下颌偏斜患者正中关系位与最大牙尖交错位髁突位置不调及影响因素的初步分析

发布时间：2018-07-13 16:40

【摘要】：目的：分析下颌偏斜患者下颌分别处于正中关系(centricrelation，CR)位与最大牙尖交错(maximum intercuspation，MI)位时咬合关系及髁突三维位置的变化，分析CR-MI髁突位置不调的临床表现及相关因素，探讨其对牙颌面畸形正畸诊断及治疗的影响。 方法：随机选取下颌偏斜患者50例为试验组，下颌非偏斜患者50例为对照组，在口内用咬合记录蜡分别获取所有研究对象CR位、MI位时的咬合记录，通过牙合叉、面弓以及咬合记录蜡将CR位咬合关系转移到AD2牙合架上，分别测量并比较CR位、MI位前牙覆牙合及覆盖；记录CR位的牙合干扰情况；采用髁突移位测量仪(measures condyle displacement，MCD)分别记录CR位、MI位时髁突位置，并计算CR-MI髁突位置在垂直向、矢状向及横向的偏移量，以CR-MI偏移量在垂直向或矢状向≥1.0mm或横向≥0.5mm为CR-MI不调的标准统计CR-MI不调的频数，比较试验组与对照组牙合干扰率、CR-MI不调率及CR-MI偏移量，比较试验组中下颌偏斜侧与非偏斜侧、有颞下颌关节紊乱症(temporomandibular joint disorder，TMD)与无TMD、男性与女性间CR-MI不调率及CR-MI偏移量，并分析CR-MI不调的相关因素。 结果：(1)CR位覆牙合小于MI位覆牙合，CR位覆盖大于MI位覆盖，，差异均具有统计学意义(P0.01)；（2)CR位牙合干扰发生率在试验组、对照组分别为90%、72%，差异具有统计学意义(χ2=5.263,P=0.022)；两组研究对象CR位牙合干扰均大多位于后牙区，分别占84%、68%；试验组中下颌偏斜侧与非偏斜侧牙合干扰率相近，分别为46%、44%；(3)CR-MI不调率在试验组为86%，对照组为12%，差异有统计学意义(χ2=54.782,P=0.000)；CR-MI偏移量试验组均大于对照组，差异具有统计学意义(P0.01)；试验组中下颌偏斜侧与非偏斜侧CR-MI不调率及CR-MI偏移量均无明显差异(P0.05)。(4)试验组中有TMD组与无TMD组间CR-MI不调率及CR-MI偏移量均无明显差异(P0.05)；试验组中男性患者与女性患者CR-MI不调率及CR-MI偏移量均无明显差异(P0.05)；CR-MI横向偏移量与前牙CR-MI覆牙合变化量及CR-MI覆盖变化量均成正相关；CR-MI偏移量与下颌偏斜量无明显相关性。 结论：下颌偏斜患者有较高的CR-MI不调率，CR-MI咬合关系也会发生变化，可能是其CR位存在牙合干扰所致。对于下颌偏斜人群，临床上观察到的咬合改变不能完全反应髁突三维方向的变化，应通过牙合架分析患者上下牙列真实的咬合关系及CR-MI不调情况，在此基础上作出正确的诊断设计。正畸治疗中应注意消除牙合干扰的影响，注意垂直方向的控制，在CR位上建立咬合关系，以利矫治效果的稳定性。
[Abstract]:Objective: to analyze the occlusal relationship and the change of three-dimensional position of condyle in mandibular oblique patients, and to analyze the clinical manifestation and related factors of CR-MI condylar unalignment. Objective: to study the effect of orthodontic diagnosis and treatment of maxillofacial malformation. Methods: 50 patients with mandibular deviation and 50 patients with non-oblique mandible were randomly selected as experimental group and 50 patients as control group. The occlusal records of all the subjects were obtained by occlusal recording wax, and the occlusion records of all the subjects were obtained by occlusal forks. The occlusal relation of CR position was transferred to the AD2 occlusal frame, and the overbite and overlay of the anterior teeth in CR position MI position were measured and compared, respectively, and the occlusal interference in CR position was recorded. The position of condyle in CR position was recorded by (measures condyle displacement device (MCD), and the displacement of CR-MI condyle in vertical, sagittal and transverse directions was calculated. The standard statistical CR-MI unmodulation frequency of CR-MI deviation in vertical or sagittal direction 鈮

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