骨性Ⅱ类错[牙合]伴高角成人下颌垂直向高度控制与颞下颌关节变化的锥形束CT分析  

Cone-beam CT analysis of vertical control of mandible and changes of temporomandibular joint in adult patients with skeletal classⅡmalocclusion with high angle

作　　者：韦钰[1] 张国瑞[1] 刘一宁 陈文远锋 张新竺 曹宝成[1] Wei Yu;Zhang Guorui;Liu Yining;Chen Wenyuanfeng;Zhang Xinzhu;Cao Baocheng(Department of Orthodontics,Lanzhou University Stomatological Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学口腔医院正畸科,兰州730000

出　　处：《中华口腔医学杂志》2022年第11期1147-1155,共9页Chinese Journal of Stomatology

基　　金：甘肃省科技计划(20YF8FA071)。

摘　　要：目的通过锥形束CT探讨骨性Ⅱ类错[牙合]伴高角成人下颌垂直向高度控制矫治前后颞下颌关节形态和位置的变化,以及下颌垂直向变化量与髁突位置变化量之间的相关性,以期为正畸临床诊断和矫治设计提供参考。方法选取2017年10月至2020年11月于兰州大学口腔医院正畸科行减数矫治并进行主动垂直向高度控制的骨性Ⅱ类错[牙合]伴高角成年患者20例,其中男性6例,女性14例,年龄(21.4±2.4)岁。将矫治前后患者锥形束CT导入Invivo Dental 5.0软件进行三维重建和校正后,测量头颅侧位截面的下颌垂直向指标(下颌平面角、后前面高比、下颌真性旋转角)、切道斜度以及髁突形态和位置及关节窝形态指标,并对矫治前后结果进行配对t检验。计算Pearson相关系数,分析下颌垂直向指标变化量与髁突位置变化量的相关性。结果矫治后20例患者前牙覆[牙合]、覆盖正常,磨牙垂直向高度得到控制。与矫治前相比,矫治后下颌平面角显著减小2.05°±1.22°(t=7.60,P<0.001)、后前面高比显著增加(1.89±3.32)%(t=2.56,P=0.019)、下颌真性旋转角显著减小1.42°±1.92°(t=3.54,P=0.002);矫治后髁突内外径显著增加(0.55±0.76)mm(t=-2.73,P=0.015)、髁突前后径显著增加(0.27±3.51)mm(t=-3.23,P=0.006)、髁突最大轴面面积显著增加(6.01±7.36)mm2(t=-2.80,P=0.013)、髁突头高度显著增加(0.33±0.72)mm(t=-2.14,P=0.046);关节窝宽度显著增加(0.56±0.93)mm(t=-2.37,P=0.032)、关节窝深度显著增加0.33(0.14,0.51)mm(Z=-2.76,P=0.006)、关节结节角显著增加1.50°±2.40°(t=-2.44,P=0.028);髁突内间隙显著减小(0.33±0.49)mm(t=2.31,P=0.035)、髁突外间隙显著减小(0.20±0.23)mm(t=3.58,P=0.003)。矫治前6例患者髁突存在前移位、7例髁突为居中位、7例髁突后移位;矫治后髁突居中位者变化不大,2例髁突后移位及3例髁突前移位者矫治后髁突处于居中位,3例髁突前移位及3例髁突后移位者关节间�Objective To investigate the shape and position changes of temporomandibular joint(TMJ)in adult skeletal classⅡmalocclusion with high angle patients after vertical mandibular control,and the correlation between vertical mandibular changes and condylar position changes.Methods Twenty adult skeletal classⅡmalocclusion with high angle patients[6 males and 14 females,aged(21.4±2.4)years]who underwent extraction treatment and active vertical control in the Department of Orthodontics,Lanzhou University Stomatological Hospital from October 2017 to November 2020 were selected.Cone-beam CT data of the patient before and after treatment were imported into Invivo Dental 5.0 software for three-dimensional reconstruction and correction,and the vertical index of mandible in reconstructed lateral cephalogram(mandibular plane angle,posterior anterior height ratio,mandibular true rotation angle)were measured.Incisal angle and variables of condyle shape,position and articular fossa shape were measured.Paired t test was performed on the results before and after treatment,and the correlation between mandibular vertical changes and condylar position changes was determined by Pearson correlation coefficient calculation.Results After treatment,the overbite and overjet were within normal range,and the vertical height of the molars was controlled.Compared with the measurement before treatment,mandibular plane angle and mandibular true rotation angle were decreased by 2.05°±1.22°(t=7.60,P<0.001)and 1.42°±1.92°(t=3.54,P=0.002),respectively.The posterior anterior height ratio was increased by(1.89±3.32)%(t=2.56,P=0.019).After treatment,the mediolateral diameter of condyle,the anteroposterior diameter of condyle,the maximum cross-sectional area of condyle,the height of condyle head,the width of articular fossa,the depth of articular fossa and the articular nodular angle were increased by(0.55±0.76)mm(t=-2.73,P=0.015),(0.27±3.51)mm(t=-3.23,P=0.006),(6.01±7.36)mm2(t=-2.80,P=0.013),(0.33±0.72)mm(t=-2.14,P=0.046),(0.56±0.93)mm(t

关 键 词：错[牙合] 安氏Ⅱ类 颞下颌关节 锥束计算机体层摄影术 成年人(19-44) 高角 垂直向高度控制 

分 类 号：R783.5[医药卫生—口腔医学]