颞下颌关节盘前移位患者再定位咬合板治疗前后上气道形态、牙颌软硬组织的变化  

Changes of upper airway morphology and dentofacial soft and hard tissue in patients with anterior disc displacement of temporomandibular joint after anterior repositioning splint treatment

作　　者：赵芳源 袁建桥 崔梦琦 张锦 张月兰[1] ZHAO Fangyuan;YUAN Jianqiao;CUI Mengqi;ZHANG Jin;ZHANG Yuelan(Department of Orthodontics,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第一附属医院正畸科,郑州450052

出　　处：《郑州大学学报(医学版)》2023年第6期791-796,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关省部共建重点项目(SBGJ202102170)。

摘　　要：目的:探讨颞下颌关节盘前移位患者再定位咬合板治疗前后上气道形态与牙颌软硬组织的变化。方法:选择下颌后退致颞下颌关节盘前移位的患者22例,再定位咬合板治疗前后拍摄CBCT、头颅侧位片,分别进行上气道、牙颌软硬组织相关指标的测量,比较治疗前后的差异。结果:治疗后患者中有94.7%的患者弹响症状减轻或消失,84.6%的患者疼痛缓解或消除,85.7%的患者张口受限好转或正常,可复侧、不可复侧盘-髁关系完全复位率分别为76.7%和8.3%。治疗后患者牙颌软硬组织指标中蝶鞍点-鼻根点-下齿槽座点角(SNB)、前颅底平面与下颌平面的交角(SN-MP)、前鼻棘点-颏下点距离(ANS-Me)、蝶鞍点-下颌角点距离(S-GO)、面突角、颏唇角、鼻下点与软组织颏下点的距离(Sn-Mes)增大(P<0.05),上齿槽座点-鼻根点-下齿槽座点角(ANB)、上、下齿槽座点在功能性牙合平面上垂足点间的距离(Wits)、髁突后切点和蝶鞍点在眶耳平面上垂足点间的距离(S-CO),上、下中切牙长轴交角(U1-L1),上、下切牙切缘的垂直距离(OB)和水平距离(OJ)及上唇突度减小(P<0.05)。治疗后患者鼾声评分降低,上气道测量指标中的腭咽容积、舌咽容积和腭咽最小横截面积均增加(P<0.05)。结论:再定位咬合板治疗下颌后退致颞下颌关节盘前移位疗效较好。通过引导下颌骨前下移位,可改善下颌后退的骨性特征及面型,改善腭咽段的狭窄,使上气道容积增大,缓解打鼾症状。Aim:To investigate the changes of upper airway morphology and dentofacial soft and hard tissue in patients with anterior disc displacement of temporomandibular joint after anterior repositioning splint treatment.Methods:Totally 22 patients with anterior disc displacement of temporomandibular joint caused by mandibular recession were included.Cone-Beam CT(CBCT)and lateral cephalogram were taken before and after splint treatment,and the related indexes of upper airway,dentofacial soft and hard tissue were measured,and the differences before and after treatment were analyzed.Results:After treatment,94.7%of the patients′bouncing symptoms were relieved or disappeared,84.6%of the patients′pain was relieved or eliminated,and 85.7%of the patients′limited mouth opening were improved or normal.The complete reduction rates of the disc-condylar relationship of the reversible and irreducible sides were 76.7%and 8.3%,respectively.SNB,SN-MP,ANS-Me,S-GO,facial process angle,mental lip angle,Sn-Mes increased significantly(P<0.05).ANB,Wits,S-CO,U1-L1 angle,overbite,overjet and upper lip protrusion decreased significantly(P<0.05).Velopharyngeal airway volume,glossopharyngeal airway volume and minimum velopharyngeal cross-sectional area increased(P<0.05).Conclusion:Anterior repositioning splint is effective in the treatment of anterior disc displacement of temporomandibular joint caused by mandibular recession.By guiding the anterior and inferior displacement of the mandible,the bony characteristics and facial shape of mandibular recession can be improved,the stenosis of velopharyngeal section can be improved,the volume of upper airway can be increased,and the symptoms of snoring can be relieved.

关 键 词：再定位咬合板 颞下颌关节 下颌后退 上气道 牙颌软硬组织 

分 类 号：R783.5[医药卫生—口腔医学]