| 摘要: | 研究背景：牙齒矯正有許多優點，但也有一些併發症：牙齦萎縮等。由於前瞻性矯正研究曠日費時，因此希望藉由橫斷式研究來了解矯正是否會造成牙齦萎縮？此外，不同牙醫、甚至同個牙醫在不同時間測量牙齦萎縮都會有一些測量誤差，但是，牙周探測的單位是毫米(mm)，十分精細，此誤差是否在接受範圍內？ 研究目的：進行並校準牙周病檢查，以審查牙醫師間多次牙周探測的可靠精準性。檢查具有矯正治療史的牙醫系學生中牙齦萎縮的發生率及其相關因素，同時探索數位科技在測量牙齦萎縮方面的應用。
研究方法： 此研究分成兩個小研究，在第一項關於矯正治療與牙齦萎縮的研究中，向2023至2024年北醫牙醫系大四學生發放了一份問卷，以了解受試者的矯正史及口內的牙齦萎縮狀況。其中包含14個問題，如牙齦表型、矯正期間是否有拔牙等，再用口掃紀錄有牙齦萎縮的受試者。第二項研究中，對四名牙醫和四名患者進行了輪流測量，以測試不同牙醫師在多次牙周探測時的精準度。
結果：有矯正治療史的受試者牙齦萎縮的勝算比（OR）為0.77，下排區域則為1.33。分析結果顯示，2023年牙齦萎縮的勝算比在下排資料中SG2有顯著差異(p=0.025, p<0.05)。然而當納入2024年的資料後，兩年的平均並無顯著差異。此外，在2023年的資料顯示，牙齦萎縮無發生在進行矯正中的患者，多數牙齦萎縮是發生在矯正之後或在矯正之前方已存在。拔牙不會造成矯正患者的牙齦萎縮（OR=1.1, p=0.83）。相較於厚或薄表型的牙齦，均勻型有較高的牙齦萎縮風險（p<0.05），而薄表型則觀察到具有更高的牙齦萎縮發生率(61%)，但無顯著差異。 第二項校正實驗中，結果顯示，醫師間在MGI（modified gingival index）的誤差相當大，牙齦萎縮次之，PD的誤差最小。儘管MGI的測量誤差大，但由於其通常不會影響牙周治療方案，醫師間的誤差仍可接受。此外，牙齦萎縮在近心側和遠心側的誤差較大。 儘管這些研究存在可能與真實世界情況不符的誤差，例如在校正實驗中，受試者四名牙醫師已知要進行測量，因此會更加仔細；牙醫系學生年輕，其牙齦萎縮程度不能作為標準，多數需要時間誘發等，然而此研究仍具代表性。期待未來能進行更系統及規模化的研究，以實現牙科治療的精準化目標。
Research Background:
Orthodontic treatment has many advantages; however, gingival recession has long been considered a potential complication that may occur some time after orthodontic treatment. Conducting prospective orthodontic studies can be time-consuming. Therefore, this study aims to use a crosssectional approach to understand whether orthodontics causes gingival recession. Additionally, different dentists may introduce some human error when measuring the recession of tissues around the teeth, leading to inter-operator and intra-operator biases. Given that periodontal probing involves measurements in millimeters, whether this error is acceptable remains to be discussed.
Research Methods:
This study consists of two small experiments. In the first experiment regarding orthodontic treatment and gingival recession, a questionnaire with 14 questions was distributed to fourth-year dental students from 2023to 2024. The questions included topics such as gingival phenotype and whether extractions were performed during orthodontic treatment to understand the participants' orthodontic history and gingival recession status. An intraoral scanner was used to record students with gingival recession.In the second experiment, a small measurement test was conducted involving four dentists and four patients to test the accuracy of periodontal probing by the dentists within the same individual.
Results:
The odds ratio (OR) for developing gingival recession in individuals who had orthodontic treatment history was calculated to be 0.77 and 1.33 for MA area. The analysis showed that the odds ratio (OR) for gingival recession was higher in the mandibular anterior (MA) region, with an OR of 5 in 2023. There was a significant difference (p=0.025, p < 0.05) after in SG2. However, when the 2024 data was included, the two-year average showed no significant difference. Additionally, the 2023 data indicated that gingival recession did not occur in all patients undergoing orthodontic treatment; most gingival recession occurred either after orthodontic treatment or was present before treatment. Extraction seems to have no influence of recession in orthodontic participants（OR=1.1, p=0.83）. The moderate phenotype have a higher risk of recession compared to those with thick or thin phenotypes(p<0.05), while the thin biotype has higher
recession rate (61%).
In the second calibration experiment, the primary focus was on the intra examiner consistency in measurements taken by the same dentist at different times. This is crucial because, in real-world scenarios, patients aretypically treated and recorded by the same dentist. The results showed that the inter-examiner error was largest for the modified gingival index (MGI), followed by gingival recession, with pocket depth (PD) having the smallest error. Although the measurement error for MGI was large, it usually does not affect periodontal treatment plans significantly, making the inter examiner error acceptable. Additionally, greater variability was observed in detecting recession at mesial and distal sites compared to the middle site, where the greatest recession typically occurs, resulting in a 1 to 2 mm error.
Although these studies may have potential biases compared to real-world scenarios, such as the four dentists in the calibration experiment being aware that they were being measured, leading to more meticulous assessments, and the young age of the dental students affecting their ability to adequately compare gum recession extents, the research still holds significant representativeness. Future systematic and large-scale studies are anticipated to further the goal of achieving precision treatment in dentistry. |
