成人非拔牙隐形矫治前后骨开窗/开裂初析

摘要/Abstract

摘要： 目的：比较成人牙列拥挤非拔牙隐形矫治前后骨开窗/开裂的变化。材料与方法：选取单纯使用隐形矫治器（Invisalign）完成第一序列矫治的成人非拔牙患者治疗前后的全牙列CBCT，应用软件Mimics 19.0和Magics 21.0分离和计算骨开窗/开裂的体积，使用卡方检验和Wilcoxon检验在α=0.05水平分别检测治疗前后骨开窗/骨开裂发生率和体积的差异。结果：获得30例成年女性患者，平均年龄24.9±3.8岁。共对840颗牙齿作测量分析，牙槽骨缺损主要发生在颊侧（99.64%），治疗前累及牙数为219颗（发生率为26.07%），治疗后的发生率为35.24%，主要是上颌磨牙和下颌前磨牙的骨开裂发生率有显著增加（P<0.05）；治疗前人均牙槽骨缺损体积为83.67±63.33mm3，治疗后为97.16±73.79mm3，无统计学差异（P>0.05），其中治疗后上颌尖牙骨开窗体积有显著减少（P<0.05），但下颌切牙骨开裂体积有明显增加（P<0.05）。结论：牙列拥挤的成人患者治疗前就存在明显的骨开窗/开裂，使用隐形矫治器非拔牙矫治有增加这些牙槽骨缺损的趋势。提示在隐形矫治中应充分评估牙槽骨的三维完整性，合理设计矫治方案以减少骨开窗/开裂的发生或加重。

关键词: CBCT, 隐形矫治, 骨开窗, 骨开裂

Abstract: Objective: To quantify the changes of alveolar bone defects in adults crowding upon non-extraction clear aligner treatment. Materials& Methods: Cone beam computed tomography (CBCT) scans from adults who complete the first sequence treatment upon non-extraction Invisalign aligner were examined retrospectively in order to record the volume and the incidence of alveolar defects three-dimensionally before and after treatment (T0 &T1). The data were collected and analyzed using the computer programs Mimics 19.0 and Magics 21.0. Differences in alveolar defects between T0 and T1 were analyzed with SAS 8.02 using the Wilcoxon test and Chi-square test for paired samples. The significance level was set at α =0.05. Results: Thirty patients (30 women, average age: 24.9±3.8 years) were chosen for retrospective evaluation. A total of 840 teeth were evaluated, of which were mainly on the buccal root surfaces(99.64%). 219 (26.07%) teeth were involved before treatment and the incidence increased to 35.24% after the treatment, among which the dehiscence in maxillary molars and mandible premolars were significantly increased after treatment(P <0.05). The average volume of alveolar defects in patients before treatment was 83.67±63.33mm3, and after treatment was 97.16±73.79mm3(P <0.05). The Wilcoxon tests showed highly significant increases in the mandible incisors, while showed highly significant decreases in the maxillary canines(P<0.05). Conclusion: Alveolar defect is a common finding in adults crowding before orthodontic treatment, and showed an increased tendency upon non-extraction clear aligner treatment. It is suggested that the three-dimensional integrity of alveolar bone should be fully evaluated in clinical treatment when using clear aligners, and the treatment plan should be reasonably designed to reduce the aggravation of alveolar bone defects.

Key words: CBCT, Clear aligner, Dehiscence, Fenestration

中图分类号:

R783.5

姜婷杨一鸣游清玲唐国华. 成人非拔牙隐形矫治前后骨开窗/开裂初析[J]. , 2019, 39(11): 982-986.

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