Korean J Orthod.  2024 Mar;54(2):79-88. 10.4041/kjod23.173.

Cone-beam computed tomographic evaluation of mandibular incisor alveolar bone changes for the intrusion arch technique: A retrospective cohort research

• Lu L
• Si J
• Wang Z
• Chen X

• KMID: 2554365
• DOI: http://doi.org/10.4041/kjod23.173

Abstract

Objective
Alveolar bone loss is a common adverse effect of intrusion treatment. Mandibular incisors are prone to dehiscence and fenestrations as they suffer from thinner alveolar bone thickness.
Methods
Thirty skeletal class II patients treated with mandibular intrusion arch therapy were included in this study. Lateral cephalograms and cone-beam computed tomography images were taken before treatment (T1) and immediately after intrusion arch removal (T2) to evaluate the tooth displacement and the alveolar bone changes. Pearson’s and Spearman’s correlation was used to identify risk factors of alveolar bone loss during the intrusion treatment.
Results
Deep overbite was successfully corrected (P < 0.05), accompanied by mandibular incisor proclination (P < 0.05). There were no statistically significant change in the true incisor intrusion (P > 0.05). The labial and lingual vertical alveolar bone levels showed a significant decrease (P < 0.05). The alveolar bone is thinning in the labial crestal area and lingual apical area (P < 0.05); accompanied by thickening in the labial apical area (P < 0.05). Proclined incisors, non-extraction treatment, and increased A point-nasion-B point (ANB) degree were positively correlated with alveolar bone loss.
Conclusions
While the mandibular intrusion arch effectively corrected the deep overbite, it did cause some unwanted incisor labial tipping/flaring. During the intrusion treatment, the alveolar bone underwent corresponding changes, which was thinning in the labial crestal area and thickening in the labial apical area vice versa. And increased axis change of incisors, non-extraction treatment, and increased ANB were identified as risk factors for alveolar bone loss in patients with mandibular intrusion therapy.

Keyword

Intrusion arch; Alveolar bone; Cone-beam computed tomography; Risk factor

Figure

• 

  Figure 1 Intrusion arch therapy of mandibular incisors. A-C, Pretreatment, D-F, posttreatment.

• 

  Figure 2 Cephalometric measurements. A, Landmarks of lateral cephalometry are used in this study. B, Illustration of the LCR-MP (representing true intrusion) and IMPA (representing labial tipping). SN, sella-nasion plane; Me, menton; Go, gonion; SNA, sella-nasion-point A angle; SNB, sella-nasion-point B angle; ANB, point A-nasion-point B angle; MP-SN, sella-nasion plane to the mandibular plane angle; IMPA, mandibular incisor to mandibular plane angle; L1-Cres, center of resistance of lower incisor; LCR-MP, the vertival distance between L1-Cres and MP.

• 

  Figure 3 Standardized orientation of cone-bean computed tomography for measurement.

• 

  Figure 4 Measurements of vertical alveolar bone levels (ABLs) and alveolar bone cross-sectional area. A, The yellow points represent the cemento-enamel junction (CEJ), and the green points represent the alveolar bone crest. The labial (La) and lingual (Li) vertical ABLs are defined as LaABL and LiABL, respectively. B, The three levels were separated by 3, 6, and 9 mm from the CEJ. C, LaABA-3 mm (6 mm, 9 mm) and LiABA-3 mm (6 mm, 9 mm) represent the labial and lingual alveolar bone cross-sectional area at 3 mm (6 mm, 9 mm) level, respectively. ABA, alveolar bone area.

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