正畸减数患者后牙前移对颞下颌关节应力影响的三维有限元分析  

Three-dimensional finite element study on the effect of posterior tooth forward movement on temporomandibular joint stress in orthodontic reduction patients

作　　者：商永慧 李帅 刘义琮 赵启航 刘文[3] Shang Yonghui;Li Shuai;Liu Yicong;Zhao Qihang;Liu Wen(Dalian Medical University,Dalian 116000,Liaoning Province,China;Qingdao Grace Jiamei Stomatology Clinic,Qingdao 266100,Shandong Province,China;Center of Stomatology,Qingdao Hospital of Rehabilitation University/Qingdao Municipal Hospital,Qingdao 266000,Shandong Province,China)

机构地区：[1]大连医科大学,辽宁省大连市116000 [2]青岛市崂山区青岛恩典嘉美口腔门诊部,山东省青岛市266100 [3]康复大学青岛医院/青岛市市立医院口腔医学中心,山东省青岛市266000

出　　处：《中国组织工程研究》2024年第34期5516-5520,共5页Chinese Journal of Tissue Engineering Research

摘　　要：背景:颞下颌关节紊乱病与颞下颌关节内有高应力密切相关。减数拔牙后伴随着磨牙位置的改变,建立新的咬合关系往往会导致颞下颌关节内应力环境发生改变。目的:在牙尖交错位时,利用三维有限元模型分析正畸减数拔牙后不同程度磨牙前移下颞下颌关节的应力分布。方法:选择在山东青岛市市立医院口腔正畸科就诊的正常牙合患者1例,收集其锥形束CT和MRI数据,分别建立减数前、减数后上下磨牙前移1/3拔牙间隙(拔除4颗第二前磨牙)及减数后上下磨牙前移2/3拔牙间隙(拔除4颗第二前磨牙)的有限元模型,通过建模软件分析牙尖交错位时颞下颌关节各部位的应力分布。结果与结论:(1)减数前后模型中髁突、关节盘、骨关节窝的受力分布基本一致,髁突的应力主要分布于髁突的前部及顶部,关节盘的应力主要分布于关节盘的中带及外侧,颞骨关节窝的应力主要集中分布在关节窝的前部及顶部。与减数前相比,减数后模型中髁突、关节盘及关节窝的等效应力值减小;正畸减数拔牙后,上下磨牙前移1/3拔牙间隙模型中髁突及关节盘的等效应力值小于上下磨牙前移2/3拔牙间隙模型。(2)从生物力学角度上讲,正畸减数拔牙可以降低颞下颌关节的应力,进而提供良好的生物力学环境。BACKGROUND:Temporomandibular joint disorders are closely related to high stress in temporomandibular joint.With the change of molar position after tooth reduction extraction,the establishment of new occlusal relationship often leads to the change of internal stress environment of the temporomandibular joint.OBJECTIVE:To analyze the stress distribution of temporomandibular joint in patients undergoing orthodontic reduction tooth extraction with different degrees of molar forward movement using the three-dimensional finite element model of the maxillary complex and temporomandibular joint.METHODS:A case of individual normal occlusal patient was selected from the Orthodontics Department of Qingdao Municipal Hospital,Shandong Province,and the finite element models of 1/3 anterior molar space(extraction of four second premolar teeth)before and after reduction and 2/3 anterior molar space(extraction of 4 second premolar teeth)after reduction were established based on the cone-beam CT and MRI data.ABAQUS software was used to analyze the stress distribution of various parts of the temporomandibular joint during the interposition of tooth tips.RESULTS AND CONCLUSION:The stress distribution of the condyle,articular disc,and osteoarticular fossa in the model before and after the reduction was basically the same.The stress of the condyle was mainly distributed in the anterior and apical part of the condyle,the stress of the articular disc was mainly distributed in the middle band and lateral part of the articular disc,and the stress of the articular fossa was mainly concentrated in the anterior and apical part of the articular fossa.However,the equivalent stress value of the condyle,articular disc and articular fossa decreased after reduction.After orthodontic reduction extraction,the equivalent stress values of condyle and articular disc in the 1/3 anterior molar space model were smaller than those in the 2/3 anterior molar space model.From the perspective of biomechanics,orthodontic reduction extraction can reduce the stre

关 键 词：组织构建 骨组织工程 正畸减数 颞下颌关节 有限元分析 磨牙前移 

分 类 号：R459.9[医药卫生—治疗学] R318.01[医药卫生—临床医学] R783.5