国际口腔医学杂志 ›› 2021, Vol. 48 ›› Issue (4): 426-432.doi: 10.7518/gjkq.2021063

• 论著 • 上一篇    下一篇

成人骨性Ⅱ类高角开牙合患者上下切牙区牙槽骨形态的三维研究

伍春兰(),唐华,陈军()   

  1. 重庆医科大学附属口腔医院正畸科 口腔疾病与生物医学重庆市重点实验室 重庆市高校市级口腔生物医学工程重点实验室 重庆 401147
  • 收稿日期:2020-11-20 修回日期:2021-04-14 出版日期:2021-07-01 发布日期:2021-06-30
  • 通讯作者: 陈军
  • 作者简介:伍春兰,住院医师,硕士,Email: wuchunlan@stu.cqmu.edu.cn

Alveolar bone morphology of anterior teeth areas in patients with high-angle skeletal Class Ⅱ open bite

Wu Chunlan(),Tang Hua,Chen Jun()   

  1. Dept. of Orthodontics, Affiliated Stomatological Hospital, Chongqing Medical University & Chongqing Key Laboratory of Oral Diseases and Biomedical Science & Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 401147, China
  • Received:2020-11-20 Revised:2021-04-14 Online:2021-07-01 Published:2021-06-30
  • Contact: Jun Chen

摘要:

目的 运用锥形束计算机断层扫描(CBCT)对成人骨性Ⅱ类高角开牙合患者上下切牙区的牙槽骨形态进行研究分析。方法 筛选成人骨性Ⅱ类高角正畸治疗前患者58例(前牙开牙合29例、正常覆牙合29例),利用Dolphin软件测量上下切牙区牙槽骨高度和牙槽骨厚度,并进行统计分析。结果 开牙合组与对照组在切牙区牙槽骨形态的差异主要体现在舌/腭侧的牙槽骨厚度及牙槽骨高度上,开牙合患者多个切牙位点处的舌/腭侧及根尖处的牙槽骨厚度较薄、牙槽骨高度较低;Pearson检验显示覆牙合与舌/腭侧牙槽骨高度呈负相关,与牙槽骨厚度呈正相关。结论 成人骨性Ⅱ类高角开牙合患者切牙区的舌/腭侧牙槽骨厚度较薄、高度较低,矫治该类患者时应谨慎切牙过度的舌向移动,并注意转矩的控制,以避免牙周组织及牙根的损伤。

关键词: 前牙开牙合, 切牙, 牙槽骨形态, 锥形束计算机断层扫描

Abstract:

Objective This study aimed to explore the differences in alveolar bone morphology of anterior teeth areas among patients with high-angle skeletal ClassⅡopen bite patients and high-angle skeletal ClassⅡnormal overbite by u-sing cone-beam computed tomography. Methods Fifty-eight untreated patients (29 anterior open bite patients and 29 normal overbite patients) with high-angle skeletal ClassⅡmalocclusion were selected. The vertical bone level and the width of the alveolar bone were measured in the midsagittal plane of the teeth by Dolphin software. The differences in alveolar bone morphology were compared between the two groups, and the correlation between the alveolar bone morphology and overbite was explored. Results Differences in alveolar bone morphology between patients with open bite and those with normal overbite were identified, and such differences primarily affected the lingual/palatal sides of the vertical bone level and the width of the alveolar bone. The vertical bone level on the lingual/palatal sides of most incisors in the open bite group was statistically lower than those in the control group, and the width of the alveolar bone on the lingual/palatal sides and the apical level was statistically thin. In the correlation analysis, a different degree of positive correlation was observed between the overbite and alveolar bone thickness at different sites of different teeth, whereas overbite was negatively related to the vertical bone level of maxillary incisors and mandibular central incisors. Conclusion The vertical bone level and thickness of the alveolar bone on the lingual/palatal sides were significantly low and thin in the high-angle skeletal ClassⅡopen bite patients, and caution should be taken in the treatment of these patients, particularly the torque of incisors and the backward movement of anterior teeth, to avoid root resorption, alveolar bone dehiscence, and fenestration in the upper and lower incisors.

Key words: anterior open bite, incisor, alveolar bone morphology, cone beam computed tomography

中图分类号: 

  • R783.5

图 1

牙根长度的三维定位 A:牙齿的轴面;B:冠状面;C:矢状面;D:为了确保测量精确性,调整后的矢状面放大即为测量平面。3条不同颜色的线代表不同的平面,蓝色:轴面;红色:矢状面;绿色:冠状面。在矢状面上使蓝线经过唇舌侧CEJ连线的中点,使绿线通过CEJ连线的中点和根尖点;冠状面上使蓝线经过CEJ连线,使红线通过切缘中点和根尖点;轴面上旋转图像使绿线与所测量牙齿的交叉线最短。"

图 2

牙槽骨厚度测量项目 A~H分别为图中黄色线段的距离,代表唇腭侧CEJ下2、4、6 mm及根尖区的牙槽骨厚度。以唇舌/腭侧CEJ连线的中点和根尖点的连线作为牙长轴。垂直于牙长轴在牙根表面做4条参考线,参考线L2(距CEJ下2 mm)、参考线L4(距CEJ下4 mm)、参考线L6(距CEJ下6 mm)、参考线LA(过根尖点)。"

图 3

牙槽骨附着高度测量项目 A:唇侧牙槽骨高度(箭头黄线);B:腭侧牙槽骨高度(箭头黄线)。水平红线:唇/腭侧CEJ连线;垂直红线:牙长轴-过CEJ连线中点及根尖点;蓝线:垂直于牙长轴在牙根表面做的4条参考线,参考线L2(距CEJ下2 mm)、参考线L4(距CEJ下4 mm)、参考线L6(距CEJ下6 mm)、参考线LA(过根尖点)。"

表 1

开牙合组与对照组间上下颌切牙区牙槽骨高度的比较"

牙位 唇侧牙槽骨附着高度 舌/腭侧牙槽骨附着高度
开牙合组/mm 对照组/mm P 开牙合组/mm 对照组/mm P
上颌侧切牙 1.55(1.00~2.17) 1.45(1.02~1.90) 0.588 1.45(0.90~3.97) 0.80(0.70~0.97) 0.000**
上颌中切牙 1.10(1.00~1.50) 1.40(1.00~1.90) 0.269 1.00(0.87~1.42) 0.90(0.80~1.00) 0.044*
下颌侧切牙 1.30(0.90~1.90) 1.30(1.00~1.90) 0.476 1.50(1.00~2.70) 1.50(1.10~2.00) 0.977
下颌中切牙 1.50(1.10~2.00) 1.55(1.00~1.92) 0.497 2.00(1.60~4.00) 1.90(1.45~2.10) 0.028*

表 2

开牙合组与对照组间上颌切牙区牙槽骨厚度的比较"

位置 上颌中切牙 上颌侧切牙
开牙合组/mm 对照组/mm P 开牙合组/mm 对照组/mm P
唇侧2 mm 0.70(0.47~1.00) 0.80(0.30~1.15) 0.530 0.60(0.23~0.98) 0.75(0.23~1.08) 0.795
唇侧4 mm 0.90(0.60~1.10) 1.20(0.95~1.50) 0.000** 0.70±0.40 0.75±0.49 0.676
唇侧6 mm 0.80(0.40~1.02) 1.10(0.65~1.20) 0.022* 0.30(0.20~0.57) 0.20(0.10~0.60) 0.046*
唇侧根尖 1.90(1.70~2.10) 2.10(1.70~2.45) 0.195 1.76±0.86 1.63±0.76 0.517
腭侧2 mm 0.80(0.50~1.10) 1.40(1.05~1.60) 0.000** 0.40(0.00~0.80) 1.15(0.90~1.40) 0.000**
腭侧4 mm 1.45(1.20~1.90) 2.10(1.70~2.40) 0.000** 1.10(0.15~1.30) 1.75(1.40~2.20) 0.000**
腭侧6 mm 2.10(1.70~2.50) 2.90(2.40~3.75) 0.000** 1.50(1.20~1.70) 2.40(2.00~3.17) 0.000**
腭侧根尖 5.95±1.45 7.84±1.53 0.000** 4.82±1.10 6.78±2.05 0.000**
总根尖(腭侧+唇侧) 7.89±1.07 9.90±1.46 0.000** 6.52±1.58 8.41±1.82 0.000**

表 3

开牙合组与对照组间下颌切牙区牙槽骨厚度的比较"

位置 下颌中切牙 下颌侧切牙
开牙合组/mm 对照组/mm P 开牙合组/mm 对照组/mm P
唇侧2 mm 0.35(0.10~0.50) 0.50(0.20~1.10) 0.102 0.30(0.20~0.50) 0.40(0.20~1.00) 0.329
唇侧4 mm 0.30(0.20~0.40) 0.40(0.20~0.75) 0.017* 0.20(0.20~0.40) 0.40(0.20~0.80) 0.019*
唇侧6 mm 0.40(0.20~0.50) 0.35(0.20~0.52) 0.897 0.30(0.20~0.40) 0.20(0.20~0.30) 0.477
唇侧根尖 3.01±0.93 3.32±1.10 0.182 3.40(2.60~4.20) 3.30(2.55~3.65) 0.624
舌侧2mm 0.00(0.00~0.30) 0.15(0.00~0.42) 0.209 0.40(0.00~0.60) 0.40(0.00~0.70) 0.503
舌侧4mm 0.40(0.10~0.90) 1.00(0.70~1.40) 0.000** 0.90(0.40~1.20) 1.40(1.10~1.75) 0.000**
舌侧6mm 0.92±0.55 1.27±0.52 0.005** 1.31±0.49 1.65±0.50 0.006**
舌侧根尖 3.69±0.79 3.77±0.79 0.634 4.00(3.40~4.50) 4.20(3.65~4.75) 0.259
总根尖(舌侧+唇侧) 6.53±0.77 7.10±0.23 0.107 6.80(5.32~8.20) 7.60(7.05~8.10) 0.175

表 4

覆牙合与牙槽骨形态的Pearson相关性分析"

位置 上颌侧
切牙
上颌中
切牙
下颌侧
切牙
下颌中
切牙
唇侧2 mm 0.069 0.027 0.166 0.198
唇侧4 mm -0.028 0.433** 0.283* 0.283*
唇侧6 mm -0.168 0.245* -0.002 -0.033
唇侧根尖 0.057 0.038 0.005 0.183
舌/腭侧2 mm 0.497** 0.431** 0.012 0.114
舌/腭侧4 mm 0.472** 0.434** 0.366** 0.402**
舌/腭侧6 mm 0.395** 0.466** 0.180 0.209
舌/腭侧根尖 0.351** 0.532** -0.019 -0.037
总根尖(唇侧+舌/腭侧) 0.340** 0.557** 0.189 0.156
唇侧牙槽骨高度 -0.223 -0.026 0.030 -0.222
舌/腭侧牙槽骨高度 -0.449** -0.227 -0.034 -0.319**
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