掩饰性治疗影响成人骨性Ⅲ类患者颞下颌关节的回顾性研究

The retrospective study about the change of TMJ and the skeleton-face type in adults of skeletal ClassⅢmalocclusion by camouflage therapy

目的探讨非拔牙掩饰性正畸治疗对成人轻中度骨性Ⅲ类均角患者的颞下颌关节影响,进一步为此类患者的正畸临床治疗提供理论依据。方法选取已治疗结束的成人均角轻中度骨性Ⅲ类病例30例(其中男17、女13例),治疗前后均拍摄锥形束投照计算机重组断层影像设备(cone-beam computed tomography,CBCT)进行三维重建,利用Invivo 5软件对颞下颌关节各个骨性结构的指标测量分析。结果(1)治疗前后双侧颞下颌关节测量指标对比均无统计学差异(P>0.05);(2)颞下颌关节形态变化:治疗前后,矢状位关节窝高度增大且髁突长度减小,两者的变化均具有统计学差异(P<0.05);冠状位髁突内外径的变化无统计学差异(P>0.05);轴位关节窝前后径增大且髁突前后径减少,两者的变化均具有显著统计学差异(P<0.05)。(3)颞下颌关节位置变化:治疗前后,矢状位关节上间隙和关节前间隙增大,具有统计学差异(P<0.05),但关节后间隙的变化无明显统计学差异(P>0.05);轴位髁突角增大以及髁突几何中心到中心矢状线的距离减小,两者变化均具有统计学差异(P<0.05)。(4)正畸治疗前后髁突相对位置的改变无明显统计学差异(P>0.05)。结论非拔牙掩饰性正畸治疗对成人轻中度骨性Ⅲ类均角患者的颞下颌关节形态及位置改变有影响。

Objective Through exploring the effect of non-extraction orthodontic treatment on temporomandibular joint in adult patients with mild to moderate skeletal ClassⅢmalocclusion,so as to provide theoretical basis for orthodontic clinical treatment of such patients.Methods Thirty patients with mild to moderate and normal-angle skeletal ClassⅢcases(including 17 males and 13 females)whose treatment had finished were selected.Before and after treatment,CBCT was taken for three-dimensional reconstruction,and Invivo 5 software was used to measure and analyze the bone structure of temporomandibular joint.Results(1)There was no difference in the measurement indexes between the left and right sides of the temporomandibular joint before and after treatment(P>0.05);(2)Morphological changes of the temporomandibular joint:After treatment,the height of the socket increased and the length of the condyle in the sagittal layer decreased,above changes were statistically significant(P<0.05).There was no statistical difference in the changes in the inner and outer diameters of the coronal condyle(P>0.05).The increase of the anteroposterior diameter of the fossa and the decrease of the anteroposterior diameter of condyle in the axillary layer were statistically significant(P<0.05);(3)Changes in the position of the temporomandibular joint:After treatment,the upper joint space and the anterior joint space in the sagittal layer increased,with statistical difference(P<0.05),but there was no statistically significant difference in the posterior space of the joint(P>0.05).In the axial layer,the condyle angle increased and the distance from the geometric center of the condyle to the central sagittal line decreased,above two changes were statistically significant(P<0.05);(4)There was no significant difference in the relative position of condyle before and after orthodontic treatment(P>0.05).Conclusion Non-extraction concealment orthodontic treatment can affect the shape and position of temporomandibular joint in adult patients with mild to moderate skeletal ClassⅢmalocclusion.