| Objective Forty patients with chronic periodontitis with pathological protrusion and displacement of anterior teeth treated with combined periodontal-orthodontic therapy were included in this study.Based on the measured data of probing depth and gingival sulcus bleeding before and after orthodontic treatment,the effects of bracketless invisible orthodontic treatment and lip-fixed orthodontic treatment on periodontitis patients' periodontal health were evaluated,and the safety of periodontitis patients receiving these two treatment methods was inferred.Based on cone beam computed tomography(CBCT)data,the changes of alveolar bone density and height in the maxillary central incisor were compared after bracketless invisible orthodontic treatment and traditional labial fixation.To explore the effect of bracketless invisible orthodontic treatment and traditional orthodontic treatment on periodontal bone tissue in patients with periodontitis,and provide a reference for clinical treatment.Materials and methods 1.From September 2016 to December 2018,40 patients in the orthodontic Department of the First Affiliated Hospital of Zhengzhou University were selected according to the inclusion criteria and divided into two groups,20 in each group.One group was treated with the age Angel non-bracket invisible appliance,the other group was treated with the traditional lip fixed appliance,and the patients' anterior teeth were pressed and adducted.All patients received systematic periodontal basic treatment three months before and after orthodontic treatment(T0)and(T1)were examined by the same dentist,including sulcus bleeding index(SBI),probing depth(PD).SPSS25.0 was used to process and analyze the data.SBI and PD data before and after orthodontic treatment in the same group were analyzed by independent sample t test.The data before and after orthodontic treatment between the two groups were compared by paired t test(P < 0.05).2.Two groups of patients were scanned by CBCT before and after orthodontic treatment,and the scanned images were input directly into the computer.The images were reconstructed by e Xam Vision.All data were measured three times by myself,and the average value was taken as the valid value.(1)In the three-dimensional image reconstructed by software,the alveolar ridge apex(C1),the enamel-cementum boundary and the midpoint of the apex(C2),the apex(C3),the apex of the palatal alveolar ridge(L1),the enamel-cementum boundary and the apex(L2),and the alveolar bone area of the apex crown(L3)were determined.Alveolar bone mineral density was measured at corresponding sites in CBCT cross-sectional images,and 6 sites were measured for each tooth.Multiple groups of data were compared using one-way ANOVA,and the test level was bilateral a=O.05.(2)Measure the alveolar bone height between right upper incisor(UR2)and right upper central incisor(UR1),UR1 and left upper central incisor(UL1),UL1 and left upper incisor(UL2).Statistical software SPSS25.0 was used to process and analyze the data.The changes of alveolar bone height after orthodontic treatment were discussed and compared with the alveolar bone spacing at different tooth positions.Group t test was used.Two groups were compared before and after treatment with paired t test,the test level was bilateral a=0.05.Result 1.(1)Before orthodontic treatment,the depth of exploration in the invisible orthodontic group was(4.27±0.75)mm;after orthodontic treatment,it was(2.12± 0.51)mm,with a change of(2.15±0.60)mm,with statistical significance(P < 0.05).Before orthodontic treatment,the probing depth of the lip fixation group was(4.25±1.02)mm;after treatment,it was(2.48 ±0.60)mm,and the change was(1.77±0.80)mm,with statistical significance(P < 0.05).After orthodontic treatment,the change of periodontal exploration depth in the invisible orthodontic group was greater than that in the fixed orthodontic group(P < 0.05).(2)Before orthodontic treatment,the gingival sulcus bleeding index in the invisible treatment group was(2.06±0.62);after orthodontic treatment was(1.12±0.22),the change was(0.94±0.53),the difference was statistically significant(P < 0.05).Before treatment,the gingival sulcus hemorrhage index in the fixed correction group was(2.06±0.57),and after treatment was(0.72±0.23),the change amount was(1.34 ± 0.44),the difference was statistically significant(P<0.05).After orthodontic treatment,the change of gingival sulcus hemorrhage index in invisible orthodontic group was greater than that in fixed orthodontic group(P < 0.05).2.(1)Before orthodontic treatment,there was no significant difference in bone mineral density between the traditional lip-lingual fixed orthodontic group and the invisible orthodontic group(p > 0.05).(2)Difference analysis of labial alveolar bone mineral density of maxillary central incisors in patients with chronic periodontitis at rest : Before and after orthodontic treatment,the alveolar bone mineral density of C1 and C3 layers of left maxillary central incisors in the traditional lip fixed appliance group decreased significantly(12.22% and 10.45% respectively),and that of C1 and C3 layers of right maxillary central incisors in the traditional lip fixed appliance group decreased significantly(14.91% and 11.06%,respectively).There was no significant difference in bone mineral density between the two groups(P > 0.05).(3)Difference analysis of palatal alveolar bone mineral density of maxillary central incisors in patients with stationary chronic periodontitis : The alveolar bone mineral density of L1 layer of left and right maxillary central incisors in the invisible orthodontic group decreased significantly(8.03% and 9.15%,respectively).The alveolar bone mineral density of L1 layer of left and right maxillary central incisors in the traditional lip fixed orthodontic group decreased significantly(23.92% and 21.14%,respectively).The alveolar bone mineral density of L3 layer of left and right maxillary central incisors in the traditional lip fixed orthodontic group decreased significantly(7.46% and 6.29%,respectively).There was no significant difference in bone mineral density(BMD)between the two groups(P > 0.05).(4)There was no significant difference in the height of maxillary alveolar bone between the two groups before orthodontic treatment(P > 0.05).After orthodontic treatment,there was no significant difference in the overall changes of alveolar bone height between the two groups(P > 0.05).(5)There were no significant changes in alveolar bone height between UL1 and UL2,UL1 and UR1,UR1 and UR2 before and after orthodontic treatment in the invisible orthodontic group and the traditional lip fixed orthodontic group.The P values were greater than 0.5,and the difference was not statistically significant(P > 0.05).Conclusion: 1.(1)From the perspective of inflammation,bracketless invisible orthodontics and traditional lip-side fixed orthodontics are relatively safe for patients with stationary periodontitis.(2)Non-bracket invisible orthodontic technology is more conducive to the recovery of periodontal soft tissue health in patients with periodontitis.2.(1)The palatal alveolar bone mineral density in the crest area of the upper central incisor decreased when the bracketless invisible orthodontic technique was applied to the patients with moderate periodontitis.The bone mineral density of the alveolar crest and apex of the upper central incisor decreased when the traditional lip-side fixation technique was applied to orthodontic treatment of patients with periodontitis and the anterior teeth with adductive pathological elongation and displacement were pressed.(2)There was no significant change in alveolar bone height of moderate periodontitis patients treated with invisible orthodontics and lip-side fixation,and the effect of different alveolar septum alveolar bone height was the same.(3)Under combined periodontal and orthodontic treatment,bone mineral density changes may occur more easily than bone height by radiological assessment of bone status. |
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