CBCT在义齿修复后颞下颌关节疾病诊治中的应用

Application of CBCT in the diagnosis and treatment of temporomandibular joint diseases after denture restoration

目的探讨锥形束CT(cone beam CT,CBCT)在义齿修复后颞下颌关节紊乱病(temporomandibular joint disorder,TMD)诊治中的应用效果。方法 20例义齿修复后出现TMD患者作为研究对象,进行CBCT检查,测定患者修复前后颞下颌关节(temporomandibular joint,TMJ)髁突及间隙数据。对出现TMD患者按照常规制作新义齿,根据义齿垂直距离恢复值进行分组,划分为A组(2mm)、B组(4mm)、C组(6mm),佩戴3个月后在CBCT下记录三组TMJ间隙指标。结果修复前后组内左右侧间隙值及髁突各项数值比较无显著差异(P>0.05);修复后TMJ前间隙值、上间隙值及髁突水平角与修复前相比均增大(P<0.05),后间隙及髁突前后径、前斜面宽、后斜面角、髁突高与修复前相比均缩小(P<0.05);B组上间隙值较A组的小(P<0.05)。结论通过CBCT确定合适的垂直距离,进行有效的咬合重建,可达到更好的修复效果。

Objective To evaluate the application of cone beam CT(CBCT)in the diagnosis and treatment of temporomandibular joint disorder(TMD)after denture restoration. Methods Twenty patients with TMD after denture restoration were treated, CBCT was performed to determine the condylar process and space data of temporomandibular joint(TMJ) before and after restoration. According to the restoration value of vertical distance of denture,the new dentures were divided into group A(2 mm),group B(4 mm) and group C(6 mm). After wearing for 3 months,the TMJ clearance indexes of three groups were recorded under CBCT. Results There was no significant difference in the values of left, right spaces and condylar process before and after repair(P >0.05),the values of anterior and supracondylar space and condylar horizontal angle of TMJ increased after repair compared with those before repair(P <0.05), the posterior space, anterior and posterior diameter of condyle,width of anterior oblique plane, angle of posterior oblique plane and height of condyle were reduced compared with those before restoration(P<0.05);the value of superior clearance in group B was smaller than that in group A(P<0.05). Conclusion CBCT shows that TMD has some changes,the proper vertical distance and effective occlusal reconstruction can achieve better restoration effect.