双颌前突患者正畸治疗后颞下颌关节紊乱病发生状况及危险因素分析

目的: 观察双颌前突患者经正畸治疗后颞下颌关节紊乱病（TMD）的发生情况,探讨造成这一现象的可能因素,以期指导TMD的合理预防。方法: 收集2019年3月—2020年10月于河北省人民医院接受正畸治疗的80例双颌前突患者的临床资料进行回顾性分析,参照相关文献判定方法,将其中正畸治疗后发生TMD的患者纳入实验组,其余患者纳入对照组,设计基线资料调查表,尽可能将影响双颌前突患者正畸治疗后发生TMD的高危因素纳入,经单因素、多因素分析后,找出双颌前突正畸治疗患者可能发生TMD的影响因素。采用SPSS 23.0软件包对数据进行统计学分析。结果: 80例双颌前突患者经正畸治疗后发生TMD 15例,占18.75%（15/80）;未发生TMD 65例,占81.25%（65/80）。分析2组基线资料后,将差异有统计学意义的变量进行单因素分析,然后将全部基线资料纳入,建立多元回归模型。结果显示,在校正其他基线资料带来的影响后,年龄、性别、压力知觉量表评分、口腔不良习惯、龋齿、颌面部外伤史、牙状况、饮食不良习惯、根管治疗史均是双颌前突患者正畸治疗后发生TMD的影响因素（OR>1,P<0.05）。结论: 双颌前突正畸治疗后发生TMD的风险因素可能与女性、年龄小、压力知觉评分高、合并口腔和饮食不良习惯、既往存在龋齿、根管治疗史及牙状况等密切相关,应加强年轻女性患者正畸治疗的科学性和规范性,宣传口腔健康知识,建立良好的饮食习惯。对既往存在根管治疗史、颌面部外伤史、龋齿等情况的正畸治疗患者应加强干预措施,对减少TMD发生具有积极意义。     

Treatment of a Case of Skeletal Class II Malocclusion with Temporomandibular Joint Disorder Using Miniscrew Anchorage

Abstract

At the present time, there are no reports in the literature on the treatment of temporomandibular joint disorder (TMD) by intrusion of molars using mini-screws. This case report describes the treatment for a female patient, aged 19 years seven months, with a TMD and an excessive lower anterior facial height. Overjet and overbite were +5.0 mm and +0.5 mm, respectively. The patient had a history of orthodontic treatment in which her first premolars were all extracted. During the first orthodontic treatment, a clockwise mandibular rotation was observed as a result of the increase of posterior dentoalveolar height. She had temporomandibular joint (TMJ) pain during mouth opening and complained of difficulty in eating due to masticatory dysfunction. The pretreatment Schüller views of both TMJ showed a posterior condyle position. In order to correct the overjet, molar relationship and the mandibular condyle position, a miniscrew was inserted into the palatal region of the upper first molar to intrude the upper posterior teeth. As the upper molars were intruded, the overjet was decreased, and a class I molar relationship was achieved by a counterclockwise mandibular rotation. After one year of treatment, an acceptable occlusion was achieved, and the condyle moved into centric position in the glenoid fossa. The patient’s teeth continued to be stable, and she had no pain in TMJ after a retention period of three years. The result of this treatment showed that molar intrusion using miniscrew anchorage is effective for treatment of a TMD patient with a posterior condyle position.     

EXAMINATION OF TEMPOROMANDIBULAR DISORDERS IN THE ORTHODONTIC PATIENT: A CLINICAL GUIDE

The possible association between orthodontic treatment and temporomandibular disorders (TMD) is a topic of great interest in the current literature. The true role of orthodontic therapy on the etiology of TMD, however, is still uncertain. From the clinical prospective, a thorough examination of the stomatognathic system is always necessary in order to detect possible TMD signs and symptoms prior to the beginning of the orthodontic therapy. Caution should be exercised when planning, performing and finalizing orthodontics, especially in patients who with history of signs and symptoms of TMD. The clinician must always eliminate patient’s pain and dysfunction before initiating any type of orthodontic mechanics. Muscle incoordination, unstable disc-condyle relationship and bone alterations are usual TMD conditions that can interfere with the presenting occlusal relationship. This article reviews these aspects and presents a detailed clinical guide for the examination of the orthodontic patient, considering aspects related to facial pain and dysfunction.     

Symptoms and signs of temporomandibular disorders before, during and after orthodontic treatment

The relationship between orthodontic treatment and symptoms and signs of temporomandibular disorders (TMD) was studied prospectively and longitudinally in 65 adolescent girls with Class II malocclusion. The subjects received orthodontic fixed appliance treatment with the straight-wire technique combined with or without extractions and were examined for symptoms and signs of TMD before, during, after, and finally one year post-treatment. Both symptoms and signs of TMD showed considerable fluctuations over the three-year period within the individuals. The general tendency was a decreased prevalence of symptoms of TMD over the three years. The prevalence of pain on mandibular movement and tenderness to palpation of the masticatory muscles was significantly less common during and after orthodontic treatment than before. Clinically registered TMJ clicking increased slightly over the three year period. One orthodontic treatment effect when normalizing Class II malocclusions with fixed appliances was a decreased prevalence of functional occlusal interferences. We concluded that the orthodontic treatment either with or without tooth extractions did not increase the risk for TMD or worsen pre-treatment signs of TMD. Subjects with Class II malocclusion and pre-treatment signs of TMD of muscular origin seemed rather to benefit functionally from orthodontic treatment in a three-year perspective.     

The role of orthodontics in temporomandibular disorders

Summary Temporomandibular Disorder (TMD) is the main cause of pain of non‐dental origin in the oro‐facial region including head, face and related structures. The aetiology and the pathophysiology of TMD is poorly understood. It is generally accepted that the aetiology is multifactorial, involving a large number of direct and indirect causal factors. Among such factors, occlusion is frequently cited as one of the major aetiological factors causing TMD. It is well known from epidemiologic studies that TMD‐related signs and symptoms, particularly temporomandibular joint (TMJ) sounds, are frequently found in children and adolescents and show increased prevalence among subjects between 15 and 45 years old. Aesthetic awareness, the development of new aesthetic orthodontic techniques and the possibility of improving prosthetic rehabilitation has increased the number of adults seeking orthodontic treatment. The shift in patient age also has increased the likelihood of patients presenting with signs and symptoms of TMD. Because orthodontic treatment lasts around 2 years, orthodontic patients may complain about TMD during or after treatment and orthodontists may be blamed for causing TMD by unsatisfied patients. This hypothesis of causality has led to legal problems for dentists and orthodontists. For these reasons, the interest in the relationship between occlusal factors, orthodontic treatment and TMD has grown and many studies have been conducted. Indeed, claims that orthodontic treatment may cause or cure TMD should be supported by good evidence. Hence, the aim of this article is to critically review evidence for a possible association between malocclusion, orthodontic treatment and TMD.     

Association of functional malocclusion with temporomandibular disorders in orthodontic patients prior to treatment

The purpose of this study was to investigate the role of functional malocclusion in temporomandibular disorders (TMD) in untreated orthodontic patients. A total of 508 orthodontic patients were enrolled. All patients were evaluated for the presence of various types of functional malocclusion and clinical signs of TMD before treatment. The chi-square test was used to evaluate the association of functional malocclusion and TMD. The frequencies of TMD were 44.2% in patients with retruded position (RP) interference and 38.1% in those without such interference (p > 0.05). The frequency of TMD in patients with protrusive interference was greater than those without (32.2% vs. 18.4%; p < 0.005). Patients with balancing interference had a significantly higher frequency of TMD than those without (49.2% vs. 23.9%; p < 0.0001). We thus conclude that patients with functional malocclusion of balancing or protrusive interference type have an increased risk for developing TMD.     

Attitude of Chinese orthodontists towards the relationship between orthodontic treatment and temporomandibular disorders

OBJECTIVE: To determine the attitude of some Chinese orthodontists towards the relationship between orthodontic treatment and temporomandibular disorders (TMDs). SUBJECTS AND METHODS: 25 orthodontists, in six public hospitals (Xi'an, the capital of Shaanxi Province, China), were asked to complete a 10-item questionnaire concerning orthodontics/TMD. RESULTS: 84% of orthodontists often asked their patients about the signs and symptoms of TMD before orthodontic treatment and 92% reported examining the TMJ region. 76% of orthodontists thought orthodontic treatment may possibly lead to a greater incidence of TMD, while 84 per cent claimed that orthodontic treatment might prevent TMD. Methods of orthodontic treatment, patient's age, and occlusal interference were regarded as risk factors leading to increased incidence of TMD. CONCLUSIONS: Some Chinese orthodontists realise the importance of the relationship between orthodontic treatment and TMD. Most thought that unsuitable orthodontic treatment might increase the development of TMD and that orthodontic treatment could prevent TMD.     

Prevalence of TMD among Children Provided with Fixed Orthodontic Treatment

BackgroundAccording to available scientific references and textbooks, there are contradictory views concerning the etiology of signs and symptoms of TMD.ObjectivesThe aim of this study was to determine a correlation between the incidence of signs and symptoms of TMD in children aged 12-18 who do not wear a fixed orthodontic appliance and the incidence of signs and symptoms of TMD in children who wear a fixed orthodontic appliance.Material and MethodsThe total number of 120 subjects were included in this survey and divided into two groups. There were 60 respondents in the experimental group that consisted of 30 boys and 30 girls with different types of malocclusion, who were treated with a fixed orthodontic straight wire technique. The remaining 60 respondents, which was a group that also consisted of 30 boys and 30 girls, were patients with neutroclusion.ResultsThe results of the study have shown that the TMJ clicking sound symptom, the most common symptom of TMD, occurs with almost equal prevalence in both groups of respondents; specifically, 56.4% in orthodontic patients, and 46.6% in the control group respondents. A statistically significantly higher percentage of female respondents in both groups have experienced headache problems (p <0.03).ConclusionOn the basis of the statistics obtained as a result of this research, we can come to the conclusion that there is no correlation between the fixed orthodontic treatment and the development of signs and symptoms of TMD.     

Signs of temporomandibular disorders in girls receiving orthodontic treatment. A prospective and longitudinal comparison with untreated Class II malocclusions and normal occlusion subjects

The aim of this investigation was to prospectively and longitudinally study signs of temporomandibular disorders (TMD) and occlusal changes in girls with Class II malocclusion receiving orthodontic treatment and to compare them with subjects with untreated Class II malocclusions and with normal occlusion subjects. Three groups of age-matched adolescent girls were examined for clinical signs of TMD and re-examined 2 years later. Sixty-five Class II subjects received orthodontic fixed straight-wire appliance treatment (Orthodontic group), 58 subjects were orthodontically untreated (Class II group), and 60 subjects had a normal occlusion (Normal group). In the Orthodontic group, the prevalence of muscular signs of TMD was significantly less common post-treatment. The Class II and the Normal groups showed minor changes during the 2-year period. Temporomandibular joint clicking increased in all three groups over the 2 years, but was less common in the Normal group. The Normal group also had a lower overall prevalence of signs of TMD than the Orthodontic and the Class II groups at both registrations. Functional occlusal interferences decreased in the Orthodontic group, but remained the same in the other groups over the 2 years. In conclusion, orthodontic treatment did not increase the risk for or worsen pretreatment signs of TMD. On the contrary, subjects with Class II malocclusions and signs of TMD of muscular origin seemed to benefit functionally from orthodontic treatment in a 2-year perspective. The Normal group had a lower prevalence of signs of TMD than the Orthodontic and the untreated Class II groups.     

ASSESSMENT OF TEMPOROMANDIBULAR DISORDER AND OCCLUSION IN TREATED CLASS III MALOCCLUSION PATIENTS

Objective:

The aims of this study were to compare the prevalence of temporomandibular disorders (TMD) in individuals submitted to either orthodontic or ortho-surgical Class III malocclusion treatment and to assess the influence of occlusal aspects on TMD severity.

Material and methods:

The sample consisted of 50 individuals divided into two groups, according to the type of treatment (orthodontic or orthodontic with orthognathic surgery). The presence of signs and symptoms of TMD was evaluated by an anamnestic questionnaire and a clinical examination, including TMJ and muscle palpation, active mandibular range of motion, joint noises and occlusal examination.

Results:

Based on the anamnestic questionnaire, 48% had no TMD, 42% had mild TMD and 10% had moderate TMD. The presence and severity of TMD did not show any relationship with the type of orthodontic treatment (p>0.05). The chi-square test showed a positive association (p<0.05) between TMD and non-working side occlusal interferences.

Conclusion:

Based on the methodology used and the results obtained, it may be concluded that Class III orthodontic treatment was not associated with the presence of TMD signs and symptoms and the non-working side contacts can be occlusal factors of risk. There was no significant difference in TMD prevalence between the studied groups (orthodontically treated patients and patients treated with orthodontics followed by orthognathic surgery).     

Treatment of a case of skeletal class II malocclusion with temporomandibular joint disorder using miniscrew anchorage

At the present time, there are no reports in the literature on the treatment of temporomandibular joint disorder (TMD) by intrusion of molars using mini-screws. This case report describes the treatment for a female patient, aged 19 years seven months, with a TMD and an excessive lower anterior facial height. Overjet and overbite were +5.0 mm and +0.5 mm, respectively. The patient had a history of orthodontic treatment in which her first premolars were all extracted. During the first orthodontic treatment, a clockwise mandibular rotation was observed as a result of the increase of posterior dentoalveolar height. She had temporomandibular joint (TMJ) pain during mouth opening and complained of difficulty in eating due to masticatory dysfunction. The pretreatment Schuller views of both TMJ showed a posterior condyle position. In order to correct the overjet, molar relationship and the mandibular condyle position, a miniscrew was inserted into the palatal region of the upper first molar to intrude the upper posterior teeth. As the upper molars were intruded, the overjet was decreased, and a class I molar relationship was achieved by a counterclockwise mandibular rotation. After one year of treatment, an acceptable occlusion was achieved, and the condyle moved into centric position in the glenoid fossa. The patient's teeth continued to be stable, and she had no pain in TMJ after a retention period of three years. The result of this treatment showed that molar intrusion using miniscrew anchorage is effective for treatment of a TMD patient with a posterior condyle position.     

Orthodontics is temporomandibular disorder–neutral

Objectives:To assess if subjects with a clinical diagnosis of temporomandibular disorders (TMDs) have a similar prevalence of orthodontic history as a population of TMD-free individuals and to assess if those subjects who have a history of ideal orthodontics have fewer symptoms than those with a history of nonideal orthodontics.Materials and Methods:Two groups of age- and sex-matched individuals belonging to either a study (“TMD”) or a control group were recruited. Subjects who underwent orthodontic treatment were classified as having a history of ideal or nonideal orthodontics based on the current presence of normal values in five reference occlusal features.Results:The correlation with a history of orthodontic treatment was not clinically significant for any of the TMD diagnoses (ie, muscle pain, joint pain, disc displacement, arthrosis), with Phi (Φ) coefficient values within the −0.120 to 0.058 range. Within the subset of patients with a history of orthodontics, the correlation of ideal or nonideal orthodontic treatment with TMD diagnoses was, in general, not clinically relevant or was weakly relevant.Conclusions:Findings confirmed the substantial absence of clinically significant effects of orthodontics as far as TMD is concerned. The very low correlation values of a negative or positive history of ideal or nonideal orthodontics with the different TMD diagnoses suggest that orthodontic treatment could not have a true role for TMD.     

Prevalence of temporomandibular disorder pain,jaw noises and oral behaviours in an adult Italian population sample

To evaluate the prevalence of temporomandibular disorder pain (TMD‐pain), temporomandibular joint (TMJ) noises, oral behaviours in an Italian adult population sample, their possible association with gender, oral behaviours, self‐reported facial trauma and orthodontic treatment. Subjects older than 18 years were recruited from general population in public spaces during their daily life. A specific questionnaire was developed to collect data on TMD‐pain, TMJ noises, oral behaviours, orthodontic treatment and facial trauma. A total of 4299 subjects were included in the study. The most common symptom in the sample was TMJ clicking (30.7%), followed by TMD‐pain (16.3%) and TMJ crepitus (10.3%). Oral behaviours were reported in 29% of the sample; 43.6% of the sample reported a previous or ongoing orthodontic treatment. TMD‐pain and TMJ clicking were significantly associated to gender, oral behaviours and a positive history of previous facial trauma. Crepitus was significantly associated to oral behaviours, facial trauma and higher age. Ongoing orthodontic treatment was significantly associated to TMD‐pain and TMJ sounds. In a general Italian adult population sample, TMD‐pain is associated to female gender and is less prevalent than TMJ clicking. TMDs are associated to trauma and oral behaviours.     

正畸治疗与颞下颌关节症状的相关研究

目的：探讨正畸治疗和颞下颌关节紊乱病（TMD）的关系。方法：设计正畸组、错[牙合]组和正常组的调查表，用Visual Foxpro6．0建立相应的数据库，对173例已正畸治疗者、95例有错[牙合]畸形但未治疗者和32例正常对照进行TMD症状、体征及相关情况的问卷调查和专科检查，所得结果用基于Helkimo指数改良设计的数据库进行分析，采用SPSS10．0软件包进行成组设计两样本比较的秩和检验。结果：正畸组和错[牙合]组在主诉症状指数、临床症状指数和咬合指数的分布上存在显著差异（P〈0．001）；正畸组和正常组在主诉症状指数和临床症状指数的分布上有显著差异（P〈0．001），但在咬合指数的分布上无显著性差异（P〉0．05）。结论：正畸治疗后患者在一定时期内易出现颞下颌关节紊乱病的症状和体征。     

Long-term follow-up of clinical symptoms in TMD patients who underwent occlusal reconstruction by orthodontic treatment

Fifty-eight patients (mean age 18.4 years) who had received splint therapy for internal derangement of the temporomandibular joint (TMJ) were examined retrospectively to investigate the efficacy of occlusal reconstruction by orthodontic treatment. The subjects were divided into three groups: 18 patients (mean age 18.6 years) who underwent orthodontic treatment combined with the use of splints (ST group); 27 patients (mean age 18.2 years) who underwent orthodontic treatment without the use of splints (NST group); and 13 patients (mean age 17.9 years) who received only splint therapy for temporomandibular joint disorders (TMD; control group). TMJ sound, pain on movement and restriction of mandibular movement were examined at the initial examination (T1), at the end of the splint therapy for TMD or beginning of orthodontic treatment (T2), at the end of orthodontic treatment (T3), and at recall or 1 year after orthodontic treatment (T4). The following results were found. (1) The percentage of patients with no joint sound at T2 was 20-30 per cent. The percentage of such patients in both the ST and NST groups increased to over 50 per cent at T3, but slightly decreased to 39-50 per cent at T4. There were no significant inter-group differences at any time point. (2) The number of patients who had no pain on movement at T2 was 60-80 per cent. The percentage of such patients in both the ST and NST groups increased to over 90 per cent at T3, but then slightly decreased to 80 per cent at T4. There were no significant inter-group differences at any time point. (3) None of the patients showed restriction of movement of the TMJ at T2 or T4. One patient in the ST group was found to have restriction at T3. There were no significant inter-group differences at any time point. (4) The most frequent type of malocclusion in both ST and NST groups was anterior open bite. These results suggest that TMD symptoms that have been eliminated by splint therapy are not likely to recur due to subsequent orthodontic treatment, but it cannot be concluded that orthodontic treatment itself had a positive effect on TMD symptoms. The results also indicate that there is a relationship between anterior open bite and TMD.     

History factors associated with symptoms of temporomandibular disorders

Differences in prevalence of head or neck trauma, orthodontic treatment and molar oral surgery procedures reported by individuals were compared among patients with temporomandibular disorders (TMD) and with two comparison groups (a sample of asymptomatic individuals, and a sample with mild or early signs). Association to specific TMD symptoms was tested amongst the comparison groups. Trauma was the most significant factor characterizing TMD patients. History of trauma was also more common among those otherwise normal but symptomatic individuals in the non-patient comparison group. Specific TMD symptoms were significantly associated with history of trauma in the comparison group. Significantly more women TMD patients had a history of orthodontic and molar oral surgery treatment than the asymptomatic comparison group. History of orthodontics was also associated with the symptomatic sample of the comparison group in women, but it was not significantly related to any specific TMD symptoms. Symptomatic members of the comparison group could not be differentiated based upon history of molar oral surgery. Certain risk factors may have been delineated, but causal relationship of treatment requires study of co-existing and predisposing behavioural and structural factors.     

Temporomandibular disorders in Saudi females seeking orthodontic treatment

The aim of this study was to describe the prevalence of signs and symptoms of temporomandibular disorders (TMD) in a group of patients seeking orthodontic treatment. One hundred and ninety one consecutive prospective orthodontic female patients, divided into three age groups of 8, 14 and 18 years, were examined for TMD signs and symptoms and orthodontic treatment need (IOTN). The percentages of signs and symptoms found were 41 and 30%, respectively. No significant association was found between IOTN and TMD signs and symptoms. The youngest age group reported significantly less headache and temporomandibular joint (TMJ) noise. Headache was significantly associated with all TMD symptoms and with tenderness to palpation. In conclusion, the results indicate that malocclusion could not be considered as a primary aetiologic factor for TMD within the age range studied.     

错矫治治疗颞下颌关节紊乱病临床疗效分析

目的 分析并评价矫治错(牙合)同时治疗颞下颌关节紊乱病(TMD)的临床效果。方法 采用直丝弓技术矫治各种错(牙合)畸形伴TMD患者42例,详细记录治疗前、治疗6个月、治疗结束、治疗结束后2年的牙(牙合)情况及TMD症状、体征变化、颞下颌关节(TMJ)X线片情况。结果 30例患者TMD症状及体征基本痊愈,占71.4％;好转7例,占16.7％;无效或加重5例,占11.9％。结论 错(牙合)畸形伴TMD的年轻患者经正畸矫治可以恢复咬合或作(牙合)重建,建立(牙合)平衡,使颞下颌关节、下颌回复到正常解剖位置。但已经发生器质性损害或TMJ解剖结构不对称的患者,治疗效果有待于进一步观察。     

Malocclusion and temporomandibular disorder: a comparison of adolescents with moderate to severe dysfunction with those without signs and symptoms of temporomandibular disorder and their further development to 30 years of age

A total of 1018 subjects were examined at the age of 11 years, 791 were reexamined at 15 years, 456 at 19 years, and 337 at 30 years. Anamnestic and clinical recordings of temporomandibular disorder (TMD) were made. Morphology, including calculation of peer assessment rating (PAR) scores, was recorded. Previous history of orthodontic treatment was assessed. Muscular endurance was recorded. The subjects completed four psychological measures. The malocclusion prevalence, occlusal contacts, psychological factors, and muscular endurance in subjects with no recorded signs and symptoms of TMD were compared with those with the most severe dysfunction at 19 years of age. The further development of TMD to 30 years of age was followed. PAR scores were significantly higher in the subjects with the most severe dysfunction. Apart from crowding of teeth, no other significant differences were found between the groups with regard to separate malocclusions, tooth contact pattern, orthodontic treatment, or extractions. A greater proportion of subjects with low endurance were found in those with TMD. Significant associations between TMD and general health and psychological well-being as well as the personality dimension of neuroticism and self-esteem were found. During the period from 19 to 30 years, the prevalence of muscular signs and symptoms showed considerable reduction, whereas clicking showed a slight increase. Locking of the joint showed a decrease from 19 to 30 years. One-quarter of the TMD subjects showed complete recovery. Thus, orthodontic treatment seems to be neither a major preventive nor a significant cause of TMD.     

骨性Ⅱ类错伴颞下颌关节紊乱矫正后的长期稳定性

目的:研究骨性Ⅱ类错伴颞下颌关节紊乱患者在正颌-正畸联合治疗后面型和咬合的长期稳定性。方法:选择10例在本院正颌-正畸中心治疗结束3年以上、资料齐全的骨性Ⅱ类错患者,男2例,女8例,平均年龄(22.3±2.9)岁,治疗结束平均随访期(2.63±1.36)a。治疗方案为术前正畸、正颌手术、术后正畸,手术根据面型测量数据采用双颌手术或上颌手术+颏成形,术中采用坚强内固定。比较治疗前(T0)、治疗结束(T1)和随访结束(T2)的X线头影测量数据,评价颞下颌关节(TMJ)症状量表和MRI的变化。采用SPSS16.0软件包分别对治疗前、随访结束与治疗结束的测量数据进行配对t检验。结果:覆盖平均增加0.62mm,有显著性差异,其余骨性、牙性复发和软组织改建无统计学意义;随访结束UI-NA距离、覆盖和覆变化>2mm占10%,Go-Co长度变化>2mm占20%,软组织颏前点的变化量>2mm占40%,LI-NB距离和颏唇沟的深度变化均小于2mm;所有患者关节症状无加重,MRI未见髁突吸收加重,盘髁关系未见明显改变。结论:骨性Ⅱ类错伴TMD患者通过正颌-正畸联合治疗,能获得面型美观和正常的咬合关系,远期面型结构及咬合关系未见明显复发趋势,未发现TMJ症状加重趋势。