使用II类弹性牵引进行透明矫治器治疗后牙槽骨开窗和骨穿孔的发生率及危险因素：一项回顾性研究

Incidence and risk factors of alveolar bone dehiscences and fenestrations after clear aligner therapy with Class II elastics: a retrospective study.

作者信息

Wang Chenxu, Zhao Yang, Guo Feng, Li Houxuan, Lei Lang

机构信息

Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China.

Department of Periodontics, Nanjing Stomatological Hospital, Affiliated Hospital of Medical School, Institute of Stomatology, Nanjing University, Nanjing, China.

出版信息

BMC Oral Health. 2025 Apr 26;25(1):644. doi: 10.1186/s12903-025-06023-0.

DOI:10.1186/s12903-025-06023-0

PMID:40287658

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12034186/

Abstract

BACKGROUND

In clear aligner therapy (CAT), Class II elastics are widely used to reinforce the anchorage during the distalization of upper molars, however, their association with alveolar bone dehiscences (ABDs) and fenestrations (ABFs) in the anterior region remains unclear. The aim of this research is to assess the incidence of ABDs/ABFs in adult patients undergoing non-extraction CAT with Class II elastics, and to explore risk factors associated with the occurrence of ABDs/ABFs.

METHODS

Thirty adult patients with Class II malocclusion who underwent non-extraction CAT with Class II intermaxillary elastics were enrolled in this study. Cone-beam computed tomography (CBCT) images were obtained before (T0) and immediately after (T1) CAT to assess the occurrence of ABDs/ABFs on the labial and lingual sides of anterior teeth. Chi-square tests were used to compare the incidence of ABDs/ABFs at T0 and T1, meanwhile, binary logistic regression was utilized to analyze the risk factors associated with ABDs/ABFs at T1.

RESULTS

On the labial side, the incidence of ABDs increased significantly in the mandibular central incisors (from 36.7 to 62.8%, P < 0.05), mandibular lateral incisors (from 36.7 to 70.0%, P < 0.05), mandibular canines (from 31.7 to 53.3%, P < 0.05) and maxillary canines (from 30.0 to 55.0%, P < 0.05). While on the lingual side, it increased significantly in the maxillary central incisors (from 1.7 to 23.3%, P < 0.05), lateral incisors (from 6.7 to 38.3%, P < 0.05), and canines (from 21.7 to 46.7%, P < 0.05). The incidence of ABFs only increased on the labial side of the maxillary canines and mandibular central incisors. The occurrence of maxillary ABDs was strongly associated with the crowding (OR = 1.318, P = 0.007), while the occurrence of the mandibular ABDs was significantly associated with root surface (labial vs. lingual, OR = 1.836, P = 0.008).

CONCLUSIONS

The incidence of ABDs/ABFs significantly increased after non-extraction CAT with Class II elastics in adults, especially on the labial root surface of the mandibular anterior teeth. Orthodontists should be well aware of the periodontal risks of CAT with Class II elastics.

摘要

背景

在透明矫治器治疗（CAT）中，II类牵引广泛用于上颌磨牙远移过程中增强支抗，然而，其与前部区域牙槽骨裂（ABDs）和开窗（ABFs）的关系仍不明确。本研究的目的是评估接受II类牵引非拔牙CAT的成年患者中ABDs/ABFs的发生率，并探讨与ABDs/ABFs发生相关的危险因素。

方法

本研究纳入30例接受II类颌间牵引非拔牙CAT的II类错颌成年患者。在CAT治疗前（T0）和治疗结束后立即（T1）获取锥形束计算机断层扫描（CBCT）图像，以评估前牙唇侧和舌侧ABDs/ABFs的发生情况。采用卡方检验比较T0和T1时ABDs/ABFs的发生率，同时，采用二元逻辑回归分析T1时与ABDs/ABFs相关的危险因素。

结果

在唇侧，下颌中切牙（从36.7%增至62.8%，P<0.05）、下颌侧切牙（从36.7%增至70.0%，P<0.05）、下颌尖牙（从31.7%增至53.3%，P<0.05）和上颌尖牙（从30.0%增至55.0%，P<0.05）的ABDs发生率显著增加。而在舌侧，上颌中切牙（从1.7%增至23.3%，P<0.05）、侧切牙（从6.7%增至38.3%，P<0.05）和尖牙（从21.7%增至46.7%，P<0.05）的ABDs发生率显著增加。ABFs的发生率仅在上颌尖牙和下颌中切牙的唇侧增加。上颌ABDs的发生与拥挤密切相关（OR=1.318，P=0.007），而下颌ABDs的发生与牙根表面（唇侧与舌侧，OR=1.836，P=0.008）显著相关。