不同矢状骨面型患者颞下颌关节三维骨性结构的锥形束CT研究

doi:10.13591/j.cnki.kqyx.2024.09.008

摘要/Abstract

摘要：

目的研究不同矢状骨面型患者颞下颌关节形态结构和空间位置的差异。方法纳入68例年轻成人错牙合畸形患者,根据矢状骨面型分类分为骨性Ⅰ类组、骨性Ⅱ类组和骨性Ⅲ类组。应用InVivo 5软件对所有患者的锥形束CT影像进行三维重建,并对与髁突、关节窝和关节结节相关的17个研究项目进行测量分析。结果不同矢状骨面型患者左右侧关节的形态结构和空间位置差异无统计学意义(P>0.05)。与骨性Ⅰ类和骨性Ⅲ类患者相比,骨性Ⅱ类患者的髁突长轴径更小,关节结节后斜面更陡峭,髁突、关节窝和关节结节的空间位置更靠后。与骨性Ⅰ类和骨性Ⅱ类患者相比,骨性Ⅲ类患者髁突水平角更小,关节结节高度更低。结论不同矢状骨面型患者的髁突形态结构、关节结节形态结构以及髁突、关节窝和关节结节的空间位置均存在明显差异。

关键词: 矢状骨面型, 颞下颌关节, 锥形束CT, 骨性结构

Abstract:

Objective To investigate the differences in the morphological structure and spatial position of the temporomandibular joint among patients with different sagittal skeletal patterns. Methods A total of 68 young adults with malocclusion were enrolled and allocated into skeletal Class Ⅰ group, skeletal Class Ⅱ group and skeletal Class Ⅲ group according to sagittal skeletal patterns. InVivo 5 software was used to reconstruct the cone-beam CT images of all patients, and 17 research items related to condyle, glenoid fossa and articular eminence were measured and analyzed. Results There was no significant difference in the morphological structure and spatial position of bilateral temporomandibular joints in patients regardless of sagittal skeletal patterns(P<0.05).Compared with skeletal Class Ⅰ and skeletal Class Ⅲ patients, skeletal Class Ⅱ patients had smaller mediolateral diameter of condyle, steeper posterior slope of articular eminence, and more posterior position of condyle, articular eminence and glenoid fossa. Compared with skeletal Class Ⅰ and skeletal Class Ⅱ patients, skeletal Class Ⅲ patients had smaller condyle axial angle and lower height of articular eminence. Conclusion There are significant differences in condyle morphological structure, articular eminence morphological structure, and spatial position of condyle, articular eminence and glenoid fossa among patients with different sagittal skeletal patterns.

Key words: sagittal skeletal patterns, temporomandibular joint, cone-beam CT, osseous structure

中图分类号:

R783.5

王博, 常新. 不同矢状骨面型患者颞下颌关节三维骨性结构的锥形束CT研究[J]. 口腔医学, 2024, 44(9): 685-691.

WANG Bo, CHANG Xin. Evaluation of three-dimensional osseous structure of temporomandibular joint according to sagittal skeletal patterns: A cone-beam computed tomography study[J]. Stomatology, 2024, 44(9): 685-691.

图/表 11

表1

图1

图2

图3

表2

图4

表3

表4

表5

表6

表7

参考文献 25

[1]	Ayyıldız E, Orhan M, Bahşi I, et al. Morphometric evaluation of the temporomandibular joint on cone-beam computed tomography[J]. Surg Radiol Anat, 2021, 43(6): 975-996. doi: 10.1007/s00276-020-02617-1 pmid: 33221971
[2]	Nithin, Ahmed J, Sujir N, et al. Morphological assessment of TMJ spaces, mandibular condyle, and glenoid Fossa using cone beam computed tomography(CBCT): A retrospective analysis[J]. Indian J Radiol Imaging, 2021, 31(1): 78-85.
[3]	Noh KJ, Baik HS, Han SS, et al. Differences in mandibular condyle and glenoid fossa morphology in relation to vertical and sagittal skeletal patterns: A cone-beam computed tomography study[J]. Korean J Orthod, 2021, 51(2): 126-134. doi: 10.4041/kjod.2021.51.2.126 pmid: 33678628
[4]	Kurusu A, Horiuchi M, Soma K. Relationship between occlusal force and mandibular condyle morphology. Evaluated by limited cone-beam computed tomography[J]. Angle Orthod, 2009, 79(6):1063-1069. doi: 10.2319/120908-620R.1 pmid: 19852595
[5]	Buschang PH, Santos-Pinto A. Condylar growth and glenoid fossa displacement during childhood and adolescence[J]. Am J Orthod Dentofacial Orthop, 1998, 113(4): 437-442.
[6]	Honey OB, Scarfe WC, Hilgers MJ, et al. Accuracy of cone-beam computed tomography imaging of the temporomandibular joint: Comparisons with panoramic radiology and linear tomography[J]. Am J Orthod Dentofacial Orthop, 2007, 132(4): 429-438.
[7]	Gorucu-Coskuner H, Atik E, El H. Reliability of cone-beam computed tomography for temporomandibular joint analysis[J]. Korean J Orthod, 2019, 49(2): 81-88. doi: 10.4041/kjod.2019.49.2.81 pmid: 30941294
[8]	Schiffman E, Ohrbach R, Truelove E, et al. Diagnostic criteria for temporomandibular disorders(DC/TMD)for clinical and research applications: Recommendations of the international RDC/TMD consortium network* and orofacial pain special interest group[J]. J Oral Facial Pain Headache, 2014, 28(1): 6-27.
[9]	Yun JM, Choi YJ, Woo SH, et al. Temporomandibular joint morphology in Korean using cone-beam computed tomography: Influence of age and gender[J]. Maxillofac Plast Reconstr Surg, 2021, 43(1): 21.
[10]	Tanne K, Tanaka E, Sakuda M. Stress distributions in the TMJ during clenching in patients with vertical discrepancies of the craniofacial complex[J]. J Orofac Pain, 1995, 9(2):153-160. pmid: 7488985
[11]	Santander P, Quast A, Olbrisch C, et al. Comprehensive 3D analysis of condylar morphology in adults with different skeletal patterns-a cross-sectional study[J]. Head Face Med, 2020, 16(1): 33.
[12]	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.
[13]	Ma QL, Bimal P, Mei L, et al. Temporomandibular condylar morphology in diverse maxillary-mandibular skeletal patterns: A 3-dimensional cone-beam computed tomography study[J]. J Am Dent Assoc, 2018, 149(7): 589-598. doi: S0002-8177(18)30121-1 pmid: 29655707
[14]	Ueki K, Nakagawa K, Takatsuka S, et al. Comparison of the stress direction on the TMJ in patients with Class Ⅰ, Ⅱ, and Ⅲ skeletal relationships[J]. Orthod Craniofac Res, 2008, 11(1):43-50. doi: 10.1111/j.1601-6343.2008.00413.x pmid: 18199079
[15]	Westesson PL, Bifano JA, Tallents RH, et al. Increased horizontal angle of the mandibular condyle in abnormal temporomandibular joints. A magnetic resonance imaging study[J]. Oral Surg Oral Med Oral Pathol, 1991, 72(3): 359-363.
[16]	Katsavrias EG. Changes in articular eminence inclination during the craniofacial growth period[J]. Angle Orthod, 2002, 72(3): 258-264. pmid: 12071610
[17]	Tariq QUA, Jan A. Condylar size and position, comparison among different sagittal skeletal relationships: A CBCT study[J]. J Coll Physicians Surg Pak, 2023, 33(5): 509-515. doi: 10.29271/jcpsp.2023.05.509 pmid: 37190683
[18]	Fan XC, Ma LS, Chen L, et al. Temporomandibular joint osseous morphology of class Ⅰ and class Ⅱ malocclusions in the normal skeletal pattern: A cone-beam computed tomography study[J]. Diagnostics, 2021, 11(3): 541.
[19]	Lobo F, Tolentino ES, Iwaki LCV, et al. Imaginology tridimensional study of temporomandibular joint osseous components according to sagittal skeletal relationship, sex, and age[J]. J Craniofac Surg, 2019, 30(5): 1462-1465. doi: 10.1097/SCS.0000000000005467 pmid: 31299744
[20]	Christiansen EL, Chan TT, Thompson JR, et al. Computed tomography of the normal temporomandibular joint[J]. Scand J Dent Res, 1987, 95(6): 499-509. doi: 10.1111/j.1600-0722.1987.tb01966.x pmid: 3480568
[21]	Yasa Y, Akgül HM. Comparative cone-beam computed tomography evaluation of the osseous morphology of the temporomandibular joint in temporomandibular dysfunction patients and asymptomatic individuals[J]. Oral Radiol, 2018, 34(1): 31-39. doi: 10.1007/s11282-017-0279-7 pmid: 30484086
[22]	Meral SE, Karaaslan S, Tüz HH, et al. Evaluation of the temporomandibular joint morphology and condylar position with cone-beam computerized tomography in patients with internal derangement[J]. Oral Radiol, 2023, 39(1): 173-179.
[23]	郭向红, 丁寅, 房伟, 等. 不同矢状骨面型颞下颌关节窝位置的测量研究[J]. 临床口腔医学杂志, 2007, 23(5): 275-277.
[24]	Gong AX, Li J, Wang ZD, et al. Cranial base characteristics in anteroposterior malocclusions: A meta-analysis[J]. Angle Orthod, 2016, 86(4): 668-680. doi: 10.2319/032315-186.1 pmid: 26528732
[25]	Al Maaitah EF, Alomari S, Al-Khateeb SN, et al. Cranial base measurements in different anteroposterior skeletal relationships using Bjork-Jarabak analysis[J]. Angle Orthod, 2022, 92(5): 613-618.