骨性Ⅲ类下颌偏斜患者颞下颌关节形态位置及上颌骨特征的三维评估

doi:10.19439/j.sjos.2023.01.017

摘要/Abstract

摘要： 目的: 研究双侧下颌角点垂直向不调的骨性Ⅲ类下颌偏斜患者颞下颌关节的形态、位置及上颌骨特征。方法: 对79例成人骨性Ⅲ类错畸形患者进行颅面部螺旋CT扫描,采用ProPlan CMF3.0三维分析软件对颞下颌关节进行三维重建,根据颏点偏斜程度分为对称组（S组：n=24）和偏斜组（n=55）。偏斜组中,根据双侧下颌角点有无垂直向不调分为2组,ASV组—双侧下颌角点存在垂直向差异（n=27）,ASNV组—双侧下颌角点不存在垂直向差异（n=28）。测量7项髁突形态、位置指标以及9项上颌骨相关指标,采用SPSS 22.0软件包对数据进行统计学分析。结果: 偏斜组的偏斜侧髁突长度均短于偏斜对侧,两侧差值均大于对称组,上颌骨均存在自身不对称以及不同程度的三维方向不调。ASV组中,偏斜侧髁突轴与水平面的角度更小,髁突前后径更小。ASNV组中,偏斜侧髁突内外径更小。方差分析和多重比较显示,ASV组和ASNV组两侧髁突长度的差值均比对称组大。ASV组和ASNV组上颌骨存在自身不对称,偏斜侧上颌骨宽度大于非偏斜侧。ASNV组更有可能存在上颌骨横向不调。ASV组上颌骨左右侧垂直向不调大于ASNV组和S组,且偏斜侧小于偏斜对侧。结论: 双侧下颌角点垂直向不调的骨性Ⅲ类下颌偏斜患者,颞下颌关节的形态、位置以及上颌骨三维方向上存在不对称,在正畸、正颌的诊断和方案设计中应予以关注。

关键词: 骨性Ⅲ类错, 面部偏斜, 颞下颌关节, 三维重建, 上颌骨特征

Abstract: PURPOSE: To study the temporomandibular joint morphology and position and the maxillary characteristics of skeletal Class Ⅲ mandibular deviation patients with vertical disproportion in bilateral gonions. METHODS: Overall 79 adult patients with skeletal Class Ⅲ malocclusions were selected. Craniofacial spiral CT scanning was performed, and three-dimensional reconstruction of the temporomandibular joint(TMJ) was carried out by using ProPlan CMF3.0 three-dimensional analysis software. The patients were divided into two groups according to the deviation degree of the mentum: symmetric group (the S group: n=24) and deviation group (n=55). The deviation group was divided into two subgroups according to whether there was vertical disproportion in bilateral gonions, i.e., ASV group: there were vertical differences in bilateral gonions(n=27), and ASNV group: there was no vertical difference in bilateral gonions (n=28). Seven condylar morphological and position indicators and nine maxilla-related indicators were measured. SPSS 22.0 software package was used for statistical analysis. RESULTS: In deviation group, the condylar length on the deviated side was shorter than the opposite side, the difference value between the two sides was greater than the symmetric group, and there were asymmetry and different degrees of disproportion in the three-dimensional direction in the maxilla. In ASV group, the angle of the condylar axis to the horizontal plane on the deviated side was smaller and the anteroposterior diameter of the condyle was smaller. In ASV group, the mediolateral dimension of condyle on the deviated side were smaller. From variance analysis and multiple comparisons, the difference of condylar length on both sides in ASV group and ASNV group was greater than that in the symmetric group. There were asymmetries in the maxillae in ASV group and ASNV group, and the maxillary width on the deviated side was greater than that on non-deviated side. Transverse maxillary disproportion was more likely to occur in the ASNV group. The vertical maxillary disproportion on both sides in ASV group was larger than that in ASNV group and S group, and the deviated side was smaller than the opposite side. CONCLUSIONS: The TMJ morphology and position of skeletal Class Ⅲ mandibular deviation patients with vertical disproportion in bilateral gonions and the maxillary asymmetry in the three-dimensional direction require attention in the diagnosis and conceptual design of surgical-orthodontic treatment.

Key words: Skeletal Class Ⅲ malocclusion, Facial deviation, Temporomandibular joint, Three-dimensional reconstruction, Maxillary features

中图分类号:

R782.2

唐汝萍, 刘帅, 赵震锦, 汪俊妍. 骨性Ⅲ类下颌偏斜患者颞下颌关节形态位置及上颌骨特征的三维评估[J]. 上海口腔医学, 2023, 32(1): 91-96.

TANG Ru-ping, LIU Shuai, ZHAO Zhen-jin, WANG Jun-yan. Three-dimensional assessment and study on temporomandibular joint and the maxillary characteristics of skeletal Class Ⅲ mandibular deviation patients[J]. Shanghai Journal of Stomatology, 2023, 32(1): 91-96.

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