The functional shift of the mandible in unilateral posterior crossbite and the adaptation of the temporomandibular joints: a pilot study
The functional shift of the mandible in unilateral posterior crossbite and the adaptation of the temporomandibular joints: a pilot study
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DOI：
10.1093/ejo/21.2.155
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发表时间：
1999-04-01
影响因子：
2.6
通讯作者：
Solow, B
中科院分区：
文献类型：
--
作者：
Nerder, PH;Bakke, M;Solow, B
研究了 6 名 7-11 岁儿童单侧后反牙合治疗过程中下颌中线和髁突功能移位的变化。在初始诊断阶段 (I)，使用覆盖咬合面的扩展板作为反射释放稳定冲刺，以确定下颌骨的结构（即非引导）位置。同一块板用于扩张和保留（阶段 II），然后是不使用矫治器的保留后阶段（III）。在每个阶段之前和之后，通过运动学和经颅X光片通过使用和不使用夹板的同时记录来确定功能转变。还在头影测量 X 光片上记录下颌横向位置。在 I 期之前，下颌中线偏离超过 2 毫米，咬合 (ICP) 时，髁突在矢状面中显示正常居中位置。使用夹板时，与 ICP 相比，反牙合侧髁突向前移位 2.4 mm（P < 0.05），而非反牙合侧髁突位置未改变。第三阶段之后，中线的偏差已经消除。 ICP 中的矢状髁位置仍然没有偏离正常，夹板位置现在是通过两个髁突对称向前移动（1.3 和 1.4 毫米）获得的。这些发现表明，TMJ 通过髁突生长或窝表面建模来适应下颌骨的移位。治疗期间，休息位置保持在 ICP 的直接尾部。因此，应使用夹板位置而不是静止位置来确定下颌骨的治疗位置。
Changes in the functional shift of the mandibular midline and the condyles were studied during treatment of unilateral posterior crossbite in six children, aged 7-11 years. An expansion plate with covered occlusal surfaces was used as a reflex-releasing stabilizing sprint during an initial diagnostic phase (I) in order to determine the structural (i.e. non-guided) position of the mandible. The same plate was used for expansion and retention (phase II), followed by a post-retention phase (III) without the appliance. Before and after each phase, the functional shift was determined kinesiographically and on transcranial radiographs by concurrent recordings with and without the splint. Transverse mandibular position was also recorded on cephalometric radiographs.Prior to phase I, the mandibular midline deviated more than 2 mm and, in occlusion (ICP), the condyles showed normally centred positions in the sagittal plane. With the splint, the condyle on the crossbite side was displaced 2.4 mm (P < 0.05) forwards compared with the ICP, while the position of the condyle on the non-crossbite side was unaltered. After phase III, the deviation of the midline had been eliminated. Sagittal condylar positions in the ICP still did not deviate from the normal, and the splint position was now obtained by symmetrical forward movement of both condyles (1.3 and 1.4 mm).These findings suggest that the TMJs adapted to displacements of the mandible by condylar growth or surface modelling of the fossa. The rest position remained directly caudal to the ICP during treatment. Thus, the splint position, rather than the rest position should be used to determine the therapeutic position of the mandible.