Kinzinger Gero, Gülden Norbert, Roth Anke, Diedrich Peter
Klinik für Kieferorthopädie, Universität Aachen, RWTH, Pauwelsstr. 30, 52074 Aachen, Germany.
J Orofac Orthop. 2006 Sep;67(5):356-75. doi: 10.1007/s00056-006-0626-5.
The objective of this study was to verify the effects of treatment to correct Class II malocclusion with the Functional Mandibular Advancer (FMA) on the relative positions of the articular disc and mandibular condyle. In particular, we aimed to find out whether the disc-condyle relationship changed between baseline and post-treatment, in temporomandibular joints initially exhibiting a physiological relationship and alternatively, in temporomandibular joints initially presenting anterior displacement of the articular disc.
Treatment progress in 15 patients was monitored at defined points in time by manual structural analysis (MSA) and magnetic resonance (MR) imaging. The disc-condyle relationship was assessed by examining the parasagittal MR images made up of three slices each (lateral, central, medial) taken in habitual intercuspation and maximum-open mouth position. The MR images were metrically analyzed to determine the sagittal positional relationship of the articular disc and mandibular condyle using two methods on the central slices of the images taken in closed-mouth position. MSA was used in particular to determine the disc-condyle relationships and to metrically record the extent of active movement of the mandible during mouth opening, protrusion, laterotrusion, and retrusion.
Comparison of baseline and post-treatment findings revealed that none of the joints exhibited a treatment-induced deterioration in the disc-condyle relationship, while the relationship improved in five joints. After categorization of the joints according to groups according to disc position, metric analysis of the MR images showed significantly-improved post-treatment disc positions in the joints that had initially exhibited anterior disc displacement. Post-treatment findings for maximum-open mouth position, protrusion, and laterotrusion corresponded to the baseline values recorded before bite-jumping, and the extent of maximum active retrusion increased significantly.
Functional jaw orthopedics for correction of skeletal Class II with the rigid fixed FMA leads to side-effects reflected in the disc-condyle relationship in the temporomandibular joints: no adverse effects were observed in joints presenting an initial physiological disc-condyle relationship, whereas the disc position may improve in joints with initial partial or total anterior disc displacement. In comparison with the baseline findings, we observed no post-treatment restriction in the extent of maximum mouth opening, protrusion, and left and right laterotrusion. Maximum active retrusion increased due to the treatment. MR imaging and MSA only partly cover the same aspects of temporomandibular joint diagnostics.
本研究的目的是验证使用功能性下颌前导器（FMA）矫正II类错牙合对关节盘和下颌髁突相对位置的影响。具体而言，我们旨在了解在颞下颌关节中，最初表现为生理关系的关节以及最初表现为关节盘前移的颞下颌关节，在基线和治疗后关节盘-髁突关系是否发生变化。
通过手动结构分析（MSA）和磁共振（MR）成像在特定时间点监测15例患者的治疗进展。通过检查在习惯性牙尖交错位和最大开口位拍摄的由三个切片（外侧、中央、内侧）组成的矢状面MR图像来评估关节盘-髁突关系。对MR图像进行测量分析，使用两种方法在闭口位图像的中央切片上确定关节盘和下颌髁突的矢状位置关系。MSA尤其用于确定关节盘-髁突关系，并测量记录下颌在开口、前伸、侧方运动和后退时的主动运动程度。
基线和治疗后结果比较显示，没有关节表现出治疗引起的关节盘-髁突关系恶化，而有五个关节的关系得到改善。根据关节盘位置对关节进行分组后，对MR图像的测量分析显示，最初表现为关节盘前移的关节在治疗后关节盘位置有显著改善。最大开口位、前伸和侧方运动的治疗后结果与咬合跳跃前记录的基线值相对应，最大主动后退程度显著增加。
使用刚性固定的FMA进行功能性颌骨矫形治疗以矫正骨骼II类错牙合会导致颞下颌关节中关节盘-髁突关系出现副作用：在最初表现为生理关节盘-髁突关系的关节中未观察到不良影响，而在最初有部分或完全关节盘前移的关节中关节盘位置可能改善。与基线结果相比，我们观察到治疗后最大开口、前伸以及左右侧方运动的程度没有受限。治疗使最大主动后退增加。MR成像和MSA仅部分涵盖颞下颌关节诊断的相同方面。
