正畸拔牙患者无托槽隐形矫治牙根吸收的研究

doi:10.13701/j.cnki.kqyxyj.2023.09.007

摘要/Abstract

摘要： 目的: 采用锥形束CT(cone beam computed tomography,CBCT)三维重建技术研究正畸拔牙患者无托槽隐形矫治后上颌牙牙根吸收。方法: 本回顾性研究纳入15例安氏Ⅱ类正畸拔牙病例,共计150颗观测牙,应用CBCT三维重建技术测量术前(T0)、术后(T1)牙根体积和牙根表面积(root surface area,RSA)的变化。结果: (1)所有患者牙根体积均减少(P＜0.001),98%观测牙发生轻度到中度牙根吸收;(2)前后牙牙根吸收的严重程度无统计学差异(P＞0.05);(3)所有患者RSA均减少(P＜0.001),前后牙RSA变化无统计学差异(P＞0.05);(4)切牙和第一磨牙中度和重度牙根吸收的发生率为23.33%~26.67%。结论: 在安氏Ⅱ类正畸拔牙患者无托槽隐形矫治过程中,大部分观测牙发生轻度到中度牙根吸收,前后牙牙根体积和表面积的变化没有统计学差异,提示正畸医生不仅需要关注前牙的牙根吸收,也应关注后牙的牙根吸收风险。

关键词: 无托槽隐形矫治, 牙根吸收, CBCT, 拔牙矫治, 表面积

Abstract: Objective: To investigate the root resorption of maxillary teeth in extraction patients treated with clear aligner using three-dimensional reconstructed cone beam computed tomography (CBCT). Methods: One hundred and fifty teeth from 15 Class Ⅱ extraction treatment patients were selected. CBCT images were obtained at pretreatment (T0) and posttreatment (T1). Root volume and root surface area(RSA)were calculated by three-dimensional reconstruction of CBCT images. Results: The root volume was significantly decreased in all patients (P<0.001), and 98% of the measured teeth showed mild to moderate root resorption. There was no significant difference in the severity of root resorption between anterior and posterior teeth (P>0.05). The RSA was significantly decreased in all patients (P<0.001). There was no significant difference in RSA between anterior and posterior teeth (P>0.05). The incidence of moderate and severe root resorption in incisors and first molars was 23.33%-26.67%. Conclusion: During clear aligner therapy for Class Ⅱ extraction treatment patients, mild to moderate root resorption occurred in most of the measured teeth, and no statistical difference in the changes of volume and surface area of anterior and posterior teeth, suggesting that orthodontists should pay attention to the risk of root resorptions not only in the anterior teeth but also in the posterior teeth.

Key words: clear aligners, root resorption, cone beam computed tomography, extraction treatment, root surface area

周良贵, 梁颖, 彭菊香, 高娟, 李棋, 郑之峻. 正畸拔牙患者无托槽隐形矫治牙根吸收的研究[J]. 口腔医学研究, 2023, 39(9): 798-803.

ZHOU Lianggui, LIANG Ying, PENG Juxiang, GAO Juan, LI Qi, ZHENG Zhijun. Evaluation of Root Resorption in Extraction Patients Treated with Clear Aligner[J]. Journal of Oral Science Research, 2023, 39(9): 798-803.

参考文献

[1] Sondeijker CFW, Lamberts AA, Beckmann SH, et al. Development of a clinical practice guideline for orthodontically induced external apical root resorption [J]. Eur J Orthod, 2020, 42(2): 115-124.
[2] Pairatchawan N, Viteporn S, Thongudomporn U. Mandibular incisor root volume changes between anterior bite planes fabricated from acrylic resin and thermoplastic materials: A prospective randomized clinical trial [J]. Angle Orthod, 2022, 92(6): 755-763.
[3] Liu W, Shao JH, Li SF, et al. Volumetric cone-beam computed tomography evaluation and risk factor analysis of external apical root resorption with clear aligner therapy [J]. Angle Orthod, 2021, 91(5): 597-603.
[4] 高娟,吕航苗,马慧敏,等.锥形束CT三维体积测量评估骨性Ⅲ类错牙合正畸正颌治疗后的牙根吸收[J].北京大学学报(医学版),2022,54(4):719-726.
[5] 郑如松,李岩涛,王兰珠,等.MSE骨性扩弓后上颌牙根及颊侧齿槽骨吸收状况的CBCT分析[J].口腔医学研究,2021,37(6):543-548.
[6] Yi J, Xiao J, Li Y, et al. External apical root resorption in non-extraction cases after clear aligner therapy or fixed orthodontic treatment [J]. J Dent Sci, 2018, 13(1): 48-53.
[7] Fang X, Qi R, Liu C. Root resorption in orthodontic treatment with clear aligners: A systematic review and meta-analysis [J]. Orthod Craniofac Res, 2019, 22(4): 259-269.
[8] Wang Y, He S, Yu L, et al. Accuracy of volumetric measurement of teeth in vivo based on cone beam computer tomography [J]. Orthod Craniofac Res, 2011, 14(4): 206-212.
[9] Maret D, Molinier F, Braga J, et al. Accuracy of 3D reconstructions based on cone beam computed tomography [J]. J Dent Res, 2010, 89(12): 1465-1469.
[10] Krieger E, Drechsler T, Schmidtmann I, et al. Apical root resorption during orthodontic treatment with aligners? A retrospective radiometric study [J]. Head Face Med, 2013, 9: 21.
[11] 张哲玮,刘妍.无托槽隐形矫治牙根吸收的临床研究[J].中华口腔正畸学杂志,2018,25(4): 191-195.
[12] Deng Y, Sun Y, Xu T. Evaluation of root resorption after comprehensive orthodontic treatment using cone beam computed tomography (CBCT): a meta-analysis [J]. BMC Oral Health, 2018, 18(1): 116.
[13] Li Y, Deng S, Mei L, et al. Prevalence and severity of apical root resorption during orthodontic treatment with clear aligners and fixed appliances: a cone beam computed tomography study [J]. Prog Orthod, 2020, 21(1): 1.
[14] Elkholy F, Schmidt F, Jäger R, et al. Forces and moments applied during derotation of a maxillary central incisor with thinner aligners: An in-vitro study [J]. Am J Orthod Dentofacial Orthop, 2017, 151(2): 407-415.
[15] Gay G, Ravera S, Castroflorio T, et al. Root resorption during orthodontic treatment with Invisalign^®: a radiometric study [J]. Prog Orthod, 2017, 18(1):12.
[16] Yassir YA, McIntyre GT, Bearn DR. Orthodontic treatment and root resorption: an overview of systematic reviews [J]. Eur J Orthod, 2021, 43(4): 442-456.
[17] Currell SD, Liaw A, Blackmore Grant PD, et al. Orthodontic mechanotherapies and their influence on external root resorption: A systematic review [J]. Am J Orthod Dentofacial Orthop, 2019, 155(3): 313-329.
[18] 赖文莉.浅谈无托槽隐形矫治技术减数矫治的临床体会[J].中华口腔医学杂志,2017,52(9):534-537.
[19] Feng X, Jiang Y, Zhu Y, et al. Comparison between the designed and achieved mesiodistal angulation of maxillary canines and posterior teeth and influencing factors: First premolar extraction treatment with clear aligners [J]. Am J Orthod Dentofacial Orthop, 2022, 162(2): e63-e70.
[20] Akl HE, El-Beialy AR, El-Ghafour MA, et al. Root resorption associated with maxillary buccal segment intrusion using variable force magnitudes [J]. Angle Orthod, 2021, 91(6): 733-742.
[21] 朱晨静,郑雅,雷浪.固定和透明矫治器治疗前牙深覆牙合的牙根吸收[J].口腔医学研究,2023,39(2):113-117.
[22] Hohmann A, Wolfram U, Geiger M, et al. Periodontal ligament hydrostatic pressure with areas of root resorption after application of a continuous torque moment [J]. Angle Orthod, 2007, 77(4): 653-659.
[23] Liu L, Song Q, Zhou J, et al. The effects of aligner overtreatment on torque control and intrusion of incisors for anterior retraction with clear aligners: A finite-element study [J]. Am J Orthod Dentofacial Orthop, 2022, 162(1): 33-41.
[24] Matsuda Y, Motokawa M, Kaku M, et al. RANKL and OPG expression: Jiggling force affects root resorption in rats [J]. Angle Orthod, 2017, 87(1): 41-48.
[25] Nigul K, Jagomagi T. Factors related to apical root resorption of maxillary incisors in orthodontic patients [J]. Stomatologija, 2006, 8(3): 76-79.
[26] 李煌,武秀萍,黄兰,等.正畸根尖区牙根外吸收的风险因素及其临床处理建议的专家共识[J].华西口腔医学杂志,2022,40(6): 629-637.
[27] Bellini-Pereira SA, Almeida J, Aliaga-Del Castillo A, et al. Evaluation of root resorption following orthodontic intrusion: a systematic review and meta-analysis [J]. Eur J Orthod, 2021, 43(4): 432-441.
[28] Lyu H, Ma H, Hou J, et al. Three-dimensional measurement of periodontal support during surgical orthodontic treatment of high-angle skeletal Class Ⅲ malocclusion: A retrospective study [J]. Am J Orthod Dentofacial Orthop, 2022, 162(6): 839-849.
[29] Jia P, Yang G, Hu W, et al. Comparison of in situ cone beam computed tomography scan data with ex vivo optical scan data in the measurement of root surface area [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2019, 128(5): 552-557.