【作者】 李颖；

【导师】 戴红卫；

【作者基本信息】 重庆医科大学 ， 口腔医学（专业学位）， 2022， 硕士

【摘要】 背景:颞下颌关节(temporomandibular joint,TMJ)在牙齿咬合和神经肌肉系统中起着重要作用,是人体最复杂的关节之一。研究显示,颞下颌关节的形态与其功能相关。牙列的咬合、咀嚼均可能对下颌的运动、面部肌肉产生影响,长期异常的下颌运动、肌电活动会影响颞下颌关节的功能,从而导致颞下颌关节形态的改变。切牙引导(incision guidance,IG)是咬合的关键因素之一,在正畸以及修复治疗中常涉及切牙引导角(incisal guidance angle,IGA)的改变。目前,已有研究表明切牙引导会影响颞下颌关节的功能。然而,切牙引导角与颞下颌关节形态之间的关系以及其对颞下颌关节生长发育和改建的影响尚不清楚。本研究通过使用锥形束计算机断层扫描(Cone Beam Computed Tomography,CBCT)对具有不同切牙引导角的多个年龄段患者的髁突、颞下颌关节窝的形态进行线性测量、角度测量以及主观评价,探究不同切牙引导角患者的颞下颌关节与年龄相关的形态学差异,探讨切牙引导角对颞下颌关节生长发育及改建的影响,从而为正畸和修复治疗中前牙倾斜度的控制、切牙引导的重建提供理论依据,为正畸以及修复诊断分析提供更全面准确的参考,同时对伴有颞下颌关节紊乱病(Temporomandibular joint disorder,TMD)的具有异常切牙引导角的错(牙合)患者的临床诊断、治疗计划提供治疗依据和帮助。目的:研究具有不同切牙引导角患者的颞下颌关节的形态学特征以及切牙引导角对颞下颌关节生长发育及改建的影响。方法:在重庆医科大学附属口腔医院数字影像资料库中,选取2016-2020年之间符合标准的274例CBCT影像,分为3组:正常对照组(45°≤IGA≤60°)64例,切牙引导角较小组(0°<IGA<45°)107例,切牙引导角较大组(IGA>60°)103例,并按年龄分为4组:a组(6-12岁),b组(13-16岁),c组(17-25岁),d组(26-33岁)。使用Dolphin11.9软件进行数据重建,对双侧颞下颌关节进行线性测量、角度测量和主观评估。分析3个切牙引导角组患者颞下颌关节的形态差异和随年龄增加的不同的变化趋势,以及颞下颌关节形态与切牙引导角的相关性。结果:在2个切牙引导角异常组中,髁突前斜面斜度(anterior inclination of the condyle,AIC)随年龄增加而增大,但在正常对照组中,AIC随年龄增加先增大,从17岁开始轻微减小(P<0.05);在各个年龄段中,AIC:正常对照组<IGA较小组<IGA较大组(P>0.05)。关节窝高度(height of the fossa,HF)在正常对照组中从6-12岁增加到17-25岁,然后随着年龄的增长而降低(P=0.049);在17-25岁年龄段中,IGA较小组<正常对照组(P=0.021)。关节结节倾斜度(articular eminence inclination,AEI)在3个IGA组中表现出不同的趋势:在IGA较小组中随年龄增加而减小;在正常对照组中先随年龄增加,17岁后开始减小;在IGA较大组中随年龄增加而增加(P>0.05)。在17-25岁年龄段,正常对照组的AEI大于IGA较小组(P=0.046);在26-33岁年龄段,IGA较大组的AEI大于IGA较小组(P=0.047)。切牙引导角与关节结节倾斜度(AEI)(P=0.016,r=0.145)、髁突外斜面斜度(Lateral inclination of the condyle,LIC)(P=0.022,r=-0.139)有弱的相关性。结论:随着年龄的增长,切牙引导角较小的患者往往有一个较平坦的关节窝,而切牙引导角较大的患者有一个更陡的髁突前斜面和关节结节后斜面。切牙引导角与颞下颌关节形态有较弱的相关性。更多还原

【Abstract】 Background: Temporomandibular joint(TMJ)plays an important role in tooth occlusion and neuromuscular system.It is one of the most complex joints in human body.Research shows that the morphology and function of temporomandibular joint are related.The occlusion and chewing of dentition may affect the movement of jaw and facial muscles.Long-term abnormal jaw movement and muscle electrical activity will inevitably affect the normal function of temporomandibular joint.Incision guidance(IG)is one of the key factors of occlusion.The change of incisal guidance angle is often involved in orthodontic and prosthetic treatment.At present,some studies have shown that there is a correlation between incisal guidance angle(IGA)and the function of temporomandibular joint.However,the relationship between incisal guidance angle and the morphology of temporomandibular joint and its effect on the growth,development and remodelling of temporomandibular joint are not clear.Through linear measurement,angle measurement and subjective evaluation of the morphology of condyle and temporomandibular joint fossa of patients with different incisal guidance angles,this study explores the age-related morphological differences of temporomandibular joint in patients with different incisal guidance angles,and discusses the influence of incisal guidance angles on the growth,development and reconstruction of temporomandibular joint,so as to provide a theoretical basis for the control of anterior tooth inclination,the reconstruction of clinical central incisor guidance and the influence of incisor guidance on the temporomandibular joint in orthodontic treatment and prosthetic treatment,and provide a more comprehensive and accurate reference for orthodontic and prosthetic diagnosis and analysis.At the same time,it is also helpful for the clinical diagnosis of malocclusion patients with abnormal incisal guidance angle accompanied with temporomandibular joint disorder The treatment plan provides treatment basis and help.Objective: To study the morphological characteristics of temporomandibular joint in patients with different incisal guidance angles and the effect of incisal guidance angle on the growth,development and reconstruction of temporomandibular joint.Methods: In the digital image database of the Affiliated Stomatological Hospital of Chongqing Medical University,274 CBCT images meeting the standard between 2016 and 2020 were selected and divided into three groups: 64 cases in the normal control group(45 ° ≤ IGA≤ 60 °),107 cases in the group with small incisal guidance angle(0 ° < IGA< 45 °),103 cases in the group with large incisal guidance angle(IGA >60 °),and then divided into four groups according to age: group a(6-12 years old),group b(13-16 years old),group c(17-25 years old)and group d(26-33 years old).The data were reconstructed by software Dolphin Imaging Version 11.9(Chatsworth,Calif),and the bilateral temporomandibular joints were measured by linear measurement,angle measurement and subjective evaluation.The morphological differences of temporomandibular joint and the different change trend with age in the three groups were analysed,as well as the correlation between temporomandibular joint morphology and incisal guidance angle.Result: Anterior inclination of condyle(AIC)increased with age in the three IGA groups but decreased from 17 years onward in normal control group(P < 0.05).In the age groups analysis,the AIC in small incisal guidance angle group was smaller than that in large incisal guidance angle group but larger than that in normal control group(P > 0.05).The height of the fossa(HF)tended to increase from 6-12 years to 17-25 years,and then decrease with age in normal control group(P = 0.049).The HF in small incisal guidance angle group was significantly smaller than that in normal control group in the 17-25-year-old group(P = 0.021).Articular eminence inclination(AEI)decreased with age in small incisal guidance angle group(P = 0.027)but increased with age in large incisal guidance angle group(P = 0.053).The AEI in normal control group was larger than that in small incisal guidance angle group at 17-25 years(P = 0.046),and it was larger in large incisal guidance angle group than in small incisal guidance angle group at 26–33 years(P = 0.047).IGA had a weak correlation with articular eminence inclination(AEI)(P = 0.016,r = 0.145)and lateral inclination of the condyle(LIC)(P = 0.022,r =-0.139).Conclusion: Patients with different incisal guidance angle have different condylar and articular fossa shapes,and different trends with age.Patients with more shallow incision guidance tended to have a flatter fossa with age,whereas patients with steeper incision guidance had a tendency towards a steeper anterior condylar slope and increased articular eminence inclination.The incisal guidance angle had a weak correlation with TMJ morphology.更多还原