Kaku Masato, Koseki Hiroyuki, Kawazoe Aki, Abedini Sara, Kojima Shunichi, Motokawa Masahide, Ohtani Junji, Fujita Tadashi, Kawata Toshitsugu, Tanne Kazuo
Dept. of Orthodontics and Craniofacial Developmental Biology, Hiroshima University, Graduate School of Biomedical Sciences, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan.
Cranio. 2011 Apr;29(2):155-63. doi: 10.1179/crn.2011.024.
At the present time, there are no reports in the literature on the treatment of temporomandibular joint disorder (TMD) by intrusion of molars using mini-screws. This case report describes the treatment for a female patient, aged 19 years seven months, with a TMD and an excessive lower anterior facial height. Overjet and overbite were +5.0 mm and +0.5 mm, respectively. The patient had a history of orthodontic treatment in which her first premolars were all extracted. During the first orthodontic treatment, a clockwise mandibular rotation was observed as a result of the increase of posterior dentoalveolar height. She had temporomandibular joint (TMJ) pain during mouth opening and complained of difficulty in eating due to masticatory dysfunction. The pretreatment Schuller views of both TMJ showed a posterior condyle position. In order to correct the overjet, molar relationship and the mandibular condyle position, a miniscrew was inserted into the palatal region of the upper first molar to intrude the upper posterior teeth. As the upper molars were intruded, the overjet was decreased, and a class I molar relationship was achieved by a counterclockwise mandibular rotation. After one year of treatment, an acceptable occlusion was achieved, and the condyle moved into centric position in the glenoid fossa. The patient's teeth continued to be stable, and she had no pain in TMJ after a retention period of three years. The result of this treatment showed that molar intrusion using miniscrew anchorage is effective for treatment of a TMD patient with a posterior condyle position.
目前，文献中尚无关于使用微型螺钉压低磨牙治疗颞下颌关节紊乱病（TMD）的报道。本病例报告描述了一名19岁7个月的女性TMD患者且下前牙面部高度过大的治疗情况。覆盖和覆合分别为 +5.0毫米和 +0.5毫米。该患者有正畸治疗史，其第一前磨牙均已拔除。在第一次正畸治疗期间，由于后牙牙槽高度增加，观察到下颌顺时针旋转。她在张口时颞下颌关节（TMJ）疼痛，并因咀嚼功能障碍而抱怨进食困难。治疗前双侧TMJ的许勒位片显示髁突位置靠后。为了纠正覆盖、磨牙关系和下颌髁突位置，在上颌第一磨牙腭侧区域植入一枚微型螺钉以压低上后牙。随着上磨牙被压低，覆盖减小，通过下颌逆时针旋转实现了I类磨牙关系。经过一年的治疗，获得了可接受的咬合，髁突在关节窝内移至正中位置。患者的牙齿持续保持稳定，在保持三年后TMJ无疼痛。该治疗结果表明，使用微型螺钉支抗压低磨牙对治疗髁突位置靠后的TMD患者有效。
