颞下颌关节盘移位患者的关节盘锚固术及牙种植同期治疗  

Joint anchor surgery and dental implant surgery carried simultanously in patients with temporomandibular joint disc displacement

作　　者：徐伟峰[1] 焦子先[1] 张善勇[1] 郑吉驷[1] 赵璟阳[1] 陈琦[1] 沈佩[1] 杨驰[1] 张瑛[1] 

机构地区：[1]上海交通大学医学院附属第九人民医院.口腔医学院口腔外科上海市口腔医学重点实验室,上海200011

出　　处：《中国口腔颌面外科杂志》2015年第4期319-323,共5页China Journal of Oral and Maxillofacial Surgery

基　　金：国家自然科学基金(81371168);上海市自然科学基金(10ZR1418200);上海市浦江人才计划;上海市科学技术委员会西医引导类项目(134119a5400);上海交通大学医学院第七期大学生创新训练项目(2013052)~~

摘　　要：目的 ：介绍一种缺牙伴颞下颌关节盘不可复性前移位的同期治疗方案。方法 ：2013年7月—2014年10月,5例缺牙伴颞下颌关节紊乱患者,平均年龄41.8岁（28~51岁）,术前经MRI检查确诊为颞下颌关节盘不可复性前移位,全景片、锥形束CT（CBCT）确定缺牙位置及缺牙区骨量,临床检查开口度均小于一指,关节区有明显疼痛。术前采用Simplant 11.04软件辅助设计种植体植入方案,并制作种植导板,术中关节盘锚固术和导板辅助一期牙种植手术先后进行,术后3个月行二期种植手术,半年后进行冠修复。结果：术后关节盘位置、开口度恢复良好,关节区无疼痛,缺牙区牙冠形态、咬合关系恢复良好。结论：对于期望种植修复牙列缺损但伴颞下颌关节盘不可复性前移位的患者,将关节盘锚固术和种植手术同期进行是一种可行的治疗方案。PURPOSE： The purpose of this study was to introduce a new treatment approach for patients who has dentition defect with anterior disc displacement without reduction. METHODS：Five patients of dentition defect with temporomandibular joint disorder, with an average age of 41.8 years（28~51 years） treated from July 2013 to October 2014 were included. MRI showed the anterior disc displacement without reduction. Panoramic radiograph, cone-beam CT（CBCT） determined the location of missing teeth and bone loss; clinical examination showed limited mouth opening（8~15mm, average 12 mm） with obvious pain in temporomandibular joint（TMJ） area. The implant program was designed and implant guide plate was make by Simplant 11.04 software before the operation. During the operation, modified articular disc anchor surgery and implant surgery were conducted simultaneously. Second-stage implant surgery after 3 months and crown restoration after 6 months were performed. RESULTS： The new approach provided a good results in recovery of articular disc position and mouth opening, and no pain in the area of TMJ; the morphology and the relationship of occlusion with adjacent artificial crown were also well rehabilitated. CONCLUSIONS： Articular disc anchor surgery and implant surgery carried out simultaneously is a preferable treatment option for patients who want implant restoration for denture defect but with anterior disc displacement without reduction.

关 键 词：颞下颌关节盘不可复性前移位 开口受限 种植修复 

分 类 号：R782.6[医药卫生—口腔医学]