内倾型深覆■伴重度磨耗患者颞下颌关节影像表现及正畸疗效分析

Analysis of temporomandibular joint imaging and orthodontic effect in patients with introverted deep overbite and severe attrition

目的:探讨内倾型深覆伴牙列重度磨耗患者颞下颌关节功能及结构特点,分析面下1/3垂直距离变化与颞下颌关节间隙变化的相关性,以及正畸修复联合治疗对颞下颌关节功能的影响。方法:选择2019年1月—2023年6月收治的80例内倾型深覆伴重度磨耗患者和40例关系正常受试者,收集临床资料、颞下颌关节功能及结构特点。80例内倾型深覆伴重度磨耗患者随机分为对照组和试验组,每组各40例。对照组采用修复治疗,试验组采用正畸修复联合治疗,治疗过程中评价疗效、CBCT影像指标。采用SPSS 26.0软件包对数据进行统计学分析。结果:内倾型深覆伴重度磨耗患者平均Helkimo指数较正常受试者显著升高(P<0.05)。CBCT扫描显示,内倾型深覆伴重度磨耗患者颞下颌关节前间隙显著增大(P<0.05),上间隙和后间隙均较正常受试者显著缩小(P<0.05)。头颅定位侧位片显示,内倾型深覆伴重度磨耗患者面下1/3垂直距离较正常受试者显著缩小(P<0.05)。2组患者治疗后Helkimo指数显著降低(P<0.05),试验组与对照组相比降低更加显著(P<0.05)。2组患者治疗后颞下颌关节前间隙显著缩小,上间隙和后间隙显著增大(P<0.05),试验组颞下颌关节间隙与对照组相比无显著差异(P>0.05)。2组患者治疗后面下1/3垂直距离显著增大(P<0.05),面下1/3垂直距离与颞下颌关节前间隙、上间隙和后间隙之间具有相关性(P<0.05)。结论:正畸修复联合治疗对内倾型深覆伴牙列重度磨耗患者颞下颌关节功能改善作用显著,优于单纯修复治疗,对颞下颌关节结构矫治作用与单纯修复治疗相似。

PURPOSE:To investigate the functional and structural characteristics of temporomandibular joint(TMJ)in introverted deep overbite patients with severe wear,to analyze the correlation between the vertical distance of the lower 1/3 of the face and TMJ space,and to compare the clinical efficacy of multidisciplinary treatment with orthodontics and prosthodontics on TMJ function.METHODS:Eighty patients with deep overbite and severe abrasion and forty subjects with normal occlusion admitted to our hospital from January 2019 to June 2023 were enrolled in this study.The clinical data were collected and the functional and structural characteristics of TMJ were collected.Eighty patients with deep overbite and severe abrasion were randomly divided into control group and experimental group,with 40 cases in each group.The control group was treated with restoration,and the experimental group was treated with orthodontic combined with restoration.The efficacy and CBCT imaging indexes were evaluated during the treatment.SPSS 26.0 software package was used for statistical analysis.RESULTS:The mean Helkimo index of patients with deep overbite and severe abrasion was significantly higher than that of patients with normal occlusion(P<0.05).CBCT scan showed that anterior space of TMJ in patients with deep overbite and severe abrasion significantly increased than those with normal occlusion(P<0.05),while superior and posterior space were significantly decreased than those with normal occlusion(P<0.05).Lateral cephalometric analysis showed that the vertical distance of submaxillofacial 1/3 in patients with deep overbite and severe abrasion significantly decreased than normal occlusion(P<0.05).The Helkimo index of the two groups after treatment was significantly reduced(P<0.05),and the Helkimo index of the experimental group was significantly lower than that of the control group(P<0.05).The anterior TMJ spaces of the two groups significantly decreased after treatment,and the superior and posterior TMJ spaces were significantly increased(P<0.05),but there was no significant difference in TMJ space between the experimental group and the control group(P>0.05).The vertical distance of submaxillofacial 1/3 in patients in both groups significantly increased after treatment(P<0.05).There were correlations between the vertical distance of lower one-third of face and the anterior,superior and posterior TMJ spaces(P<0.05).CONCLUSIONS:The clinical effect of dual disciplinary treatment of orthodontics and prosthodontics on TMJ function was significantly better than that of prosthodontics alone,and the effect on TMJ structure correction is similar to that of prosthodontics.