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。

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.