应用CBCT技术对全口义齿再修复时颞下颌关节盘间隙变化的分析

目的 应用CBCT技术,分析全口义齿再修复时颞下颌关节盘的间隙变化,以确定患者一次垂直距离恢复的最大值,为临床提供依据。方法 选择全口义齿使用超过5年的需要再修复患者30例,按常规制作新的全口义齿,根据患者全口义齿垂直距离恢复情况分为3组, A组为恢复1.0mm~2.5mm, B组为恢复2.5mm~5.0mm, C组为恢复大于5.0mm。通过自身对照,观察新旧全口义齿垂直距离改变,并在CBCT下记录颞下颌关节盘间隙变化,结合临床患者资料,分析垂直距离改变和颞下颌关节盘间隙的关系,明确垂直距离恢复程度对关节的影响。结果 A组关节盘上、前、后变化在(0.10~0.50)±0.20mm区间,患者新全口义齿一周内可适应; B组关节盘上、前、后变化在(0.50~1.11)±0.32mm区间,患者新全口义齿适应时间相对长; C组关节盘上、前、后变化在>(1.50±0.50) mm区间,患者新全口义齿失败可能性明显增加。结论 全口义齿再修复时建议一次性恢复垂直距离高度以不超过2.5mm为宜,最大值在5mm以内,以减少全口义齿修复失败和诱导颞下颌关节疾病的可能,大于5mm以上明显存在失败风险。

Difference analysis of temporomandibular joint space after complete denture secondary restoration by CBCT

Objective To clarify the maximum vertical dimension of occlusion on patients who received complete denture secondary restoration.Methods The 30 patients wearing complete denture more than 5 years and requiring secondary restoration were chosen for treatment with new complete denture. The change in vertical dimension of occlusion on patients between old and new denture treatment was recorded, and the change in the temporomandibular joint space was observed by CBCT, and the relationship between vertical dimension and TMJ space were analyzed according to the clinical data.Results When the vertical distance was less than 2.5mm, the patients were adapted to the new denture within one week and the temporomandibular joint disc change was within the range of(0.10~0.50)±0.20mm. When the vertical distance was between 2.5 to 5.0mm, the patients spent longer time on adapting to the new denture and the temporomandibular joint disc change was within the range(0.50~1.11)±0.32mm. When the vertical distance was more than 5.0mm, the risk of failure increased signifi-cantly and the temporomandibular joint disc change was more than 1.50±0.50mm.Conclusion To reduce the risk of failure for total denture restoration and the possible induction of temporomandibular joint disease, the best vertical dimension should be less than 2.5mm and 5mm is the maximum in complete denture secondary restoration.