摘要
目的:探讨改良Twin-block矫治器对恒牙早期安氏Ⅱ类1分类错[牙合]患者颞下颌关节位置及形态结构变化的影响。方法:临床选择30例恒牙早期安氏Ⅱ类1分类错[牙合]患者,男女各15例,平均年龄12.2岁,均采用改良Twin-block矫治器进行Ⅰ期矫形治疗,所有患者矫治前后行CBCT扫描,利用QR-NNT软件对原始影像进行3D重建,测量矢状向、冠状向关节间隙大小,分析髁突位置变化;测量髁突内外径、前后径,关节窝宽度、深度,髁突长度,分析关节形态变化。结果:矫治后上颌牙弓宽度增加,改良Twin-block矫治器刺激下颌骨生长,患者双侧磨牙达中性关系,覆[牙合]覆盖明显改善,侧貌趋于直面型。导下颌向前后关节前间隙减小(0.50±0.19)mm(P<0.01),关节上间隙和后间隙分别增大(1.25±1.84)mm(P<0.01)和(1.48±1.60)mm(P<0.01),冠状向关节内间隙增大(0.91±1.92)mm(P<0.05),关节上间隙增大(0.85±1.25)mm(P<0.01),差异有统计学意义;髁突内外径、前后径,髁突长度,关节窝宽度均有所增加,差异有统计学意义,关节窝深度减小,差异无统计学意义。结论:改良Twin-block矫治器矫治安氏Ⅱ类1分类患者解除了上颌牙弓狭窄对下颌的限制,髁突在关节窝内向前向下移位,充分利用了恒牙早期生长潜力,促进下颌骨生长发育,随着髁突生长,颞下颌关节发生适应性改建,软硬组织改变,面部比例更加趋于协调,可快速、高效改善面部外形。
Objective:To investigate the effect of modified Twin-block appliance on the position and morphological structure of temporomandibular joint in patients with ClassⅡdivision 1 malocclusion in the early stage of permanent teeth.Methods:30 ClassⅡdivision 1 patients(15 boys and 15 girls,with an average age of 12.2 years old)with retraction of mandible in early permanent dentition were selected and treated with modified Twin-block appliance.CBCT was taken before and after treatment,and 3D reconstruction of the original image was carried out by QR-NNT.The sagittal and coronal articular space were measured,and the changes of condylar position were analyzed.The internal and external diameter of condyle,the anterior and posterior diameter,the width and depth of articular fossa and the length of condyle were all measured,meanwhile the changes of joint morphology were analyzed.SPSS16.0 was used for statistical analysis.Results:Modified Twin-block appliance increased the width of the maxillary arch and stimulated the growth of the mandible.The patient's bilateral first molar reached a neutral relationship,the overbite and overjet were significantly improved,the profile improved remarkably.After the mandible was guided forward,the anterior-articular space was reduced by(0.50±0.19)mm(P<0.01),the supra-articular space and posterior-articular space were increased by(1.25±1.84)mm(P<0.01)and(1.48±1.60)mm(P<0.01)respectively,and the coronal intra-articular space was increased by(0.91±1.92)mm(P<0.05),the supra-articular space was increased by(0.85±1.25)mm(P<0.01);The internal and external diameter,the anterior and posterior diameter,the length of condyle and the width of articular fossa were all increased,the differences were statistically significant.The depth of articular fossa was decreased,the difference was not statistically significant.Conclusion:The modified Twin block appliance can relieve the limitation of maxillary arch on the mandible,and the condylar position in the fossa has the trend of moving forward and downward,making full use of the early growth potential of permanent teeth and promoting the growth and development of mandible.With the growth of condyle,the temporomandibular joint underwent adaptive reconstruction,the soft and hard tissue changes,and the facial proportion tends to be more coordinated,which can quickly and efficiently improve the facial profile.
作者
王淑敏
张宇
王振宁
徐璐璐
WANG Shu-min;ZHANG Yu;WANG Zhen-ning;XU Lu-lu(Department of Stomatology,the 989th Hospital of the PLA Joint Logistic Support Force,Luoyang 471031,China;Department of Orthodontics,First Medical Center,General Hospital of Chinese PLA,Beijing 100853,China)
出处
《口腔颌面修复学杂志》
2023年第3期186-192,共7页
Chinese Journal of Prosthodontics
基金
国家自然科学基金项目面上项目(项目编号:82170986)
解放军总医院军事医学青年专项课题成长项目(项目编号:QNC19022)
军队生物安全建设计划课题(项目编号:A3705012033)。
