Section of Orthodontics, Aarhus University, Vennelyst Blvd 9, 8000 Aarhus, Denmark.
Department of Economics, Leibniz University Hannover, Am Königsworther Platz 1, 30167 Hannover, Germany.
Eur J Orthod. 2024 Apr 1;46(2). doi: 10.1093/ejo/cjae005.
Juvenile idiopathic arthritis (JIA) frequently affects the temporomandibular joint (TMJ), which can alter mandibular growth and development and result in dentofacial deformities.
To assess the outcomes of orthopedic treatment with distraction splint (DS) in patients with JIA-related dentofacial deformity.
The retrospective study involved 30 patients with JIA and unilateral TMJ involvement, another study group of 20 patients with JIA and bilateral TMJ involvement, and a control group of 18 non-JIA orthodontic patients with Class II and III malocclusions. The inclusion criteria were DS treatment and cone-beam computed tomography (CBCT) scans before (T0) and 2 years after treatment (T1). Dentofacial morphology and deformity were evaluated based on a validated three-dimensional CBCT-based morphometric analysis. Intergroup differences in outcome measures were compared at T0 and T1, and intragroup changes between T0 and T1 were assessed using the Kruskal-Wallis test.
Initial evaluations at T0 revealed significant differences between the unilateral and bilateral JIA groups and the control group for three out of eight dentofacial deformity variables: inter-side difference in total posterior mandibular height, mandibular axial angle, and posterior/anterior face height (ratio). At follow-up (T1), significant inter-group differences were only observed in total posterior mandibular height indicating that intergroup differences were less pronounced after splint treatment. Assessing inter-group changes between T0 and T1 showed that all parameters remained constant except posterior/anterior face height ratio, which significantly decreased between T0 and T1.
The findings demonstrate the potential of DS treatment for patients with JIA and unilateral or bilateral TMJ involvement to generally support normal dentofacial growth or at least limit further deterioration of dentofacial deformities.
幼年特发性关节炎（JIA）常累及颞下颌关节（TMJ），可改变下颌生长发育，导致牙颌面畸形。
评估牵引夹板（DS）矫形治疗 JIA 相关牙颌面畸形的效果。
本回顾性研究纳入 30 例单侧 TMJ 受累 JIA 患者、20 例双侧 TMJ 受累 JIA 患者和 18 例非 JIA 正畸患者（安氏Ⅱ类和Ⅲ类错颌畸形）作为对照组。纳入标准为接受 DS 治疗且治疗前后均行锥形束 CT（CBCT）扫描（T0 和 T1）。基于验证后的三维 CBCT 形态计量分析评估牙颌面形态和畸形。比较 T0 和 T1 时各组间的结果测量指标差异，采用 Kruskal-Wallis 检验评估 T0 与 T1 时组内变化。
T0 时，单侧和双侧 JIA 组与对照组在 8 项牙颌面畸形变量中的 3 项存在显著差异：双侧后下颌总高度、下颌轴向角和后/前面部高度（比值）的总差值。T1 时，仅总后下颌高度存在显著组间差异，表明夹板治疗后组间差异不明显。T0 与 T1 时组间变化评估显示，除后/前面部高度比值外，所有参数均保持不变，后/前面部高度比值显著降低。
DS 治疗可支持 JIA 单侧或双侧 TMJ 受累患者的正常牙颌面生长，或至少可限制牙颌面畸形的进一步恶化。
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