正畸正颌联合治疗骨性Ⅲ类错[牙合]畸形颞下颌关节变化  

Changs of TMJ in patients with skeletal Class Ⅲ malocclusion in different treatment stages of combined orthodontic and surgical treatment

作　　者：王丹[1,2] 方梦如 李强 马俊青[1] WANG Dan;FANG Mengru;LI Qiang;MA Junqing(Jiangsu Key Laboratory of Oral Diseaseas,Department of Orthodontics,The Affiliated Stomatological Hospital of Nanjing Medical University,Nanjing 210029,China;Department of stomatatology,Lianshui County People s Hospital,Kangda College of Nanjing Medical University,Huai an 223400,China)

机构地区：[1]南京医科大学口腔疾病研究江苏省重点实验室,南京医科大学附属口腔医院正畸科,江苏南京210029 [2]南京医科大学康达学院附属涟水县人民医院口腔科,江苏淮安223400

出　　处：《口腔生物医学》2020年第3期176-180,共5页Oral Biomedicine

基　　金：国家自然科学基金(81771029);江苏省高校优势学科建设工程资助项目(2018-87);江苏省高等学校自然科学研究(18KJA320004)。

摘　　要：目的:测量骨性Ⅲ类错[牙合]畸形患者正畸正颌联合治疗前后颞下颌关节髁突位置和形态各项指标,评估正畸正颌联合治疗对颞下颌关节的影响,为术前综合评估治疗方案提供参考。方法:选择20例严重骨性Ⅲ类错[牙合]畸形患者,搜集其在正畸治疗前,术前正畸去代偿治疗后,正畸正颌联合治疗结束后的锥形束CT(CBCT)数据。通过CBCT精确测量颞下颌关节髁突—关节窝各径值、间隙值、角度值,比较分析治疗前后颞下颌关节骨性结构的变化。结果:正畸治疗前、正畸正颌联合治疗后,患者左右两侧颞下颌关节各测量项目对比无统计学差异(P>0.05)。治疗前与正畸治疗去代偿后相比左侧髁突水平角减小,有统计学差异(P<0.05),其余颞下颌骨性结构在三维方向各测量项目无统计学差异(P>0.05)。治疗前与正畸正颌联合治疗后比较,左右髁突水平角、关节上间隙、关节前间隙都增大,有统计学差异(P<0.05)。结论:术前正畸对患者颞下颌关节无明显影响,正畸正颌联合治疗后髁突位置向后向下方向改变。Objective:Changes of the position and shape of the condyle of TMJ before and after orthodontic-orthognathic treatment were measured to evaluate its influence on TMJ and to provide reference for the prediction of preoperative comprehensive therapeutic schedule.Methods:20 patients with severe skeletal ClassⅢmalocclusion were selected.CBCT of these patients were collected before orthodontic treatment,after decompensation and after orthodontic-orthognathic treatment.The diameter,gap and angle of TMJ were measured through CBCT,and compared the changes before and after treatment.Results:There was no statistical difference in the measurement items of TMJ between the left and right sides(P>0.05)before and after treatment.There was a significant difference(P<0.05)in the horizontal angle of the left condyle before and after decompensation of orthodontic treatment,while there was no significant difference(P>0.05)in the other three-dimensional measurement items of TMJ.The horizontal angle of the left and right condyles,the supra articular space and the anterior articular space increased significantly before and after treatment(P<0.05).Conclusions:The preoperative orthodontic treatment had no significant effect on the temporomandibular joint.But after orthodontic-orthognathic surgery,the condyle position changed backward and downward.

关 键 词：骨性Ⅲ类错[牙合]畸形 颞下颌关节 正畸正颌联合治疗 

分 类 号：R783.5[医药卫生—口腔医学]