Dr. Aous Dannan (DDS, M.Sc.) (1) Prof. Dr. Mohammad Atef Darwish (DDS, PhD.) (2) Prof. Dr. Mohammad Nasser Sawan (DDS, PhD.) (3) 博士Aous Dannan器（ DDS ，硕士） （ 1 ）博士，教授穆罕默德阿提夫达尔维什器（ DDS ，博士。 ） （ 2 ）博士，教授穆罕默德纳赛尔坡器（ DDS ，博士。 ） （ 3 ）
(1): Department of Periodontology, Faculty of Dental Medicine, Witten/Herdecke University, Witten, Germany. （ 1 ） ：部牙周病，牙医系医学，威滕/ Herdecke大学，威滕，德国。
(2): Department of Periodontology, Faculty of Dental Medicine, Damascus University, Damascus, Syria. （ 2 ） ：部牙周病，牙医系医学，大马士革大学，叙利亚大马士革。
(3): Department of Orthodontics, Faculty of Dental Medicine, Damascus University, Damascus, Syria. （ 3 ） ：正畸部，牙科学院医学，大马士革大学，叙利亚大马士革。
ABSTRACT 摘要
Objective: The aim of this study is to investigate whether orthodontic extrusion movements have negative effects on the gingival tissues, and to detect the relationship between orthodontic tooth extrusion and the width of the keratinized gingiva. 目的：本研究以调查是否正畸挤压流动产生负面影响的牙龈组织，并检测之间的关系正畸牙齿挤压和宽度的角化牙龈。
Materials and methods: Fourteen upper canines of seven patients having different Angle classifications were selected for the study. 材料和方法：犬14上的7名患者有不同的角度挑选分类的研究。 According to the abnormal position of those canines they were subjected to orthodontic extrusion forces in order to bring them back to a normal level within the dental arch and, therefore, to correct the abnormality. Plaque index (PI), probing depth (PD), gingival index (GI), papillary bleeding index (PBI) and keratinized gingiva width (KGW) were measured around the examined canines at baseline, one month, 3 months and 6 months after the initiation of the extrusion movements. 根据异常的立场，这些犬，他们受到挤压正畸部队，以促使他们重新回到正常水平范围内牙弓，因此，纠正异常。菌斑指数（ PI ） ，探测深度（ PD ） ，牙龈指数（胃肠） ，乳头出血指数（苯并）和角化牙龈宽度（ KGW ）周围测定犬的研究在基线， 1个月， 3个月和6个月后开始挤压运动。
Results: The values of (PI) and (GI) increased significantly during the whole period of study, whereas the (PD) and (PBI) values did not show any important differences. 结果：价值观（ PI ）及（胃肠）显着增加在整个学习期间，而（ PD ）的和（苯并）值并没有显示出任何重大的分歧。 A very slight increase of the (KGW) of about 0.14 mm was detected at the examined teeth after 6 months comparing to baseline without any statistical significance. 一个非常轻微增加（ KGW ）的0.14毫米发现牙齿的审查6个月后的基准比较，没有任何统计学意义。
Conclusions: No negative effects on the gingival tissues were noted around the canines during the application of orthodontic extrusion. 结论：没有任何负面影响牙龈组织中指出各地在犬中的应用正畸挤压。 All the periodontal parameters were kept within normal limits without any signs of a considerable periodontal destruction. 所有的牙周参数保持在正常范围没有任何迹象表明有相当牙周破坏。
Key words 关键词
Gingiva, Oral hygiene, Orthodontic extrusion. 牙龈，口腔卫生，口腔正畸挤压。
Introduction 导言
Movement of a tooth by extrusion involves applying traction forces in all regions of the periodontal ligament to stimulate marginal apposition of crestal bone. 运动牙齿的挤压涉及申请牵引部队在各地区的牙周膜，以刺激边缘沉积的crestal骨头。 Because the gingival tissue is attached to the root by connective tissue, the gingiva follows the vertical movement of the root during the extrusion process. 由于牙龈组织是连接到根的结缔组织，对牙龈如下的垂直运动的根源在挤压过程。 Similarly, the alveolus is attached to the root by the periodontal ligament and is in turn pulled along by the movement of the root. 同样，肺泡附在根的牙周膜，并反过来又退出了沿线的运动的根源。
During the orthodontic tooth movement, it is very important for the periodontal tissues to be in a balanced situation along with the tooth at the cervical areas [1]. 在正畸牙齿移动，这是非常重要的牙周组织将在一个平衡的局势随着牙齿在地区宫颈[ 1 ] 。
The attached gingiva is the part of gingival tissues that is continuous with the marginal gingiva. 所附的牙龈是部分牙龈组织是连续的边缘牙龈。 It is firm, resilient, and tightly bound to the underlying periosteum of alveolar bone. The width of the attached gingiva is defined as the distance between the mucogingival junction and the projection on the external surface of the bottom of the gingival sulcus or the periodontal pocket. 它是坚定的，富有活力，紧紧结合的基本骨膜牙槽骨。宽度所附的牙龈是指之间的距离mucogingival交界处和投影的外表面的底部龈沟或牙周袋。 It should not be confused with the width of the keratinized gingiva because the latter also includes the marginal gingiva. 它不应该混淆的宽度角化牙龈，因为后者还包括牙龈边缘。
It has been assumed that a minimal width of attached gingiva is required for optimal gingival health to be maintained. However, several studies have challenged the view that a wide keratinized gingiva is more protective against the accumulation of plaque than a thin or a nonexistent zone. 据认为，最小的宽度是重视牙龈所需的最佳牙龈健康维持。然而，一些研究已经提出质疑认为，广泛的角化牙龈的更为有力的保护对斑块的积累比薄或不存在区。 Teeth with subgingival restorations and narrow zones of keratinized gingiva have higher gingival inflammation scores than teeth with similar restorations and wide zones of attached gingiva [2]. 龈下牙修复狭长地带角化牙龈有较高的牙龈发炎得分高于类似的牙齿修复和地区的广泛重视牙龈[ 2 ] 。 Moreover, it seems to be that a sufficient amount of keratinized gingiva is more valuable for the gingival health and to allow the orthodontic appliances, whether removable or fixed, to achieve the corrective treatment without any harmful effect on the periodontal hard and/or soft tissues [3]. 此外，它似乎是足够数额的角化牙龈更有价值的牙龈健康，并允许矫正器具，无论是移动或固定，以实现矫正治疗没有任何有害的影响牙周硬和/或软组织[ 3 ] 。 The orthodontic extrusion movements seem to be the least harmful to the periodontal tissues when applied correctly in the orthodontic treatment. 正畸挤压动作似乎是最有害于牙周组织时，正确适用的矫正治疗。
Ingeber et al. Ingeber等。 [4] studied the effect of the extrusive orthodontic movement on the one or two - wall infrabony defects, and they found that the extrusion of one tooth or more had a significant effect of reducing the periodontal pocket depths. [ 4 ]研究的影响，喷出正畸运动的一个或两个-墙i nfrabony缺陷，他们发现，挤出一个或多个牙齿有重大影响减少牙周袋深度。
In other studies [4,8], it had been demonstrated that teeth extrusion, when gingival inflammation is already existed, reduced the probing depth values, the bleeding on probing and induced the creation of new bone on the alveolar bone crest. 在其他一些研究[ 4,8 ] ，它已经表明，牙齿挤压时，牙龈发炎是已经存在，降低了探测深度价值观，出血探测和人工创造新的骨的齿槽骨嵴。
Upwarding and the extrusion of the molars without any scaling or root planning had been shown to reduce the amount of the bacterial pathogens around those molars and to enhance the healing of the osseous defect [5]. Upwarding和挤压的磨牙没有任何规模或根的规划已被证明减少数额的细菌病原体围绕这些臼齿和提高愈合的骨缺损[ 5 ] 。 However, most of the studies considering the periodontal tissues' changes during an orthodontic extrusion discussed only the histological changes in order to find out the aspects of the alveolar bone remodeling, and rarely mentioned the clinical changes of the gingival tissues. 然而，大多数研究考虑牙周组织'的变化在讨论正畸挤压只有组织学变化，以便找出问题的牙槽骨改建，以及很少提及的临床变化，牙龈组织。
Kajiyama et al. 村冈等人。 [6] examined the effect of the orthodontic extrusion movement on the gingival tissue in the central incisors of five Macaca Fuscata monkeys. [ 6 ]检查的效果正畸挤压运动对牙龈组织中的中门齿的五个猕猴Fuscata猴子。 After those incisors had been extruded, a slight movement of the gingival margin in the same direction of the extruded teeth could be noted and an increase of the keratinized gingiva width (KGW) was also recorded. 在这些门齿已挤压，轻微运动，牙龈缘在同一方向的挤压牙齿可以注意到，增加的角化牙龈宽度（ KGW ）也记录在案。 However, it is still difficult to find out the real reason of the increase of the keratinized gingiva during the orthodontic extrusion whether it is due to the proliferation of the gingival tissue or to its elastic nature, that is because the proliferation of the fibroblasts as well as the connective tissue changes in volume and the intra-fibers spaces were all immeasurable in most of the studies. 但是，它仍然是很难找出真正的原因增加的角化牙龈在正畸挤压它是否是由于增殖的牙龈组织或其弹性的性质，这是因为增殖的成纤维细胞，以及作为结缔组织的变化量和内纤维的空间都是不可估量的大多数研究。 The aim of the current study was to examine the effect of the orthodontic extrusion movements on the periodontal parameters during a 6-month period of clinical observation and to find out whether orthodontic tooth extrusion makes the gingival margin move in a coronally direction. 的目的，目前的研究是审查的影响，挤压运动正畸的牙周参数在6个月期间的临床观察，并找出是否正畸牙齿挤压使牙龈缘朝冠的方向发展。
Material and Methods 材料和方法
Study Population 人口研究
Seven adult orthodontic patients from the department of orthodontics, faculty of Dental medicine - Damascus University (five females and two males, mean age of 19.5(2.5) years were selected to participate in this study. 七成人正畸患者的正畸科，口腔系医学-大马士革大学（ 5名女性和两名男性，平均年龄为1 9.5（ 2 .5）年被选为参与这项研究。
To be eligible for the study, those patients had to meet the following criteria: (1) good general health; (2) lack of antibiotic therapy during the previous 6 months; (3) absence of anti-inflammatory drug administration in the month preceding the study; (4) periodontally healthy with generalized probing depths < 3 mm and no radiographic evidence of periodontal bone loss; and (5) requirement of upper canines extrusion in order to correct their abnormal positions into a more normal level within the dental arch. 有资格的研究，这些患者必须满足以下条件： （ 1 ）良好的健康状况; （ 2 ）缺乏抗生素治疗在过去6个月; （ 3 ）没有类抗炎药管理的前一个月该研究; （ 4 ）牙周病与全身健康的探测深度“ 3毫米，没有证据的X光牙周骨质流失;和（ 5 ）要求犬上挤压，以纠正其异常的职位成为一个更正常的水平内牙弓。
An oral approval from the patients to be subjected to the study, or from the parents of patients less than 18 years of age, was obtained prior to the commencement of the study. 一项口头批准，病人受到的研究，或从父母的患者不到18岁，获得前开始这项研究。
One week before the baseline examination, all patients underwent a session of supra - and subgingival ultrasonic scaling. 一个星期之前，基线检查，所有患者接受了会议的前-和龈下超声洁。
Experimental Design 实验设计
It was recommended to include in this study only the patients with simple to moderate canine position-abnormality, with the ability to finish the orthodontic correction in 6 months maximally. Through a complete orthodontic treatment plan, the upper first premolars in both the right and the left sides had to be extracted for all of the patients. 有人建议，包括在本研究中只有简单的患者，中度犬位置异常，有能力完成正畸矫治6个月内最大限度地。通过一个完整的正畸治疗计划，上第一前磨牙中的权利和左右两侧已被提取的所有患者。
10 days after the extraction of the first premolars, the upper canines (right and left) were subjected to coronally orthodontic extrusion movements. 10天之后提取第一前磨牙，上犬齿（左，右）受到挤压冠矫正运动。
The technique used in the current study involved placing orthodontic brackets on the buccal aspect of the teeth adjacent to the tooth that is to undergo extrusion (in this case; canines) in a passive position that will not cause any orthodontic movement of the anchor teeth. 所使用的技术在目前的研究涉及矫正置于括号内的口腔方面的牙齿附近的牙齿是进行挤压（在这种情况下;犬）处于被动的立场，即不会造成任何矫正运动的锚定牙齿。 The brackets on the canines are positioned more apically than the brackets on the adjacent teeth; the difference in distance represents the desired extrusion. A 0.016-in. 方括号的尖牙的位置更apically比括号内的邻牙;的差异代表距离理想的挤压。阿0.016中。 nickel-titanium arch wire was attached to the brackets. 镍钛合金丝弓附于括号内。 When greater movement was desired, a second, more rigid wire (0.016 in. x 0.022 in.), attached only to the brackets of the adjacent teeth, was used to stabilize everything. Following extrusion, a more rigid 0.018-in.stainless steel arch wire was inserted and set by means of a metal ligature for a minimum retention period of 12 weeks (Figures 1, 2). 当更多的运动是理想的，第二，更严格的铁丝网（ 0.016英寸x 0.022英寸） ，只重视括号内的邻牙，是用来稳定一切。挤压之后，更严格的0.018 - in.stainless钢弓丝插入，并用金属结扎最低限度的保留期为12周（图1 ， 2 ） 。
Figure 1 图1
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The initial occlusion - study models 最初的闭塞-研究模型 |
Figure 2 图2
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During the canine extrusion 在犬挤压 |
All important modifications were made according to every case separately. 所有重要的修改提出了根据每一个案件分开。 All the orthodontic procedures were done at the department of Orthodontics - Faculty of Dental Medicine - Damascus University. 所有的矫正工作程序，在部门的正畸-牙科学院医学-大马士革大学。
Clinical Monitoring and Keratinized Gingiva Width (KGW) Assessment 临床监测和角化牙龈宽度（ KGW ）评估
The status of the periodontal tissues around the canines to be extruded was determined by clinical periodontal assessments, including Plaque Index ( PI ) [7], Papillary Bleeding Index ( PBI ) [8], Probing Depth ( PD ) and Gingival Index ( GI ) [9]. 的地位牙周组织各地的犬被挤压确定的临床牙周评估，包括菌斑指数（ PI ） [ 7 ] ，乳头出血指数（苯并） [ 8 ] ，探讨深度（ PD ）和牙龈指数（胃肠） [ 9 ] 。
The plaque index assesses only the thickness of the plaque at the gingival area of the tooth. 的菌斑指数不仅评估厚度的牌匾在牙龈领域的牙齿。 It examines the following scoring units of the teeth: distofacial, facial, mesiofacial and lingual surfaces. 它审查了以下得分单位的牙齿： distofacial ，面部， mesiofacial和舌表面。 A mouth mirror and a dental explorer are used after air drying of the teeth to assess plaque, and the (PI) score for each area is obtained by totaling the four plaque scores per tooth. 口腔镜和牙科使用浏览器后，空气干燥的牙齿菌斑，评估，以及（ PI ）的评分为每个地区共获得了4个斑块分数每牙齿。 The criteria for the (PI) are as follows: 的标准（ PI ）的如下：
0 = No plaque in the gingival area. 0 =无斑块牙龈地区。
1 = A film of plaque adhering to the free gingival margin and adjacent area of the tooth. 1 =电影斑块坚持免费牙龈缘和邻近地区的牙齿。 The plaque may be recognized only by running a probe across the tooth surface. 斑块可只承认通过运行探针在牙齿表面。
2 = Moderate accumulation of soft deposits within the gingival pocket and on the gingival margin and / or adjacent tooth surface that can be seen by the naked eye. 2 =中度积累的软存款牙龈内的口袋和牙龈边缘和/或相邻的牙齿表面，可以看到肉眼。
3 = Abundance of soft matter within the gingival pocket and / or the gingival margin and adjacent tooth surface. 3 =丰度的软物质牙龈内的口袋和/或牙龈边缘和邻近牙齿表面。
The papillary bleeding index (Fig. 3) assesses the sulcus bleeding on probing at the interdental papilla. 乳头出血指数 （图3 ）评估沟出血探索在齿间乳头。 This index used a scale of 0 to 4 as follows: 该指数用于大规模的0至4如下：
Figure 3 图3
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| 0 = No bleeding. 0 =没有出血。 1 = Isolated dots or thin line less than half of the area probed. 1 =孤立点或细线不到一半的面积探讨。 2 = Thin line more than one half of probed area or a discrete speck of blood interdentally. 2 =薄线有一半以上的探索领域或分立斑点的血液interdentally 。 3 = Interdental triangle filled with blood. 3 =齿间三角填补了鲜血。 Blood flows slowly. 血液流动缓慢。 4 = Profuse bleeding immediately on probing. 4 =丰富的出血立即探测。 Interdental triangle filled. 齿间三角填补。 |
The probing depth is the distance to which an instrument (probe) penetrates into the pocket. 该探测深度的距离的一种手段（探针）渗透到了口袋里。 In our study, the periodontal pocket depth was measured with a millimeter-calibrated periodontal probe (Michigan O probe) on the following scoring units of the teeth: distofacial, facial, mesiofacial and lingual surfaces. 在我们的研究，牙周袋深度测量与毫米波校准牙周探针（密歇根ö探针）对下列单位的得分牙齿： distofacial ，面部， mesiofacial和舌表面。 The probe was inserted with a firm, gentle pressure to the bottom of the pocket. 探针插入坚定，温柔的压力，底部的口袋里。 The shank should be aligned with the long axis of the tooth surface to be probed. 小腿应符合长轴牙齿表面的探讨。
The Gingival Index assesses the severity of gingivitis and its location in four possible areas: the distofacial papilla, the facial margin, the mesiofacial papilla and the entire lingual gingival margin. 牙龈指数评估的严重性牙龈炎和它的位置可能在四个领域： distofacial乳头，面边缘，在mesiofacial乳头和整个舌牙龈边缘。 Each of the four gingival units is assessed according to the following criteria: 四个牙龈单位的评估按照下列标准：
0 = Normal gingiva. 0 =正常牙龈。
1 = mild inflammation, slight color change, slight edema: no bleeding on palpation. 1 =轻度发炎，轻微的颜色变化，轻度水肿：无出血触诊。
2 = moderate inflammation, redness, edema and glazing: bleeding on probing. 2 =中度炎症，发红，水肿及玻璃：出血探测。
3 = severe inflammation, marked redness, edema, ulceration: spontaneous bleeding. 3 =严重的炎症，标志着发红，水肿，溃疡：自发性出血。
Those clinical parameters were assessed as follows: at baseline (prior to orthodontic appliance placement), after 1 month, after 3 months and after 6 months. 这些临床参数进行了评估如下：在基准（前正畸设备安置） ， 1个月后， 3个月后，后6个月。
The width of keratinized gingiva was measured at every canine according to the method explained by (Sadowsky and Begole) [10] where every single measurement was made from the free gingival edge to the muco-gingival conjunction on the buccal surface of the canine. 的宽度角化牙龈是衡量每一个犬根据法解释（ Sadowsky和Begole ） [ 10 ]在每一个测量是由自由牙龈边缘的粘膜牙龈结合的颊面犬。 The resulted measurements were recorded to the nearest 1 mm. 测量的结果记录到最接近的1毫米。
Statistics 统计
The values were calculated as the mean + standard deviation (SD) and Analysis Of Variance (ANOVA), a calculation procedure to allocate the amount of variation in a process and determine if it is significant or is caused by random noise, was used to evaluate the statistical significance of the differences of the clinical measurements among the experimental categories in each group/column. 人的价值计算，平均+标准差（ SD ）和方差分析（方差） ，计算程序分配的数量变化的过程中，并确定它是否是重大的或造成的随机噪声，是用来评估统计意义的差异，临床测量的实验类，每组/列。
A probability of P < 0.05 was accepted for rejection of the null hypothesis and to state that with a 95% level of confidence that the two parameters are not the same. 一种概率的P “ 0.05被接纳为拒绝零假设，并指出，有95 ％的信任程度，这两个参数也不尽相同。 All the statistical analyses were done by means of a computer software program (SPSS -2006). 所有的统计分析进行了通过计算机软件程序（ SPSS软件-2006 ） 。
Results 结果
The clinical periodontal indices of the subjects recorded at baseline were expressed as Mean (SD) as follows: 0.10(0.212), 2.06(0.501), 0.31(0.231) and 0.39(0.349) for the PI, PD, GI and PBI respectively. 牙周病的临床指标的科目记录的基线，表达了平均数（标准差）如下： 0.10 （ 0.212 ） ， 2.06 （ 0.501 ） ， 0.31 （ 0.231 ）和0.39 （ 0.349 ）为有价证券投资，帕金森病，胃肠道和苯并分别。 After 6 months the indices were measured as 0.67(0.636), 2.27(0.549), 0.81(0.262) and 0.57(0.432) for the PI, PD, GI and PBI respectively. 经过6个月的指标衡量0.67 （ 0.636 ） ， 2.27 （ 0.549 ） ， 0.81 （ 0.262 ）和0.57 （ 0.432 ）为有价证券投资，帕金森病，胃肠道和苯并分别。 The values of PI increased significantly when comparing the values at baseline with those after 6 months (P<0.05), where the (PD) and (PBI) values did not show any important differences. 价值的有价证券投资显着增加时，比较基准值，与那些经过6个月（ P “ 0.05 ） ，在（ PD ）的和（苯并）值并没有显示出任何重大的分歧。 The gingival index also increased significantly from (0.31) at baseline to (0.52), (0.75) and (0.81) after 1 month, 3 months and 6 months respectively (P<0.05). 在牙龈指数也大大增加从（ 0.31 ）在基准（ 0.52 ） ， （ 0.75 ）和（ 0.81 ）后1个月， 3个月和6个月（ P均“ 0.05 ） 。
Table (1) illustrates the records of the clinical indices during different time points of the study. 表（ 1 ）说明了记录的临床指标在不同时间点的研究。
Table 1 表1
| Time 时间 | Baseline 基线 | 1 Month 1个月 | 3 Months 3个月 | 6 Months 6个月 | ANOVA Test 方差分析测试 | |
| Index 指数 | ||||||
| PI 有价证券投资 | 0.10±0.212 0.10 ± 0.212 | 0.37±0.372 0.37 ± 0.372 | 0.37±0.340 0.37 ± 0.340 | 0.67±0.636* 0.67 ± 0.636 * | (P<0.05)* （ P “ 0.05 ） * | |
| PD 帕金森病 | 2.06±0.501 2.06 ± 0.501 | 2.25±0.518 2.25 ± 0.518 | 2.05±0.377 2.05 ± 0.377 | 2.27±0.549 2.27 ± 0.549 | NS 新斯科细亚省 | |
| GI 胃肠 | 0.31±0.231 0.31 ± 0.231 | 0.52±0.312** 0.52 ± 0.312 ** | 0.75±0.391*** 0.75 ± 0.391 *** | 0.81±0.262* 0.81 ± 0.262 * | (P<0.05)**** （ P “ 0.05 )**** | |
| PBI 苯并 | 0.39±0.349 0.39 ± 0.349 | 0.53±0.414 0.53 ± 0.414 | 0.89±0.836 0.89 ± 0.836 | 0.57±0.432 0.57 ± 0.432 | NS 新斯科细亚省 | |
| KGW KGW | 5.21±1.476 5.21 ± 1.476 | 5.42±1.222 5.42 ± 1.222 | 5.35±1.215 5.35 ± 1.215 | 5.35±1.215 5.35 ± 1.215 | NS 新斯科细亚省 |
|
The periodontal indices (PI, PD, GI and PBI) and the keratinized gingiva width (KGW) records during different time points of the study. 牙周指数（有价证券投资，帕金森病，胃肠道和苯并）和角化牙龈宽度（ KGW ）记录在不同时间点的研究。 | |
| Results of pairwise comparisons over the time points within each group: 结果配对比较的时间点，每个组： | |
| * * | (Baseline) versus (6 months) （基线）与（ 6个月） |
| ** ** | (Baseline) versus (1 month) （基线）与（ 1个月） |
| *** *** | (Baseline) versus (3 months) （基线）与（ 3个月） |
| **** **** | (Baseline) versus (1, 3 and 6 months) （基线）与（ 1 ，第3和第6个月） |
The width of the keratinized gingiva registrations (measured in millimeters) were as follows: 5.21(1.476), 5.42(1.222), 5.35(1.215) and 5.35(1.215) mm at Baseline, 1 month, 3 months and 6 months respectively. No statistically significant results were found between the measurements during the whole period of observation. 的宽度角化牙龈登记（以毫米）的结果如下： 5.21 （ 1.476 ） ， 5.42 （ 1.222 ） ， 5.35 （ 1.215 ）和5.35 （ 1.215 ）毫米基准， 1个月， 3个月， 6个月。否统计学结果发现之间的测量在整个观察期。
Discussion 讨论
This study was designed to show whether extrusive orthodontic movements have negative effects on the gingival tissues, and to detect the relationship between tooth extrusion and the width of the keratinized gingiva. 这项研究的目的是要表明是否喷出正畸运动产生负面影响的牙龈组织，并检测之间的关系牙齿挤压和宽度的角化牙龈。 Fourteen upper canines (7 patients) were subjected to this study. 14个上犬齿（ 7例）受到这项研究。 The values of the plaque index PI increased significantly after 6 months, and this logical increase reflects the high ability of fixed orthodontic appliances to retain the dental plaque within their components (eg brackets, wires, etc...). This concept was clearly explained by Travess et al. 的价值观斑块指数显着上升6个月后，这合乎逻辑的增加反映了高能力的固定正畸装置保留菌斑在其组成部分（如括号，电线等.. ） 。这个概念是清楚的解释由Travess等。 [11] and Zhao et al. [ 11 ] ，赵等人。 [12] in their related studies. [ 12 ]在其相关研究。
However, according to the repeated oral hygiene instructions, which were given to the patients during the whole period of the study, the values of the plaque index were kept within normal limits since a maximum value of 0.67 has been recorded after 6 months. 然而，根据反复口腔卫生的指示，这是考虑到患者在整个研究期间，价值观的菌斑指数保持在正常范围以来的最高值0.67已记录后6个月。
Looking deeply into the probing depth PD values, it could be seen that the mean of the measured values was 2.06 mm at the baseline which was a normal value and expressed the healthy situation of the chosen samples (No gingival pockets were existed at Baseline). 展望深入探测深度放电的价值观，可以看出，平均实测值为2.06毫米的基线这是一个正常价值，并表示健康状况所选择的样本（牙龈口袋里没有人存在于基线） 。 No statistical significance was noted related to the different values of PD during the whole period of the study, despite a slight increase after 1 month and after 6 months. This maximum value of 2.27mm of PD after 6 months is considered to be an accepted healthy gingival probing depth and could be explained by the plaque accumulation and the slight gingivitis occurred. 无统计学意义注意到有关的不同的价值观的PD在整个研究期间，尽管略有增加后1个月和后6个月。这个最高价值二点二七毫米的PD 6个月之后被认为是公认的健康牙龈探测深度和可以解释的斑块的积累和轻度牙龈炎的发生。 Those results agree definitely with the study results of Kajiyama et al. 这些结果一致肯定的研究成果木尾等。 [6] who noted the absence of any diseased gingival pockets or gingivitis on the buccal surfaces of extruded upper incisors. [ 6 ]谁注意到，没有任何疾病牙龈口袋或牙龈炎的口腔表面的挤压切牙。
All the values of the gingival index were kept within normal limits without any signs of destructive progress in the periodontal tissues around the examined teeth. 所有的价值牙龈指数保持在正常范围没有任何迹象破坏性的进展情况牙周组织的检查牙齿。 However, the gradual increase of the gingival index from 0.31 (Baseline) to 0.81 (after 6 months) is considered to be normal and logic according to the gradual increase of the plaque index. 然而，逐渐增加的牙龈指数从0.31 （基线）至0.81 （后6个月）被认为是正常的和逻辑按照逐步增加的菌斑指数。
Orthodontic extrusion forces coronal migration of the root and increases the bone ridge as well as the quantity of attached gingiva, in particular when weak to moderate forces are applied [13, 14]. 正畸挤压力量冠状移民的根源，并增加了骨脊以及数量的重视牙龈，尤其是当弱到温和力量应用[ 13 ， 14 ] 。 The amount of attached gingiva is increased through eversion of the sulcular epithelium, appearing first as immature non keratinized tissue (known as "red patch") and then as keratinized tissue (Fig. 4); the process of keratinization requires 28 to 42 days[15]. 数额重视牙龈是通过增加外翻的沟上皮细胞，出现第一次作为不成熟的非角化组织（称为“红补丁” ） ，然后作为角化组织（图4 ） ;的过程中角化需要28至42天[ 15 ] 。 After coronal movement of the periodontal attachment has occurred, minor surgical correction may be necessary. 冠状运动后的牙周附着已经发生，手术矫正未成年人可能是必要的。 To avoid or minimize this correction, some authors recommend weekly fibrotomy (incision of the supracrestal gingival fibers) [16, 17]. 为了避免或尽量减少这一更正，一些作者建议每周fibrotomy （切口的supracrestal牙龈纤维） [ 16 ， 17 ] 。
Figure 4 图4
 |
| Development of a band of immature non-keratinized tissue ("red patch") 发展带的未成熟的非角化组织（ “红补丁” ） |
In our study, no significant increase of the keratinized gingiva width of the examined canines could be noted after 6 months of continuous extrusion forces. 在我们的研究中，没有显着增加的角化牙龈宽度的检查犬可以注意到6个月后的连续挤压力量。 A slight increase from 5.21mm (at Baseline) to 5.35mm (after 6 months) could be noted, but without any statistical significance. There was also an increase of KGW from 5.21mm (at Baseline) to 5.42mm (after 1 month), and that might be related to the gingival inflammation occurred during the first month. 略有增加五点二一毫米（在基准） ，以5.35毫米（ 6个月后）可指出，但没有任何统计学意义。还增加了KGW从五点二一毫米（在基准） ，以5.42毫米（后1个月） ，这可能与牙龈发炎期间发生的第一个月。 These results - although not statistically significant - agree with the results of Kajiyama et al. 这些结果-虽然没有统计学-同意的结果，木尾等。 [6] and with those of Bathenhorst et al. [18]. [ 6 ] ，并与Bathenhorst等。 [ 18 ] 。
In almost every orthodontic treatment plan, estimating the orthodontic forces to be applied seems to be of great importance. 几乎在每一个矫正治疗计划，估计正畸部队将适用似乎是非常重要的。
Forces of 15 g for the fine root of a lower incisor and 60 g for a molar are sufficient for slow extrusion. 部队的15政的细根的门齿，并降低60克的摩尔有足够的缓慢挤压。 Some authors recommend that the maximum force for a slow movement should not exceed 30 g [15, 19] whereas rapid extrusions are accomplished with forces higher than 50 g [20]. 有些作者建议的最大力量，一个缓慢的运动应不超过三十零克[ 15 ， 19 ] ，而型材的快速完成部队高于50克[ 20 ] 。 After a latency period of a few days to a few weeks, including a period of hyalinization, slow extrusion occurs at a rate of approximately 1 mm or less per week [15]. 经过一段潜伏期几天到几个星期，其中包括一段透明，缓慢挤压发生率约为1毫米或少于每星期[ 15 ] 。
The forces used in our study varied depending on the physiologic response of the patient and other factors such as root surface morphology. 该部队用在我们的研究根据不同的生理反应，病人和其他因素，如根表面形貌。 Moreover, the extent of the forces exerted could only be approximated, since it was difficult to quantify the forces applied. 此外，多大的压力，只能近似，因为它是难以量化的力量适用。
The orthodontic forces must be adjusted on the basis of the clinically verified speed of extrusion. 正畸力量，必须调整的基础上，临床验证的速度挤压。 It is imperative that constant force be maintained between the extrusion and hyalinization phases; otherwise, the desired orthodontic movement will not take place. 当务之急是，常数保持部队之间的挤压和透明的阶段，否则，理想的矫正运动不会发生。 Periodontal ligament tension is needed for bone remodeling and movement of the periodontal attachment [21], and the force must be applied along the tooth axis to prevent any undesirable tilting. 牙周韧带的紧张局势需要改建和运动的牙周附着[ 21 ] ，和部队必须适用沿齿轴，以防止任何不良倾斜。 According to the methods used in the current study, it could be stated that we used slow orthodontic extrusion forces of 30g. 根据所采用的方法在目前的研究，可以说，我们用缓慢矫正挤压部队30克。 All the evidence - based literatures which are related to the orthodontic-periodontic relationships were reviewed by Sanders [22] in 1999 to explain the relationship between the orthodontic tooth movements and several types of periodontal problems, and it has been shown that the correct orthodontic treatment of patients who have excellent oral hygiene and do not suffer from any periodontal diseases was a non-harmful treatment, and it was also proved that the absence of good oral hygiene in corporation with periodontal disorders would make any orthodontic movement a real risk factor for the periodontal tissues. 所有的证据-基于文献的有关正畸，牙周的关系进行了审查桑德斯[ 2 2]在1 999年解释之间的关系正畸牙齿移动和几种类型的牙周问题，它已经表明，正确的矫正治疗谁的病人具有良好的口腔卫生，不遭受任何牙周疾病是一个非有害的待遇，也有人证明，缺乏良好的口腔卫生的公司，牙周疾病会作出任何矫正运动的真正危险因素牙周组织。 However, the importance of the oral hygiene during the orthodontic treatments had been discussed in details in many other studies [23-27] 然而，重要的口腔卫生在正畸治疗已经进行了详细的许多其他研究[ 23-27 ]
In the current study, and before any fixed orthodontic appliance had been applied to the patients, written and verbal oral hygiene instructions were given to them with emphasize on keeping the mouth "clean" through the 6 months of observation. 在目前的研究，并在任何固定矫治器已适用于患者，书面和口头口腔卫生的指示，给予他们强调保持嘴“干净”的通过6个月的观察。 All of the oral hygiene instructions were repeated for the patients at every visit. 所有的口腔卫生一再指示，为每一个病人的访问。 This could explain why the whole indices were kept within normal limits, and no signs of a serious destruction of the periodontal tissues according to the extrusion forces were noted. 这可以解释为什么整个指数保持在正常范围，并没有迹象表明严重破坏牙周组织根据部队挤出指出。
Thus, within the limitations of the current study and the restricted sample volume, it could be stated that the extrusion of the teeth during an orthodontic treatment does not have any specific negative effects on the gingival tissues when a good level of oral hygiene is maintained by the patients. 因此，在限制目前的研究和样本量的限制，可以说，挤出的牙齿在正畸治疗没有任何具体的不利影响时，牙龈组织一个良好的水平，口腔卫生保持的患者。 However, when the gingival inflammation arises during an orthodontic treatment, an increase of the periodontal parameters might be expected. 然而，当牙龈发炎过程中产生的一种矫正治疗，增加了牙周参数可以预料。
In conclusion, this study initially demonstrated a low increase in PI and GI indices during the whole period of clinical observation of canines underwent slow extrusive forces. 最后，这项研究最初表现出了低增长PI和消化道指数在整个期间的临床观察犬进行缓慢的挤压力量。 The PD and PBI indices did not show any important difference. 帕金森病和苯并指数并没有表现出任何重要的区别。 A very slight increase of the KGW was detected at the examined teeth after 6 months comparing to baseline without any statistical significance. 一个非常轻微上升的KGW检测检查牙齿的6个月后的基准比较，没有任何统计学意义。 Whether the orthodontic forces used in this study were "only extrusive" without any other possible movements' components was not exactly clear and may need further studies as often on vestibular ectopic canines, there is a buccal vector on the displacement. 是否矫正力量用于此项研究的是“只喷出”没有任何其他可能的运动的组成部分是不完全清楚，可能需要进一步研究，常常在前庭异位尖牙，有一个颊载体的位移。
Acknowledgments 鸣谢
The authors are grateful to Prof. Dr. 作者感谢博士，教授 Ramadan Darwich for his statistical advice. 斋月Darwich的统计咨询意见。
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