牙列重度磨耗患者咬合重建前、后颞下颌关节的线性测量

Evaluation of occlusal reconstruction and cone-beam CT measurement of temporomandibular joint in patients with severe tooth wear

目的:对牙列重度磨耗患者垂直距离进行恢复后,研究颞下颌关节间隙与垂直距离增高之间的相关性,探讨恢复髁突位置对咬合重建的影响。方法:纳入30例牙列重度磨耗行咬合重建的患者,在恢复垂直高度前后,对其双侧的颞下颌关节进行锥形束CT(cone-beam CT,CBCT)扫描,测量颞下颌关节前、上、后间隙大小,分析髁突位置;比较垂直距离恢复前、后的关节间隙等指标,分析患者恢复垂直距离前、后髁突位置的变化。采用SPSS 19.0软件包对颞下颌关节前、上、后间隙进行统计学分析。结果:30例牙列重度磨耗患者颞下颌关节各间隙两侧之间差异无统计学意义(P>0.05),故将两侧颞下颌关节间隙合并统计。治疗前关节前、上、后间隙分别为(2.01±0.52)mm、(3.15±0.94)mm、(2.70±0.98)mm;治疗后关节前、上、后间隙分别为(2.03±0.35)mm、(3.46±0.74)mm、(2.79±0.58)mm。通过计算In(P/A)值和线性比率(linear ratio,LR)得出重度磨耗患者治疗前52%髁突前移位;咬合重建治疗后,治疗前髁突前移位的患者复位率达86.7%。结论:重度磨耗患者除了恢复其垂直距离外,还应诱导髁突回到正常位置,避免产生关节症状。

PURPOSE:To explore the correlation between increased vertical dimensions and temporomandibular joint(TMJ) spaces of patients with severe tooth wear after occlusal reconstruction treatment.METHODS:The TMJ spaces and the condylar positions of 30 patients were measured by cone-beam CT(CBCT) before and after treatment.SPSS 19.0 software package was used to analyze the anterior,superior and posterior space of TMJ.Independent sample t test was utilized to evaluate the correlation between vertical dimension and TMJ spaces.RESULTS:There was no significant difference between TMJ spaces of two sides,the data of two sides were combined for further analysis.The mean anterior interspace,superior interspace,posterior interspace was(2.01±0.52)mm,(3.15±0.94)mm,(2.70±0.98)mm before treatment,and(2.03±0.35)mm,(3.46±0.74)mm,(2.79±0.58)mm after treatment,respectively.Based on calculating the In(P/A) and linear ratio(LR),condylar position moved backward for 52% patients before treatment.After occlusal reconstruction,the reduction rate of anterior displacement of condyle was 86.7%.CONCLUSIONS:In addition to restoring its vertical dimensions of patients with severe tooth wear,the condyle should be induced to appropriate position to prevent TMJ symptoms.