兩種前牽引技術(shù)在上頜發(fā)育不足治療中的顳下頜關(guān)節(jié)評價

亢靜 彭明慧 陳潔

[摘要]目的：采用CBCT評價前牽引矯治上頜發(fā)育不足患者治療前后的顳下頜關(guān)節(jié)變化。方法：選取就診于上海市黃浦區(qū)第二牙病防治所正畸科11～13歲骨性Ⅲ類、上頜發(fā)育不足的患兒40例，隨機(jī)納入種植體牽引組和支架牽引組，每組20例。對患者進(jìn)行前牽引矯治12個月，治療前后采用德國西諾德公司OTHOPHOS XG 3D Ceph三合一數(shù)字化攝片機(jī)拍攝頭顱定位側(cè)位片以及兩側(cè)處于牙尖交錯位的顳下頜關(guān)節(jié)CBCT，對治療前頭影測量、顳下頜關(guān)節(jié)前間隙、上間隙、后間隙、顳下頜關(guān)節(jié)窩深度、髁突前后徑、髁突近遠(yuǎn)中徑和髁突傾斜度進(jìn)行測量分析;另選取平均年齡11～13歲骨性I類未經(jīng)正畸治療的15例患兒為對照組，在知情告知下不進(jìn)行任何正畸治療，對其1年前后的顳下頜關(guān)節(jié)CBCT進(jìn)行測量。結(jié)果：種植體牽引組和支架牽引組治療后CBCT均顯示顳下頜關(guān)節(jié)前間隙顯著增大，上間隙和后間隙顯著減小，髁狀突傾斜角增大，髁狀突在關(guān)節(jié)窩中向后上移位，顳下頜關(guān)節(jié)深度在治療前后增大，增長量種植體牽引組較支架牽引組略大，說明前牽引后關(guān)節(jié)窩有明顯的生長改建。結(jié)論：采用上頜前牽引矯治上頜骨發(fā)育不足的病例中，上頜骨均有明顯生長，顳下頜關(guān)節(jié)深度增加，髁突位置向后上移位，有利于顳下頜關(guān)節(jié)發(fā)育。

[關(guān)鍵詞]種植支抗;前牽引;顳下頜關(guān)節(jié);CBCT;上頜發(fā)育不足

[中圖分類號]R782.2 ? ?[文獻(xiàn)標(biāo)志碼]A ? ?[文章編號]1008-6455（2019）12-0097-05

The Estimate ?of Temporomandibular Joint Structural Alteration with Maxillary Protraction on Skeletal Class Ⅲ

KANG Jing1， PENG Ming-hui1， CHEN Jie2

（1.Department of Orthodontics; 2. Department of Radiology，the Second Oral Disease Preventive Center of Huangpu Area， Shanghai 200020，China）

Abstract： ?Objective ?To investigate the temporomandibular joint（TMJ） structural alteration of skeletal class Ⅲ ?children before and after maxillary protraction used by CBCT. ?Methods ?40 skeletal Class Ⅲ patients （25 boys and 15 girls，11-13 years old ） who had Maxillary hypoplasia from the Second Oral Disease Preventive Center of Huangpu Area shanghai were included in the study. ?They were divided into 2 groups radomly. The first group got maxillary protraction with micro-plant for 10 to 12 months. The second group got maxillary protraction with casting frame for 10 to 12 months. The control group involved 15 skeletal Class I children （7 boys and 8 girls，11-13 years old ）. We dont give them any orthodontic treatment. Their pre- and post-treatment cephalometric radiograph and CBCT were measured respectively for anterior， upper and posterior diastemas of TMJ. ?Results ?In the two protraction groups， Anterior diastema of TMJ increased obviously， while upper and posterior diastemas of TMJ decreased after treatment. The sagittal condylar inclination and the depth of glenoid fossa increased after protraction. These indicated the temporomandibular fossa was reconstructed during the treatment. ?Conclusion ?Maxillary protraction could promote the growth of maxilla and improve the growth of TMJ.

Key ?words： maxillary protraction; Class Ⅲ;cephalometric analysis; micro-implant; CBCT; maxillary hypoplasia

骨性Ⅲ類錯牙合畸形在我國發(fā)病率較高，患者多表現(xiàn)為軟組織凹面型，面中1/3凹陷，上頜骨發(fā)育不足，下頜骨發(fā)育過度。……