安氏Ⅲ类错正畸前后颞下颌关节形态变化的研究

The study on TMJ morphological changes in patients with Angle class Ⅲ malocclusion pretreatment and after treatment

目的 探讨骨性和功能性Ⅲ类错牙合在正畸前、后颞下颌关节形态变化与颞下颌关节紊乱病 (TMD)之间的关系。方法 利用矫正薛氏位X线片在正畸前后对Ⅲ类骨性错牙合正畸前 19例和正畸后 11例、功能性错牙合正畸前 2 0例和正畸后 18例的双侧颞下颌关节的髁突居关节窝中的位置 (前移、居中、后移 ) ,从上述两类错牙合患者中各选 5例做双侧颞下颌关节矢状位核磁共振扫描 ,观察正畸前、后关节盘的位置及形态变化。结果 正畸前Ⅲ类功能性和骨性错牙合髁突居关节窝前位 ;正畸后Ⅲ类功能性错牙合髁突居关节窝中位 ,Ⅲ类骨性错牙合髁突仍居关节窝前位。正畸前、后功能性Ⅲ类错牙合关节盘位置及形态均基本正常 ;Ⅲ类骨性错牙合正畸后有少部分患者髁突明显前移 ,关节盘形态异常。结论 正畸前后功能性Ⅲ类错牙合颞下颌关节结构基本正常 ,与TMD关系不密切 ;骨性Ⅲ类错牙合正畸后关节结构表现出异常 ,提示与TMD有关 。

Objective To evaluate TMJ morphological changes in patients with skeletal and dental class Ⅲ malocclusion before and after treatment in order to find out whether these two types of malocclusion were related to structural and functional disorder of TMJ.Methods 39 pretreatment and 29 after treatment orthodontic patients were examined on right and left TMJ with corrected lateral cephalometric radiograghs.Bilateral TMJ relationships of fossa-condyles were observed with subjective evaluation,lineral and area measurement.10 patients meniscus positions and morphological change were imaged with 0.5 -T sagittal magnetic resonance imaging system on rigth and left TMJ.Results ①Pretreatment skeletal and dental Class Ⅲ patients demonstrated significantly more anteriorly positioned condyles.After treatment dental Class Ⅲ patients demonstreated concentricly positioned condylers,skeletal class Ⅲ patients were the same as the pretreatment.②Pretreatment:most of meniscus positions and morphology were normal and in concave shapes in skeletal and dental ClassⅢ malocclusion.After treatment:in skeletal ClassⅢ malocclusion few of meniscus positions were significantly anteriorly and their shapes were abnormal with thicken anterior band.Conclusion Skeleltal classⅢ malocclusion is associated with abnormal structure and function of TMJ.