Vpliv ortodontskega premika zoba na stanje zobne pulpe

Golež, Aljaž (avtor), Cankar, Ksenija (mentor), Ovsenik, Maja (komentor)

Ortodontsko zdravljenje, ki za dosego terapevtskega učinka izkorišča ortodontski premik zoba, (OPZ) je v široki klinični rabi. Izmed zobozdravstvenih posegov, ki lahko vplivajo na zobno pulpo, se omenja tudi ortodontski premik zoba, saj lahko ortodontska sila vpliva na prekrvljenost zobnih in obzobnih tkiv. Za razliko od fiziološkega dogajanja v pozobnici in alveolni kostnini je vpliv ortodontskega premika zoba na zobno pulpo zelo slabo raziskan. Prospektivna klinična raziskava je temeljila na povezavi med predkliničnimi in kliničnimi raziskovalnimi metodami za oceno zobne pulpe med ortodontskim premikom zob pri človeku. V raziskavo smo vključili 42 preiskovancev (249 zob), mladostnikov s stalnim zobovjem, pri katerih je bilo načrtovano ortodontsko zapiranje vrzeli v stranskem predelu spodnjega zobnega loka z nesnemnim ortodontskim aparatom. Stanje zobne pulpe smo spremljali pred ortodontskim zdravljenjem, med aktivnimi ortodontskim vlekom za zapiranje vrzeli (1. dan, 4. dan, 7. dan, 21. dan in 28. dan) in po koncu ortodontskih premikov zob. Za spremljanje stanja zobne pulpe smo poleg standardnih kliničnih testov senzibilitete uporabili tudi sodobne metode ocene stanja zobne pulpe: oksigenacijo zobne pulpe, laserski doplerski (LD) pretok krvi in magnetno resonančno (MR) slikanje zobne pulpe. Na 3D študijskih modelih, pridobljenih s 3D optičnim bralnikom, smo izmerili premike zob in izračunali hitrost OPZ. Rezultati raziskave kažejo, da se med aktivnim ortodontskim vlekom značilno zniža LD pretok zobne pulpe, zniža SpO2 in se značilno zvišata prag senzitivnosti na električni test pulpe (EPT) ter T2 relaksacijski čas (RM-ANOVA; p<0,01). Kazalniki zobne pulpe so medsebojno povezani, najmočneje sta povezana LD pretok in SpO2 (R=0,433; p<0,001). Enokoreninski zobje ob vrzeli so imeli bolj izrazito spremembo kazalnikov stanja pulpe (2-smerna RM-ANOVA; p<0,001). Višja hitrost OPZ 4. dan je bila povezana z večjim zmanjšanjem LD pretoka zobne pulpe (Lin. regresija; p=0,025). Z raziskavo smo potrdili, da OPZ vpliva na spremembe v stanju zobne pulpe, spremembe so najbolj izrazite v začetnih fazah OPZ. Večje spremembe smo zaznali v enokoreninskih zobeh in v zobeh, ki so bližje vrzeli. Med kazalniki stanje zobne pulpe obstaja povezanost, najmočnejša je med LD pretokom in SpO2 zobne pulpe, saj oba opisujeta prekrvavitev tkiva. T2 uteženo kartiranje je kot MR kazalnik stanja zobne pulpe je enako dobro kot vitalitetni testi zaznalo spremembe stanja zobne pulpe, vendar ne opisuje istih lastnosti. Ugotovili smo, da vrsta zoba, lokacija zoba in hitrost OPZ značilno vplivajo na stanje zobne pulpe in jih lahko uvrstimo med klinično relevantne dejavnike tveganja, različni tipi OPZ imajo med seboj različne učinke na zobno pulpo ter da je višja starost pacienta povezana z manj ugodnimi spremembami stanja zobne pulpe med OPZ.

• Jezik: Slovenski jezik
• Ključne besede: Ortodontski premik zoba, Zobna pulpa, Dejavniki tveganja, Prekrvavitev, Senzitivnost zobne pulpe, Oksigenacija, Laserski doplerski pretok krvi, Magnetno resonančno slikanje
• Vrsta gradiva: Doktorsko delo/naloga
• Organizacija: MF - Medicinska fakulteta
• Leto izida: 2024
• PID: 20.500.12556/RUL-166281
• Datum objave v RUL: 01.01.2025

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Effects of orthodontic tooth movement on dental pulp condition​

Izvleček

Orthodontic treatment, a therapeutic procedure that relies on orthodontic tooth movement (OTM), is widely used in clinical practice. Among dental procedures that can affect the dental pulp, OTM is often mentioned, as orthodontic forces can influence the blood supply to the dental and periodontal tissue. Unlike the physiological processes occurring in the periodontal ligament and alveolar bone, the impact of OTM on the dental pulp is poorly understood. The prospective clinical study investigated the relationship between preclinical and clinical research methods to assess the dental pulp during OTM in humans. Study included 42 participants (249 teeth), adolescents with permanent dentition, who were scheduled for orthodontic closure of space in the lateral region of the lower dental arch using a fixed orthodontic appliance. The condition of the dental pulp was monitored before orthodontic treatment, during the active orthodontic force for gap closure (days 1, 4, 7, 21, and 28), and after the completion of tooth movements. In addition to standard clinical sensitivity tests (EPT), modern methods to assess the condition of the dental pulp were used: dental pulp oxygenation (SpO2), Laser Doppler (LD) blood flow, and magnetic resonance imaging (MRI) of the dental pulp. 3D study models, obtained with a 3D optical scanner tooth movements, were measured and the rate of OTM was calculated. The results of the study show that during the active orthodontic force, LD blood flow to the dental pulp decreased significantly, SpO2 decreased, and the sensitivity threshold to the EPT and T2 relaxation time increased significantly (RM-ANOVA; p<0.01). Dental pulp indicators were interrelated, with the strongest correlation between LD blood flow and SpO2 (R=0.433; p<0.001). Single-rooted teeth near the gap showed more pronounced changes in pulp indicators (2-way RM-ANOVA; p<0.001). A higher rate of OTM in at day 4 was associated with a greater reduction in dental pulp blood flow (Lin. regression; p=0.025). Our study confirmed that OTM affects the condition of the dental pulp, with the most pronounced changes occurring in the initial phases of OTM. Greater changes were observed in single-rooted teeth and in teeth closer to the gap. There is a correlation between the indicators of the dental pulp condition, with the strongest correlation between LD blood flow and SpO2 of the dental pulp, as both describe tissue perfusion. T2-relaxation times, as an MRI indicators of the dental pulp condition, detected changes in the dental pulp condition as well as vitality tests, but does not describe the same properties. We observed that the type of tooth, tooth location, and rate of OTM significantly influence the condition of the dental pulp and can be classified as clinically relevant risk factors, different types of OTM have different effects on the dental pulp, and that higher patient age is associated with less favourable changes in the condition of the dental pulp during OTM.

• Ključne besede: Orthodontic tooth movement, Dental pulp, Risk factors, Perfusion, Dental pulp sensitivity, Oxygenation, Laser-Doppler flowmetry, Magnetic Resonance Imaging