2种参考体系下上颌前牙区牙槽骨改建特点的CBCT研究

doi:10.3969/j.issn.1674-8115.2025.11.010

摘要/Abstract

摘要：

目的·比较在骨性稳定结构与牙体长轴2种参考体系下，使用微种植支抗辅助内收压低上前牙，拔除双侧第一前磨牙患者的上颌前牙区牙槽骨改建与牙移动比例（bone remodeling/tooth movement ratio，B/T Ratio）是否有差异。方法·收集23份样本的资料，包括患者治疗前后锥形线束计算机断层扫描（cone-beam computed tomography，CBCT）资料，年龄与性别，ANB角（上下齿槽座角）值和FMA角（下颌平面角）值的治疗前资料；所有患者均遵循相同的正畸治疗标准流程完成治疗。使用Dolphin Imaging软件重叠治疗前后CBCT影像后，在骨性稳定结构参考体系下测量牙尖点矢状向位移、根尖点矢状向位移、压低量以及唇倾度变化值；同时分别测量以骨性稳定结构（G组）与牙体长轴（Y组）为参考体系时，牙槽嵴顶部（Level 1）、根中部（Level 2）以及根尖部（Level 3）位置的牙移动距离、骨改建距离以及B/T Ratio；归一化处理后比较2种参考体系中B/T Ratio的差异。结果·ANB角与FMA角平均值分别为6.00°±2.08°与30.24°±5.95°，有骨性Ⅱ类与高角倾向。上颌中切牙在矢状向上的双侧牙尖点位移值［右侧（6.07±2.58）mm，左侧（6.33±2.27）mm］均超过根尖点位移值［右侧（3.92±2.06）mm，左侧（3.90±2.27）mm］，同时垂直向压低量双侧基本对称［右侧（2.90±1.51）mm，左侧（2.87±1.80）mm］，并伴随唇倾度角度改变（右侧4.26°±9.19°，左侧4.00°±8.84°）。G组中牙移动距离由牙槽嵴顶部向根尖部递减，而Y组无类似趋势；G组和Y组的骨改建距离及B/T Ratio均由牙槽嵴顶部向根尖部递减。归一化处理后，除左上中切牙Level 1水平线位置的B/T Ratio值在G组与Y组的比较中未显示出统计学差异以外，其余位置的组间差异均有统计学意义（均P<0.05）。结论·上前牙在微种植支抗辅助内收压低时，相较于牙体长轴参考体系受自身移动的影响，应用骨性稳定结构参考体系能更准确地反映真实的牙槽骨改建情况。

关键词: 骨改建, 牙移动, 锥形束计算机断层扫描

Abstract:

Objective ·To compare differences in the bone remodeling/tooth movement ratio (B/T ratio) between the skeletal stable structure reference system and the dental long-axis reference system among extraction patients (extracted bilateral first premolars) undergoing maxillary anterior retraction and intrusion with micro-implant anchorages. Methods ·A total of 23 samples were retrospectively analyzed. Pretreatment and posttreatment cone-beam computed tomography (CBCT) data, along with pretreatment demographic (age, gender) and cephalometric parameters (ANB angle and FMA angle), were collected from patient records. All subjects underwent standardized orthodontic treatment protocols. Using Dolphin Imaging software, pretreatment and posttreatment CBCT images were superimposed. Labial inclination changes, incisal edge sagittal displacements, root apex sagittal displacements, and intrusion values were measured under skeletal stable structure reference system. For both group G (skeletal stable structure) and group Y (dental long-axis), tooth movement distances, bone remodeling distances, and B/T ratios were measured at three levels: alveolar crest (Level 1), mid-root (Level 2), and root apex (Level 3). Normalized data were compared to evaluate intergroup differences in B/T ratios. Results ·Average ANB and FMA angles were 6.00 °±2.08° and 30.24 °±5.95°, respectively, consistent with skeletal Class Ⅱ malocclusion and vertical hyperdivergence tendencies. The maxillary central incisors exhibited sagittal displacement gradients in which incisal edge displacements [right: (6.07±2.58) mm; left: (6.33±2.27) mm] exceeded apical displacements [right: (3.92±2.06) mm; left:(3.90±2.27) mm]. Concurrently, intrusion values demonstrated comparable vertical changes bilaterally [right: (2.90±1.51) mm; left: (2.87±1.80) mm], accompanied by labial inclination changes of 4.26°±9.19° (right) and 4.00°±8.84° (left). In group G, tooth movement distance progressively decreased from Level 1 to Level 3, whereas no such gradient was observed in group Y. Both groups demonstrated decreasing bone remodeling distances and B/T ratios from Level 1 to Level 3. After normalization, statistically significant intergroup differences (P<0.05) were identified across all measurement levels except for the B/T ratio at Level 1 of the left maxillary central incisor. Conclusion ·When evaluating alveolar bone remodeling during orthodontic retraction and intrusion of maxillary anterior teeth with micro-implant anchorages, the skeletal stable structure reference system provides more accurate assessments than the dental long-axis reference system, as the latter is susceptible to displacement artifacts inherent to the reference itself.

Key words: bone remodeling, tooth movement, cone-beam computed tomography

中图分类号:

R783

李璐璐, 吴建勇. 2种参考体系下上颌前牙区牙槽骨改建特点的CBCT研究[J]. 上海交通大学学报（医学版）, 2025, 45(11): 1507-1514.

LI Lulu, WU Jianyong. A cone-beam computed tomographic study comparing characteristics of maxillary anterior regional alveolar bone remodeling under two reference systems[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(11): 1507-1514.

图/表 6

图1 三维重建牙颌影像定位示意图Note： White image refers to T0 (before treatment), while green image refers to T1 (after treatment). Orientation was performed based on T1 image. Upper left window shows the coronal view of the combined CBCT image of T0 and T1, while upper right window shows the sagittal view and lower left window shows the axial view. Lower right window shows the combined 3-dimensional reconstructed CBCT image. The red line represents the sagittal plane. The blue line (H line) represents the horizontal plane. The green line (V line) represents the coronal plane. Measurements were conducted on the sagittal slice (upper right window).

Fig 1 Positioning of the three-dimensional reconstructed dental and maxillofacial image

图2 CBCT影像中的测量基线与测量参数示意图Note： A. Sagittal measurements of tooth movement in group G at crestal (Lg1), mid-root (Lg2), and apical (Lg3) levels. B. Sagittal measurements of bone remodeling in group G at crestal (Bg1), mid-root (Bg2), and apical (Bg3) levels. C. Sagittal measurements of tooth intrusion movement in group G. Ha—apical retraction; Hc—coronal retraction; V—intrusion. D. Sagittal measurements of tooth inclination movement in group G. Δangle—labial inclination change.

Fig 2 Diagram of measurement baselines and parameters in CBCT images

图3 牙体长轴参考体系截取平面示意图

Fig 3 Schematic diagram of the section planes in the dental long- axis reference system

表1 骨性稳定结构为参考体系下的牙移动与牙槽骨改建情况（G组）

Tab 1 Tooth movement and alveolar bone remodeling in group G based on the skeletal stable structure reference system

Alveolar bone level	Tooth movement/mm	Alveolar bone remodeling/mm	B/T Ratio
T11
Level 1	3.49±2.21	2.83±1.78	0.84(0.76, 1.03)
Level 2	3.05±2.29	1.96±1.46	0.75(0.59, 0.90)
Level 3	2.09±2.51	1.09±1.27	0.59(0.47, 0.81)
T21
Level 1	3.55±2.06	2.83±1.65	0.74(0.67, 0.98)
Level 2	3.18±2.18	2.00±1.42	0.63(0.54, 0.76)
Level 3	2.81±2.54	1.29±1.25	0.55(0.44, 0.61)

表2 牙体长轴为参考体系下的牙移动与牙槽骨改建情况（Y组）

Tab 2 Tooth movement and alveolar bone remodeling in group Y based on the dental long-axis reference system

Alveolar bone level	Tooth movement/mm	Alveolar bone remodeling/mm	B/T Ratio
T11
Level 1	4.93±1.87	4.28±1.27	0.88(0.79, 1.00)
Level 2	4.71±1.98	3.77±1.30	0.84(0.73, 0.92)
Level 3	4.54±2.15	2.92±1.29	0.72(0.49, 0.81)
T21
Level 1	5.08±1.60	4.40±1.23	0.89(0.82, 0.97)
Level 2	4.94±1.69	3.79±1.03	0.81(0.65, 0.93)
Level 3	5.00±1.90	3.01±1.11	0.64(0.50, 0.73)

表3 归一化后G组与Y组B/T Ratio比较

Tab 3 Comparison of normalized B/T Ratio between group G and group Y

Group		M(Q₁, Q₃)	Z value	P value
T11 B/T Ratio
Level 1	Group G	0.58(0.47, 0.86)	-2.798	0.005
Level 1	Group Y	0.35(0.19, 0.56)	-2.798	0.005
Level 2	Group G	0.56(0.46, 0.62)	-4.010	0.000
Level 2	Group Y	0.28(0.21, 0.33)	-4.010	0.000
Level 3	Group G	0.81(0.70, 0.90)	-3.498	0.000
Level 3	Group Y	0.40(0.25, 0.46)	-3.498	0.000
T21 B/T Ratio
Level 1	Group G	0.43(0.28, 0.86)	-0.016	0.987
Level 1	Group Y	0.54(0.41, 0.72)	-0.016	0.987
Level 2	Group G	0.37(0.27, 0.51)	-1.977	0.048
Level 2	Group Y	0.57(0.22, 0.83)	-1.977	0.048
Level 3	Group G	0.65(0.53, 0.70)	-2.419	0.016
Level 3	Group Y	0.51(0.34, 0.62)	-2.419	0.016

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