【作者】 李慧玲；

【导师】 刘继辉；

【作者基本信息】 大连医科大学 ， 口腔医学（专业学位）， 2019， 硕士

【摘要】 目的:比较分析在无托槽隐形矫治和固定矫治两种不同的矫治技术下,采用锥形束CT(Cone Beam Computed Tomograph,CBCT)技术,测量不同矢状骨面型患者正畸治疗前后的牙根长度,继而计算出牙根吸收量,分析两种技术造成的牙根吸收量的差异,以此对临床正畸治疗及正畸医生选择恰当的矫治方式提供一定依据。材料与方法:选取2015年1月-2019年1月就诊于沈阳市口腔医院正畸科的患者作为本实验的研究对象,共60例,分为隐形组和固定组,分别采用无托槽隐形矫治技术和直丝弓矫治技术,入选病例均为非拔牙病例,均无正畸治疗史,正畸治疗前牙根发育完成并没有牙根吸收,其中隐形组30例,骨性I类、骨性II类、骨性III类各10例,男性12例,女性18例,平均年龄24.5岁,平均治疗时间2.4年;固定组30例,骨性I类、骨性II类、骨性III类各10例,男性16例,女性14例,平均年龄22.5岁,平均治疗时间1.8年。纳入研究的患者知情同意后,在矫治前后均拍摄CBCT,研究者将DICOM文件导入InvivoDental 5软件中,先在Section模块中利用Reorientation功能将图像进行三维重建,并通过调整患者轴向、矢状及冠状截面而找到被测量牙齿的牙根最长的图像,然后对牙根长度进行测量,继而计算出牙根吸收量,将结果输入Microsoft Excel软件中进行整理,导入SPSS 21.0软件进行统计学分析,对于患者治疗前后牙根长度变化采用配对t检验进行分析,检验标准为P<0.05时,差异有统计学意义。结果:1.骨性I类患者上颌牙根吸收情况:隐形组上颌中切牙牙根吸收量为0.50士0.08mm,固定组为0.97士0.39 mm,两者差异有统计学意义(P<0.05);隐形组上颌侧切牙牙根吸收量为0.51士0.20mm,固定组为0.77士0.26 mm,两者差异有统计学意义(P<0.05);隐形组上颌尖牙牙根吸收量为0.35士0.25mm,固定组为0.57士0.14 mm,两者差异有统计学意义(P<0.05)。2.骨性I类患者下颌牙根吸收情况:隐形组下颌中切牙牙根吸收量为0.60士0.19mm,固定组为0.89士0.14mm,两者差异有统计学意义(P<0.05);隐形组下颌侧切牙牙根吸收量为0.51士0.11mm,固定组为0.72士0.17mm,两者差异有统计学意义(P<0.05);隐形组下颌尖牙牙根吸收量为0.42士0.11mm,固定组为0.52士0.10mm,两者差异无统计学意义(P>0.05)。3.骨性II类患者上颌牙根吸收情况:隐形组上颌中切牙牙根吸收量为1.40士0.60mm,固定组为1.02士0.13mm,两者差异有统计学意义(P<0.05);隐形组上颌侧切牙牙根吸收量为1.16士0.23mm,固定组为1.07±0.22mm,两者差异无统计学意义(P>0.05);隐形组上颌尖牙牙根吸收量为0.94士0.20mm,固定组为0.63士0.16 mm,两者差异有统计学意义(P<0.05)。4.骨性II类患者下颌牙根吸收情况:隐形组下颌中切牙牙根吸收量为1.00士0.24mm,固定组为0.91士0.28mm,两者差异无统计学意义(P>0.05);隐形组下颌侧切牙牙根吸收量为1.04士0.26mm,固定组为1.01士0.20mm,两者差异无统计学意义(P>0.05);隐形组下颌尖牙牙根吸收量为0.57士0.14mm,固定组为0.72士0.20mm,两者差异有统计学意义(P<0.05)。5.骨性III类患者上颌牙根吸收情况:上颌中切牙牙根吸收量为1.22士0.28mm,固定组为0.83士0.38 mm,两者差异有统计学意义(P<0.05);隐形组上颌侧切牙牙根吸收量为1.21士0.29mm,固定组为0.90士0.17mm,两者差异有统计学意义(P<0.05);隐形组上颌尖牙牙根吸收量为0.89士0.15mm,固定组为0.72士0.11mm,两者差异有统计学意义(P<0.05)。6.骨性III类患者下颌牙根吸收情况:隐形组下颌中切牙牙根吸收量为1.16士0.16mm,固定组为0.82士0.21mm,两者差异有统计学意义(P<0.05);隐形组下颌侧切牙牙根吸收量为1.07士0.16mm,固定组为0.87士0.23mm,两者差异有统计学意义(P<0.05);隐形组下颌尖牙牙根吸收量为0.98士0.17mm,固定组为0.79士0.13mm,两者差异有统计学意义(P<0.05)。结论:1.在采用无托槽隐形矫治器和固定自锁矫治器正畸治疗后,患者均出现了不同程度的牙根吸收。2.在骨性I类患者中,无托槽隐形矫治器出现的上下颌前牙牙根吸收量均小于固定矫治器。3.在骨性II类患者中,无托槽隐形矫治器出现的上颌前牙牙根吸收量大于固定矫治器。4.在骨性III类患者中,无托槽隐形矫治器出现的上下颌前牙牙根吸收量均大于固定矫治器。5.无托槽隐形矫治器和固定自锁矫治器矫治后,骨性II类患者牙根吸收量大于骨性III类患者,骨性III类患者大于骨性I类患者。更多还原

【Abstract】 Objective:Comparative analysis of cone-beam CT(Cone Beam Computed Tomograph)was used to measure the root length of patients with different sagittal planes before and after orthodontic treatment in two different treatments: bracketless invisible correction and fixed orthodontic treatment.Then calculate the amount of root resorption and analyze the difference of root resorption caused by the two techniques,so as to provide a basis for clinical orthodontic treatment and orthodontic doctors to choose the appropriate treatment.Materials and Methods:The patients who were treated in the orthodontics department of Shenyang Stomatological Hospital from January to September 2019 were selected as the research object of this experiment.A total of 60 cases were divided into invisible group and fixed group,respectively,using bracketless invisible correction technique and straight The technique of wire arch treatment included non-extraction cases,and there was no history of orthodontic treatment.Before orthodontic treatment,the root development wascompleted without root resorption,including 30 cases of invisible group,skeletal class I,skeletal class II,and bony.There were 10 cases in class III,12 males and 18 females,with an average age of 24.5 years and an average treatment time of 2.4 years.There were 30 patients in the fixed group,10 cases of skeletal class I,skeletal class II and skeletal class III,male 16 For example,14 women,with an average age of 22.5 years,had an average treatment time of 1.8 years.After the informed consent of the patients included in the study,the CBCT was taken before and after the correction.The researchers imported the DICOM file into the InvivoDental 5 software,and then reconstructed the image in the Section module using the Reorientation function,and adjusted the patient’s axial,sagittal and The longest image of the root of the tooth to be measured is found in the coronal section,and then the length of the root is measured,and then the root absorption is calculated.The result is entered into Microsoft Excel software for sorting and imported into SPSS 21.0 software for statistical analysis.The changes of the length of the anterior and posterior teeth were analyzed by paired t-test.The test standard was statistically significant at P<0.05.Result:1.Absorption of maxillary roots in patients with skeletal class I: The root resorption of the maxillary central incisor in the invisible group was 0.50 ± 0.08 mm,and the fixed group was 0.97 ± 0.39 mm.The difference was statistically significant(P <0.05);The root resorption of the maxillary lateral incisors was 0.51 ± 0.20 mm,and the fixed group was 0.77 ± 0.26 mm.The difference was statistically significant(P <0.05).The maxillary canine root resorption was 0.35 ± 0.25 mm in the invisible group.0.57 ± 0.14 mm,the difference was statistically significant(P <0.05).2.Mandibular root resorption in patients with skeletal class I: the root resorption of the mandibular central incisor in the invisible group was 0.60 ± 0.19 mm,and the fixed group was 0.89 ± 0.14 mm.The difference was statistically significant(P <0.05);The root resorption of the mandibular lateral incisors was 0.51 ± 0.11 mm,and the fixed group was 0.72 ± 0.17 mm.The difference was statistically significant(P <0.05).The invisible group had a root resorption of 0.42 ± 0.11 mm.The fixed groupwas 0.52 ± 0.10 mm,the difference was not statistically significant(P> 0.05).3.The maxillary root resorption of skeletal class II patients: the maxillary central incisor root resorption amount was 1.40 ± 0.60 mm,the fixed group was 1.02 ±0.13 mm,the difference was statistically significant(P < 0.05);invisible group maxillary lateral incision The root resorption amount was 1.16±0.23 mm,and the fixed group was 1.07±0.22 mm.There was no significant difference between the two groups(P>0.05).The maxillary canine root resorption amount was 0.94 ± 0.20 mm in the invisible group and 0.63± in the fixed group.0.16 mm,the difference was statistically significant(P<0.05).4.Mandibular root resorption in patients with skeletal class II: the root resorption of the mandibular central incisor in the invisible group was 1.00 ± 0.24 mm,and the fixed group was 0.91 ± 0.28 mm.There was no significant difference between the two groups(P > 0.05).The root resorption of the mandibular lateral incisors was 1.04 ±0.26 mm,and the fixed group was 1.01 ± 0.20 mm.There was no significant difference between the two groups(P>0.05).The invisible group had a root resorption of 0.57 ± 0.14 mm,and the fixed group was 0.72 ± 0.20 mm,the difference was statistically significant(P <0.05).5.The maxillary root resorption of skeletal class III patients: the maxillary central incisor root resorption amount was 1.22±0.28 mm,the fixed group was 0.83±0.38 mm,the difference was statistically significant(P<0.05);the invisible group maxillary lateral resection The root resorption amount was 1.21±0.29 mm,and the fixed group was 0.90±0.17 mm.The difference was statistically significant(P<0.05).The maxillary canine root resorption amount was 0.89±0.15 mm in the invisible group and 0.72± in the fixed group.0.11 mm,the difference was statistically significant(P<0.05).6.Absorption of mandibular root in patients with skeletal class III: The root resorption of the mandibular central incisor in the invisible group was 1.16±0.16 mm,and the fixed group was 0.82 ± 0.21 mm.The difference was statistically significant(P<0.05).The invisible group The root resorption rate of the mandibular lateral incisors was 1.07 ± 0.16 mm,and the fixed group was 0.87 ± 0.23 mm.The difference wasstatistically significant(P<0.05).The invisible group had the root root absorption of0.98±0.17 mm.The fixed group was 0.79 ± 0.13 mm,the difference was statistically significant(P < 0.05).Conclusion:1.After orthodontic treatment with invisible appliance without brackets and fixed self-locking appliance,all the patients showed different degrees of root resorption.2.In patients with skeletal class I,the amount of root absorption of the upper and lower anterior teeth with invisible appliance without brackets was less than that with fixed appliance.3.In skeletal class II patients,the amount of root absorption of maxillary anterior teeth with invisible appliance without brackets was greater than that with fixed appliance.4.In patients with skeletal class III,the amount of root absorption of upper and lower anterior teeth with invisible appliance without brackets was greater than that with fixed appliance.5.After orthodontic treatment with invisible orthodontic appliance without brackets and fixed self-locking orthodontic appliance,the amount of root absorption of patients with skeletal class II was greater than that of patients with skeletal class III,and that of patients with skeletal class III was greater than that of patients with skeletal class I.更多还原