Study of condylar motion trajectory changes before and after occlusal reconstruction in severe attrition
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摘要:
目的 对于重度磨耗患者，在下颌运动过程中，髁突的运动轨迹具有关键性意义。因此，本研究分析咬合重建治疗前后此类患者的髁突运动轨迹特性。 方法 选取2022年1月—2023年6月于蚌埠医科大学第一附属医院口腔科就诊的30例重度磨耗咬合患者为研究对象，给予咬合重建治疗后，使用CADIAX进行髁突运动轨迹描记。 结果 在开闭口运动中，不可复性盘前移位侧的Y、Z、S值治疗后降低，X轴和髁突运动始末位置距离(DIF)值升高(P＜0.05)，而可复性移位侧的X、Y、Z、S值及DIF值均降低(P＜0.05)。可复性和不可复性盘前移位侧的矢状髁道倾斜度(SCI)、水平髁道倾斜度(TCI)及5 mm位移时的这些指标同样降低(P＜0.05)。在前伸后退运动中，可复性和不可复性盘状物前移位侧沿X轴、Y轴、Z轴和S的位移及DIF治疗后显著降低(P＜0.05)。不可复性侧在5 mm位移时的SCI、TCI和最大位移时TCI治疗后均显著降低，可复性侧的TCI和5 mm位移时TCI治疗后也更低(P＜0.05)。在侧向运动中，不可复性前移位侧的X轴和Y轴位移及DIF治疗后显著降低。工作侧为可、不可复性盘前移位侧时，髁突空间位移峰值治疗后明显增加。不可复性盘前移位侧在SCI和5 mm位移时的SCI显著降低，可复性盘前移位侧的SCI同样降低(P＜0.05)。 结论 在重度磨耗患者中，髁突轨迹描记可以评估髁突运动的动态范围大小，可以作为重度磨耗患者诊疗效果评价的重要依据。 Abstract:Objective In patients with severe wear, the trajectory of the condyle is of critical importance during the mandibular movement. Therefore, the purpose of this study was to analyze the characteristics of condylar movement in such patients before and after occlusal reconstruction. Methods Thirty patients with severe attrition occlusion in the First Affiliated Hospital of Bengbu Medical University from January 2022 to June 2023 were selected as the study objects. After occlusal reconstruction, CADIAX was used to trace the condylar movement. Results During mouth opening and closing movement, the Y-axis, Z-axis, and S values on the irreducible anterior displacement side decreased after treatment, while the X-axis and position distance ofcondyle movement(DIF) values were higher after treatment (P < 0.05). However, the values of X, Y, Z, S, and DIF increased. On the reducible anterior displacement side, the X, Y, Z, S, and DIF values all decreased after treatment (P < 0.05). In addition, the sagittal condylar inclination (SCI), transversal condylar inclination (TCI), and these indicators at 5 mm displacement on the reducible anterior displacement side and irreducible anterior displacement side also decreased after treatment (P < 0.05). In the forward and backward movement, the displacement along the X, Y, Z axes, as well as the S and DIF values on both the reducible and irreducible anterior displacement sides significantly decreased after treatment (P < 0.05). In addition, SCI, TCI, and TCI at 5 mm of the irreducible anterior displacement were higher than those after treatment, and TCI and TCI at 5 mm of the reducible anterior displacement were higher than those after treatment as well (P < 0.05). In lateral movement, the X axis and Y axis displacement and the DIF were significantly reduced after treatment. When the working side had reducible or irreducible anterior displacement, the peak displacement of the condylar space increased significantly in the treatment group. In addition, the irreducible anterior displacement side had lower SCI and SCI at 5 mm displacement after treatment, while SCI of the reducible anterior displacement side also decreased (P < 0.05). Conclusion In patients with severe attrition, condylar trace can evaluate the dynamic range of condylar movement and serve as an important basis for effectiveness of diagnosis and treatment. -
Key words:
- Severe attrition /
- Occlusal reconstruction /
- Temporal-mandibular joint
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表 1 开闭口运动可复性、不可复性盘前移位侧及治疗后髁突位移比较(x±s，mm)
Table 1. Comparison of condylar displacement between reducible and irreducible anterior displacement and after treatment in open-closed movement(x±s, mm)
时间 X Y Z S DIF 可复性 不可复性 可复性 不可复性 可复性 不可复性 可复性 不可复性 可复性 不可复性 治疗前 13.85±1.47 11.12±2.18 0.42±0.37 0.40±0.35 4.66±1.02 4.62±1.41 14.31±1.56 13.25±2.26 0.43±0.46 0.36±0.74 治疗后 12.48±1.85 12.35±2.07 0.31±0.33 0.30±0.32 3.45±1.21 3.41±1.13 12.45±1.37 11.26±2.15 0.38±0.43 0.63±0.38 t值 1.257 2.117 1.081 1.086 1.677 1.648 3.125 3.897 1.015 1.351 P值 0.047 0.046 0.037 0.042 0.032 0.040 0.010 0.012 0.045 0.027 
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表 2 开闭口运动可复性、不可复性盘前移位侧及治疗后髁道倾斜度比较(x±s)
Table 2. Comparison of condylar inclination between reducible and irreducible anterior displacement and after treatment in open-closed movement(x±s)
时间 SCI(max) SCI(5 mm) TCI(max) TCI(5 mm) 可复性 不可复性 可复性 不可复性 可复性 不可复性 可复性 不可复性 治疗前 19.46±2.53 25.18±2.73 44.56±2.97 47.15±2.42 2.87±1.52 2.64±1.65 3.91±1.05 2.96±1.18 治疗后 17.45±2.48 17.24±2.19 42.98±2.73 42.65±2.14 1.18±1.32 1.03±1.18 0.82±0.85 0.73±0.76 t值 1.752 4.568 2.773 2.531 1.223 1.432 2.125 2.646 P值 0.034 0.005 0.048 0.023 0.043 0.040 0.030 0.037
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表 3 前伸后退运动可复性、不可复性盘前移位侧及治疗后髁突位移比较(x±s，mm)
Table 3. Comparison of condylar displacement between reducible and irreducible anterior displacement and after treatment in the forward and backward movement(x±s, mm)
时间 X Y Z S DIF 可复性 不可复性 可复性 不可复性 可复性 不可复性 可复性 不可复性 可复性 不可复性 治疗前 6.81±1.84 7.15±2.16 0.41±0.45 0.33±0.39 5.82±1.38 6.25±1.67 9.83±1.65 9.72±2.25 0.35±0.42 0.42±0.37 治疗后 6.13±0.73 6.57±0.84 0.15±0.25 0.11±0.21 5.02±1.34 5.38±1.48 9.01±1.25 9.14±1.38 0.24±0.21 0.25±0.26 t值 1.284 2.365 2.652 2.258 1.332 1.573 1.698 1.475 1.665 1.693 P值 0.047 0.038 0.019 0.046 0.046 0.039 0.038 0.039 0.041 0.045
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表 4 前伸后退运动可复性、不可复性盘前移位侧及治疗后髁道倾斜度比较(x±s)
Table 4. Comparison of condylar inclination between reducible and irreducible anterior displacement and after treatment in the forward and backward movement(x±s)
时间 SCI(max) SCI(5 mm) TCI(max) TCI(5 mm) 可复性 不可复性 可复性 不可复性 可复性 不可复性 可复性 不可复性 治疗前 38.65±2.24 40.18±2.97 46.81±2.65 49.12±2.64 3.65±0.21 2.53±0.76 4.25±1.61 2.42±1.51 治疗后 38.48±2.18 39.12±2.25 42.17±2.24 43.18±2.15 1.62±0.32 1.35±0.13 0.94±1.25 0.86±1.38 t值 1.675 1.724 1.445 5.075 2.552 1.638 2.892 1.549 P值 0.167 0.487 0.428 0.015 0.026 0.038 0.017 0.038
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表 5 侧方运动可复性、不可复性盘前移位侧及治疗后髁突位移比较(x±s，mm)
Table 5. Comparison of condylar displacement between reducible and irreducible anterior displacement and after treatment in the lateral movement(x±s, mm)
组别 例数 X Y Z S DIF 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 可复性前移位 非工作侧 17 6.68±1.74 7.18±1.73 0.74±0.82 0.63±0.38 5.48±1.32 5.32±1.29 8.94±1.79 9.08±1.24 0.32±0.27 0.30±0.21 工作侧 17 0.46±0.87 0.42±0.37a 0.48±0.56 0.40±0.42a 0.14±0.87 0.15±0.42a 1.73±1.21 1.01±0.34a 0.41±0.45 0.25±0.16 不可复性前移位 非工作侧 13 7.13±1.14 7.26±1.78 0.76±0.79 0.61±0.36 6.13±1.89 5.47±1.31 9.46±2.53 9.21±1.38 0.38±0.36 0.32±0.24 工作侧 13 0.95±0.92 0.43±0.51a 0.52±0.48 0.39±0.41a 0.16±0.88 0.18±0.37a 1.95±0.93 1.04±0.35a 0.58±0.67 0.26±0.18a 注：可复性、不可复性工作侧与治疗前比较，aP＜0.05。
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表 6 侧方运动可复性、不可复性盘前移位侧及治疗后髁道倾斜度比较(x±s)
Table 6. Comparison of condylar inclination between reducible and irreducible anterior displacement and after treatment in the lateral movement(x±s)
时间 SCI(max) SCI(5 mm) TCI(max) TCI(5 mm) 可复性 不可复性 可复性 不可复性 可复性 不可复性 可复性 不可复性 治疗前 38.65±2.46 40.13±2.65 46.25±2.24 48.12±2.13 6.64±2.21 7.26±2.84 7.27±2.48 7.36±2.24 治疗后 32.21±2.05 34.17±2.76 42.31±2.25 41.87±1.96 5.32±2.38 6.43±2.02 4.81±2.73 4.85±2.81 t值 5.165 4.346 1.864 5.897 2.488 0.298 2.165 1.778 P值 0.009 0.011 0.256 0.007 0.128 0.119 0.178 0.243
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