傳統直絲弓固定矯治器與無托槽隱形矯治器對正畸患者咬合功能及牙周健康的影響

劉建捷　孫娜

[摘要]目的：探討傳統直絲弓固定矯治器與無托槽隱形矯治器對正畸患者咬合功能及牙周健康的影響。方法：將102例正畸患者隨機均為對照組和觀察組，對照組：51例，給予傳統直絲弓固定矯治器矯治;觀察組：51例，給予無托槽隱形矯治器矯治，觀察兩組裝配固定矯治器前及裝配后24h的咬合功能和治療前及矯治6個月后的牙周健康狀況，評估兩組矯治滿意度。結果：粘戴托槽24h后，兩組患者口腔咬合功能指標中咀嚼效能（ME）、去皮花生仁的咀嚼次數（MT）、最大咬合力（MF）及咬合速率（SO）值顯著降低（P<0.05），最大合力時間（MFT）值顯著升高（P<0.05），觀察組變化幅度顯著小于對照組（P<0.05）;矯治6個月后，兩組間牙齦指數（GI）、齦溝探診深度（SPD）、齦溝出血指數（SBI）及菌斑指數（PLI）值較矯治前對比，差異有統計學意義（P<0.05）;矯治6個月后，兩組齦溝液中天門冬氨酸轉氨酶（AST）及堿性磷酸酶（ALP）含量均顯著提高（P<0.05），觀察組上升幅度顯著小于對照組（P<0.05）;觀察組矯治后對咀嚼功能、固定功能、美觀程度、舒適性、方便程度及語言功能的滿意度顯著高于對照組（P<0.05）。結論：無托槽隱形矯治器能緩解正畸患者口腔咬合功能障礙，利于牙周組織健康，患者滿意度高，效果優于傳統直絲弓固定矯治器。

[關鍵詞]正畸;無托槽隱形矯治器;傳統直絲弓固定矯治器;咬合功能;牙周健康;矯治滿意度

[中圖分類號]R783.5? ? [文獻標志碼]A? ? [文章編號]1008-6455（2019）10-0109-04

Abstract： Objective To explore the effects of traditional straight-wire fixed appliance and bracketless invisible appliance on occlusal function and periodontal health of orthodontic patients. Methods? A total of 102 orthodontic patients were randomly and evenly divided into control group and observation group. Control group was treated with traditional straight-wire fixed appliance， and observation group was treated with bracketless invisible appliance. The occlusal function before assembly of fixed appliance and after 24h of assembly and periodontal health status before treatment and after 6 months of correction were observed in the two groups. The correction satisfaction was evaluated in the two groups. Results? After 24 h of adhesive wearing brackets， the oral occlusal function indexes of masticatory efficiency （ME） and masticatory frequency （MT）， the maximum masticatory force （MF） and occlusion rate （SO） of blanched groundnut kernel were significantly decreased in the two groups （P<0.05），? and maximum force time （MFT） was significantly increased （P<0.05）， and the changes in observation group were significantly smaller than those in control group （P<0.05）. After 6 months of correlation， there were statistically significant differences in the gingival index （GI）， sulcus probing depth （SPD）， sulcus bleeding index （SBI） and plaque index （PLI） between the two groups compared with those before correlation （P<0.05）. After 6 months of correlation，the levels of aspartate aminotransferase （AST） and alkaline phosphatase （ALP） in gingival crevicular fluid were significantly increased in the two groups （P<0.05）， and the increases in observation group were significantly smaller than those in control group （P<0.05）. The satisfactions of masticatory function， fixation function，aesthetics，comfort，convenience and language function in observation group after correction were significantly higher than those in control group （P<0.05）. Conclusion? Bracketless invisible appliance for patients with orthodontic correction can relieve the oral occlusal dysfunction， and it is helpful to periodontal tissue health， and it has high patientssatisfaction， and its effects are better than the traditional straight-wire fixed appliance.

Key words： orthodontic; bracketless invisible appliance; traditional straight-wire fixed appliance; occlusal function; periodontal health; correction satisfaction

隨著人們生活品質和審美意識的逐漸提高，對于口腔美觀的追求也日益增加，越來越多的錯牙合畸形患者希望通過正畸矯治來改善外觀形象[1-2]。傳統直絲弓固定矯治器能影響患者牙齒美觀度和牙面外形清潔度，增加其不適感，且極易造成食物殘渣滯留，導致菌斑堆積，增加齲齒、釉質脫礦及牙齦萎縮的發生風險[3]。因此，臨床上尋求一種更美觀、實用、安全的矯治器成為一種臨床口腔醫學新趨勢。近年來，無托槽隱形矯治器成為一門新興矯正技術，通過計算機輔助設計、制作成一系列熱壓膜矯治器，利用變形后回彈力不斷小范圍進行牙位移動，以達到錯牙合畸形牙齒矯正的目的[4]。然而，無論是傳統直絲弓固定矯治器還是無托槽隱形矯治器初期均會造成口腔咬合障礙，長期還會影響口腔自潔，引發牙周附著組織的喪失和炎癥，不利于牙周健康[5]。……