下颌切牙牙根与牙槽骨反应的差异——骨性Ⅲ类掩饰性与联合治疗比较

doi:10.13591/j.cnki.kqyx.2026.05.007

摘要/Abstract

摘要：

目的比较骨性Ⅲ类错𬌗成人分别采用掩饰性治疗与正畸-正颌联合治疗后下颌切牙牙根吸收与牙槽骨改建的差异。方法研究纳入30例成人骨性Ⅲ类患者，分为掩饰性治疗组（CA，n=15）与正畸正颌联合治疗组（CO，n=15）。利用锥形束CT（CBCT）测量下颌切牙治疗前后及术前去代偿后的牙根长度、唇舌侧牙槽骨顶端垂直骨距离（La-/L-VBL）与各层牙槽骨厚度（ABT）。组内采用配对t检验或重复测量方差分析，组间采用独立样本t检验。结果治疗后，两组牙根均轻度吸收。牙槽骨L-VBL均显著增加，La-VBL在CA组变化较小，CO组去代偿后增幅明显，术后较稳定；ABT两组舌侧均显著变薄，CA组唇侧改变不明显，CO组去代偿期根颈部吸收，根尖部增厚，术后与术前方向一致但幅度较小；总体比较显示，CA组舌侧ABT减小幅度显著大于CO组，CO组唇侧中下部厚度更易恢复。结论两种治疗的根吸收程度相近。舌侧为骨吸收重点区域，掩饰治疗更易引发广泛骨质变薄与牙槽嵴顶下移；联合治疗在术后阶段唇侧中下部骨量更易恢复。

关键词: 骨性Ⅲ类, 正畸-正颌联合治疗, 掩饰性治疗, 锥形束CT

Abstract:

Objective To compare mandibular incisor root resorption and alveolar bone remodeling in adults with skeletal Class Ⅲ malocclusion treated by orthodontic camouflage versus combined orthodontic-orthognathic therapy. Methods Thirty adults were enrolled and allocated to a camouflage group （CA，n=15） or a combined treatment group （CO，n=15）. Cone-beam CT （CBCT） was used to measure root length，labial/lingual vertical bone level （La-/L-VBL），and alveolar bone thickness （ABT） at multiple levels before and after treatment； in the CO group，an additional presurgical decompensation time point was assessed. Within-group changes were tested with paired t tests or repeated-measures ANOVA，between-group differences with independent-samples t tests. Results Both groups showed mild root shortening，with significant increases in L-VBL. La-VBL changed little in the CA group but increased markedly after decompensation in the CO group and then stabilized postoperatively. Lingual ABT decreased significantly in both groups； labial changes were minimal in CA. In CO，labial cervical thinning with apical thickening was observed during decompensation，with the same direction of change but smaller magnitude after surgery. Overall，the reduction in lingual ABT was greater in CA，whereas labial mid-apical thickness recovered more readily in CO. Conclusion The magnitude of root resorption was similar between approaches. The lingual plate is the principal site of bone loss； camouflage more readily induces widespread thinning and crestal apicalization，while the combined approach shows better postoperative recovery of labial mid-apical bone.

Key words: skeletal Class Ⅲ, combined orthodontic-orthognathic treatment, camouflage treatment, cone-beam CT

中图分类号:

R783.5

王若雯, 王华. 下颌切牙牙根与牙槽骨反应的差异——骨性Ⅲ类掩饰性与联合治疗比较[J]. 口腔医学, 2026, 46(5): 363-368.

WANG Ruowen, WANG Hua. Comparative evaluation of root resorption and alveolar bone remodeling of mandibular incisors following camouflage treatment versus orthognathic surgery combined with orthodontics with skeletal Class Ⅲ malocclusion[J]. Stomatology, 2026, 46(5): 363-368.

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参考文献 26

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样本特征	掩饰性治疗组（n=15）	正畸-正颌联合治疗组（n=15）
性别（男/女）	7/8	6/9
年龄/岁	21.07±2.96	20.80±2.08
治疗时长/月
术前去代偿	-	13.12±6.39
术后精细调整	-	9.16±4.97
总治疗时长	26.87±12.24	23.12±6.63

骨面型描述	治疗前（T0）		P
骨面型描述	掩饰性治疗组（CA）	正畸-正颌联合治疗组（CO）	P
SNA/（°）	82.45±3.06	82.16±3.65	0.817
SNB/（°）	84.05±2.70	86.05±4.60	0.157
ANB/（°）	-1.61±1.01	-2.90±1.54	0.061
Wits/mm	-6.44±2.69	-11.88±4.10	0.001^*
FMA/（°）	25.89±3.55	24.44±4.06	0.306
SN-GoGn/（°）	29.15±4.36	29.99±5.03	0.629
U1-SN/（°）	111.18±7.63	108.93±6.06	0.378
U1-NA/mm	7.29±3.30	7.33±2.85	0.967
U1-NA/（°）	28.73±7.99	26.79±5.88	0.457
L1-GoGn/（°）	87.39±6.70	82.77±6.49	0.065
L1-NB/mm	4.37±2.44	4.56±2.30	0.831
L1-NB/（°）	20.59±6.01	18.80±5.89	0.418
IMPA/（°）	83.31±6.76	79.21±6.06	0.092

测量变量	治疗前（T0'）	治疗后（T1'）	P
中切牙
牙根长度	11.05±0.97	10.51±1.01	0.000^*
La-VBL	1.88±0.97	2.15±0.94	0.100
L-VBL	1.82±0.69	4.41±2.61	0.000^*
La-S1	0.56±0.32	0.53±0.45	0.580
La-S2	0.42±0.23	0.45±0.34	0.685
La-S3	0.95±0.47	1.02±0.52	0.560
La-S4	2.97±1.03	3.40±1.15	0.067
L-S1	0.78±0.49	0.15±0.19	0.000^*
L-S2	1.55±0.78	0.44±0.51	0.000^*
L-S3	3.01±1.19	1.29±1.14	0.000^*
L-S4	5.67±4.60	3.87±1.80	0.000^*
侧切牙
牙根长度	12.21±0.98	11.43±1.23	0.000^*
La-VBL	1.64±0.75	2.10±0.89	0.000^*
L-VBL	1.72±0.59	2.88±1.71	0.001^*
La-S1	0.61±0.30	0.62±0.35	0.863
La-S2	0.30±0.24	0.41±0.33	0.045
La-S3	1.08±0.65	1.13±0.80	0.685
La-S4	3.57±1.29	3.82±1.32	0.260
L-S1	0.95±0.52	0.30±0.34	0.000^*
L-S2	1.69±0.79	0.97±0.86	0.000^*
L-S3	2.83±1.23	1.73±1.56	0.000^*
L-S4	5.12±1.57	4.14±1.99	0.000^*

测量变量	治疗前（T0）	正颌术前（T1）	治疗后（T2）	P	多重比较
中切牙
牙根长度	11.70±1.00	11.00±0.96	10.49±1.12	0.000^*	T0>T1>T2
La-VBL	2.42±0.68	3.67±2.31	3.14±2.27	0.000^*	T1>T2>T0
L-VBL	2.19±0.81	4.06±2.38	4.36±2.42	0.000^*	T2>T1>T0
La-S1	0.63±0.35	0.37±0.40	0.40±0.39	0.002^*	T0>T2>T1
La-S2	0.63±0.21	0.51±0.31	0.55±0.33	0.907	-
La-S3	0.76±0.28	0.88±0.49	0.94±0.70	0.207	-
La-S4	2.25±0.73	3.26±0.98	3.17±1.33	0.000^*	T1>T2>T0
L-S1	0.51±0.35	0.18±0.26	0.05±0.15	0.000^*	T0>T1>T2
L-S2	1.06±0.43	0.53±0.33	0.35±0.29	0.000^*	T0>T1>T2
L-S3	1.98±0.72	0.95±0.81	0.66±0.54	0.000^*	T0>T1>T2
L-S4	4.45±1.03	2.87±1.18	2.72±1.19	0.000^*	T0>T1>T2
侧切牙
牙根长度	12.46±0.97	11.97±1.04	11.42±1.09	0.000^*	T0>T1>T2
La-VBL	2.57±1.17	3.43±1.87	3.36±1.76	0.000^*	T1>T2>T0
L-VBL	2.47±0.81	3.57±2.38	4.66±2.44	0.000^*	T2>T1>T0
La-S1	0.67±0.25	0.45±0.40	0.42±0.39	0.000^*	T0>T1>T2
La-S2	0.50±0.19	0.53±0.28	0.55±0.26	0.472	-
La-S3	0.71±0.22	0.92±0.35	1.09±0.53	0.000^*	T2>T1>T0
La-S4	2.45±0.63	3.56±0.85	3.65±1.31	0.000^*	T2>T1>T0
L-S1	0.57±0.56	0.10±0.23	0.09±0.26	0.000^*	T0>T1>T2
L-S2	1.21±0.68	0.64±0.44	0.53±0.40	0.000^*	T0>T1>T2
L-S3	1.91±0.78	0.91±0.66	0.83±0.61	0.000^*	T0>T1>T2
L-S4	4.15±1.04	2.85±0.74	2.81±1.03	0.000^*	T0>T1>T2

测量变量	掩饰性治疗（T1'-T0'）	联合治疗组（T1-T0）	联合治疗组（T2-T0）	$\frac{T1\text{'}-T0\text{'}/T1-T0}{P}$	$\frac{T1\text{'}-T0\text{'}/T2-T0}{P}$
中切牙
牙根长度	-0.54±0.27	-0.70±0.64	-1.21±0.86	0.203	0.802
La-VBL	0.27±0.86	1.25±2.22	0.72±2.17	0.027^*	0.124
L-VBL	2.59±2.53	1.87±2.47	2.17±2.32	0.270	0.001^*
La-S1	-0.03±0.33	-0.26±0.44	-0.23±0.37	0.025^*	0.480
La-S2	0.03±0.40	-0.12±0.27	-0.08±0.35	0.103	0.946
La-S3	0.07±0.65	0.12±0.45	0.19±0.66	0.714	0.967
La-S4	0.43±1.24	1.01±0.87	0.92±1.16	0.041^*	0.076
L-S1	-0.63±0.47	-0.33±0.35	-0.46±0.38	0.007^*	0.000^*
L-S2	-1.12±0.69	-0.53±0.50	-0.71±0.51	0.000^*	0.000^*
L-S3	-1.72±1.18	-1.02±0.77	-1.31±0.54	0.009^*	0.000^*
L-S4	-1.80±1.55	-1.58±1.19	-1.73±1.13	0.540	0.000^*
侧切牙
牙根长度	-0.77±0.61	-0.49±0.84	-1.04±0.81	0.146	0.155
La-VBL	0.46±0.51	0.86±1.72	0.79±1.85	0.026^*	0.351
L-VBL	1.16±1.64	1.10±2.22	2.19±2.44	0.061	0.059
La-S1	0.01±0.21	-0.22±0.33	-0.26±0.32	0.002^*	0.000^*
La-S2	0.11±0.28	0.03±0.32	0.04±0.30	0.303	0.401
La-S3	0.05±0.67	0.21±0.32	0.38±0.48	0.233	0.031^*
La-S4	0.25±1.18	1.11±0.66	1.19±1.12	0.000^*	0.002^*
L-S1	-0.66±0.48	-0.49±0.42	-0.48±0.42	0.016^*	0.136
L-S2	-0.73±0.72	-0.57±0.59	-0.68±0.48	0.034^*	0.769
L-S3	-1.10±1.16	-1.00±0.78	-1.08±0.77	0.041^*	0.917
L-S4	-0.98±1.35	-1.35±0.77	-1.34±1.00	0.206	0.255