伴颞下颌关节紊乱病安氏Ⅱ类1分类错患者咀嚼运动中髁突轨迹分析

目的: 探讨伴颞下颌关节紊乱病（temporomandibular disorders,TMD）的安氏Ⅱ类1分类（Ⅱ¹）错患者咀嚼运动中髁突轨迹特征,进一步分析TMD和安氏Ⅱ¹错因素对咀嚼运动中髁突轨迹的影响。方法: 按照实验纳入标准分别收集无TMD的正常组（nTMD-N）10例、无TMD的安氏Ⅱ¹组（nTMD-Ⅱ¹）10例、伴TMD的安氏Ⅱ¹组（TMD-Ⅱ¹）14例患者。采用Cadiax Ⅳ 记录3组实验对象咀嚼运动时的髁突轨迹,利用GDSW软件测量并分析咀嚼运动轨迹的各项数据指标。采用SPSS 26.0软件包对所得结果进行统计学分析。结果: nTMD-Ⅱ¹组和TMD-Ⅱ¹组的咀嚼运动轨迹特征与nTMD-N组相比有所差异。左侧或右侧单侧咀嚼运动时,nTMD-N组、nTMD-Ⅱ¹组和TMD-Ⅱ¹组的各项数据无统计学差异。双侧咀嚼运动时,nTMD-Ⅱ¹组的SCI值显著大于nTMD-N组,nTMD-N组的S值显著大于nTMD-Ⅱ¹组（P<0.05)。结论: 单侧咀嚼运动时,TMD和安氏Ⅱ¹错因素对咀嚼运动轨迹影响较小。安氏Ⅱ¹类错因素对双侧咀嚼运动有影响,Ⅱ¹患者正常咀嚼时髁突整体运动幅度较正常者小。双侧咀嚼运动时,TMD对Ⅱ¹类患者咀嚼运动轨迹无明显影响。     

Assessment of masticatory function in patients with non‐sagittal occlusal discrepancies

Non‐sagittal occlusal discrepancies such as posterior cross‐bite and anterior openbite are common types of malocclusion, but studies on masticatory function related to those malocclusions have been scarce. The aim of this study was to quantify the masticatory performance in patients with non‐sagittal discrepancies compared to those with normal occlusion, using both objective and subjective measures. Maximum bite force and contact area using Dental Prescale^® system as a static objective assessment, Mixing Ability Index (MAI) as a dynamic objective evaluation and food intake ability (FIA) as a subjective assessment were analysed from 21 people in normal occlusion (Group N) and 64 patients with posterior cross‐bite (Group C), anterior openbite (Group O) or both (Group B). The differences of the maximum bite force, the contact area, the MAI and the FIA were compared, and their correlations were figured out. The non‐sagittal malocclusion groups showed lower values in the maximum bite force, the contact area, the MAI and the FIA compared to those in the normal group (P < 0·0001). Compared to Group N, Groups C, O and B showed 61·5%, 42·1% and 40·1% of the maximum bite force, and 84%, 84% and 76% of hard food FIA, respectively. However, there were no significant differences among Groups C, O and B. The MAI showed higher correlation with the FIA (r = 0·38, P < 0·01), than with the maximum bite force and the contact area (both r = 0·24, P < 0·5). These results revealed that masticatory function in patients with non‐sagittal discrepancies is significantly reduced both objectively and subjectively.     

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??Objective??To evaluate the effect of articular disc repositioning combined with orthodontic functional appliance in the treatment of juvenile bilateral temporomandibular joint ??TMJ??anterior disc displacement??ADD?? and  skeletal class ??malocclusion. Methods??Fourteen juvenile patients with bilateral TMJ ADD and skeletal class ?? malocclusion were selected from March 2016 to March 2018 in the Department of Oral Surgery??Ninth People’s Hospital??Shanghai Jiao Tong University School of Medicine. Magnetic resonance imaging ??MRI?? and cephalometric radiographs before surgery and  follow-ups were performed for all patients. Condylar height and relevant cephalometric radiographs were measured and compared by statistical analysis. Results??Compared with pre-surgery??MRI showed the condylar height increased ??1.74±0.98??mm during follow-ups after surgery ??P??0.001??. New generated bone was observed on all condyles. About 84.61% of the new bone formed at superior and posterior-anterior surface. Cephalometric radiographs showed that SNB increased ??1.83±1.56??°??P??0.001????pogonion position ??pog-G?? moved ??2.18±3.13??mm ??P = 0.028?? forward and incisor overjet decreased ??3.55 ± 1.86??mm ??P??0.001????whereas no significant changes were found in SNA??Sn - G Vert??Y-Axis??U1 - SN??IMPA ??L1-MP?? or U1-L1 ??P > 0.05??. Conclusion??Articular disc repositioning combined with postoperative orthodontic functional appliances can effectively promote condylar growth and reduce oral-maxillofacial deformities in juvenile patients with bilateral  TMJ ADD and skeletal class??malocclusion.     

儿童青少年骨性Ⅱ类错(牙合)畸形矫治后面型变化的研究

目的:对比分析儿童青少年骨性Ⅱ类错(牙合)畸形患儿拔牙与非拔牙矫治前后的软组织侧貌变化差异.方法:由近年代向远年代抽取在该院口腔正畸科完成矫治的44例骨性Ⅱ类错(牙合)畸形患儿为研究对象,根据是否拔牙矫治分为拔牙组和非拔牙组,各22例.拔牙组患儿均拔除4颗双尖牙.对矫治前后的X线头颅侧位定位片进行软组织美学指标的测量分析.结果:拔牙组除颏唇沟角(Li-B'-Pos)和面角(NsPg'-FH)矫治前后的变化差异无统计学意义(P＞0.05)外,其余各测量指标均向面突度减小的方向变化,前后差异均有统计学意义(P＜0.05);非拔牙组矫治前后仅下唇倾角(B'Li-FH)和上唇凸距(Ls～REP)的变化差异有统计学意义(P＜0.05).矫治前两组患儿上唇倾角(A'Ls-FH)、Ls-REP、下唇凸距(Li-REP)、Z角和颏沟倾角(Pg'B'-FH)比较,差异均有统计学意义(P＜0.05).矫治后拔牙组的A'Ls-FH、上下唇角(A'Ls-B'Li)、Z角和Pg'B'-FH均大于非拔牙组,差异均有统计学意义(P＜0.05).结论:软组织侧面型较突的骨性Ⅱ类错(牙合)畸形患儿通过拔牙矫治有望获得较大的面型改变,而非拔牙矫治对患儿的侧貌影响较小.     

微种植体支抗治疗成人骨性安氏Ⅱ类错殆的疗效评估

目的：探讨微种植体支抗治疗成人骨性安氏Ⅱ类错殆的临床效果。方法：回顾性分析我院2011年8月～2014年7月收治的85例成人骨性安氏Ⅱ类错殆患者,所有患者均应用微种植体支抗技术进行治疗,比较患者治疗前后的投影测评结果。结果：治疗后,患者面部美观情况显著改善,磨牙在水平向和垂直向均未发生明显移动,而 U1-SN、U1-NA 及 LS-EP 则比治疗前显著减小,U1-L1、U1-SN 比治疗前明显增大。结论：微螺钉种植体是一个疗效确切的成人骨性安氏Ⅱ类错殆治疗技术,具有良好的应用前景。     

Skeletal class II malocclusion caused by mouth breathing in a pediatric patient undergoing treatment by interceptive guidance of occlusion

A 7-year 10-month-old boy was evaluated for mouth breathing and snoring habits. Examination revealed soft convex tissues, maxillary protrusion, mandibular retrusion, and a class II sagittal osteofascial pattern. The patient failed a water holding test. He was clinically diagnosed with skeletal class II malocclusion caused by mouth breathing. Under interceptive guidance of occlusion (iGo), the malocclusion improved with fixed maxillary expansion using functional appliances and interventional treatment of mouth breathing by lip closure exercises. These treatments enabled the patient to gradually return to nasal breathing and guided him to develop physiological occlusion for a coordinated jaw-to-jaw relation. At the 5-year 2-month post-correction follow-up visit (at the age of 13 years), the patient had stable occlusion, a coordinated osteofascial pattern, and normal dentition, periodontium, and temporomandibular joints.