咬合垂直距离升高后咀嚼肌和颞下颌关节的适应性改建

咬合重建修复中为开辟修复间隙和改善颞下颌关节症状常常涉及咬合垂直距离的升高.本文就咬合垂直距离升高动物模型建立、咬合垂直距离升高后咀嚼肌和颞下颌关节适应性改建作一综述,为临床咬合重建修复提供理论依据.     

正常者瞳孔间距与咬合垂直距离关系的研究

目的：研究正常[牙合]者瞳孔间距（Interpupillary Distance，IPD）与咬合垂直距离（Occlusal Vertical Dimension，OVD）的关系。方法：对116名福建籍青年正常[牙合]者测量其OVD与IPD，并进行两者相关回归分析。结果：总样本的OVD均值为65．35mm±4．70mm，IPD均值为63．98mm±3．26mm，男性正常[牙合]者OVD均值为68．16mm±4．23mm，IPD均值为65．46mm±2．96mm，女性正常[牙合]者的OVD均值为63．22mm±3．86mm，IPD均值为62．86mm±3．05mm;总样本的IPD与OVD的相关系数r=0．633，男性样本的IPD与0VD的相关系数r=0．563，女性样本的IPD与OVD的相关系数r=0．531。结论：IPD与OVD间存在显著相关性，IPD可以作为需咬合重建患者确定其OVD的参考指标。     

无牙颌患者的咬合垂直距离与咀嚼肌肌电关系的实验研究

作者选择了颌关系正常、能合作的15名无牙颌受试者。在4kg咬合力作用下，在不同的咬合垂直距离时，测定了颞肌及嚼肌的肌电幅值，实验结果表明，在控制咬合力状态下，无牙颌患者的咀嚼肌肌电幅值随着垂直距离增加而逐渐下降，两者间呈非常显著性负相关关系；在肌电活动变化过程中，有一相对稳定区域，由此提示，为无牙颌患者重建的咬合垂直距离有一定生理范围，约1.0mm(后牙区测点）。     

He垂直距离减小和下颌后移对颞下颌关节的创伤分析

目的：咬合因素作为颞下颌关节紊乱（ＴＭＤ）发病的重要因素,目前其致病机理仍不是十分清楚。研究咬合因素对下颌关节的创伤过程,将有助于我们对其诊断和治疗。方法：将临床上收集的,明确有不良咬合因素的颞下颌关节紊乱的病例共４９例,根据其不同的咬合因素归类并临床分期,然后作统计学分析,同时解剖测量分析７具尸体颞颌关节盘和髁状突的前后斜面。结果：病理性的Hｅ垂直距离减小对ＴＭＤ发病的影响最大,病理性的Ｈｅ垂直     

无牙颌总义齿咬合垂直距离修复前后颞下颌关节的对比研究

通过对１４例戴旧总义齿的无牙颌患者行新总义齿修复垂直距离升高前后颞颌关节间隙及髁状突相对于蝶窦中心的位置变化研究，发现咬合垂直距离的改变能引起髁状突位置的改变，垂直距离升高后，髁状突呈前移位，在总义齿修复中，防止及减缓垂直距离的降低，对维持ＴＭＪ的正常位置，预防无牙颌ＴＭＪＤＳ的发生有重要意义．     

头影测量在确定咬合垂直距离时的应用

X线头影测量一直以来应用在正畸和正颌外科领域,在口腔修复中应用相对较少。近年来,X线头影测量技术被应用于口腔修复中,尤其是在临床咬合重建中对垂直距离进行预测、评估、量化能起到重要作用。本文就X线头影测量在口腔修复中确定垂直距离时的应用作一综述。     

He力与全口义齿垂直距离关系的研究—咬合力测试

通过测定截不同垂直距离全口义齿的无牙颌患者的最大咬合力及咀嚼效率，研究垂直距离与咬合力间的关系，探求其实际临床意义。结果表明：最大咬合力随垂直距离增高而变大，再会得间呈正比关系，最大咬合力值在受试者的过高位并不是舒适位；在舒适位时咀嚼效率最大，过低，过高位均减小。由此提示，从过低位到舒适位，咬合力及咀嚼效率产大，此为临床Ｈｅ磨损患者作Ｈｅ重建提供了理论依据。     

咬合与颞下颌关节及口颌系统肌肉

咬合与颞下颌关节及口颌系统肌肉胡敏，周继林，洪民以往学者们用表示静止时上下颌牙齿的接触关系，而用咬合说明下颌运动中上下颌牙的接触关系，近年来，已开始认识到不能将与咬合完全分开来看，应该从口颌系统整体的功能关系进行观察。咬合与颞下颌关节、口颌系统肌肉以...     

咬合重建修复过程中咀嚼肌肌电图的变化

目的：探讨对垂直距离降低的患咬合重建修复过程中，咀嚼肌肌电图的变化。方法：对15例验垂直距离降低的患先用塑料验垫式可局部义齿过渡修复并恢复垂直距离，患适应后再按此高度永久修复。对比分析修复前、过渡修复一个月后以及永久修复一个月后嚼肌、颞肌前束和颞肌后束表面肌电图的变化。结果：①息止位时过渡修复及永久修复后嚼肌、颞肌前束和颞肌后束肌电幅值较术前均有明显减少趋势；②大力咬合位，过渡修复时颞肌后束肌电幅值较术前显减少，嚼肌和颞肌前束肌电无显改变。永久修复后嚼肌和颞肌前柬肌电较过渡修复时和术前有显提高，颢肌后柬肌电值较过渡修复时也显增加；③咀嚼时嚼肌和颞肌前柬肌电值在过渡修复及永久修复后逐步增加，永久修复后增加显。而颞肌后束肌电值无明显改变。结论：对垂直距离降低的病人升高垂直距离并进行咬合重建修复后，能显减少息止位嚼肌、颞肌前束和颞肌后束的紧张度，增强咀嚼肌大力咬合及咀嚼运动时的收缩能力。     

Relationship of occlusal vertical dimension to the health of the masticatory system

Changes in occlusal vertical dimension have been claimed to cause masticatory system disorders. Early articles on this subject were mainly limited to clinical case reports, and the more recent clinical studies have been flawed by the lack of control groups, blind evaluation, and by poor definition of criteria for evaluating the health of the masticatory system. Research with humans and animals has shown that if increases in occlusal vertical dimension are not extreme and the appliance used covers most of the dentition, there is a good possibility of adaptation. Current scientific knowledge does not support the hypothesis that moderate changes in occlusal vertical dimension are detrimental to the masticatory system.     

咬合垂直距离与咀嚼肌肌电、咬合力关系的研究

目的研究老年无牙颌患者垂直距离和咬合力、咀嚼肌肌电幅值的关系,为临床上确立正常垂直距离提供参考。方法研究对象来自浙江大学附属口腔医院就诊的10位老年无牙牙合患者,用常规法确定垂直距离,以正常咬合垂直距离为基准位(M位),间隔0.5 mm形成13个咬合垂直距离。应用咬合力计测量患者不同垂直距离的咬合力,同时用记录双侧颞肌前束、咬肌的肌电活动,对垂直距离、咬合力和肌电进行统计研究。结果 1无牙颌患者的咬合力与垂直距离呈正相关(P<0.05)。2标准化咬肌(NMM)和标准化颞肌前束肌电幅值(NATM)与垂直距离呈负相关(P<0.05)。3颞肌前束肌电/咬合力(ATM/BF)、咬肌肌电/咬合力(MM/BF)比值与着垂直距离呈负相关(P<0.05)。结论 1随着垂直距离的增加,最大咬合力增大,正常咬合垂直距离并非产生最大咬合力的区域。2随着咬合垂直距离的增加,咬肌的肌电活动明显下降,颞肌前束的肌电活动变化则不及咬肌明显。3咬肌肌电/咬合力、颞肌前束肌电活动/咬合力比值均随着咬合垂直距离的增加而减小。4在正常咬合垂直附近有一稳定区,该区内最大咬合力、咬肌以及颞肌前束的肌电活动均不出现明显变化。     

Relationship between disorder in the stomatognathic system and general joint involvement in individuals with rheumatoid arthritis

Seventy-one individuals with rheumatoid arthritis (RA) were examined and compared with 52 individuals without history or symptoms of joint disease (C group) with regard to disorders of the stomatognathic system. Laboratory findings and articular and functional rheumatologic indices were compared. The clinical dysfunction index of Helkimo for the stomatognathic system was positively correlated to both the articular Ritchie index and the functional Lee index. The concentration of C-reactive protein (CRP) and the Ritchie index were positively correlated to temporomandibular joint (TMJ) pain. Vertical overbite was negatively correlated to the Ritchie index. In addition, there were positive correlations among TMJ crepitus, anterior open bite, sagittal distance between retruded position and intercuspal position, and erythrocyte sedimentation rate (ESR). The concentration of CRP, the ESR, and the Ritchie and Lee indices were highest in the individuals with bilateral current TMJ symptoms and lowest in those with previous but not current TMJ symptoms. It was concluded that the severity of TMJ involvement in RA is correlated to concentration of serum acute-phase reactants and to rheumatologic indices.     

Relationship between disorder in the stomatognathic system and general joint involvement in individuals with rheumatoid arthritis

Seventy-one individuals with rheumatoid arthritis (RA) were examined and compared with 52 individuals without history or symptoms of joint disease (C group) with regard to disorders of the stomatognathic system. Laboratory findings and articular and functional rheumatologic indices were compared. The clinical dysfunction index of Helkimo for the stomatognathic system was positively correlated to both the articular Ritchie index and the functional Lee index. The concentration of C-reactive protein (CRP) and the Ritchie index were positively correlated to temporomandibular joint (TMJ) pain. Vertical overbite was negatively correlated to the Ritchie index. In addition, there were positive correlations among TMJ crepitus, anterior open bite, sagittal distance between retruded position and intercuspal position, and erythrocyte sedimentation rate (ESR). The concentration of CRP, the ESR, and the Ritchie and Lee indices were highest in the individuals with bilateral current TMJ symptoms and lowest in those with previous but not current TMJ symptoms. It was concluded that the severity of TMJ involvement in RA is correlated to concentration of serum acute-phase reactants and to rheumatologic indices. □ Inflammation; laboratory tests; Lee index; Ritchie index; temporomandibular joint disease