, 安氏Ⅲ类,长期观察,锥形束CT," /> , 安氏Ⅲ类,长期观察,锥形束CT,"/> 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
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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (1): 52-61. doi: 10.19723/j.issn.1671-167X.2023.01.008

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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 XU1,*(),Xiao XU1,Jian-xia HOU1,Xiao-tong LI2,*(),Xiao-xia WANG3   

  1. 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)

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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

CLC Number: 

  • R783.5

Figure 1

Example of measuring alveolar bone thickness and area on CBCT images of the lower anterior teeth, orientated by the root long axis A, example and illustrations of morphometric measurements of the alveolar bone around the lower anterior teeth in skeletal class Ⅲ patients. B, reference points and lines: 1 and 2, cemento-enamel junction (CEJ) points; 3, midpoint of the CEJ; 4 and 5, alveolar crest points; 6, root apex; 7, root long axis, a line from points 3 to 6; 8, 9 and 10, intersecting line perpendicular to the root long axis at 4, 6 and 8 mm apical to the midpoint of the CEJ; 11, intersecting line perpendicular to the root long axis at the root apex. C, measurement variables: ABH, vertical bone level on the labial side, (distance from the CEJ to the alveolar crest parallel to the root long axis); BW-4, labial thickness at 4 mm apical to the CEJ; BW-6, labial thickness at 6 mm apical to the CEJ; BW-8, labial thickness at 8 mm apical to the CEJ; BW-a, labial thickness at the apex; BA-4, LA-4 and WA-4, labial, lingual and whole area at 4 mm apical to the CEJ; BA-6, LA-6 and WA-6, labial, lingual and whole area at 6 mm apical to the CEJ; BA-8, LA-8 and WA-8, labial, lingual and whole area at 8 mm apical to the CEJ; BA-a, LA-a and WA-a, labial, lingual and whole area at the apex."

Table 1

Comparison of periodontal clinical parameters before and after the periodontal-orthodontic-orthognathic combined treatment of lower anterior teeth in patients with skeletal Angle class Ⅲ malocclusion"

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 -1.439b 0.945a -0.762b -0.707b 7.231a
  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 -2.313b 1.842a -1.428b -1.380b 8.716a
  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 -1.830b 1.311a -1.795b -1.000b 10.229a
  P value 0.067 0.198 0.073 0.317 < 0.001*

Table 2

Comparison of periodontal biotypes before and after the periodontal-orthodontic-orthognathic combined treatment of lower anterior teeth in patients with skeletal Angle class Ⅲ malocclusion"

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

Figure 2

Comparison of labial alveolar bone thickness before and after the periodontal-orthodontic-orthognathic combined treatment of lower anterior teeth in patients with skeletal Angle class Ⅲ malocclusion T0, before treatment; T1, 6 months after PCRS; T2, 12 months after PCRS; T3, before orthognathic surgery; T4, after the periodontal-orthodontic-orthognathic combined treatment. A, labial alveolar bone thickness at 4 mm apical to the CEJ; B, labial alveolar bone thickness at 6 mm apical to the CEJ; C, labial alveolar bone thickness at 8 mm apical to the CEJ; D, labial alveolar bone thickness from toot apex to CEJ."

Table 3

Comparison of labial alveolar bone area before and after the periodontal-orthodontic-orthognathic combined treatment of lower anterior teeth in patients with skeletal Angle class Ⅲ malocclusion"

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

Table 4

Comparison of the whole alveolar bone area before and after the periodontal-orthodontic-orthognathic combined treatment of lower anterior teeth in patients with skeletal Angle class Ⅲ malocclusion"

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

Figure 3

Comparison of alveolar bone heights before and after the periodontal-orthodontic-orthognathic combined treatment of lower anterior teeth in patients with skeletal Angle class Ⅲ malocclusion T0, before treatment; T1, 6 months after PCRS; T2, 12 months after PCRS; T3, before orthognathic surgery; T4, after the periodontal-orthodontic-orthognathic combined treatment. *P < 0.05, a significant difference."

Figure 4

Example of soft tissue changes of lower anterior teeth in a patient with skeletal Angle class Ⅲ malocclusion during the periodontal-orthodontic-orthognathic combined treatment A, before treatment; B, 6 months after PCRS; C, 12 months after PCRS; D, before orthognathic surgery; E, after the periodontal-orthodontic-orthognathic combined treatment."

Figure 5

Example of alveolar bone changes of lower anterior teeth in a patient with skeletal Angle class Ⅲ malocclusion during the periodontal-orthodontic-orthognathic combined treatment A, canine before treatment; B, lateral incisor before treatment; C, central incisor before treatment; D, canine 6 months after PCRS; E, lateral incisor 6 months after PCRS; F, central incisor 6 months after PCRS; G, canine 12 months after PCRS; H, lateral incisor 12 months after PCRS; I, central incisor 12 months after PCRS; J, canine before orthognathic surgery; K, lateral incisor before orthognathic surgery; L, central incisor before orthognathic surgery; M, canine after the periodontal-orthodontic-orthognathic combined treatment; N, lateral incisor after the periodontal-orthodontic-orthognathic combined treatment; O, central incisor after the periodontal-orthodontic-orthognathic combined treatment."

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