锥形束CT在颞下颌关节疾病诊治中的应用进展

锥形束CT（CBCT）凭借其分辨率高、价格低廉、操作方便、放射剂量低、扫描时间短等优点已广泛应用到口腔医学的众多领域中,为口腔颌面部疾病的诊治提供了有效的辅助检查手段。本文就CBCT在颞下颌关节区域检查的优势、可靠性以及CBCT在颞下颌关节疾病诊治中的应用进展作一综述。     

咬合重建前后颞下颌关节症状及骨性结构影像学改变的研究

目的研究咬合重建前后颞下颌关节症状及骨性结构的影像学变化。方法选择2011年1月至12月口腔修复门诊需咬合重建的患者20例,分别在修复前及修复后3个月进行颞下颌关节临床症状及锥形束CT影像学检查,在垂直于髁状突横轴的矢状位重建影像,测得关节前、中、后间隙。结果进行卡方检验、配对样本均数t检验以及直线相关分析。结果经过3个月的咬合重建修复,患者咀嚼肌和关节区压痛有显著改善,关节弹响未见明显好转。CBCT结果显示咬合重建后关节前间隙减小、后间隙增大,直线相关和回归分析显示关节后间隙的改变与咬合增高距离相关,并推导出线性回归方程。结论测量关节后间隙对确定咬合增高的距离有一定的参考价值。     

术前正畸对骨性Ⅲ类错(马合)患者颞下颌关节影响的锥形束CT研究

目的 探讨术前正畸对行正畸-正颌联合治疗的骨性Ⅲ类错颌患者颞下颌关节（TMJ）的影响。方法 选取24例行正畸-正颌联合治疗的骨性Ⅲ类错颌患者,分别在术前正畸完成前后检查并记录关节症状,并行锥形束CT（CBCT）扫描,在三维方向测量髁突各径值（d）、髁突高度（h）、不同角度下关节间隙（L）、双侧髁突间距（R）及各髁突角度值,比较和分析不同时期TMJ症状及骨性结构的变化情况。结果 术前正畸前后关节症状无明显改变;颞下颌关节骨性结构在三维方向上的各测量指标均无显著变化（P>0.05）。结论 在正畸-正颌联合治疗过程中,术前正畸不会对患者TMJ产生明显影响。     

替牙期骨性Ⅲ类高角错牙合颞下颌关节CBCT测量分析

目的应用CBCT测量分析替牙期骨性Ⅲ类高角错牙合颞下颌关节的骨性结构,探讨替牙期骨性Ⅲ类高角错牙合与正常牙合颞下颌关节的形态结构差异。方法选取符合纳入标准的替牙期骨性Ⅲ类高角错牙合与正常牙合患者各20例,在牙尖交错位拍摄CBCT,使用Invivo 5软件进行图像重建,选取所要研究的颞下颌关节区域进行测量分析。结果替牙期骨性Ⅲ类高角组髁突长轴径、关节窝宽度、髁状突长度大于正常组,而髁突前后径、关节窝深度、关节结节后斜面倾斜角和髁状突高度小于正常组(P<0.05)。结论替牙期骨性Ⅲ类高角错牙合颞下颌关节的髁状突和关节窝形态结构与正常牙合不同。     

单侧有多种症状的颞下颌关节紊乱患者双侧关节锥形束CT对比研究

目的:探讨单侧有多种症状的颞下颌关节紊乱(temporomandibular disorders,TMD)患者双侧颞下颌关节(temporomandibular joint,TMJ)在锥形束CT(cone-beam computed tomography,CBCT)成像上可能存在差异的参考层面,为TMD诊断和对比研究提供参考.方法:选取仅一侧TMJ有多种症状的TMD患者(不含仅有一种症状的病例)50例,通过CBCT三维成像和重建,观察比较同一患者两侧TMJ重建后横断面的水平角;平行于髁突长轴的斜位关节间隙、髁突长轴径值、髁突垂直角;垂直于髁突长轴的斜位与矢状位的关节结节斜度、关节窝深度和关节间隙,采用SPSS 13.0软件包对每例患者上述各测量指标进行两配对样本t检验.结果:两侧TMJ在矢状位60°关节间隙时的测量值差异显著(P＜0.05),平行位120°关节间隙、矢状位90°关节间隙时的测量值差异显著(P＜0.01),其余测量值均无显著差异.结论:对于单侧有多种症状的TMD患者,矢状位或垂直位是较易观察到两侧关节有差异的位置,在这一层面重建意义较大.     

锥形束CT在颞下颌关节紊乱病中的应用

锥形束CT可提供高分辨率的三维影像信息,在临床牙科领域巳得到广泛应用,为提高临床诊疗水平发挥了一定作用。锥形束CT在颞下颌关节疾病中主要用于颞下颌关节紊乱病的检查,本文就近些年锥形束CT技术在颞下颌关节紊乱病中的应用综述如下。     

个别正常与骨性Ⅲ类错颞下颌关节的CBCT对比分析

目的探讨哈尔滨地区个别正常与骨性Ⅲ类错青年患者颞下颌关节CBCT影像的差异性。方法选取颞下颌关节健康的个别正常志愿者及高角骨性Ⅲ类错患者各40例,两组样本均为哈尔滨地区青年人(年龄为20~28岁)。获取两组牙尖交错位的颞下颌关节CBCT影像,采用Mimics16.0和Simplant O&O软件对颞下颌关节的位置形态进行测量,用SPSS17.0软件进行统计学分析。结果骨性Ⅲ类错组和个别正常组测量结果比较有8个测量项目有明显差异(P<0.05),分别为MI指数、髁突相对位置、髁突半径值、关节窝深、髁突指数、关节窝指数、两侧关节窝外径、两侧髁突长轴夹角。结论哈尔滨地区骨性Ⅲ类错患者与正常人群颞下颌关节位置形态具有差异。     

应用锥形束CT诊断颞下颌关节骨关节病的探讨

目的探讨锥形束CT（cone beam CT，CBCT）在颞下颌关节骨关节病诊断中的应用前景。方法临床诊断为颞下颌关节骨关节病（炎）、不可复（可复）性盘前移位伴骨关节病患者共48例（96侧关节）。48例同时拍摄经咽侧位x线平片和CBCT，比较两种x线检查方法的病变检出率、医师判断的重复性和一致性。结果颞下颌关节骨关节病x线表现分为6型：髁突表面皮质骨模糊消失型（I型）、表面缺损破坏型（Ⅱ型）、髁突磨平型（Ⅲ型）、骨质硬化型（IV型）、骨质增生型（V型）、囊样变型（Ⅵ型）。CBCT的检出率分别为65．63％、37．50％、27．08％、31．25％、28．13％、1．04％；经咽侧位x线平片的检出率分别为52．08％、19．79％、32．29％、23．96％、12．50％、2．08％。对每一型病变的程度和范围，同一医师两次判断或不同医师之间，对I、Ⅱ型病变的评判，经咽侧位x线平片和CBCT均有高度的一致性，Kappa值大于0．60。结论除Ⅲ型外，CBCT对每一类型的病变均有很高的检出率，所显示的病变及其部位清晰、明确。CBCT清晰的病变影像、明确的病变部位和显示多层面病变的优势，使其有望成为颞下颌关节骨关节病判定病变程度、预后以及药物治疗后效果的定量评价手段。     

颞下颌关节骨性结构观测及临床意义

本文报告了20例剥制颅骨40侧颞下颌关节骨性结构的观测结果,颞下颌关节窝的横径、前后径和髁状突内外径、前后径、前斜面距和后斜面距等与文献报道结果相似,但下颌结节后斜面斜度则有所不同;报告了髁状突角的变化及髁状突与关节窝的不协调结果.观测结果为X线摄片、颞下颌关节骨性结构病症诊治及颞下颌人工关节设计提供有意义参数.     

不同垂直骨面型的成人骨性Ⅱ类患者腭部区域骨厚度的CBCT研究

目的 利用CBCT分析不同垂直骨面型成人骨性Ⅱ类患者腭部区域骨厚度差异,为临床上骨性Ⅱ类患者支抗钉植入提供参考依据.方法 选取骨性Ⅱ类成人患者CBCT资料共74例(年龄20～40岁),根据垂直骨面型分为:高角组(男11例,女11例)、均角组(男15例,女15例)、低角组(男11例,女11例).应用Dolphin Ima...     

Three-dimensional study of the upper airway in different skeletal Class II malocclusion patterns

Objectives:To characterize upper airway volume and morphology in patients with different skeletal patterns of Class II malocclusion compared to Class I.Materials and Methods:A total of 197 individuals who had cone-beam computed tomography were allocated into groups according to ANB, SNA, and SNB angles (Class I, Class II maxillary protrusion, Class II mandibular retrusion), each subdivided into hypodivergent, normal, and hyperdivergent. Nasopharynx (NP), oropharynx (OP), and hypopharynx (HP) were assessed with three-dimensional image reconstruction software.Results:Intergroup comparison did not detect significant differences in volume and morphology of NP, OP, and HP. The males displayed larger OP and HP volume than the females. Positive correlations between age and NP, OP, HP volume and between craniocervical angle and OP and HP volume were observed. Linear regression analysis detected a tendency for OP and HP volume to increase as maxillary and mandibular length increased.Conclusions:Upper airway volume and morphology were similar in different skeletal patterns of Class II malocclusion. Actual upper and lower jaw lengths were more closely related to upper airway volume and morphology than the angles that reflected their position relative to the cranial base.     

Three-dimensional positional assessment of glenoid fossae and mandibular condyles in patients with Class II subdivision malocclusion

Objectives:To test the null hypotheses that the positions of the glenoid fossae and mandibular condyles are identical on the Class I and Class II sides of patients with Class II subdivision malocclusion.Materials and Methods:Retrospective three-dimensional (3D) assessments of the positions of the glenoid fossae and mandibular condyles were made in patients with Class II malocclusion. Relative to a fiducial reference at the anterior cranial base, distances from the glenoid fossae and condyles were calculated in pretreatment cone beam computed tomographic scans of 82 patients: 41 with Class II and 41 with Class II subdivision malocclusions. The 3D distances from glenoid fossae to sella turcica in the X (right-left), Y (anterior-posterior), Z (inferior-superior) projections were calculated.Results:Patients with Class II malocclusion displayed a symmetric position of the glenoid fossae and condyles with no statistically significant differences between sides (P > .05), whereas patients with Class II subdivision showed asymmetry in the distance between the glenoid fossae and anterior cranial base or sella turcica (P < .05), with distally and laterally positioned glenoid fossae on the Class II side. (P < .05). Male patients had greater distances between glenoid fossae and anterior cranial fossae (P < .05). The condylar position relative to the glenoid fossae did not differ between the two malocclusion groups nor between males and females (P > .05).Conclusions:The null hypotheses were rejected. Patients with Class II subdivision malocclusion displayed asymmetrically positioned right- and left-side glenoid fossae, with a distally and laterally positioned Class II side, although the condyles were symmetrically positioned within the glenoid fossae.     

Orthodontic camouflage treatment of skeletal class II malocclusion with severe maxillary dentoalveolar protrusion

This case report describes the orthodontic treatment of a 14-year-old male patient who presented with prognathic maxilla, severe dentoalveolar proclination, deepbite and retained deciduous tooth. We selected headgear and fixed appliance to correct malocclusion but cooperation towards headgear was found less during treatment. So we chose orthodontic camouflage treatment to correct dentoalveolar problems without altering the skeletal base relation. The final treatment results were good and patient had improvement in esthetic and function.     

不同垂直骨面型青年女性下颌体形态的测量分析

目的采用锥形束CT（CBCT）分析不同垂直骨面型青年女性患者的下颌体截面的高度和宽度以及下颌体皮质骨厚度,确定不同垂直骨面型患者下颌体形态结构的特点及差异。方法选取在山东大学口腔医院正畸科就诊的女性患者64例,年龄19~40岁,均行CBCT扫描,根据垂直骨面型分为3组,其中低角组14例,均角组31例,高角组19例。测量其下颌体形态,包括下颌体截面高度、宽度及其皮质骨厚度。使用SPSS 16.0软件对测量值进行统计学分析,确定不同垂直骨面型患者下颌体形态结构的特点及差异。结果高角组下颌体截面高度在下颌联合部较低角组大,但低角组在磨牙段较高角组大（P<0.05）。低角组的下颌体截面上1/3宽度在前牙和前磨牙段较高角组宽,而下1/3宽度在下颌联合部、侧切牙段较高角组宽（P<0.05）。除前磨牙段以外,低角组的下颌基底部皮质骨厚度较高角组明显增厚（P<0.05）;低角组颊侧上1/3皮质骨厚度在尖牙、前磨牙以及磨牙段均较高角组厚（P<0.05）,而下1/3皮质骨厚度只在尖牙和第二磨牙段较高角组厚（P<0.05）;低角组舌侧下1/3皮质骨厚度在下颌联合部较高角组厚（P<0.05）,而上1/3皮质骨厚度在前磨牙与磨牙段均较高角组厚（P<0.05）。结论不同垂直骨面型者下颌体截面高度和宽度的差别较下颌体皮质骨厚度的差别明显;下颌体截面高度从前牙段向磨牙段逐渐减小;低角组的下颌体截面宽度较其他两组宽大;下颌体皮质骨厚度从低角、均角到高角组依次变薄。     

54例正常人双侧颞下颌关节CBCT测量值分析

目的：探讨应用CBCT（cone-beamcomputedtomography）对成年人两侧颞下颌关节进行多项指标数据测量分析。方法：在TMJ成像与测量技术的基础上,筛选出正常成人54例,通过严格的TMJ临床检查确定为健康关节,利用Newtom9000CBCT对其ICP位颞下颌关节进行成像后测量分析。结果：在轴位测得髁状突水平角以及单侧髁状突距矢状中线的距离;平行于髁状突长轴的斜位,测髁状突长轴径,垂直角度,沿髁状突长轴顶内外极间任意角间隙宽度;垂直于髁状突长轴的斜位测量关节髁状突前中后任意角间隙宽度,关节凹深度和前斜面角度关节颈厚度;矢状位测关节髁状突前中后任意角间隙宽度,关节凹深度和前斜面角度关节颈厚度。结论：正常成人双侧髁状突位置及关节窝形态性别差异不明显,双髁状突位置及关节窝形态基本对称。     

3种功能矫治器矫治骨性Ⅱ类错的临床疗效对比研究

目的探讨Twin- block、Activator和Herbst功能矫治器治疗骨性Ⅱ类错的临床疗效是否存在差异。方法 选择使用Twin- block、Activator和Herbst功能矫治器矫治成功的60例骨性Ⅱ类错患者为研究对象。根据使用矫治 器的不同，将其分为Twin- block组、Activator组和Herbst组，每组均为20例患者。在正畸治疗前和功能矫治完成后 （第一恒磨牙建立中性关系）对每位患者拍摄X线头颅侧位片，对其治疗前后X线头影测量值进行比较。结果3 组患者功能矫治器治疗后，矢状向关系上ANB角、SNB角、Go- Gn、Co- Gn、L1-MP的变化具有统计学意义，垂直 向关系上N-Me、ANS-Me、S- Go、SN-MP及Co- Go的变化具有统计学意义。与Twin- block组、Activator组相比， Herbst组患者下前牙的唇倾（L1-MP）更明显，但抑制上前牙前倾（U1- SN）的效果不明显。3组患者上颌向前生长 （Ptm- A）及垂直向变化（OB、N-Me、ANS-Me、S- Go、Co- Go）无明显差异。结论Twin- block、Activator和Herbst 矫治器对骨性Ⅱ类错的早期矫治机制是相似的，但Herbst矫治器对下颌的矫形和下前牙的唇倾作用更明显。     

Influence of vertical skeletal pattern on cortical and alveolar bone thickness and root spacing in the anterior maxilla assessed by cone beam computed tomography

PurposeThe aim of this study was to evaluate the dimensional properties of bone in the anterior maxilla in patients with different vertical skeletal patterns in order to ensure safe placement of temporary anchorage devices.Materials and methodsFifty-one CBCT images were divided into three equal groups according to vertical skeletal pattern, based on palatal plane to mandibular plane angle. Cortical bone thickness, alveolar bone thickness and interdental root distance were measured between the teeth in the anterior maxilla at 6 mm and 8 mm apical to the interdental cementoenamel junction.ResultsCortical bone thickness was significantly different among vertical groups at some sites. Hyper-divergent subjects had thinner cortical bone than hypo-divergent and normo-divergent subjects. All three groups, in the anterior maxilla, cortical bone thickness tended to increase from between central incisors (U1–U1) to between lateral incisor and canine (U2–U3). Alveolar bone thickness was greatest between central and lateral incisors (U1–U2), and the thinnest alveolar bone was at U1–U1 area. Average interdental root distance ranged from 1.33 ± 0.48 mm to 3.43 ± 1.25 mm. The largest and smallest interdental root distances were at U1–U1 and U1–U2 sites, respectively.ConclusionPlacement of TADs in hyper-divergent subjects should be performed with caution. The suitable site for TADs in the anterior maxilla was between the lateral incisor and canine in all vertical skeletal patterns.     

Morphological changes in the temporomandibular joint after orthodontic treatment for Angle Class II malocclusion

Objective: The aim of this study was to examine the morphological temporomandibular joint (TMJ) changes that occur after orthodontic treatment in patients with Angle Class II malocclusion.

Methods: The post-treatment changes in TMJ morphology were analyzed, based on TMJ cephalometric laminographs in 19 patients with Angle Class II malocclusion and labial inclination of the upper incisors after premolar extraction.

Results: The condylar pass angle, articular eminence to the Frankfort horizontal plane angle, and total, upper, and lower heights of the articular fossa increased significantly on both sides after treatment and retention. The anteroposterior width of the articular fossa decreased significantly on both sides after treatment and retention.

Discussion: These results suggest that adaptive bone remodeling of the TMJ occurs during the correction of occlusion with labial inclination of the upper incisors by orthodontic treatment after premolar extraction in patients with Angle Class II malocclusion.