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Journal of Peking University(Health Sciences) ›› 2019, Vol. 51 ›› Issue (5): 919-924. doi: 10.19723/j.issn.1671-167X.2019.05.021

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Occlusal changes before and after orthodontic treatment in patients with aggressive periodontitis

Ren-jie DU1,Jian JIAO2,Yan-heng ZHOU1,Jie SHI1,△()   

  1. 1. Department of Orthodontics, 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 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
  • Received:2018-10-08 Online:2019-10-18 Published:2019-10-23
  • Contact: Jie SHI E-mail:sjlily@yeah.net
  • Supported by:
    Supported by the New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(PKUSSNCT-16A03);Supported by the New Clinical Techniques and Therapies of Peking University School and Hospital of Stomatology(YS010118)

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Abstract:

Objective: To evaluate the efficacy of occlusal improvement in the labial fixed orthodontic treatment in aggressive periodontitis patients and to explore the relationship between occlusal improvement and inflammation control. Methods: Twenty-two aggressive periodontitis patients who underwent combined periodontal-orthodontic treatment were included in this study. The patient’s photos were matched to the dental models and digital three dimentional models were acquired using 3Shape R700 laser scanner. The occlusal force distribution maps were generated in the OrthoAnalyzer software. The newly established occlusal force distribution score (OFDS) and proximal contact score (PCS) were used to evaluate the occlusal distribution changes before and after labial fixed orthodontic treatment for assessing the effectiveness of orthodontic treatment. The multi-level linear regression analysis was used to explore the relationship between the probing depth changes and OFDS or PCS changes to screen out the favorable orthodontic strategy for inflammation control, which would provide clinical strategy for combined periodontal-orthodontic treatment in aggressive periodontitis patients. Results: At the patient level, OFDS was improved significantly after orthodontic treatment compared with the score before orthodontic treatment(84.5±20.9 vs.105.3±22.6, P <0.001) and PCS was improved significantly after orthodontic treatment compared with the score before orthodontic treatment(68.9±9.1 vs. 83.7±6.3, P <0.001).At the tooth level, the OFDS was significantly increased in the maxillary anterior teeth (P <0.001) while the PCS of the anterior teeth in both maxillary and mandible arches were significantly increased significantly (P <0.01). No significant changes were found in other tooth positions. The multi-level linear regression model showed that no significant correlation was found between age and gender and probing depth decrease (P >0.05). The baseline probing depth,OFDS improvements and PCS improvements (P <0.001) were positively correlated with probing depth decrease. Conclusion: This study showed that the distribution of occlusal force was more reasonable and the proximal contacts were more ideal in aggressive periodontitis patients. Orthodontic treatment was effective in improving occlusal force distribution by the above two ways. Especially, the OFDS and PCS improvements were both positively correlated with probing depth decrease, indicating that in the combined periodontal-orthodontic treatment for aggressive periodontitis patients, occlusal force distribution and proximal contact should be improved in order to facilitate periodontal improvement.

Key words: Aggressive periodontitis, Malocclusion, Probing depth, Occlusal force distribution

CLC Number: 

  • R783.5

Figure 1

Accumulated points rules for occlusal force distribution score A, example of effective occlusion area; B, compact occlusion contacts on non-supporting cusps of non-functional side (arrow); C, lingual surfaces trisected from incisal edge to gingival margin; D, when the occlusal distribution color is only blue, points will be halved; E, compact occlusion area located on the middle gingiva of two teeth (arrow)."

Table 1

Clinical features of 22 aggressive periodontitis patients"

Variebles n(%)
Gender
Male 6(27.3)
Female 16(72.7)
Angle classification
Ⅰ 4(18.2)
Ⅱ 16(72.7)
Ⅲ 2(9.1)
Classification of periodontitis
Local 1(4.5)
Generalized 21(95.5)
Extraction or not
Extraction 6(27.3)
Non-extraction 16(72.7)
Total 22(100)

Table 2

Paired t test on changes of OFDS and PCS at patient level"

Items Pre-treatment Post-treatment t P
OFDS 84.5±20.9 105.3±22.6 -9.028 <0.001
PCS 68.9±9.1 83.7±6.3 -8.671 <0.001

Table 3

Paired t test on changes of OFDS at tooth level"

OFDS of different tooth position Pre-treatment Post-treatment t P
Maxillary
Left
Central incisor 2.2±1.8 5.2±1.9 -6.890 <0.001
Lateral incisor 2.4±2.0 5.2±1.8 -7.738 <0.001
Canine 3.0±1.7 5.6±1.2 -6.411 <0.001
Second premolar 2.9±1.6 3.2±1.6 -0.646 0.525
First molar 3.6±3.3 4.0±2.5 -0.509 0.616
Second molar 2.3±2.0 2.8±1.6 -1.779 0.090
Right
Central incisor 1.9±1.3 5.5±1.4 -9.279 <0.001
Lateral incisor 2.7±1.5 5.4±1.5 -7.286 <0.001
Canine 3.1±1.6 5.5±0.9 -5.786 <0.001
Second premolar 2.9±1.7 3.5±1.6 -1.204 0.242
First molar 4.0±3.0 4.9±2.4 -1.870 0.076
Second molar 2.6±1.8 3.1±2.1 -0.917 0.369
Mandible
Left
Central incisor 4.8±2.4 5.7±1.3 -2.084 0.050
Lateral incisor 5.0±2.1 5.0±2.1 <0.001 1.000
Canine 5.7±1.3 5.7±1.3 <0.001 1.000
Second premolar 3.5±1.2 3.3±1.5 0.576 0.571
First molar 4.7±2.5 4.8±2.8 -0.234 0.817
Second molar 2.0±1.8 2.1±1.5 -0.568 0.576
Right
Central incisor 4.9±2.4 5.4±1.8 -1.451 0.162
Lateral incisor 5.5±1.8 5.3±1.8 1.000 0.329
Canine 5.6±1.4 5.7±1.3 -1.000 0.329
Second premolar 2.8±1.7 3.1±1.8 -0.819 0.422
First molar 5.0±2.6 3.9±3.2 1.827 0.082
Second molar 2.0±1.5 2.1±1.7 -0.311 0.759

Table 4

Comparison on changes of PCS at tooth level"

PCS of different tooth position Pre-treatment Post-treatment P
Maxillary
Left
Central incisor 2.1±1.5 4.0(4.0, 4.0) <0.001
Lateral incisor 2.6±1.4 3.9±0.4 <0.001
Canine 3.2±1.0 4.0(4.0, 4.0) 0.001
Second premolar 3.8±0.6 3.7±0.7 0.665
First molar 3.8±0.6 3.9±0.5 0.331
Second molar 1.7±0.9 1.9±0.8 0.481
Right
Central incisor 1.7±0.8 3.9±0.4 <0.001
Lateral incisor 2.0±1.6 4.0(4.0, 4.0) <0.001
Canine 2.5±1.6 4.0(4.0, 4.0) <0.001
Second premolar 3.8±0.5 3.9±0.4 0.162
First molar 4.0(4.0, 4.0) 4.0±0.2 0.329
Second molar 1.9±0.4 2.0(2.0, 2.0) 0.329
Mandible
Left
Central incisor 2.8±1.2 3.9±0.4 <0.001
Lateral incisor 2.9±1.2 3.8±0.9 0.001
Canine 3.5±0.7 4.0(4.0, 4.0) 0.009
Second premolar 3.7±0.5 3.9±0.4 0.083
First molar 3.9±0.4 3.9±0.4 1.000
Second molar 1.9±0.4 1.9±0.4 1.000
Right
Central incisor 2.7±1.2 3.9±0.4 <0.001
Lateral incisor 2.9±1.2 3.8±0.9 0.001
Canine 3.3±0.7 4.0(4.0, 4.0) <0.001
Second premolar 4.0±0.2 3.9±0.6 0.540
First molar 4.0±0.2 4.0(4.0, 4.0) 0.329
Second molar 2.0±0.2 2.0(2.0, 2.0) 0.329

Table 5

Multi-level linear regression analysis of probing depth decrease and various level factors"

Items 95%CI P
Patient level
Age 0.006 (-0.042, 0.030) 0.744
Gender -0.072 (-0.390, 0.533) 0.760
Tooth level
OFDS(T2-T1) 0.050(0.024, 0.077) <0.001
PCS(T2-T1) 0.244(0.182,0.305) <0.001
Baseline PD(T0) 0.363(0.286,0.440) <0.001
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