错牙合畸形患者髁突位置及正畸治疗前后髁突位置变化的CBCT评估

Evaluation of condylar position in patients with malocclusion and changes in condylar position before and after orthodontic treatment using cone beam computed tomography

摘要

口颌系统的功能健康、稳定是口腔正畸治疗的基本目标之一。健康人群的下颌处于牙尖交错位（intercuspal position，ICP）时髁突位置基本位于关节窝的中央，颞下颌关节功能稳定。错牙合畸形患者由于正畸牙齿移动及咬合改变，可能发生颞下颌关节的相关改建，特别是髁突位置的改变。传统的髁突位置的评估方法是通过牙合架来转移下颌位置，然后在髁突位置测量仪上进行测量，但此方法得到的髁突位置变化缺乏一致性。近年来，锥形束CT（cone beam computed tomography，CBCT）成为正畸治疗检查的首选，CBCT可精准地测量关节间隙，确定髁突位置的改变。本文对髁突位置的CBCT评估及正畸治疗前后的错牙合畸形髁突位置变化的研究进行综述。文献复习结果表明，不同错牙合畸形患者的髁突位置存在差异，正畸治疗前后髁突位置也可能发生变化，使用CBCT可以较低的辐射剂量和更高的精确度评价错牙合畸形的髁突位置，有助于进一步研究错牙合畸形患者髁突位置变化的机制，并为患者治疗提供更准确、个性化的指导。

Abstract

The functional health and stability of the oral and maxillofacial system is one of the basic goals of orthodontic treatment. Currently, it is believed that, in general, the condyle is located in the center of the joint fossa when the mandible is in an intercuspal position (ICP) in healthy normal people. At this time, the function of the temporomandibular joint (TMJ) is stable. Due to orthodontic tooth movement and subsequent occlusal changes, patients with malocclusion may experience related remodeling of the temporomandibular joint, especially changes in the position of the condyle. The position of the mandibular condyle is traditionally evaluated using a condylar position indicator. However, this method lacks consistency in obtaining condylar position changes. In recent years, in the clinical application of orthodontic treatment, cone beam computed tomography (CBCT) has become the first choice for examination. CBCT can accurately measure the interarticular space and determine changes in condylar position. This article reviews the CBCT assessment of condylar position and related research on condylar position changes in patients with malocclusion before and after orthodontic treatment. The literature review results indicate that there are differences in the condylar position of patients with different malocclusions, and the condylar position may also change before and after orthodontic treatment. With a lower radiation dose, CBCT has higher accuracy in evaluating the condylar position in patients with malocclusion who undergo orthodontic treatment, thus promoting further study of the mechanism of condylar position changes in patients with malocclusion in the future and providing more accurate and personalized guidance for patient treatment.

关键词

髁突位置 / 锥形束CT / 正畸治疗 / 错牙合畸形 / 颞下颌关节 / 安氏分类 / 垂直骨面型 / 颞下颌关节紊乱综合征

Key words

condylar position / cone beam computed tomography / orthodontic treatment / malocclusion / temporomandibular joint / Angle’s classification / vertical facial types / temporomandibular joint disorder syndrome

Author summay

潘逸华，住院医师，硕士研究生，Email: [e-mail]