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快速犬齒後拉矯正治療的長期評估

Long-tern evaluation of rapid canine retraction

摘要


快速犬齒後拉矯正治療是一種不同於傳統矯正的創新技術。利用牙周膜牽引術,使犬齒能在四週之內完成後拉(retraction),除了能顯著的減少矯正時間之外,也被證實僅有極少量的後牙錨定喪失。然而,快速犬齒後拉對於犬齒之牙周膜、牙髓以及牙根的長期影響仍然不明。本研究的目的是快速犬齒後拉治療的長期術後評估。研究的樣本包括55位接受快速犬齒後拉治療的病人(包括32位成人及23位青少年),評估的時間由開始接受治療(T1)至術後評估(T2)為4.0±0.8 年。評估測量包括牙周附連喪失程度(attachment loss),牙齒活性測量(EPT),而牙根吸收則利用比較Tl及T2的根尖X光片,由牙根長度/牙冠長度比例、牙根吸收程度評分來評估。另外,牙根黏連,牙根內吸收和牙髓石也藉由根尖X光片來記錄分析。結果顯示,在牙周部分,受測的牙齒都沒有在統計學上有意義的牙周附連喪失;在牙齒活性部分,受測的牙齒,不論成人或是青少年,其活性皆在4年內恢復;在牙根尖吸收部分,在青少年方面,並沒有明顯的吸收,牙根的長度也有繼續增長;而在成人部分,雖有統計學上有意義的根尖吸收,惟減少的比例很小,平均只有小於0.05比例的吸收,牙根吸收程度評分也只顯示稍許牙根尖的圓鈍,並沒有嚴重的吸收;在側向牙根吸收部分,大部分的受測牙齒只顯示少許側面牙根面的不規則。結論,快速犬齒後拉治療對於犬齒牙周膜、牙髓或是牙根,就長期而言,皆沒有不良的影響。

並列摘要


Rapid canine retraction is an innovative technique for retracting the canine through periodontal ligament (PDL) distraction. Advantages of rapid canine retraction include decreasing the total treatment time and minimizing the anchorage loss. However, its long- term and possible side effects on periodontal and pulpal tissues and dental roots remain unknown. Fifty-five orthodontic patients (32 adults and 23 teenagers) who underwent extraction of their upper/lower 1st premolars and received apid canine retraction were included for evaluation. The period of evaluation was from right before (TI) to 4 years (T2,4.0±0.8 years) after the rapid canine retraction. The periodontal attachment level for each retracted canine was recorded at T1 and T2. The pulp vitality of the retracted canines was tested electrically at yearly intervals up to T2. Standardized periapical radiographs were taken at T1 and T2 for evaluating the apical root resorption by the root/tooth length ratio and for scrutinizing the soundness of the lamina dura and PDL. Pulp stone/obliteration, if any, was recorded. The evaluations revealed that there was no significant periodontal attachment loss, and the lamina dura and PDL remained sound in all retracted canines. Pulp vitality had recovered within 4 years in all cases, and there was no pulp stone/obliteration. Apical root resorption was acceptable in all retracted canines, while the teenager group had less resorption than the adult group. In conclusion, the rapid canine retraction had no detrimental effects on periodontal and pulpal tissues, and no excessive root resorption was observed in long-term results.

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