青少年骨性Ⅱ类高角错[牙合]患者颞下颌关节形态的锥形束CT研究

A CBCT study on the morphology of the temporomandibular joint of skeletal class Ⅱ malocclusion adolescents with hyperdivergent pattern

目的探讨青少年骨性Ⅱ类高角错[牙合]患者的颞下颌关节形态特征及其颞下颌关节随生长改建的相关规律。方法采用回顾性研究,从2015年1月至2019年10月于东莞健力口腔医院正畸科就诊并拍摄锥形束CT(CBCT)的患者中选择符合纳入标准的青少年骨性Ⅱ类高角组52例、青少年正常对照组54例与成人骨性Ⅱ类高角组患者50例,在牙尖交错位进行CBCT扫描,利用NNTviewer 5.1软件对颞下颌关节进行三维重建,测量髁突形态、关节窝形态与关节间隙等11项指标,运用独立样本t检验分别比较青少年骨性Ⅱ类高角组与青少年正常对照组、青少年骨性Ⅱ类高角组与成人骨性Ⅱ类高角组在上述指标上的差异。结果与青少年正常对照组相比,青少年骨性Ⅱ类高角组的髁突外形更小,髁突倾斜角更大,关节前间隙、关节上间隙与关节结节后斜面角度更小(P<0.001)。与成人骨性Ⅱ类高角组相比,青少年骨性Ⅱ类高角组的髁突内外径、前后径与高度更小,关节窝深度与宽度更小(P<0.001)。结论青少年骨性Ⅱ类高角组与青少年正常对照角组在髁突形态及位置、关节窝形态上均存在一定程度差异;随年龄增大,骨性Ⅱ类高角患者的颞下颌关节形态增大,但盘突关系及生长型稳定。

Objective To investigate the characteristics of morphology and growth-associatedremodeling of the temporomandibular joint of skeletal class Ⅱ malocclusion adolescents with hyperdivergentpattern.MethodsA retrospective study was conducted with 52 skeletal class Ⅱ malocclusion adolescentswith hyperdivergent pattern,54 normal control adolescents and 50 skeletal class Ⅱ malocclusion adultswith hyperdivergent pattern selected from the patients who visited the department of orthodontics of JianliStomatological Hospital of Dongguan between January 2015 and October 2019.CBCT scans were acquiredin centric occlusion.NNT viewer 5.1 software was used to rebuild 3D image data of the temporomandibularjoint.11 items related with the morphology of the condyle,the morphology of the glenoid fossa and the TMJspace were compared between the skeletal class Ⅱ malocclusion adolescents with hyperdivergent patternand normal control adolescents,and between the adolescents and adults with skeletal class Ⅱ malocclusion and hyperdivergent pattern using the independent sample t test.ResultsCompared with thenormal control adolescents,the condyles of the skeletal class Ⅱ malocclusion adolescents withhyperdivergent pattern were smaller,shorter,tipped more anteriorly and positioned more anteriorly,angles of the posterior wall of articular tubercle were smaller(P<0.001).Compared with the skeletal class malocclusion adults with hyperdivergent pattern,the condyles of the skeletal class Ⅱ malocclusionadolescents with hyperdivergent pattern were smaller and shorter,and the depth and the width of theglenoid fossa were narrower(P<0.001).ConclusionsSkeletal class Ⅱ malocclusion adolescents withhyperdivergent pattern have different forms and positions of condyle,forms of glenoid fossa compared withnormal control adolescents.With the increase of the ages,the forms of the condyle and the widths ofglenoid fossa of skeletal class Ⅱ malocclusion patients with hyperdivergent pattern increase,while thepositions of the condyle and the growth pattern remain stable.