恒牙列安氏Ⅰ、Ⅱ~1、Ⅱ~2、Ⅲ类颞下颌关节骨性结构的锥形束CT比较
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摘要
目的:研究不同性别和安氏Ⅰ、Ⅱ1、Ⅱ2、Ⅲ类之间颞下颌关节及其周围相关骨性结构的差异。方法:对123例不同安氏分类错?畸形患者拍摄锥形束CT(CBCT),使用Mimics19.0软件进行三维重建,在矢状面上对颞下颌关节的前间隙、上间隙、后间隙、关节窝宽度、关节窝深度、髁突高度、髁突水平角、髁突半径、髁突前后径以及髁突长轴径进行测量分析,对髁突在关节窝的位置采用Pullinger法进行分析。采用SPSS 22.0软件包对数据进行统计学处理。结果:安氏Ⅰ类、Ⅱ1类、Ⅱ2类及Ⅲ类患者中,男性双侧髁突相关骨性结构均显著大于女性,Ⅱ1类患者髁突长轴径、前后径相对其他类型较小,Ⅲ类骨性患者的关节窝具有宽和浅的特征。安氏Ⅰ类、Ⅱ1类及Ⅲ类患者髁突在关节窝的位置主要为前位或居中,而Ⅱ2类主要为居中或后移位。不同安氏分类法的左右侧髁突相关结构无显著差异(P>0.05)。结论:不同安氏分类法中,错?畸形患者的颞下颌关节在髁突形态与结构、关节间隙、关节窝形态及髁突位置等方面存在显著差异。
PURPOSE: To compare characteristics of temporomandibular joint and related structures according to gender and Angle Ⅰ, Ⅱ 1, Ⅱ 2 and Ⅲ class. METHODS: Cone-beam CT(CBCT) was performed in 123 patients with malocclusion, and three-dimensional reconstruction was performed with Mimics 19.0 software. The anterior, upper, and posterior spaces of temporomandibular joint, width and depth of acetabulum, height and horizontal angle of condyle, radius of condyle, and anteroposterior and long-axis diameter of condyle were analysed on sagittal plane. The position of condyle in the joint fossa was analyzed using Pullinger methods. SPSS 22.0 software package was used for statistical analysis.RESULTS: Significant differences were found in the long axis and radius of the condyles between Class Ⅰ and Ⅲ, ClassⅠ and Ⅱ1, respectively(P<0.05). The widest acetabulum was observed in Class Ⅲ, followed by Class Ⅰ, Ⅱ1, and Ⅱ2.Moreover, the deepest acetabulum was found in Class Ⅱ2, followed by Class Ⅱ1, Ⅰ, and Ⅲ. No significant differences were detected in the left and right condyle-related structures among different temporomandibular articulation. In addition,the anterior articular space was significantly larger in Class Ⅰ patients, compared with Class Ⅱ 2 patients.CONCLUSIONS: There are significant differences in condylar morphology, joint space, joint fossa morphology and condylar position between different Angle classifications.
PURPOSE: To compare characteristics of temporomandibular joint and related structures according to gender and Angle Ⅰ, Ⅱ 1, Ⅱ 2 and Ⅲ class. METHODS: Cone-beam CT(CBCT) was performed in 123 patients with malocclusion, and three-dimensional reconstruction was performed with Mimics 19.0 software. The anterior, upper, and posterior spaces of temporomandibular joint, width and depth of acetabulum, height and horizontal angle of condyle, radius of condyle, and anteroposterior and long-axis diameter of condyle were analysed on sagittal plane. The position of condyle in the joint fossa was analyzed using Pullinger methods. SPSS 22.0 software package was used for statistical analysis.RESULTS: Significant differences were found in the long axis and radius of the condyles between Class Ⅰ and Ⅲ, ClassⅠ and Ⅱ1, respectively(P<0.05). The widest acetabulum was observed in Class Ⅲ, followed by Class Ⅰ, Ⅱ1, and Ⅱ2.Moreover, the deepest acetabulum was found in Class Ⅱ2, followed by Class Ⅱ1, Ⅰ, and Ⅲ. No significant differences were detected in the left and right condyle-related structures among different temporomandibular articulation. In addition,the anterior articular space was significantly larger in Class Ⅰ patients, compared with Class Ⅱ 2 patients.CONCLUSIONS: There are significant differences in condylar morphology, joint space, joint fossa morphology and condylar position between different Angle classifications.
引文
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[12]龚爱秀,李静.前方牵引矫治替牙期骨性Ⅲ类错?畸形后颞下颌关节结构变化的CT测量研究[J].口腔医学, 2014, 34(3):164-166.
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[16] Katsavrias EG, Halazonetis DJ. Condyle and fossa shape in ClassⅡand ClassⅢskeletal patterns:a morphometric tomographic study[J]. Am J Orthod Dentofacial Orthop, 2005, 128(3):337-346.
[17] Pullinger AG, Solberg WK, Hollender L, et al. Relationship of mandibular condyle position to dental occlusion factors in an asymptomatic population[J]. Am J Orthod Dentofacial Orthop,1987, 91(3):200-206.
[18] Vitral RW, da Silva Campos MJ, Rodrigues AF, et al.Temporomandibular joint and normal occlusion:Is there anything singular about it? A computed tomographic evaluation[J]. Am J Orthod Dentofacial Orthop, 2011, 140(1):18-24.
[2] Razumilava N, Gores GJ. Cholangiocarcinoma[J]. Lancet, 2014,383(9935):2168-2179.
[3] Al Taki A, Ahmed MH, Ghani HA, et al. Impact of different malocclusion types on the vertical mandibular asymmetry in young adult sample[J]. Eur J Dent, 2015, 9(3):373-377.
[4] Assun觭觔o ZL. ClassⅡmalocclusion nonextraction treatment with growth control[J]. Dental Press J Orthod, 2014, 19(6):113-122.
[5] Choi YR, Jeong CW, Ryu DJ, et al. Temporomandibular joint internal derangement on MRI in patient with facial asymmetry[J].Int J Oral Maxillofac Surg, 2015, 44(1):e200-e200.
[6] Güven O, Tozoglu S, Tekin U, et al. Relationship between activity of gluthatione peroxidase and nitric oxide in synovial fluid and the progression of temporomandibular joint internal derangement[J]. J Craniofac Surg, 2015, 26(3):e210-213.
[7] Santiago RC, Júnior GC, Vitral RWF. Densidade mineralóssea de sítios específicos da maxila para a inser觭觔o de mini-implantes[J]. Dental Press J Orthod, 2009, 14(3):69-74.
[8] Roza MR, Silva LA, Januario AL, et al. Cone beam computed tomography in the diagnosis of temporomandibular joint alterations in cats[J]. J Feline Med Surg, 2011, 13(6):393-398.
[9]刘俊玲,李洪发,费丽思,等.恒牙期安氏Ⅱ1颞下颌关节骨性结构的锥形束CT研究[J].口腔医学研究, 2013, 29(5):453-456.
[10] Rodrigues AF, Fraga MR, Vitral RW. Computed tomography evaluation of the temporomandibular joint in ClassⅡdivision 1and ClassⅢmalocclusion patients:condylar symmetry and condyle-fossa relationship[J]. Am J Orthod Dentofacial Orthop,2009, 136(2):199-206
[11] Vitral RW, Telles CS, Fraga MR, et al. Computed tomography evaluation of temporomandibular joint alterations in patients with classⅡdivision 1 subdivision malocclusions:condyle-fossa relationship[J]. Am J Orthod Dentofacial Orthop, 2004, 126(1):48-52.
[12]龚爱秀,李静.前方牵引矫治替牙期骨性Ⅲ类错?畸形后颞下颌关节结构变化的CT测量研究[J].口腔医学, 2014, 34(3):164-166.
[13] Arnett GW, Bergman RT. Facial keys to orthodontic diagnosis and treatment planning. Part I[J]. Am J Orthod Dentofacial Orthop, 1993, 103(4):299-312.
[14] Franchi L, Pavoni C, Faltin K, et al. Thin-plate spline analysis of mandibular shape changes induced by functional appliances in ClassⅡmalocclusion:A long-term evaluation[J]. J Orofac Orthop, 2016, 77(5):325-333.
[15] Bench RW, Gugino CF, Hilgers JJ. Bio-progressive therapy[J]. J Clin Orthod, 1977, 11(9):616-627.
[16] Katsavrias EG, Halazonetis DJ. Condyle and fossa shape in ClassⅡand ClassⅢskeletal patterns:a morphometric tomographic study[J]. Am J Orthod Dentofacial Orthop, 2005, 128(3):337-346.
[17] Pullinger AG, Solberg WK, Hollender L, et al. Relationship of mandibular condyle position to dental occlusion factors in an asymptomatic population[J]. Am J Orthod Dentofacial Orthop,1987, 91(3):200-206.
[18] Vitral RW, da Silva Campos MJ, Rodrigues AF, et al.Temporomandibular joint and normal occlusion:Is there anything singular about it? A computed tomographic evaluation[J]. Am J Orthod Dentofacial Orthop, 2011, 140(1):18-24.