クラスI不正咬合症例における歯間エナメル質減少が臨床的アタッチメントロス、プロービング時の出血、う蝕発生率に及ぼす影響：レトロスペクティブ・コホート研究

Effect of Interdental Enamel Reduction on Clinical Attachment Loss, Bleeding on Probing, and Incidence of Caries in Treating Class I Malocclusion Cases: A Retrospective Cohort Study.

抄録

はじめに 歯間エナメル質減少法（Interdental Enamel Reduction：IER）は、エナメル質除去と解剖学的再形成によって永久歯の歯間距離を縮小させる臨床処置である。本研究の目的は、臨床的アタッチメントロス（CAL）やプロービング時出血（BOP）など、IERが患者の歯肉の健康状態に及ぼす影響を調査することである。さらに本研究では、フッ素塗布の有無にかかわらず、IER後のう蝕発生率を評価した。方法 この後方視的コホート研究では、過去2年以内に矯正治療を開始し終了した患者90名を以下の3群に分けた：第1群では、下顎前歯の近心間ストリッピングを行った。第 2 群は下顎前歯の臼歯間ストリッピングを行い、IER 後にフッ素塗布を行った。第3群の患者は、臼歯間ストリッピングを行わずに矯正治療のみを受けた。その後、CAL、BOP、う蝕の発生率を調べた。結果 IER群とコントロール群のCALはそれぞれ2.06±0.18と2.08±0.16であった。また、BOPはIER群で3.01±0.14、対照群で3.05±0.19であった。う蝕の発生率、BOP、CALはIER群と対照群で有意差はなかった（P>0.05）。さらに、う蝕の発生率は、IER後にフッ化物外用剤を投与した群と投与しなかった群で有意差はなかった（P=0.999）。結論 矯正治療前の下顎前歯部近心部ストリッピングは，う蝕，BOP，CAL の発生率を有意に増加させない．さらに、IER 後のフッ化物局所塗布はう蝕発生率に有意な影響を与えない。

Introduction Interdental Enamel Reduction (IER) is a clinical procedure that reduces the mesiodistal size of permanent teeth by enamel removal and anatomical re-contouring. The aim of this study was to investigate the effect of IER on patients' gingival health status, including clinical attachment loss (CAL) and bleeding on probing (BOP). Furthermore, in this study, the incidence of caries after IER with or without fluoride therapy was evaluated. Methods In this retrospective cohort study, 90 patients who had started and completed their orthodontic treatment within the past two years were divided into three groups as follows: In group 1, patients had received interproximal stripping on their anterior mandibular teeth. Patients in group 2 had also received interproximal stripping on their mandibular anterior teeth and topical fluoride had been applied after IER. Patients in group 3 had only received orthodontic treatment without any interproximal stripping. Then, patients were examined for CAL, BOP, and incidence of caries. Results CAL for patients in the IER and control groups were 2.06±0.18 and 2.08±0.16, respectively. Also, BOP for patients in the IER and control groups were 3.01±0.14 and 3.05±0.19, respectively. Incidences of caries, BOP, and CAL were not significantly different between the group of patients who received IER and the control group (P>0.05). Moreover, the incidence of caries was not significantly different between the patients who received topical fluoride after IER and those who did not receive fluoride (P=0.999). Conclusion Interproximal stripping of mandibular anterior teeth before orthodontic treatment does not significantly increase the incidence of caries, BOP, and CAL. Moreover, the application of topical fluoride after IER has no significant effect on the incidence of caries.