Department of Orthodontics, Medical Corps, Israel Defense Forces, Ramat Gan, Israel.
Department of Periodontology, Medical Corps, Israel Defense Forces, Ramat Gan, Israel.
Am J Orthod Dentofacial Orthop. 2018 Sep;154(3):375-381. doi: 10.1016/j.ajodo.2017.12.012.
Alveolar bone loss is regarded as a potential adverse event during orthodontic treatment, especially in adults. The purposes of this study were to evaluate the prevalence and severity of interdental alveolar crest height loss in adult orthodontic patients compared with an untreated control group and to identify comorbidity risk factors for such bone loss (high BMI score, high blood pressure, high cholesterol levels, and smoking).
Standardized bitewing radiographs of patients' buccal segments were taken before and after treatment of 34 consecutive adults treated in an orthodontic clinic. The control group included 29 patients from the operative dental clinic matched according to age and sex. Mean ages of the participants before treatment were 35.7 ± 6.7 and 35.6 ± 7.3 years for the control and treatment groups, respectively. Before orthodontic treatment, the patients were evaluated, treated as needed, and approved by a periodontist. They were periodontically healthy before treatment. Interdental alveolar crest height loss was calculated by subtracting the distance on a bitewing x-ray from the cementoenamel junction to the interdental alveolar crest at each interproximal tooth surface from the mesial aspect of the first premolar to the distal aspect of the second molar (8 sites per quadrant). Changes in interdental alveolar crest height were calculated by subtracting the cementoenamel junction-interdental alveolar crest distance before treatment from the corresponding distance after treatment.
The mean individual bone losses of all interproximal surfaces were 0.130 ± 0.192 and 0.072 ± 0.280 mm in the treatment and control groups, respectively. These differences did not reach statistical significance (P = 0.353). Twenty-two patients (65%) from the treatment group and 10 patients (34%) from the control group had an increase in the cementoenamel junction-interdental alveolar crest distance of more than 1 mm in at least 1 site, with borderline significance between the groups (P = 0.079). Notably, no association was observed between bone loss with any comorbidity factor.
The results of this study correspond to the conventional understanding in the orthodontic and periodontal literature that orthodontic tooth movement per se does not cause attachment loss. However, orthodontists should always be aware of the possibility of periodontal deterioration during orthodontic treatment. Therefore, comprehensive periodontal examination is necessary during orthodontic treatment, especially in adults.
牙槽骨丧失被认为是正畸治疗过程中的一个潜在不良事件，尤其是在成年人中。本研究的目的是评估与未经治疗的对照组相比，成人正畸患者的牙间牙槽嵴高度丧失的发生率和严重程度，并确定这种骨丢失的合并症危险因素（高 BMI 评分、高血压、高胆固醇水平和吸烟）。
对 34 名连续接受正畸治疗的成年患者的颊侧段标准咬合翼片进行治疗前后拍摄。对照组包括 29 名来自口腔外科诊所的患者，根据年龄和性别进行匹配。治疗组和对照组的参与者在治疗前的平均年龄分别为 35.7±6.7 岁和 35.6±7.3 岁。在接受正畸治疗之前，患者接受了评估，根据需要进行了治疗，并接受了牙周病医生的批准。他们在治疗前是牙周健康的。通过从第一前磨牙的近中面到第二磨牙的远中面，在每个近中面牙间牙槽嵴上减去咬合翼片上的釉牙骨质界到牙间牙槽嵴的距离，计算牙间牙槽嵴高度的丧失（每个象限 8 个位点）。通过从治疗前的釉牙骨质界-牙间牙槽嵴距离中减去治疗后的相应距离，计算牙间牙槽嵴高度的变化。
所有近中面的个体骨丢失平均值分别为治疗组 0.130±0.192mm 和对照组 0.072±0.280mm。这些差异没有达到统计学意义（P=0.353）。在治疗组中，22 名患者（65%）和对照组中 10 名患者（34%）在至少 1 个部位的釉牙骨质界-牙间牙槽嵴距离增加了 1mm 以上，两组之间存在边缘显著差异（P=0.079）。值得注意的是，骨丢失与任何合并症因素之间均无关联。
本研究的结果与正畸和牙周文献中的传统观点一致，即正畸牙齿移动本身不会导致附着丧失。然而，正畸医生在正畸治疗过程中始终应该意识到牙周恶化的可能性。因此，在正畸治疗期间，特别是在成年人中，需要进行全面的牙周检查。
