial sites or (1.81±0.89) mm of distal sites (P<0.05). CEJ-AC of 233 anterior teeth was more than 2 mm, accounting for 58.25%, and 117 anterior teeth with dehiscence were found, accounting for 29.25%. Multilevel and multivariate Logistic regression showed age, jaw, tooth and site were the relevant factors to the position of alveolar crest. Conclusion: The position of alveolar crest of skeletal Angle class Ⅲ patients who received periodontal bone augmentation surgery was lower than that of the general population, causing periodontal risks during decompensation orthodontics therapy before orthognathic surgery. The position of alveolar crest was lower in older patients than in younger patients, in mandibular teeth than in maxillary teeth, in canines than in central incisors or lateral incisors, and in central sites than in mesial sites or distal sites of labial side, which showed much higher risk.

Key words: Malocclusion, Angle class Ⅲ, Cemento-enamel junction, Alveolar crest

中图分类号: 

  • R781.4

图1

牙周手术术中测量CEJ-AC(A,近中;B,中央;C,远中)"

表1

骨性安氏Ⅲ类错牙合畸形患者牙位的分布情况"

Teeth Central incisors Lateral incisors Canines Total
Maxillary 54 53 54 161
Mandible 79 80 80 239
Total 133 133 134 400

表2

上、下颌前牙CEJ-AC结果及比较"

Items Maxillary/mm, x?±s Mandibular/mm, x?±s
Central incisors Lateral incisors Canines Central incisors Lateral incisors Canines
Mesial 1.33±0.64 1.51±0.59 1.60±0.72 1.94±0.91 1.95±0.91 2.08±0.96
Central 1.86±0.92 2.18±1.63 2.45±2.10 3.29±1.79 3.36±1.75 4.22±2.38
Distal 1.47±0.66 1.49±0.56 1.56±0.70 1.96±0.92 2.02±0.75 2.05±1.19
Average 1.72±1.13 2.54±1.60*

图2

不同牙位间牙槽嵴顶位置比较"

图3

不同位点间牙槽嵴顶位置比较"

表3

不同颌位及牙位中央位点牙槽嵴顶位置比较"

Items Central incisors Lateral incisors Canines Average
Maxillary 1.86±0.92 2.18±1.63 2.45±2.10 2.16±1.63
Mandibular 3.29±1.79 3.36±1.75 4.22±2.38 3.63±2.03
Average 2.71±1.66 2.89±1.79 3.51±2.42 3.04±2.01

表4

CEJ-AC>2 mm及有骨开裂牙的分布状况"

Items Central incisors Lateral incisors Canines Total
CEJ-AC>2 mm Dehiscences CEJ-AC>2 mm Dehiscences CEJ-AC>2 mm Dehiscences CEJ-AC>2 mm Dehiscences
Maxillary 13 (24.07) 4 (7.41) 17 (32.08) 4 (7.55) 23 (42.59) 9 (16.67) 53 (32.92) 17 (10.56)
Mandibular 58 (73.42) 31 (39.24) 56 (70.00) 28 (35.00) 66 (82.50) 41 (51.25) 180 (75.31) 100 (41.84)
Total 71 (53.38) 35 (26.32) 73 (54.89) 32 (24.06) 89 (66.42) 50 (37.31) 233 (58.25) 117 (29.25)

表5

牙槽嵴顶位置相关因素的多水平多因素Logistic回归分析"

Relevant factors Estimate OR (95%CI) P
Patient level
Gender (Female as reference) -0.143 0.867 (0.658, 1.142) 0.310
Age 0.131 1.140 (1.113, 1.168) <0.001
Body mass index(BMI) 0.030 1.030 (0.983, 1.080) 0.210
Jaw level (Mandible as reference) -1.470 0.230 (0.184, 0.287) <0.001
Tooth level (Canine as reference)
Central incisor -0.516 0.597 (0.463, 0.770) <0.001
Lateral incisor -0.282 0.754 (0.587, 0.969) 0.028
Site level (Distal site as reference)
Mesial site -0.055 0.946 (0.735, 1.219) 0.668
Central site 1.562 4.768 (0.658, 1.142) <0.001
Probing depth -0.154 0.857 (0.706, 0.961) 0.119
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