基于美学修复目的咬合重建对颞下颌关节的影响(1)
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[摘要]目的：探讨以美容为目的的固定修复治疗所形成的咬合重建对颞下颌关节可能产生的影响。方法：通过固定修复、咬合重建的方法对牙列不齐、面下1/3垂直距离较短的患者，按下颌息止颌位时的面下1/3垂直距离减去2～3mm确定下颌位置并以此为标准进行修复治疗，使患者实现正常的面容及咬合形态，同时观察颞下颌关节(TMJ)的结构和功能的变化。结果：3例前牙超覆牙合、 超覆盖，面下1/3垂直距离偏短的患者进行咬合重建，均恢复了正常的咬合形态，改善了咀嚼功能和容貌，同时1例伴有TMJ症状的患者TMJ症状消失。结论：对面下1/3垂直距离不足的咬合畸形患者恢复正常的咬合形态及面下1/3垂直距离，在改善容貌和咬合功能的同时，也去除了TMD的易感(occlusion)因素，对于缓解或解除TMD症状有良好的效果。
[关键词]咬合重建；美学修复；颞下颌关节
[中图分类号]R783 [文献标识码]A [文章编号]1008-6455(2012)05-0841-02
The effects of occlusal reconstruction of esthetic prosthetic to TemporoMandibular Joint
CAO Li,YUE Su-xia
(Department of Stomatology,Baotou Central Hospital,Baotou 014040,Inner mongolia,China)
Abstract: Objective To investigate the effects to the TMJ of patients who had malocclusion were treated occlusal reconstruction of esthetic prosthodontics. Methods Three patients,I were crowded malalinment,Ⅱ were whole dental cross bite,Ⅲ were Angle Ⅱ malocclusion who had deep over bite,deep over jet,maxillary forward,mandibular retraction,decrease of vertical dimension and symptoms of TMD.Patients Ⅰ and Ⅱ were alined teeth by fixed ceramic crowns,not changed mandibular position. Patient Ⅲ were mowed mandible forward and downward according to the mandibular postural position and got occlusal reconstruction by fixed ceramic crowns. Results Three patients who had esthetic occlusal reconstruction rehabilitated normal articulation and improved masticatory movement and face.Symptoms of TMD of patient Ⅲ disappeared. Conclusion When patients of malocclusion were treated occlusal reconstruction of esthetic prosthodontics,the occlusal factors of TMD were removed and symptoms TMD eliminated.
Kye words:occlusal reconstruction;esthetic prosthodontics;TMJ
临床有许多牙列不齐或缺牙的患者要求进行固定修复以改善容貌和咬合功能。对于此类患者的治疗设计经常涉及到咬合形态的大幅度改变，特别是一些安氏Ⅱ错牙合患者，在上颌牙弓内收的同时，还伴有下颌的前移和垂直距离的升高。这种咬合重建势必会导致TMJ关节腔内髁突位置的改变和下颌运动轨迹的改变。笔者从临床病例的治疗效果探讨这种改变对TMJ的功能的影响。
1 资料和方法
1.1病例选择：本组研究选择13例精神状态良好，单颌或双颌前突，牙齿排列不齐，面下1/3垂直距离低(息止牙合间隙>5mm)，有强烈改变容貌要求的患者。
1.2治疗步骤
1.2.1制作咬合板(bite plate)：根据息止颌位时面下1/3垂直距离减去2～3mm确定修复治疗后下颌位置，并根据对颌牙合面形态制作解剖咬合板，要求患者24h佩戴，无TMJ症状佩戴1个月，有TMJ症状随时调整咬合板，直到无症状，佩戴1个月。
1.2.2佩戴咬合板1个月后患者无任何不适，左右两侧分次牙体预备，根据咬合板重新确定的下颌位置取颌记录进行固定修复
1.3典型病例：某女 ......
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