伴颞下颌关节紊乱病成年病人不同颌位动态咬合特征及差异  

Dynamic occlusal characteristics and differences in adult patients with TMD in different jaw positions

作　　者：张春香[1,2] 金晶 智铖 王静 于晓彤 姜怡林 陈子怡 张淋坤 ZHANG Chunxiang;JIN Jing;ZHI Cheng;WANG Jing;YU Xiaotong;JIANG Yilin;CHEN Ziyi;ZHANG Linkun(Department of Orthodontics,Tianjin Stomatological Hospital,Tianjin 300041,China;Key Laboratory of Oral Function Recon-struction of Tianjin,Tianjin 300041,China;Second Department of Orthodontics,Huhhot Stomatological Hospital,Huhhot 010030,China;Medical College of Nankai University,Tianjin 300071,China;Department of Stomatology,Shanxi Bethune Hospital,Taiyuan 030000,China;School of Stomatology,China Medical University,Shenyang 110122,China)

机构地区：[1]天津市口腔医院正畸科,天津300041 [2]天津市功能重建重点实验室,天津300041 [3]呼和浩特市口腔医院正畸二科,呼和浩特010030 [4]南开大学医学院,天津300071 [5]山西白求恩医院口腔科,太原030000 [6]中国医科大学口腔医学院,沈阳110122

出　　处：《西南医科大学学报》2023年第2期162-166,共5页Journal of Southwest Medical University

基　　金：天津市医学重点专科第二轮建设项目(TJYXZDXK-024A);天津市首批卫生计生行业高层次人才选拔培养工程(津人才2018-19号);天津市卫生行业重点攻关项目(15KG119)。

摘　　要：目的利用T-scan数字化电子咬合分析系统来记载伴颞下颌关节紊乱病(temperomandibular disorders,TMD)病人在进行动态咬合时的接触,并分析当下颌由不同颌位起始开始运动时的咬合特征以及时间特点,以此来探究下颌运动时的咬合特征及其与TMD的相关性。方法选择40例18~30岁成人作为研究对象,根据DC/TMD诊断标准将其分为对照组(n=17)和TMD组(n=23)。通过T-scan分别记录受试者由牙尖交错位(intercuspal position,ICP)和参考位置(reference position,RP)起始的咬合过程,记录下颌运动时间指标以及ICP最大咬合时测量指标。结果TMD组由RP开始下颌运动的时间较由ICP开始的时间长,并且左侧方咬合分离时间、右侧方咬合分离时间的差异具有统计学意义(P<0.05)。相较于对照组,TMD组在由RP起始运动时,左右两侧的侧方咬合分离时间差异均有统计学意义(P<0.05);当下颌由牙尖交错位开始运动时,前伸咬合分离时间的差异具有统计学意义(P<0.05)。与对照组相比,TMD组的左右侧力值比差值、COF横向偏移量以及COF平均偏移距离均较大,差异均具有统计学意义(P<0.05)。结论当成年病人存在TMD时,由RP和ICP起始的下颌运动均会存在时间差异。另外,伴TMD成年病人在咬合时,相较于那些无TMD症状的病人,左右侧的咬合力分布会更加不均衡。Objective The T-scan digital electronic occlusion analysis system was used for recording the dynamic occlusal contact of patients with TMD and analysing the occlusal characteristics and temporal characteristics of their jaw movements in different jaw positions to investigate the correlation between occlusal characteristics and TMD during jaw movements.Methods Forty adults aged 18-30 years were selected as study subjects and divided into control group(N=17)and TMD group(N=23)according to the DC/TMD diagnostic criteria.The subjects’occlusal processes initiated by ICP(intercuspal position,ICP)and RP(reference position,RP)were recorded by T-scan separately,and the mandibular movement time index as well as the ICP measurement at maximum occlusion were recorded.Results The TMD group had longer mandibular movement times initiated by RP than by ICP,with significant differences(P<0.05)in left lateral occlusal separation time and right lateral occlusal separation time.Compared to the control group,the TMD group had significant differences(P<0.05)in left and right lateral occlusal separation time when the mandible was moved from RP initiation.When the mandible began to move from the apical position,the difference in the separation time of the anterior extension occlusion was statistically significant(P<0.05).Compared with the control group,TMD group had larger ratio difference of left and right side force value,COF lateral offset and mean COF offset distance,and the differences were statistically significant(P<0.05).Conclusion There were differences in the timing of mandibular movements initiated by RP and ICP respectively in adults with TMD;the distributions of occlusal forces between the right and left sides were more disequilibrium in adults with TMD than those without TMD.

关 键 词：咬合 颞下颌关节紊乱病 颞下颌关节 牙尖交错位 参考位置 

分 类 号：R783.5[医药卫生—口腔医学]