Bresin A
Department of Orthodontics, Faculty of Odontology, Göteborg University, P.O. Box 450, SE-405 30 Göteborg, Sweden.
Swed Dent J Suppl. 2001(150):1-49.
The aim of this series of investigations was to study the effect of masticatory muscle function on the growth pattern and on the internal structure of the mandible during growth. The muscular and dentoskeletal growth adaptation to prolonged bite-raising and the role of the functional state of the masticatory muscles in this adaptation were also to be elucidated. Differences in masticatory muscle function were induced in young rats by altering the consistency of the diet. Bite-raising was produced by the insertion of posterior bite blocks. Morphometric analysis of the internal bone structures of the mandible was performed on microradiographs, and videodensitometric analysis was performed on lateral radiographs and microradiographs. The effect of muscle function and bite-raising on mandibular growth was studied on a series of lateral cephalograms, superimposed on bone markers. Muscle belly, sarcomere and aponeurosis length adaptation to bite-raising was studied in situ with a digital caliper and under a microscope after fluorescent vital staining of the deep masseter muscle. A soft diet altered the pattern of growth of the mandible and reduced bone growth in the angular region. Transversal dimensions and cross-sectional area of the dentoalveolar process were smaller. Bone mass in areas possibly subjected to direct loads or bending forces was smaller. This was due to either less trabecular bone or thinner cortical bone. Only a few sites showed lower bone density. Posterior bite-blocks affected the size of the mandible as well as its growth pattern, and intruded lower molars. The soft diet influenced the effect of bite-blocks and caused less intrusion of upper molars and less inhibition of bone growth at the angular process. The deep masseter muscle adapted to bite-raising by elongation of the aponeurosis, but less in rats on a soft diet. Changes in masticatory muscle function affected the growth of the mandible in both the sagittal and transversal plane. Reduced loads on molars and condyle and smaller bending forces in other regions of the mandible possibly reduced the levels of stimulation of the osteocyte network and osteoblasts, thus inducing less trabecular bone and cortical bone formation in specific areas. In rats fed the soft diet, smaller increase in bone density represented an adaptation process in areas characterised by a lower bone apposition rate. The forces produced by the passive stretching of the masseter muscle affected the skeletal growth pattern and dental eruption. Weaker forces possibly produced by passive stretching of hypofunctional muscles resulted in more eruption of the upper molars and less inhibition of periosteal bone apposition in the angular region. Length adaptation in the masseter muscle through lengthening of the aponeurosis and dentofacial growth adaptation possibly decreased passive forces applied to teeth and skeletal structures, particularly in rats with higher functional demands. This may have caused a gradually decreasing effect of the appliance.
这一系列研究的目的是探讨咀嚼肌功能对生长过程中下颌骨生长模式及内部结构的影响。同时,还将阐明肌肉和牙-骨骼生长对长期咬升的适应性,以及咀嚼肌功能状态在这种适应性中的作用。通过改变幼鼠饮食的质地来诱导咀嚼肌功能的差异。通过在后牙区植入咬合块来实现咬升。对下颌骨内部骨结构进行形态计量分析,采用微放射照片,并对侧位X线片和微放射照片进行视频密度测定分析。在一系列叠加有骨标记物的侧位头影测量片上,研究肌肉功能和咬升对下颌骨生长的影响。在对咬肌深层进行荧光活体染色后,用数字卡尺在原位并在显微镜下研究肌腹、肌节和腱膜长度对咬升的适应性。软食改变了下颌骨的生长模式,减少了角区的骨生长。牙槽突的横向尺寸和横截面积较小。可能承受直接载荷或弯曲力的区域骨量较小。这是由于小梁骨较少或皮质骨较薄。只有少数部位骨密度较低。后牙咬合块影响下颌骨的大小及其生长模式,并使下磨牙萌出受阻。软食影响咬合块的作用,导致上磨牙萌出受阻较少,角突处骨生长受抑制较少。咬肌深层通过腱膜伸长来适应咬升,但软食喂养的大鼠适应程度较低。咀嚼肌功能的改变影响下颌骨在矢状面和横断面上的生长。磨牙和髁突上的负荷降低以及下颌骨其他区域较小的弯曲力可能降低了骨细胞网络和成骨细胞的刺激水平,从而在特定区域诱导较少的小梁骨和皮质骨形成。在喂食软食的大鼠中,骨密度较小的增加代表了骨沉积率较低区域的一种适应过程。咬肌被动拉伸产生的力影响骨骼生长模式和牙齿萌出。功能低下的肌肉被动拉伸可能产生较弱的力,导致上磨牙萌出更多,角区骨膜骨沉积受抑制较少。咬肌通过腱膜伸长实现长度适应以及牙颌面生长适应,可能减少了作用于牙齿和骨骼结构的被动力,特别是在功能需求较高的大鼠中。这可能导致矫治器的效果逐渐降低。