,锥形束计算机体层摄影术,骨开裂,骨开窗," /> ,锥形束计算机体层摄影术,骨开裂,骨开窗,"/> Decompensation effectiveness and alveolar bone remodeling analysis of mandibular anterior teeth after preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusion
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Journal of Peking University (Health Sciences) ›› 2023, Vol. 55 ›› Issue (1): 62-69. doi: 10.19723/j.issn.1671-167X.2023.01.009

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Decompensation effectiveness and alveolar bone remodeling analysis of mandibular anterior teeth after preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusion

Yu FU1,Xin-nong HU1,Sheng-jie CUI2,Jie SHI2,*()   

  1. 1. Fourth Clinical Division, 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
  • Received:2022-10-10 Online:2023-02-18 Published:2023-01-31
  • Contact: Jie SHI E-mail:sjlily@yeah.net
  • Supported by:
    the National Natural Science Foundation of China(81901053);New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT-20G02);New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT-22A05)

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Abstract:

Objective: To evaluate the decompensation effectiveness and alveolar bone remodeling of mandibular anterior teeth after preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusion using lateral cephalogram and cone-beam computed tomography (CBCT). Methods: Thirty high-angle patients with skeletal class Ⅱ malocclusion who had received preoperative orthodontic treatment and orthognathic surgery in Peking University School and Hospital of Stomatology between Ja-nuary 2017 and August 2022 and had taken lateral cephalogram and CBCT before and after preoperative orthodontic treatment were selected. Items were measured with lateral cephalogram including: The lower central incisor (L1)-Frankfort plane angle (L1-FH), the L1-mandibular plane angle (L1-MP), the L1-nasion-supramental angle (L1-NB) and the vertical distance from the incisal edge of lower central incisor to NB line (L1-NB distance), etc. The incidence of dehiscence/fenestration and the length of dehiscence at labial side (d-La) and lingual side (d-Li) were measured using CBCT. Pearson correlation analysis was used to evaluate the correlation between the changes of d-Li of L1 and age, duration of preoperative orthodontic treatment and the cephalometric measurements before preoperative orthodontic treatment to screen out risk factors affecting the periodontal risk of preoperative orthodontic treatment in high-angle patients with skeletal class Ⅱ malocclusions. Results: After preoperative orthodontic treatment, L1-FH, L1-MP, L1-NB and L1-NB distances changed by 11.56°±5.62°, -11.13°±5.53°, -11.57°±5.43° and (-4.99±1.89) mm, respectively, and the differences were all statistically significant (P < 0.05). Among the 180 measured mandibular anterior teeth, 45 cases with labial dehiscence/fenestration before preoperative orthodontic treatment (T0) had no longer labial dehiscence/fenestration after preope-rative orthodontic treatment (T1); 142 cases without lingual dehiscence/fenestration at T0 had lingual dehiscence/fenestration at T1. After preoperative orthodontic treatment, the d-La of lower lateral incisors (L2), lower canines (L3) and lower anterior teeth (L1+L2+L3) decreased by (0.95±2.22) mm, (1.20±3.23) mm and (0.68±2.50) mm, respectively, and the differences were statistically significant (P < 0.05); the d-Li of L1, L2, L3 and L1+L2+L3 increased by (4.43±1.94) mm, (4.53±2.35) mm, (3.19±2.80) mm and (4.05±2.46) mm, respectively, and the differences were statistically significant (P < 0.05). The increase of d-Li of L1 was positively correlated with L1-FH (r=0.373, P=0.042). Conclusion: This study showed that high-angle patients with skeletal class Ⅱ ma-locclusion could achieve ideal decompensation effect of mandibular anterior teeth after preoperative orthodontic treatment with bilateral mandibular first premolars extracted, but the lingual periodontal risk of mandibular anterior teeth was increased. This risk could be correlated to L1-FH before preoperative orthodontic treatment, which should be paid more attention in the design of orthodontic-orthognathic surgical treatment.

Key words: Skeletal class Ⅱ malocclusion, Cone-beam computed tomography, Dehiscence, Fenestration

CLC Number: 

  • R783.5

Figure 1

Flow chart of the process of patients' selection and screening PKUSS, Peking University School and Hospital of Stomatology; CBCT, cone-beam computed tomography; ANB, subspinale-nasion-supramental angle; SN-MP, sella-nasion plane-mandibular plane angle."

Figure 2

Measurement plane, landmarks and variables A, horizontal plane; B, coronal plane; C, sagittal plane. M, alveolar crest at the mesial side; D, alveolar crest at the distal side; Mid, average of mesial and distal alveolar crest; d-La, the vertical distance from La (lowest alveolar crest at the labial side) to the mid-plane; d-Li, the vertical distance from Li (lowest alveolar crest at the lingual side) to the mid-plane; Fh, the highest point of the fenestration; Fl, the lowest point of the fenestration; f-La, the vertical distance from Fh to Fl."

Table 1

Basic information of subjects"

Items Female (n=22) Male (n=8) Total (n=30)
Age/years, $\bar x \pm s$ 28.45 ± 5.10 31.5 ± 6.53 29.27 ± 5.56
Duration of preoperative orthodontic treatment/months, $\bar x \pm s$ 20.68 ± 2.97 21.25 ± 3.37 20.83 ± 3.03

Table 2

Paired samples t test on changes of cephalometric variables"

Variables T0 T1 ΔT1-T0 t P
ANB/(°) 9.55 ± 2.02 9.35 ± 2.46 -0.20 ± 0.85 -1.313 0.199
SN-MP/(°) 46.50 ± 4.97 46.19 ± 5.08 -0.31 ± 0.86 -1.998 0.055
FH-MP/(°) 37.19 ± 4.97 36.76 ± 5.18 -0.43 ± 0.86 -2.735 0.011
L1-FH/(°) 42.19 ± 6.05 53.75 ± 5.80 11.56 ± 5.62 11.260 < 0.001
L1-MP/(°) 100.62 ± 5.48 89.49 ± 4.80 -11.13 ± 5.53 -11.011 < 0.001
L1-NB/(°) 40.13 ± 5.32 28.56 ± 4.59 -11.57 ± 5.43 -11.679 < 0.001
L1-NB distance/mm 12.35 ± 2.08 7.36 ± 2.22 -4.99 ± 1.89 -14.486 < 0.001

Table 3

Comparison on numbers of teeth with dehiscence/fenestration before and after preoperative orthodontic treatment"

Location Tooth position Posttreatment conditionPretreatment conditionP
T0 (-) T0 (+)
LabialL1 T1 (-) 35 7 >0.999
T1 (+) 8 10
L2 T1 (-) 20 24 < 0.001
T1 (+) 3 13
L3 T1 (-) 11 14 0.013
T1 (+) 3 32
L1+L2+L3 T1 (-) 66 45 < 0.001
T1 (+) 14 55
LingualL1 T1 (-) 2 0 < 0.001
T1 (+) 47 11
L2 T1 (-) 5 0 < 0.001
T1 (+) 50 5
L3 T1 (-) 13 0 < 0.001
T1 (+) 45 2
L1+L2+L3 T1 (-) 20 0 < 0.001
T1 (+) 142 18

Table 4

Alveolar bone remodeling grading of mandibular anterior teeth with dehiscence/fenestration at T0 after preoperative orthodontic treatment  n(%)"

Location Alveolar bone remodeling grading L1 L2 L3 L1+L2+L3
LabialⅠ 9 (53.0) 33 (89.2) 34 (73.9) 76 (76.0)
Ⅱ 4 (23.5) 3 (8.1) 9 (19.6) 16 (16.0)
Ⅲ 4 (23.5) 1 (2.7) 3 (6.5) 8 (8.0)
LingualⅠ 0 0 0 0
Ⅱ 0 0 1 (50.0) 1 (5.6)
Ⅲ 11 (100.0) 5 (100.0) 1 (50.0) 17 (94.4)

Table 5

Paired t test/Wilcoxon signed rank test on changes of d-La and d-Li"

Tooth position Variables T0 T1 ΔT1-T0 ta/ Zb P
L1 d-La/mm 2.21 ± 1.83 2.33 ± 2.01 0.12 ± 1.63 -0.214 0.831b
d-Li/mm 2.61 ± 1.07 7.04 ± 2.12 4.43 ± 1.94 -6.681 < 0.001b
L2 d-La/mm 3.19 ± 2.92 2.24 ± 2.07 -0.95 ± 2.22 -3.459 0.001b
d-Li/mm 2.17 ± 0.60 6.70 ± 2.63 4.53 ± 2.35 14.906 < 0.001a
L3 d-La/mm 5.22 ± 3.77 4.03 ± 3.02 -1.20 ± 3.23 -3.693 < 0.001b
d-Li/mm 1.77 ± 0.82 4.95 ± 2.85 3.19 ± 2.80 -6.493 < 0.001b
L1+L2+L3 d-La/mm 3.54 ± 3.19 2.86 ± 2.53 -0.68 ± 2.50 -4.481 < 0.001b
d-Li/mm 2.18 ± 0.92 6.23 ± 2.70 4.05 ± 2.46 22.117 < 0.001a

Table 6

Correlation analysis of changes of d-Li of L1"

Variable r P
Age -0.137 0.470
Duration of preoperative orthodontic treatment 0.226 0.231
ANB -0.332 0.074
SN-MP -0.133 0.484
FH-MP -0.096 0.614
L1-FH 0.373 0.042
L1-MP -0.324 0.080
L1-NB -0.351 0.057
L1-NB distance -0.356 0.054
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