Nojima Kunihiko, Nagata Mai, Ootake Tomohisa, Nishii Yasushi, Yakushiji Takashi, Narita Masato, Takano Nobuo, Sueishi Kenji
Department of Orthodontics, Tokyo Dental College.
Nagata Orthodontic Office.
Bull Tokyo Dent Coll. 2019 Jun 21;60(2):139-149. doi: 10.2209/tdcpublication.2018-0047. Epub 2019 Apr 10.
Here, we report retention following surgical orthodontic treatment in a patient with vertical maxillary excess associated with temporomandibular joint osteoarthritis (TMJOA) and marked mandibular retrusion. The patient was a man aged 20 years 10 months who presented with the chief complaint of maxillary protrusion. The facial profile was of the convex type due to marked mandibular retrusion. In addition, the patient had a gummy smile. Intraoral findings revealed a Class II molar relation, +11 mm overjet, and 0 mm overbite. Mandibular dentition arch length discrepancy showed crowding of -2 mm, and the maxillary dentition showed a spaced arch of +5 mm. Panoramic radiographs confirmed flattening of the condylar head and proliferation of the bone margin. Cephalometric analysis of the skeletal pattern revealed that, horizontally, the maxilla was anterior and the mandible posterior; vertically, a dolichofacial pattern was noted. The anterior maxillary tooth axis was standard, but the anterior mandibular tooth axis showed labial inclination. Based on these findings, skeletal maxillary protrusion associated with TMJOA was diagnosed. Surgical orthodontic treatment comprised bilateral mandibular first premolar extraction with two-jaw surgery and genioplasty. Orthodontic treatment was performed with a multibracket system using a 0.22-slot pre-adjusted edgewise appliance. At 2 years and 11 months after initiation of treatment, the maxilla was transposed 6 mm upwards by orthognathic surgery and the mandible 17 mm anteriorly and 5 mm upwards by counterclockwise rotation. At 3 years and 10 months, the Pogonion was moved 6 mm anteriorly by genioplasty. At 4 years, orthodontic treatment was concluded on confirming satisfactory occlusion and improvement in facial features. At 2 years after completion of treatment, occlusion and the maxillofacial morphology remain stable, with almost no relapse. In addition, no temporomandibular joint disorder symptoms have occurred. Careful comprehensive follow-up observation will be continued.
在此，我们报告了一例患有垂直性上颌骨过度生长并伴有颞下颌关节骨关节炎（TMJOA）及明显下颌后缩的患者接受外科正畸治疗后的保持情况。患者为一名20岁10个月的男性，主诉为上颌前突。由于明显的下颌后缩，面部侧貌呈凸面型。此外，患者存在露龈笑。口内检查发现磨牙关系为Ⅱ类，覆盖为+11mm，覆合为0mm。下颌牙弓长度差异显示拥挤度为-2mm，上颌牙列显示牙弓间隙为+5mm。全景X线片证实髁突头部扁平及骨边缘增生。头颅侧位片的骨骼分析显示，水平方向上，上颌在前，下颌在后；垂直方向上，呈现长面型。上颌前牙轴正常，但下颌前牙轴呈唇倾。基于这些发现，诊断为与TMJOA相关的骨骼性上颌前突。外科正畸治疗包括双侧下颌第一前磨牙拔除术、双颌手术及颏成形术。正畸治疗采用多托槽系统，使用0.22英寸槽沟的预成直丝弓矫治器。治疗开始后2年11个月，通过正颌手术将上颌向上移位6mm，下颌逆时针旋转向前移位17mm并向上移位5mm。3年10个月时，通过颏成形术将颏点向前移动6mm。4年时，在确认咬合满意及面部特征改善后结束正畸治疗。治疗完成后2年，咬合及颌面形态保持稳定，几乎没有复发。此外，未出现颞下颌关节紊乱症状。将继续进行仔细的综合随访观察。
