ABSTRACT
Objective@#To establish a quantitative three-dimensional method based on intraoral scan to evaluate the changes of soft tissue, and to evaluate the changes of supracrestal gingival thickness (SGT) in skeletal class Ⅲ patients induced by periodontal regenerative and corticotomy surgery (PRCS).@*Methods@#Twenty-two systematically and periodontally healthy skeletal class Ⅲ patients (4 males and 18 females, aged between 19 and 35 years), who were in need of combined orthodontic-orthognathic treatment and referred to the Department of Periodontology from the Department of Orthodontics and the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from January, 2018 to March, 2019, were collected in the study. The teeth involved were 112 anterior teeth (46 maxillary anterior teeth and 66 mandibular anterior teeth). PRCS in anterior tooth area was conducted before orthodontic decompensation. Probing depth (PD), bleeding index (BI) and keratinized gingiva width (KGW) were recorded before surgery and 6 months post-surgery. The intraoral digital impressions of maxillary and mandibular anterior teeth were obtained by 3-shape intraoral scanner before surgery and 6 months after surgery. The Standard Tessellation Language (STL) files were processed using Geomagic qualify 12.2 software to establish the soft tissue morphological measurement model, and to quantitatively analyze the changes of gingival thickness situated 1 to 2 mm apical to the free gingival margin on the median sagittal measurement plane.@*Results@#Probing depth and bleeding index had no significant difference before and 6 months after operation (P>0.05). KGW in 6-month post-operation group [(5.18±2.32) mm] was significantly higher than that in pre-operation group [(4.22±1.43) mm] (P<0.05). Supracrestal gingival thickness situated 1 to 2 mm apical to the free gingival margin also significantly increased 6 months after surgery (P<0.05). The changes of gingival thickness situated 1 to 2 mm apical to the free gingival margin in the upper anterior area were (0.68±0.56) and (1.00±0.69) mm, respectively. The changes in the lower anterior area were (0.38±0.42) and (0.58±0.45) mm, respectively. The gingival changes of the upper anterior teeth were also significantly higher than those of the lower anterior teeth (P<0.01).@*Conclusions@#The described quantitative measurement based on intraoral scan could be an effective method for quantitative evaluation of the changes of soft tissue. PRCS could safely increase the supracrestal gingival thickness as well as KGW in skeletal class Ⅲ patients who were in need of combined orthodontic-orthognathic treatment.
ABSTRACT
Modulation of orthodontic tooth movement (OTM) is desirable not only to patients because it shortens treatment time, but also to orthodontists, since treatment duration is associated with increased risk of gingival inflammation, decalcification, dental caries, and root resorption. The increased focus on the biological basis of tooth movement has rendered Orthodontics a more comprehensive specialty that incorporates facets of all fields of medicine. Current knowledge raises the possibility of using new therapeutic modalities for modulation of OTM, such as corticotomy, laser therapy, vibration (low-intensity pulsed ultrasound), local injections of biomodulators and gene therapy; with the latter being applicable in the near future. They are intended to enhance or inhibit recruitment, differentiation and/or activation of bone cells, accelerate or reduce OTM, increase stability of orthodontic results, as well as assist with the prevention of root resorption. This article summarizes recent studies on each one of these therapeutic modalities, provides readers with information about how they affect OTM and points out future clinical perspectives.
A modulação do movimento dentário ortodôntico (MDO) é desejável para os pacientes, pois reduz o tempo de tratamento, e também para ortodontistas, uma vez que a duração do tratamento tem sido associada a um aumento do risco de inflamação gengival, descalcificação, cárie dentária e reabsorção radicular. O crescente foco sobre os mecanismos biológicos da movimentação dentária levou a Ortodontia a ser uma especialidade mais abrangente, que hoje incorpora aspectos de todas as áreas da Medicina. Com o conhecimento atual, o uso de novas modalidades terapêuticas que visam a modulação da MDO, como a corticotomia, terapia a laser de baixa intensidade e vibração (ultrassom pulsátil de baixa intensidade) já são uma realidade clínica. Outras, como injeções locais de biomoduladores e a terapia genética, serão utilizadas em breve. Elas destinam-se a aumentar ou inibir o recrutamento, à diferenciação e/ou ativação das células ósseas, a acelerar ou reduzir a MDO, a aumentar a estabilidade dos resultados ortodônticos, bem como auxiliar na prevenção da reabsorção radicular. Esse artigo resume os estudos mais recentes sobre cada uma dessas novas modalidades terapêuticas, fornecendo informações aos leitores a respeito de como afetam a MDO e aponta futuras perspectivas clínicas.