使用矯正植體後拉上顎前牙之上顎中門齒牙根尖吸收

Apical Root Resorption of Maxillary Central Incisor in En Masse Anterior Retraction by Using Miniscrews

張民欣(Peter MH Chang) ； 王郁智(YC Wang) ； 劉育佳(YC Liu) ； 劉人文(Eric JW Liou)

《中華民國齒顎矯正學雜誌》 20卷1期 (2008/03) Pp. 23-32

https://doi.org/10.30036/TJO.200803.0004

摘要

目的：本研究為回溯性研究，目的是觀察使用矯正植體錨定，後拉(retraction)及下壓內縮(intrusion)上顎前牙時，上顎中門齒牙根尖吸收的情形，以及可能會影響牙根尖吸收的因素。
研究對象及方法：本研究包含五十位上顎前牙前突之成年病患，其中三十位病患，接受拔除上顎雙側第一小臼齒、合併使用矯正植體後拉上顎前牙之齒顎矯正治療方式（第一組）。另外二十位病患，接受拔除上顎雙側第一小臼齒、但不使用矯正植體後拉上顎前牙之齒顎矯正治療方式（第二組）。所有研究對象分別在治療前後，拍攝測顱X光與上顎門齒牙根尖X光片。使用測量軟體(Image J)將X光片以一比一的比例數位化後，計算：(1)上顎中門齒牙根尖的吸收率，(2)治療前後，上顎中門齒移動的方向及距離，(3)治療前的角U1-SN、角SNA、角SNB及角ANB。使用獨立樣本t檢定(Independent t-test)來比較兩組差異，使用皮爾森相關係數(Pearson correlation coefficient)來分析牙根尖吸收率和各測量值的相關性。
結果：研究的結果顯示，第一組的角ANB (7.1°±1.9°)、中門齒後拉量（門齒切緣=8.15±2.37mm；牙根尖=2.97±2.71mm）、及治療時間（855.6±222.4天），有意義的大於第二組的角ANB(3.2°±2.9°)、中門齒後拉量（門齒切緣=6.46±2.10mm；牙根尖=1.30±1.60mm）、及治療時間（682.1±148.7天）。除此之外，兩組其它測量值無顯著性差異存在。在上顎中門齒牙根尖吸收率方面，第一組的上顎中門齒牙根尖吸收率為16.4±9.0% (2.6±1.2mm)，第二組的上顎中門齒牙根尖吸收率為13.5±7.5% (2.1±1.1mm)，兩組無顯著性的差異存在。在相關性分析中，只有治療時間與牙根尖吸收率，有顯著正相關存在。雖然第一組的治療時間有意義的大於第二組，但兩組的上顎中門齒牙根尖吸收率卻無顯著性的差異，這顯示可能有其它比治療時間更重要的因子，會影響上顎中門齒的牙根尖吸收。另外，兩組牙根尖吸收率的標準差都偏大，顯示個體性差異可能也是影響牙根尖吸收的因素。
結論：使用矯正植體後拉及下壓內縮上顎中門齒時，雖然其經歷了較大範圍的移動，但不一定會有較嚴重的牙根尖吸收。治療時間和個體性差異，可能比牙齒的移動量，更影響上顎中門齒的牙根尖吸收。

關鍵字

牙根尖吸收 ； 矯正植體

並列摘要

Purposes: This study is a retrospective study. The purpose of this study is to observe the apical root resorption of maxillary central incisors during en masse anterior retraction-and-intrusion under miniscrew anchorage.
Material and methods: Fifty adult patients with maxillary protrusion were included, and 30 patients of them were treated with miniscrew anchorage and extraction of the maxillary first premolars (Group-I), and the other 20 patients were treated with extraction of the maxillary first premolars (Group-II). For each patient, periapical films of the maxillary incisors and lateral cephalometric radiographs were taken before (T1) and after treatment (T2) for the measurements of the (1) U1-SN, SNA, SNB, and ANB angle at T1, (2) amount of anterior retraction-and-intrusion of maxillary central incisor at T1-T2, and (3) apical root resorption of the maxillary central incisors at T1-T2. The inter-group differences were analyzed by Independent t-test, and the correlations were analyzed by Pearson correlation analysis.
Results: Group-I had significantly greater ANB angle (7.1°±1.9°), amount of anterior retraction (incisal edge=8.15±2.37mm; root apex=2.97±2.71mm) and longer duration of treatment (855.6±222.4days) than Group-II (ANB=3.2°±2.9°, amount of anterior retraction: incisal edge=6.46±2.10mm; root apex=1.30±1.60mm, duration of treatment=682.1±148.7days). The apical root resorption of maxillary central incisors in Group-I was 16.4±9.0% (2.6±1.2mm) and 13.5±7.5% (2.1±1.1mm) in Group-II. Although the apical root resorption of maxillary central incisors was significantly correlated to the duration of treatment (p=0.026), due to great standard deviation, there was no significant difference of apical root resorption between two groups.
Conclusion: In this study, although the maxillary central incisors in group-I experienced more extent of movement, it did not have greater amount of apical root resorption. Treatment duration and individual variation may take on more important roles in apical root resorption than the extent of tooth movement.

並列關鍵字

apical root resorption ； miniscrew