【摘要】：目的：分析下頜偏斜患者下頜分別處于正中關(guān)系(centricrelation，CR)位與最大牙尖交錯(maximum intercuspation，MI)位時咬合關(guān)系及髁突三維位置的變化，分析CR-MI髁突位置不調(diào)的臨床表現(xiàn)及相關(guān)因素，探討其對牙頜面畸形正畸診斷及治療的影響。 方法：隨機(jī)選取下頜偏斜患者50例為試驗(yàn)組，下頜非偏斜患者50例為對照組，在口內(nèi)用咬合記錄蠟分別獲取所有研究對象CR位、MI位時的咬合記錄，通過牙合叉、面弓以及咬合記錄蠟將CR位咬合關(guān)系轉(zhuǎn)移到AD2牙合架上，分別測量并比較CR位、MI位前牙覆牙合及覆蓋；記錄CR位的牙合干擾情況；采用髁突移位測量儀(measures condyle displacement，MCD)分別記錄CR位、MI位時髁突位置，并計(jì)算CR-MI髁突位置在垂直向、矢狀向及橫向的偏移量，以CR-MI偏移量在垂直向或矢狀向≥1.0mm或橫向≥0.5mm為CR-MI不調(diào)的標(biāo)準(zhǔn)統(tǒng)計(jì)CR-MI不調(diào)的頻數(shù)，比較試驗(yàn)組與對照組牙合干擾率、CR-MI不調(diào)率及CR-MI偏移量，比較試驗(yàn)組中下頜偏斜側(cè)與非偏斜側(cè)、有顳下頜關(guān)節(jié)紊亂癥(temporomandibular joint disorder，TMD)與無TMD、男性與女性間CR-MI不調(diào)率及CR-MI偏移量，并分析CR-MI不調(diào)的相關(guān)因素。 結(jié)果：(1)CR位覆牙合小于MI位覆牙合，CR位覆蓋大于MI位覆蓋，，差異均具有統(tǒng)計(jì)學(xué)意義(P0.01)；（2)CR位牙合干擾發(fā)生率在試驗(yàn)組、對照組分別為90%、72%，差異具有統(tǒng)計(jì)學(xué)意義(χ2=5.263,P=0.022)；兩組研究對象CR位牙合干擾均大多位于后牙區(qū)，分別占84%、68%；試驗(yàn)組中下頜偏斜側(cè)與非偏斜側(cè)牙合干擾率相近，分別為46%、44%；(3)CR-MI不調(diào)率在試驗(yàn)組為86%，對照組為12%，差異有統(tǒng)計(jì)學(xué)意義(χ2=54.782,P=0.000)；CR-MI偏移量試驗(yàn)組均大于對照組，差異具有統(tǒng)計(jì)學(xué)意義(P0.01)；試驗(yàn)組中下頜偏斜側(cè)與非偏斜側(cè)CR-MI不調(diào)率及CR-MI偏移量均無明顯差異(P0.05)。(4)試驗(yàn)組中有TMD組與無TMD組間CR-MI不調(diào)率及CR-MI偏移量均無明顯差異(P0.05)；試驗(yàn)組中男性患者與女性患者CR-MI不調(diào)率及CR-MI偏移量均無明顯差異(P0.05)；CR-MI橫向偏移量與前牙CR-MI覆牙合變化量及CR-MI覆蓋變化量均成正相關(guān)；CR-MI偏移量與下頜偏斜量無明顯相關(guān)性。 結(jié)論：下頜偏斜患者有較高的CR-MI不調(diào)率，CR-MI咬合關(guān)系也會發(fā)生變化，可能是其CR位存在牙合干擾所致。對于下頜偏斜人群，臨床上觀察到的咬合改變不能完全反應(yīng)髁突三維方向的變化，應(yīng)通過牙合架分析患者上下牙列真實(shí)的咬合關(guān)系及CR-MI不調(diào)情況，在此基礎(chǔ)上作出正確的診斷設(shè)計(jì)。正畸治療中應(yīng)注意消除牙合干擾的影響，注意垂直方向的控制，在CR位上建立咬合關(guān)系，以利矯治效果的穩(wěn)定性。
[Abstract]:Objective: to analyze the occlusal relationship and the change of three-dimensional position of condyle in mandibular oblique patients, and to analyze the clinical manifestation and related factors of CR-MI condylar unalignment. Objective: to study the effect of orthodontic diagnosis and treatment of maxillofacial malformation. Methods: 50 patients with mandibular deviation and 50 patients with non-oblique mandible were randomly selected as experimental group and 50 patients as control group. The occlusal records of all the subjects were obtained by occlusal recording wax, and the occlusion records of all the subjects were obtained by occlusal forks. The occlusal relation of CR position was transferred to the AD2 occlusal frame, and the overbite and overlay of the anterior teeth in CR position MI position were measured and compared, respectively, and the occlusal interference in CR position was recorded. The position of condyle in CR position was recorded by (measures condyle displacement device (MCD), and the displacement of CR-MI condyle in vertical, sagittal and transverse directions was calculated. The standard statistical CR-MI unmodulation frequency of CR-MI deviation in vertical or sagittal direction 鈮

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