Herbst双期减数矫治与单纯固定减数矫治对颞下颌关节影响的锥形束CT研究

A cone-beam CT investigation on the effect of two-phase treatment and fixed appliance treatment only on temporomandibular joint

目的 应用锥形束CT研究Herbst双期减数矫治与单纯固定减数矫治对颞下颌关节骨性结构形态及位置关系的影响,以期为临床提供参考.方法 选取恒牙列早期安氏Ⅱ类错（牙合）下颌后缩患者30例,其中Herbst双期减数矫治组（双期矫治组）15例,单纯固定减数矫治组（固定矫治组）15例.所有患者矫治前后均拍摄锥形束CT,测量颞下颌关节各测量项目并进行Wilcoxon秩和检验.结果 双期矫治组矫治后髁突前后径[7.41 （2.55） mm]、髁突头高度[3.58（0.86） mm]均较矫治前[6.58（2.05）和2.81（0.64） mm]显著增加（P＜0.05）,固定矫治组颞下颌关节各骨性测量项目矫治前后差异无统计学意义（P＞0.05）;双期矫治组髁突头高度矫治前后变化量[0.60（0.48） mm]显著大于固定矫治组[0.02 （0.21） mm] （P＜0.05）,其他项目矫治前后变化量两组差异无统计学意义（P＞0.05）.结论 Herbst双期减数矫治与单纯固定减数矫治相比,除髁突生长改建的变化外,对颞下颌关节其他骨性形态及位置均未产生差异性影响.

Objective To assess the effects of two phase treatment（Herbst and fixed appliance） and fixed appliance treatment only（edgewise appliance） on temporomandibular joint in Cass Ⅱ patients with mandibular retrusion using cone-beam CT（CBCT） analysis.Methods Thirty Class lⅡ patients with mandibular retrusion in the permanent dentition were divided into two groups.Group A consisted of 15 patients with two phase treatment.Group B consisted of 15 patients with fixed appliance treatment only.CBCT was taken before（T1） and after（T2） treatment.The Invivo Dental software was used to calculate the relevant parameters of temporomandibular joint.Wilcoxon analysis was carried out.Results In group A,the condylar anterior-posterior diameters（7.41[2.55]） and the condylar head height（3.58[0.86]） increased significantly after treatment（P〈O.05）.In group B,all skeletal measurements had no significant changes（P〉0.05） after treatment.The changes of condylar head height in group A（0.60[0.48]） showed greater than in group B（0.02[0.21]）（P〈0.05）.No significant differences in the temporomandibular joint spaces were found before and after treatment,and between the two groups（P〉0.05）.Conclusions Compared with fixed appliance treatment only,except for condylar growth changes,no significant changes of other skeletal morphology of the temporomandibular joint and the condyle position within the glenoid fossa were found between patients with two phase treatment and with fixed appliance treatment only.