牙齿重度磨耗垂直距离增高值与颞下颌关节间隙的相关性探索

Correlation between the increased vertical dimensions and the temporomandibular joint spaces in patients with severe tooth wear

目的探索牙齿重度磨耗咬合重建患者升高咬合前的颞下颌关节间隙与垂直距离增高值之间的相关性。方法应用锥形束计算机断层扫描(cone-beam computed tomography,CBCT),对42名牙齿重度磨耗咬合重建患者升高咬合前的颞下颌关节间隙和髁突位置进行测量。受试者戴用3副垂直距离增高值分别为2、4和6 mm的过渡性义齿后,自主选择出感觉相对最舒适的1副。比较3个垂直距离增高值组间的关节间隙等指标,试分析不同垂直距离增高值与修复前颞下颌关节之间的相关性。结果选择2 mm、4 mm过渡性义齿患者的上间隙平均值分别为(3.58±0.98)mm、(3.07±0.60)mm,4 mm过渡性义齿患者的上间隙小于2 mm过渡性义齿患者(P<0.05)。垂直距离增高值与颞下颌关节间隙值、髁突位置、性别、年龄之间均无显著线性相关(P>0.05)。结论研究结果呈现出颞下颌关节上间隙越小,患者选择垂直距离增高值越大的趋势,但受多因素影响,尚未发现牙齿重度磨耗患者颞下颌关节间隙和髁突位置是影响垂直距离高度增高值的显著性指标。

Objective To explore the correlation between the increased vertical dimensions and the temporomandibular joint spaces before treatment in patients with severe tooth wear during occlusal reconstruction. Methods The temporomandibular joint spaces and the condylar positions of 42 patients were measured by cone-beam computed tomography（ CBCT） before treatment. Then the 3 different transitional removable dentures with 2 mm,4 mm,6 mm increased vertical dimensions were manufactured for each subject. The subjects chose the most comfortable one by themselves after wearing 3 transitional dentures. We compared the temporomandibular joint spaces in 3groups of different increased vertical dimensions,and tried to analyze the correlation between the 3 different increased vertical dimensions and the temporomandibular joint spaces. Results The mean superior space in the group of 2 mm and 4 mm increased vertical dimensions was（ 3. 58 ± 0. 98） mm,（ 3. 07 ± 0. 60） mm respectively. The mean superior space in the 4 mm group was narrower than the 2 mm group（ P 〈0. 05）. No significant linear correlation was found between increased vertical dimension with temporomandibular joint spaces,condylar positions,gender and age（ P〉 0. 05）. Conclusion The results presented a tendency that the narrower the superior space is,the higher the transitional removable denture that patient choose is. On account of many factors,the temporomandibular joint spaces and the condylar positions in patients with severe tooth wear have not yet been found to be significant indicators affecting the increased vertical dimensions.