两种前牵引技术在上颌发育不足治疗中的颞下颌关节评价  

The Estimate of Temporomandibular Joint Structural Alteration with Maxillary Protraction on Skeletal Class Ⅲ

作　　者：亢静 彭明慧 陈洁 KANG Jing;PENG Ming-hui;CHEN Jie(Department of Orthodontics,the Second Oral Disease Preventive Center of Huangpu Area,Shanghai 200020,China;Department of Radiology,the Second Oral Disease Preventive Center of Huangpu Area,Shanghai 200020,China)

机构地区：[1]上海市黄浦区第二牙病防治所正畸科,上海200020 [2]上海市黄浦区第二牙病防治所放射科,上海200020

出　　处：《中国美容医学》2019年第12期97-101,共5页Chinese Journal of Aesthetic Medicine

基　　金：上海市卫计委科技项目基金(编号:201440506)

摘　　要：目的:采用CBCT评价前牵引矫治上颌发育不足患者治疗前后的颞下颌关节变化。方法:选取就诊于上海市黄浦区第二牙病防治所正畸科11~13岁骨性Ⅲ类、上颌发育不足的患儿40例,随机纳入种植体牵引组和支架牵引组,每组20例。对患者进行前牵引矫治12个月,治疗前后采用德国西诺德公司OTHOPHOS XG 3D Ceph三合一数字化摄片机拍摄头颅定位侧位片以及两侧处于牙尖交错位的颞下颌关节CBCT,对治疗前头影测量、颞下颌关节前间隙、上间隙、后间隙、颞下颌关节窝深度、髁突前后径、髁突近远中径和髁突倾斜度进行测量分析;另选取平均年龄11~13岁骨性I类未经正畸治疗的15例患儿为对照组,在知情告知下不进行任何正畸治疗,对其1年前后的颞下颌关节CBCT进行测量。结果:种植体牵引组和支架牵引组治疗后CBCT均显示颞下颌关节前间隙显著增大,上间隙和后间隙显著减小,髁状突倾斜角增大,髁状突在关节窝中向后上移位,颞下颌关节深度在治疗前后增大,增长量种植体牵引组较支架牵引组略大,说明前牵引后关节窝有明显的生长改建。结论:采用上颌前牵引矫治上颌骨发育不足的病例中,上颌骨均有明显生长,颞下颌关节深度增加,髁突位置向后上移位,有利于颞下颌关节发育。Objective To investigate the temporomandibular joint(TMJ)structural alteration of skeletal class Ⅲ children before and after maxillary protraction used by CBCT.Methods 40 skeletal Class Ⅲ patients(25 boys and 15 girls,11-13 years old)who had Maxillary hypoplasia from the Second Oral Disease Preventive Center of Huangpu Area shanghai were included in the study.They were divided into 2 groups radomly.The first group got maxillary protraction with micro-plant for 10 to 12 months.The second group got maxillary protraction with casting frame for 10 to 12 months.The control group involved 15 skeletal Class Ⅰ children(7 boys and 8 girls,11-13 years old).We don’t give them any orthodontic treatment.Their pre-and posttreatment cephalometric radiograph and CBCT were measured respectively for anterior,upper and posterior diastemas of TMJ.Results In the two protraction groups,Anterior diastema of TMJ increased obviously,while upper and posterior diastemas of TMJ decreased after treatment.The sagittal condylar inclination and the depth of glenoid fossa increased after protraction.These indicated the temporomandibular fossa was reconstructed during the treatment.Conclusion Maxillary protraction could promote the growth of maxilla and improve the growth of TMJ.

关 键 词：种植支抗 前牵引 颞下颌关节 CBCT 上颌发育不足 

分 类 号：R782.2[医药卫生—口腔医学]