twin-block矫治器治疗后患者颞下颌关节的适应性改建

Adaptable rebuilding of the temporomandibular joint after orthodontic treatment with twin-block appliance

twin-block矫治器是治疗下颌发育不足引起的安氏Ⅱ类错畸形的一种简单有效的功能矫治器,其治疗可引起髁突和关节盘的适应性改建,使下颌骨得以生长改建从而改善上下颌骨不调的关系,但矫治后是否对患者颞下颌关节(TMJ)产生实质性的改建以及对成人矫治的效果,目前尚存在较大的争论。本文就twin-block矫治器的矫治原理以及治疗后患者TMJ髁突和关节窝的适应性改建作一综述,以利于口腔正畸医生正确理解功能性矫治器引起TMJ改建的机制,为临床上治疗下颌后缩型安氏Ⅱ类错畸形提供理论依据,并指导其适应证和矫治时机的选择。

To stimulate condylar growth by twin-block is an appropriate way to treat Angle class Ⅱ malocclusion associated with mandibular skeletal retrusion. The adaptation of condylar cartilage to mandibular forward positioning constitutes the fundamental rationale for orthodontic functional therapy, which partially contributes to the correction of jaw discrepancies by achieving mandibular growth modification. However, functional appliance therapy delivers more stable results when used at or after the peak of pubertal period while its effect is more equivocal and controversial on adult patients. In this article, the treatment principle of twin-block appliance, adaptable rebuilding in condylar process and glenoid fossa of the temporomandibular joint were reviewed, which help orthodontists to comprehend the mechanism of adaptable rebuilding of the temperomandibular joint induced by functional appliance. This review also provides a basic theory, treatment opportunity and indication to recognize, diagnose, and treat patients with mandibular retrusion of Angle class Ⅱ malocclusion.