Ryakhovsky A N, Ryakhovsky S A
Central Research Institute of Dentistry and Maxillofacial Surgery, Moscow, Russia.
Avantis Dental Clinic, Moscow, Russia.
Stomatologiia (Mosk). 2025;104(4):73-82. doi: 10.17116/stomat202510404173.
To develop a technique for 3D analysis of the upper part of the cervical spine, to study possible correlations with temporomandibular joint (TMJ) parameters in patients with signs of its dysfunction.
The data from cone beam computed tomography (CBCT) of the heads of 92 patients who sought treatment for TMJ dysfunction (49 people), comprehensive dental treatment (28 people), and orthognathic surgical treatment (15 people) were analyzed. Patients with signs of TMJ dysfunction were divided into 2 subgroups: 1 - patients with asymmetric narrowing of the articular gap (24 people); 2 - patients with symmetrical narrowing (25 people). The width of the articular gap in the posterior and upper thirds was chosen as the main parameters of the TMJ. To analyze the cervical spine, a technique was developed that determines the rotation of the cervical vertebrae; lateral tilt of the cervical vertebrae; anteroposterior tilt of the cervical vertebrae; distance from the tooth (2nd vertebra) to the atlas (1st vertebra); postural compensation.
Contrary to expectations, we found no signs of even a weak relationship between the studied parameters of the TMJ and the cervical spine within the entire group of subjects (the correlation coefficients were 0.17-0.22). However, it was noted that there was a pronounced mutual dependence between violations of the ratios of the elements of the TMJ and the parameters of displacement of the cervical vertebrae in patients of the 1st subgroup.
Any methods of fixing the patient's head can distort its natural position during a CBCT scan, especially its postural balance. Therefore, such an analysis and analysis of the anteroposterior tilt of the vertebrae were intentionally excluded for the study. Nevertheless, the study showed that even with standard methods of conducting CBCT examinations with stops for the patient's head, it is possible to reliably record and quantify disorders not only of the TMJ, but also of the cervical spine.
开发一种用于颈椎上部三维分析的技术，研究其与颞下颌关节（TMJ）功能障碍体征患者TMJ参数之间可能存在的相关性。
分析了92例因TMJ功能障碍（49例）、综合牙科治疗（28例）和正颌外科治疗（15例）而寻求治疗的患者头部锥形束计算机断层扫描（CBCT）数据。有TMJ功能障碍体征的患者分为2个亚组：1-关节间隙不对称变窄的患者（24例）；2-关节间隙对称变窄的患者（25例）。选择关节间隙后上部三分之一处的宽度作为TMJ的主要参数。为了分析颈椎，开发了一种确定颈椎旋转、颈椎侧倾、颈椎前后倾、从齿状突（第二颈椎）到寰椎（第一颈椎）的距离以及姿势代偿的技术。
与预期相反，在整个受试者组中，我们未发现所研究的TMJ参数与颈椎之间存在哪怕是微弱关系的迹象（相关系数为0.17 - 0.22）。然而，值得注意的是，在第一亚组患者中，TMJ各组成部分比例失调与颈椎位移参数之间存在明显的相互依赖性。
在CBCT扫描过程中，任何固定患者头部的方法都可能扭曲其自然位置，尤其是其姿势平衡。因此，本研究有意排除了这种分析以及对椎体前后倾的分析。尽管如此，研究表明，即使采用让患者头部固定的标准CBCT检查方法，也能够可靠地记录和量化不仅TMJ而且颈椎的紊乱情况。
