Liou Eric J W, Chen Po-Hsung, Wang Yu-Chih, Yu Chung-Chih, Huang C S, Chen Yu-Ray
Department of Orthodontics and Craniofacial Dentistry, Chang Gung Memorial Hospital, and Graduate Institute of Oral and Craniofacial Medicine, Chang Gung University, Taoyaun, Taiwan.
J Oral Maxillofac Surg. 2011 Mar;69(3):781-5. doi: 10.1016/j.joms.2010.10.035.
Clinically, we have observed the phenomenon of postoperatively accelerated orthodontic tooth movement in patients who had orthognathic surgery. This phenomenon lasts for a period of 3 to 4 months. However, the underlying mechanisms of this phenomenon have not been well studied yet. The purpose of this prospective clinical pilot study was to study the postoperative changes in bone physiology and metabolism and the corresponding responses in the dentoalveolus, such as the changes in tooth mobility.
Twenty-two consecutive adult patients who had 2-jaw orthognathic surgery were included in this study. The levels of serum alkaline phosphatase and C-terminal telopeptide of type I collagen (ICTP), as well as the tooth mobility of the maxillary and mandibular incisors based on the Periotest method (Siemens AG, Bensheim, Germany), were examined preoperatively and 1 week, 1 month, 2 months, 3 months, and 4 months postoperatively. The data were analyzed statistically.
Both tooth mobility of the maxillary and mandibular incisors and ICTP significantly increased from 1 week to 3 months postoperatively and then decreased to their preoperative levels in the fourth month postoperatively. The changes in tooth mobility were significantly in correspondence with the changes in ICTP. The alkaline phosphatase level significantly increased from the first to fourth month postoperatively, but it was not significantly correlated to the changes in tooth mobility.
The orthognathic surgery triggers a 3- to 4-month period of higher osteoclastic activities and metabolic changes in the dentoalveolus postoperatively, which possibly accelerates postoperative orthodontic tooth movement.
在临床上，我们观察到接受正颌手术的患者术后出现正畸牙加速移动的现象。这种现象持续3至4个月。然而，这一现象的潜在机制尚未得到充分研究。这项前瞻性临床初步研究的目的是研究术后骨生理和代谢的变化以及牙槽骨相应的反应，如牙齿松动度的变化。
本研究纳入了22例连续接受双颌正颌手术的成年患者。术前及术后1周、1个月、2个月、3个月和4个月检测血清碱性磷酸酶和I型胶原C端肽（ICTP）水平，以及基于Periotest方法（德国西门子公司，本斯海姆）检测上颌和下颌切牙的牙齿松动度。对数据进行统计学分析。
上颌和下颌切牙的牙齿松动度和ICTP在术后1周内至3个月均显著增加，然后在术后第4个月降至术前水平。牙齿松动度的变化与ICTP的变化显著相关。碱性磷酸酶水平在术后第1个月至第4个月显著升高，但与牙齿松动度的变化无显著相关性。
正颌手术术后会引发牙槽骨3至4个月的破骨细胞活性增强和代谢变化，这可能加速术后正畸牙移动。
