功能性矫治器前伸下颌对颞下颌关节影响的研究进展

安氏Ⅱ类错(牙合)发病率高,且多源于下颌后缩或下颌发育不足.临床上常用功能性矫治器调整上下颌骨的矢状向关系.本文从功能性矫治器的作用机制、矫治时机以及治疗后患者颞下颌关节的适应性改建方面进行了阐述,以了解功能性矫治器前伸下颌对颞下颌关节的影响.     

twin-block矫治器治疗后患者颞下颌关节的适应性改建

twin-block矫治器是治疗下颌发育不足引起的安氏Ⅱ类错(牙合)畸形的一种简单有效的功能矫治器,其治疗可引起髁突和关节盘的适应性改建,使下颌骨得以生长改建从而改善上下颌骨不调的关系,但矫治后是否对患者颞下颌关节(TMJ)产生实质性的改建以及对成人矫治的效果,目前尚存在较大的争论.本文就twin-block矫治器的矫治原理以及治疗后患者TMJ髁突和关节窝的适应性改建作一综述,以利于口腔正畸医生正确理解功能性矫治器引起TMJ改建的机制,为临床上治疗下颌后缩型安氏Ⅱ类错(牙合)畸形提供理论依据,并指导其适应证和矫治时机的选择.     

肌激动器治疗前后关节盘矢状位置与颞下颌关节临床症状和体征的关系

目的 探讨功能矫治中关节盘矢状位置对颞下颌关节临床功能的影响.方法 选择20个AngleⅡ1错(牙合)患者,采用Activator功能矫治器治疗.用MRI检查治疗前后关节盘位置, Helkimo指数评价功能矫形前后的颞下颌关节功能.探讨治疗前后关节盘位置的改变及其与颞下颌关节症状之间的关系.结果 治疗前关节盘位置正常者,治疗后临床检查指数有下降趋势;治疗前关节盘前移位者,治疗后临床检查指数升高.结论 功能矫形虽然不会导致关节盘前移位的发生,但对于治疗前已经存在关节盘前移位者,治疗后可能会引发或加重其TMD症状和体征.     

下颌骨缺损整复后颞下颌关节的变化

目的 :观察单侧或部分下颌骨缺损重建术后升支高度和下颌骨髁状突运动的变化。材料和方法 :30例患者按手术方式的不同分为两组 ,A组为保留髁状突的下颌骨部分切除、自体骨移植或病变骨冷冻再植整复组 ,B组为未保留髁状突组 ,术后通过X线检查评价结果。结果 :所有患者手术后都表现有不同程度的髁状突运动障碍。主要有升支高度降低、髁状突水平运动和转动能力降低 ,且A、B两组间存在明显差别 ,B组改变大于A组。结论 :下颌骨缺损重建对颞下颌关节结构和功能具有一定的影响 ,保留髁状突时所受影响要明显小于未保留髁状突组。因此保留髁状突有利于获得较好的术后功能效果     

下颌骨矢状劈开后退术对颞下颌关节的影响

目的:评价下颌骨矢状劈开后退术对颞下颌关节(TMJ)的影响.方法:研究我院50 例术前有颞下颌关节病(TMD),且行下颌骨矢状劈开后退术的患者,从关节压痛、弹响、张口度、张口型等方面量化评估术前、术后颞下颌关节症状变化情况.结果:从关节压痛、弹响、张口度、张口型等各方面评估均显示术后颞下颌关节症状评分均显著低于术前(P<0.05).结论:对于术前有颞下颌关节病的患者,行下颌骨矢状劈开后退术可以有效改善颞下颌关节症状.     

牵张力作用下颞下颌关节受力的三维有限元研究

目的 研究不同方向牵张力作用下颞下颌关节的受力状况,探讨下颌骨牵张成骨过程中牵张力合理的方向.方法 通过建立颞下颌关节及下颌骨的三维有限元模型,在模型上模拟牵张力的作用,得到下颌骨牵张成骨过程中,颞下颌关节的受力状况.牵张力的方向为平行于下颌骨下缘或平行于正中矢状面.分别观察牵张延长1 mm、3 mm、5 mm的应力分布状况.结果 不同方向牵张力作用下颞下颌关节的受力情况是不同的.当牵张力平行正中矢状面时,颞下颌关节的受力较大.结论 在下颌骨牵张成骨过程中,牵张力的方向具有重要的生物力学效果.     

Ⅲ类错He伴颞下颌关节紊乱病患者治疗后关节间隙变化研究

目的观察前方牵引矫治Ⅲ类错对TMJ影响。方法对19例安氏Ⅲ类错伴TMD的替牙期患者,用前方牵引矫治器进行矫治。分别于治疗前、后摄双侧薛氏位闭口X线片,行关节间隙的测量,作统计学t检验。结果治疗后关节前、后间隙线性测量及面积测量改变值,与治疗前相比有显著性差异(P＜0.01),线性百分比为13.34±2.05％,关节后、前间隙面积之比,较治疗前有显著性变化(P＜0.05)。结论前方牵引矫治器通过引导下颌姿势位后移,改善上、下颌骨矢状关系,使髁突后移并稳定于正常关节位,恢复了、肌肉、关节的协调关系。     

下颌骨缺损整复合颞下颌关节的变化

目的：观察单侧或部分下颌骨缺损重建术后升支高度和下颌骨髁状突运动的变化。材料和方法：30例患者按手术方式的不同分为两组，A组为保留髁状突的下凳骨部分切除、自体骨移植或病变骨冷冻再植整复组，B组为未保留髁状突组，术后通过X线检查评价结果。结果：所有患者手术后都表现有不同程度的髁状突运动障碍。主要有升支高度降低、髁状突水平运动和转动能力降低，且A、B两组间存在明显差别，B组改变大于A组。结论：下颌骨缺损重建对颞下颌关节结构和功能具有一定的影响，保留髁状突时所受影响要明显小于未保留髁状突组。因此保留髁状突有利于获得较好的术后功能效果。     

颞下颌关节-下颌骨-Herbst矫治器系统三维有限元模型的建立

目的 建立“颞下颌关节-下颌骨-Herbst矫治器系统”的三维有限元模型，为模拟Herbst矫治器工作状态，进一步探讨Herbst矫治器矫治机理奠定基础。方法 采用CT扫描技术，以处于青春生长高峰期、Ⅱ类骨性错He的儿童的颅面骨作标本，以及使用图形数字化仪等方法，建立包括完整天然牙列和颞颌关节的下颌骨三维正交各向异性有限元模型，在此模型上增加Herbst矫治器，模拟临床上Herbst矫治器的工作状态。结果建立了“颞下颌关节-下颌骨-Herbst矫治器系统”的三维正交各向异性有限元模型，提高了模型的相似性，确保实验结果的准确性。结论 该模型有较好的生物力学相似性和几何相似性，为研究Herbst矫治器的矫治机理，提供了有利的条件，使实验结果更真实、可靠。     

Forsus矫治器治疗安氏Ⅱ类下颌后缩患者颞下颌关节变化的CBCT分析

目的 通过CBCT研究Forsus矫治器对生长发育期患者颞下颌关节的影响。方法 选取28例（男性14例,女性14例）生长发育期的安氏Ⅱ类错(牙合)患者,采用直丝弓矫治配合Forsus矫治器导下颌向前。每位患者在治疗前后均行CBCT扫描,使用Invivo 5软件对患者治疗前后的颞下颌关节有关数据进行测量。结果 治疗后SNB增加,ANB减小;关节窝宽度增加,关节结节倾斜角减小;髁突顶部矢状面面积、髁突顶部冠状面面积增加,差异有统计学意义（P<0.05）;男性患者髁突体积、髁突顶部高度增加,髁突前后径减小,差异有统计学意义（P<0.05）。颞下颌关节窝面积、关节窝矢状总间隙面积、关节间隙、髁突内外径、髁突最大轴面面积不变（P>0.05）。结论 Forsus矫治器治疗后,髁突与关节窝相对位置关系不变,关节窝形态及髁突顶部形态改建,男性较女性髁突改建更明显。     

Effective temporomandibular joint growth and chin position changes: Activator versus Herbst treatment. A cephalometric roentgenographic study

In 138 successfully treated Class II division 1 patients (40 Activator and 98 Herbst) effective temporomandibular joint (TMJ) growth changes (a summation of condylar remodelling, glenoid fossa remodelling, and condylar position changes within the fossa), and their influence on the position of the chin and the rotation of the mandible were analysed retrospectively. Lateral head films in habitual occlusion from before and after an average treatment period of 2.6 years for the Activator patients and 0.6 years for the Herbst patients were evaluated. Two different treatment changes were assessed: (1) overall growth changes and (2) treatment effects (overall growth changes minus age-related normal growth values: Bolton Standards). The comparison between the Activator and the Herbst group revealed larger effective TMJ and chin changes during Activator therapy due to the longer observation period (2.6 years versus 0.6 years). The treatment effects showed marked group differences for both the amount and direction of effective TMJ changes. The changes were vertical and slightly anterior in the Activator group, and predominantly posterior in the Herbst group. Concerning the chin changes, the treatment effects for the Herbst group exceeded those for the Activator group in both directions, caudally and anteriorly. The Activator group showed an anterior rotation and the Herbst group a slight posterior rotation of the mandible. The present investigation revealed that the effective TMJ and chin changes were increased by both Activator and Herbst treatment. However, the Herbst appliance renders more favourable sagittally orientated treatment effects in a much shorter period of time compared with the Activator.     

Facial changes in children treated with the Activator appliance: a lateral cephalometric study

Using lateral cephalometry, facial profile changes in 32 children treated with the Activator appliance were assessed and compared to profile changes in 12 untreated children of same age and with similar malocclusions. The results of this study indicated that the maxillary region of the facial profile underwent similar changes in both groups. In contrast, the mandibular changes were different, with the treated group showing more mandibular advancement than the untreated group during the period examined.     

Herbst双期拔牙矫治对颞下颌关节骨性结构影响的锥形束CT研究

目的 应用锥形束CT（CBCT）研究Herbst双期拔牙矫治对颞下颌关节骨性结构的影响。方法选取15例以下颌后缩为主要临床表现的恒牙列早期安氏Ⅱ类错牙合患者,采用Herbst双期拔牙矫治,在Herbst矫治器矫治前两周（T1期）、Herbst矫治器初戴入矫治时（T2期）、Herbst矫治器拆除时（T3期）及二期固定矫治器拆除时（T4期）时进行CBCT扫描,应用InvivoDental软件对CBCT图像进行三维重建和相关测量。结果1）14例患者（28侧颞下颌关节）在T3期出现髁突后上区外侧边缘高密度、内部区域低密度类似“新月形”的增生影像。2）T3-T2期、T4-T1期,髁突前后径平均增加了0.62、0.66mm（P<0.01）;髁突头高度平均增加了0.54、0.53mm（P<0.01）。结论Herbst功能矫治器能促进髁突发生生长改建。     

Activator headgear therapy

A method of treatment is described using an activator and cervical headgear simultaneously to correct malocclusions of the Class II, Division 1 type. The case reports of ten treated patients are used to demonstrate the effects of the application of this technique. Changes in the dentition and facial skeleton were analyzed and the significance of the different responses to the application of the same appliances assessed. The hypothesis proposing that a simultaneous application of both appliances may result in a number of desirable effects greater than that induced by each individual appliance is examined. The hypothetical basis for the application of this technique is partially substantiated by the clinical observations. Within a period of about 1 year, correction of the Class II molar occlusion to a Class I molar occlusion is obtained, with a simultaneous reduction of overbite and overjet. Skeletal changes were found to be variable and related to facial type and the rate of facial growth. Brachyfacial and mesofacial types responded most favorably to treatment. The most favorable effects were observed when there was a large quantitative mandibular growth and brachyfacial or mesofacial growth pattern. In dolichofacial types with a slow mandibular growth rate, mandibular rotation was found to be clockwise; cervical traction appears contraindicated, and a combination of activator with occipital medium to high pull is considered more appropriate.     

A systematic review of cephalometric facial soft tissue changes with the Activator and Bionator appliances in Class II division 1 subjects

The objective of the present systematic review was to evaluate, through lateral cephalograms, facial soft tissue changes after the use of the Activator and Bionator appliances in Class II division 1 malocclusion subjects. Several electronic databases (PubMed, Medline, Medline In-Process and Other Non-Indexed Citations, Cochrane Database, Embase, Web of Sciences, and Lilacs) were searched with the assistance of a senior health sciences librarian. Abstracts, which appeared to fulfil the initial criteria, were selected by consensus. The original articles were then retrieved. Their references were also hand searched for possible missing articles. Clinical trials, which assessed facial soft tissue changes with the use of either an Activator or a Bionator appliance without any surgical intervention or syndromic characteristics, were considered. A comparable untreated control group was required to factor out normal growth changes. Five articles using the Activator and six using the Bionator fulfilled the selection criteria and quantified facial soft tissue changes. An individual analysis of these articles was undertaken and some methodological flaws were identified. Based on the available evidence, a significant amount of controversy regarding the soft tissue changes produced by the Activator and the Bionator exists. Soft tissue changes that were reported as being statistically significant were of questionable clinical significance. Long-term, double-blinded, prospective randomized clinical trials are needed to confirm the findings. Three-dimensional quantification is also required to overcome current limitations in our understanding of the soft tissue changes obtained with the use of removable functional appliances.     

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颞下颌关节强直是口腔颌面部一类严重的疾病,造成患者张口受限,语言、咀嚼功能障碍,口腔卫生状况下降,面部不对称以及小颌畸形等。本文简要介绍了颞下颌关节强直的病因、病理以及临床治疗的基础与临床研究。     

Management of temporomandibular joint arthritis in children and adolescents: An introduction for orthodontists

Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease of childhood. JIA can affect any joint and the temporomandibular joint (TMJ) is one of the joints most frequently involved. TMJ arthritis impacts mandibular growth and development and can result in skeletal deformity (convex profile and facial asymmetry), and malocclusion. Furthermore, when TMJs are affected, patients may present with pain at joint and masticatory muscles and dysfunction with crepitus and limited jaw movement. This review aims to describe the role of orthodontists in the management of patients with JIA and TMJ involvement. This article is an overview of evidence for the diagnosis and treatment of patients with JIA and TMJ involvement. Screening for the orofacial manifestation of JIA is important for orthodontists to identify TMJ involvement and related dentofacial deformity. The treatment protocol of JIA with TMJ involvement requires an interdisciplinary collaboration including orthopaedic/orthodontic treatment and surgical interventions for the management of growth disturbances. Orthodontists are also involved in the management of orofacial signs and symptoms; behavioural therapy, physiotherapy and occlusal splints are the suggested treatments. Patients with TMJ arthritis require specific expertise from an interdisciplinary team with members knowledgeable in JIA care. Since disorders of mandibular growth often appear during childhood, the orthodontist could be the first clinician to see the patient and can play a crucial role in the diagnosis and management of JIA patients with TMJ involvement.     

功能矫治前徙下颌对颞下颌关节盘-突-窝位置关系影响的MRI研究

目的研究安氏Ⅱ类1分类错[牙合]患者功能前徙下颌后颞下颌关节（temporomandibular joint，TMJ）盘-突-窝位置关系的改变，探讨功能矫治对TMJ结构产生的影响。方法25例安氏Ⅱ类1分类错[牙合]患者（男性10例，女性15例），平均（11．1±1．1）岁（8．1～13．0岁），接受Activator功能矫治，平均疗程10．9个月，矫治效果满意。治疗前后分别对患者TMJ进行MRI扫描检查并用配对t检验进行盘-突-窝位置关系的定量对比分析。结果治疗前后左侧TMJ髁突前缘与关节窝拐点的距离（Ca-Tm）[分别为（-0．1±1．5）mm和（-0．6±0．9）mm]、右侧TMJ关节前间隙（Ca-Ca′）[分别为（2．3±0．8）mm和（1．8±0．5）mm]的差异有统计学意义（P〈0．05），反映髁突向前移位。反映双侧关节盘在关节窝中位置的各测量项目治疗前后的差异均无统计学意义（P〉0．05）。反映双侧关节盘相对于髁突位置的各测量项目治疗前后的差异均无统计学意义（P〉0．05）。结论功能矫治安氏Ⅱ类1分类错[牙合]在促进下颌发育、改善患者[牙合]-颌一面畸形的同时，不会对TMJ功能产生不利影响，相反可能有助于改善患者治疗前存在的不良的TMJ功能状态。     

流体静力牙合垫在TMD诊断和治疗中的应用

目的观察流体静力牙合垫治疗颞下颌关节紊乱病的效果.方法选择5例常规方法治疗效果不明显的颞下颌关节紊乱病患者,先用流体静力牙合垫辅助建立下颌肌位,再制作硬树脂牙合垫保持该位置.结果患者戴流体静力牙合垫一周,大多数症状缓解或消失,治疗后随访1年,疗效稳定.结论流体静力牙合垫可能是一种诊断与治疗颞下颌关节紊乱病的有效辅助装置,有进一步研究的价值.