国际口腔医学杂志

国际口腔医学杂志 ›› 2024, Vol. 51 ›› Issue (6): 687-698.doi: 10.7518/gjkq.2024087

• 口腔正畸专栏 • 上一篇    

基于颞下颌关节思考成人安氏Ⅱ2分类错 畸形的治疗

李榕(),赵青()   

  1. 口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心四川大学华西口腔医院正畸科 成都 610041
  • 收稿日期:2024-03-21 修回日期:2024-07-08 出版日期:2024-11-01 发布日期:2024-11-04
  • 通讯作者: 赵青
  • 作者简介:李榕，硕士，Email：825651703@qq.com
  • 基金资助:
    国家自然科学基金(82171003)

Treatment of adult Class Ⅱ division 2 malocclusion based on temporomandibular joint

Rong Li(),Qing Zhao()   

  1. State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
  • Received:2024-03-21 Revised:2024-07-08 Online:2024-11-01 Published:2024-11-04
  • Contact: Qing Zhao
  • Supported by:
    National Natural Science Foundation of China(82171003)

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摘要：

安氏Ⅱ2分类错畸形以前牙内倾型深覆、磨牙远中关系为特征，患者的前牙切导异常，导致下颌运动轨迹被迫后退。多数患者表现出下颌后缩，并伴有咀嚼肌疼痛、关节盘移位以及髁突位置异常等颞下颌关节紊乱症状。对于安氏Ⅱ2分类的成人患者，正畸治疗和正畸正颌联合治疗主要是改善前牙舌倾、打开咬合以及协调上下牙列和颌骨的矢状向关系，但相关治疗措施对于颞下颌关节的影响尚有争议。本文综述了成人安氏Ⅱ2分类患者的颞下颌关节特征、正畸治疗及正畸正颌联合治疗对颞下颌关节的影响，总结了有利于恢复正常盘-髁关系的咬合板治疗措施，以期能为成人安氏Ⅱ2分类患者正畸治疗的临床诊断和方案设计提供参考，最终实现咬合和关节的协调、稳定。

关键词: 安氏Ⅱ2分类错(牙合)畸形, 颞下颌关节紊乱病, 关节盘前移位, 正畸治疗, 正畸正颌联合治疗, 咬合板

Abstract:

Class Ⅱ division 2 malocclusion is characterized by the distal occlusion of the first molars and a deep overbite of the lingually inclined upper incisors. Abnormal incisal guidance leads to a retruded mandibular movement. Most patients exhibit a retruded mandible, accompanied with temporomandibular joint (TMJ) disorders, including masticatory muscle pain, disc displacement, and abnormal condylar positioning. For adult patients with Class Ⅱ division 2 malocclusion, orthodontic treatment and combined orthodontic-orthognathic treatment aim to correct deep overbite with an inward inclination and to coordinate the sagittal relationship of the upper and lower dental arches. However, the effect of these treatment measures on the TMJ remains unknown. In this study, the TMJ conditions, orthodontic treatment, combined orthodontic-orthognathic treatment, and the effects of these treatment measures in adult patients with Class Ⅱ division 2 malocclusion are reviewed. In addition, the occlusal splint treatment, which is conducive to restoring normal disc-condyle relationships, is summarized. This study aimed to provide reference for the clinical diagnosis and treatment planning of orthodontic treatment in adult Class Ⅱ division 2 patients, thereby achieving coordination and stability between occlusion and the TMJ.

Key words: Class Ⅱ division 2 malocclusion, temporomandibular disorders, anterior temporomandibular joint disc displacement, orthodontic treatment, combined ortho-dontic-orthognathic treatment, occlusal splint

中图分类号: 

  • R783.5

表 1

再定位咬合板、松弛咬合板以及稳定咬合板的特点总结"

咬合板类型优点缺点适应证参考研究
再定位咬合板可以帮助髁突主动捕获关节盘，因此关节盘复位的概率更大，有利于改善盘-髁关系咬合板治疗与正畸牙移动无法同时进行关节盘部分前移位、可复性盘前移位及不可复性盘前移位发生的3个月之内

病例对照研究[54]

自身前后对照研究[55,61]

队列研究[58]

松弛咬合板有效降低咀嚼肌张力；可以发挥前牙平导的作用、利于深覆的矫正；可以与正畸牙移动同时进行无法使髁突主动捕获关节盘，因此使关节盘复位的作用效果较弱存在咀嚼肌紊乱、亢进、痉挛的患者

自身前后对照研究[61,64-65]

随机对照研究[66]

稳定咬合板改善TMJ疼痛的效果最好；咬合板与全牙列接触，舒适度更高，适合长期佩戴无法使髁突主动捕获关节盘，因此使关节盘复位的作用效果较弱正中关系位与牙尖交错位不调；需要建立适应性正中关系位的患者

自身前后对照研究[61,71]

随机对照研究[68-69]

图 1

成人安氏Ⅱ2分类患者的咬合板治疗决策树"

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