正畸治疗对成年安氏Ⅱ类高角型错患者颞下颌关节影响的研究

The effect of orthodontic treatment on the morphology of temporomandibular joint in adults with high-angle Class Ⅱ malocclusions

目的探讨正畸治疗对成年安氏Ⅱ类高角型错患者颞下颌关节的影响。方法对2007年10月至2001年10月到云南省第二人民医院口腔正畸科就诊的21例成年安氏Ⅱ类高角型错患者,采用自锁托槽矫治技术进行正畸治疗,分别于治疗前、后,利用16层螺旋CT,进行颞下颌关节扫描,然后通过多层面重建(multiplanarreformation,MPR)技术对颞下颌关节进行三维重建及参数测量,并对结果进行统计学分析。结果治疗后有27侧髁状突处于关节窝内中性位,占57.2%(27/42),与治疗前比较,差异无统计学意义(P>0.05);而处于关节窝前位和后位的髁状突构成比分别为33.3%(12/42)和9.5%(4/42),与治疗前比较,差异均有统计学意义(均P<0.05)。髁状突前斜面倾角测量值在治疗后平均增大1.64°,与治疗前比较差异有统计学意义(P<0.05);关节结节后斜面斜度,关节窝前后径、内外径和关节窝高度的测量值与治疗前比较,差异无统计学意义(P>0.05)。结论正畸治疗能使成年安氏Ⅱ类高角型错患者的髁状突位置前移及髁状突前斜面适应性改建,但不会对颞下颌关节骨性结构和功能产生不利影响。

Objective To investigate lhe morphology of temporomandibular joint in adults with high-angle Class Ⅱ realocclusions before and after orthodontic treatment. To know the effect of orthodontic treatment on temporomaudibular joint. Methods Twenty-one high-angle cases were chosen from adults with Angle classⅡ maloeclusions. These patients were treated using self-ligating braces and underwent 16-slice spiral CT. The parameters of skeletal morphology of TMJ were measured in the muhiplauner reformation （MPR） images before and after the treatment. The ~sults were anal- ysed by SPSS software. Results Twenty-seven condyle of the 42 were in a center position in the glenoid fossa, the rate being 57.2%; there was no significant difference before and after the orthodontic treatment（P 〉 0.05）. The rate of anteri- or displacement was 33.3% （ 12 / 42） ;the rate of retrodisplac.ement was 9.5% （4 / 42）. There was significant difference between the results before and after the treatment （P 〈 0.05）. The Condyle anterior oblique angle was 1.64° bigger than it was before the treatment, and there was significant difference between the two results （P 〈 0.05）. There was no significant difference between the measurements of tuberculum articulare angle, the anteroposterior diameter and external and internal diameter of the glenoid fossa, and the hight of the glenoid fossa before and after the treatment （P 〉 0.05）. Conclusion The condyle of adults with high-angle Class Ⅱ malocelusions can be moved in anterior position in the glenoid fossa through orthodontic treatment and the condyle anterior oblique would be reconstructed adapting to the new position. But orthodontic treatment won ＇ t cause any adverse effect on the bone structure and function of temporomandibular joint.