自体骨移植辅助正畸-正颌治疗骨性Ⅱ类错𬌗伴牙周炎疗效

Efficacy of autogenous bone grafting as adjunct to combined orthodontic-orthognathic treatment of skeletal Class Ⅱ malocclusion with periodontitis

摘要

目的 探讨牙周自体骨移植辅助正畸-正颌联合治疗对骨性Ⅱ类错𬌗伴Ⅱ期牙周炎患者牙周功能、颌面硬组织形态及软组织美学的改善效果。方法 采用单盲随机对照研究设计，选取2025年1月-12月收治的骨性Ⅱ类错𬌗伴Ⅱ期牙周炎患者60例作为研究对象。采用随机数字表法结合密封不透光信封分配隐藏分为观察组与对照组，每组30例。对照组采用正畸-正颌联合治疗，观察组在此基础上于正畸治疗1个月后实施髂前上棘来源的皮质-松质混合骨颗粒移植修复牙槽骨缺损，植骨术后3个月被动维持正畸，确认骨愈合后恢复主动加力。比较两组治疗前后牙周功能指标（牙周袋深度、附着丧失、牙龈出血指数、菌斑指数、牙槽骨高度）、颌面硬组织指标（SNA角、SNB角、ANB角、下颌平面角、上颌突距、下颌突距）、颌面软组织美学指标（鼻唇角、面下1/3高度比、上唇突度、审美平面角、颏唇沟深度）及客观疗效指标（PAR指数），并评估治疗总有效率；为控制基线差异、反映干预的净效应，各组间疗效比较均以各指标治疗前后变化值（差值）作为分析变量。结果 观察组治疗后各项牙周功能指标均显著优于对照组（P<0.05）；颌面硬组织中ANB角、下颌平面角低于对照组，SNA角、SNB角改善幅度更大（P<0.05）；软组织美学指标改善程度显著高于对照组（P<0.05）；观察组PAR指数降低幅度大于对照组（P<0.05）；治疗后，观察组治疗总有效率为96.67%，高于对照组的70.00%（P<0.05）；两组并发症发生率比较差异无统计学意义（P>0.05）。结论 牙周自体骨移植辅助正畸-正颌联合治疗骨性Ⅱ类错𬌗伴Ⅱ期牙周炎可有效重塑颌面美学形态，改善牙周功能及咬合关系，实现颌面软硬组织的协调重塑，提高治疗疗效。

Abstract

Objective This study evaluates the adjunctive efficacy of autogenous bone grafting in combined orthodontic-orthognathic treatment for improving periodontal function, maxillofacial hard-tissue morphology, and soft-tissue facial aesthetics in patients with skeletal Class Ⅱ malocclusion complicated by stage Ⅱ periodontitis. Methods A single-blind, randomized controlled design was adopted. Sixty patients with skeletal Class Ⅱ malocclusion and stage Ⅱ periodontitis treated between January and December 2025 were enrolled and assigned to an observation group or a control group (n=30 each) using a random-number table, with allocation concealment achieved using sealed opaque envelopes. The control group received combined orthodontic-orthognathic treatment alone, whereas the observation group additionally underwent, one month after initiation of orthodontic therapy, grafting of cortico-cancellous bone particles harvested from the anterior superior iliac spine (ASIS) to reconstruct alveolar bone defects. For three months after grafting, orthodontic appliances were kept passive. Active orthodontic loading was resumed only after bone healing was confirmed. Periodontal parameters [probing depth (PD), attachment loss (AL), gingival bleeding index (GBI), plaque index (PLI) and alveolar bone height (ABH)], hard-tissue cephalometric variables (SNA, SNB, and ANB angles, mandibular plane angle, and maxillary and mandibular protrusion distances), soft-tissue aesthetic variables (nasolabial angle, lower facial third height ratio, upper-lip protrusion, esthetic plane angle, and mentolabial sulcus depth), and the Peer Assessment Rating (PAR) index were compared before and after treatment, and the overall treatment effectiveness rate was evaluated. To control for baseline differences and capture the net intervention effect, all between-group comparisons were based on the pre-to-post treatment change (difference) in each variable. Results After treatment, all periodontal parameters were significantly better in the observation group than in the control group (all P<0.05). For hard tissues, the ANB angle and mandibular plane angle were significantly lower in the observation group than in the control group, while the SNA and SNB angles improved more markedly in the observation group (P<0.05). Improvements in all soft-tissue aesthetic variables and the reduction in the PAR index were likewise significantly greater in the observation group (P<0.05). The overall treatment effectiveness rate was 96.67% in the observation group, which was higher than 70.00% in the control group (P<0.05). The incidence of complications did not differ significantly between groups (P>0.05). Conclusion Autogenous bone grafting as an adjunct to combined orthodontic-orthognathic treatment for skeletal Class Ⅱ malocclusion with stage Ⅱ periodontitis can effectively reshape maxillofacial aesthetic morphology, improve periodontal function and occlusal relationship, achieve coordinated remodeling of maxillofacial soft and hard tissues, and enhance therapeutic efficacy.

关键词

牙周自体骨移植 / 骨性Ⅱ类错𬌗 / Ⅱ期牙周炎 / 正畸-正颌联合治疗 / 颌面美学 / 临床疗效

Key words

Periodontal autogenous bone grafting / Skeletal Class Ⅱ malocclusion / Stage Ⅱ periodontitis / Orthodontic-orthognathic combined treatment / Maxillofacial aesthetics / Clinical efficacy

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