摘要
目的：利用锥形束计算机断层扫描（CBCT）和电子咬合架技术，评估安氏II类错𬌗患者正畸治疗前后颞下颌关节（TMJ）形态及位置变化，以及下颌功能性运动的改变。
方法：回顾性纳入82名成年患者（女性43名，男性39名；年龄18-35岁），包括54名安氏II类1分类和28名安氏II类2分类错𬌗患者。所有参与者接受综合正畸治疗。其中，II类1分类患者中20名非拔牙治疗，13名单弓拔牙，21名双弓拔牙；所有II类2分类患者均非拔牙治疗。治疗前后进行CBCT评估TMJ形态和髁突位置，包括冠状面和矢状面关节间隙、轴向髁突角、髁突高度、长度、矢状倾斜度及关节窝形态。使用电子咬合架评估下颌功能性运动，包括切导前伸运动、侧方运动、开闭口运动、髁突运动轨迹和前伸髁突倾斜度。主要比较II类1类和2类患者治疗前后的变化。由于各亚组样本量有限，仅作为探索性亚组分析，对II类1分类患者按拔牙模式进行了额外分析。
结果：在安氏II类1分类错𬌗患者中，治疗后髁突大小、矢状倾斜度、关节间隙或关节窝形态无明显整体变化（P > 0.05），但切导前伸运动距离显著减少（P = 0.020）。探索性拔牙模式亚组分析提示髁突长度、高度、矢状倾斜度、前关节间隙和切导前伸范围有轻微变化，但由于各亚组患者数量少，需谨慎解读。在安氏II类2分类错𬌗患者中，治疗后双侧髁突长度、高度和矢状倾斜度显著增加。左侧前、右侧前和左侧上关节间隙减小，而双侧后关节间隙增加。右侧后斜面角减小，双侧髁突前伸轨迹角减小。切导前伸、侧方运动或开闭口距离未见显著变化。
结论：正畸治疗与成人安氏II类错𬌗患者的适应性TMJ重塑相关。安氏II类1分类患者总体结构稳定，功能变化有限，尽管探索性分析提示不同拔牙亚组存在适度的重塑模式。相比之下，安氏II类2分类患者在髁突尺寸、矢状倾斜度、关节间隙和前伸髁突轨迹方面表现出更明显的变化。总体而言，下颌功能性运动的变化有限。由于拔牙模式亚组分析是探索性的且基于相对较小的样本，这些结果不应被过度解释为拔牙相关TMJ重塑的确凿证据。
原文摘要
OBJECTIVE: This study aimed to evaluate the morphological and positional changes in the temporomandibular joint (TMJ), as well as alterations in mandibular functional movement, before and after orthodontic treatment in patients with Class II malocclusion using cone-beam computed tomography (CBCT) and electronic articulator technology.
METHODS: A total of 82 adult patients (43 females, 39 males; aged 18-35 years) were retrospectively enrolled, including 54 with Class II Division 1 and 28 with Class II Division 2 malocclusion. Sample size adequacy was evaluated before data analysis, and the final sample size met the minimum requirement for the primary subtype-specific pre-treatment and post-treatment comparisons. All participants underwent comprehensive orthodontic treatment. Among Class II Division 1 patients, 20 were treated without extraction, 13 underwent single-arch extraction, and 21 underwent double-arch extraction; all Class II Division 2 patients were treated without extraction. CBCT was performed before and after treatment to evaluate TMJ morphology and condylar position, including coronal and sagittal joint spaces, axial condylar angle, condylar height, condylar length, condylar sagittal inclination, and glenoid fossa morphology. Mandibular functional movements were assessed using an electronic articulator, including incisal protrusive movement, lateral excursion, mouth opening-closing movement, condylar movement trajectory, and protrusive condylar inclination. The main comparisons were conducted before and after treatment within Class II Division 1 and Class II Division 2 patients. In Class II Division 1 patients, additional analyses according to extraction pattern were performed only as exploratory subgroup analyses because of the limited sample size in each subgroup.
RESULTS: In patients with Class II Division 1 malocclusion, no significant overall changes were observed in condylar size, sagittal inclination, joint space, or fossa morphology after treatment (P > 0.05), whereas the incisal protrusive movement distance significantly decreased (P = 0.020). Exploratory extraction-pattern subgroup analyses suggested mild changes in condylar length, condylar height, sagittal inclination, anterior joint space, and incisal protrusive range; however, these findings should be interpreted cautiously because of the small number of patients in each subgroup. In patients with Class II Division 2 malocclusion, bilateral condylar length, height, and sagittal inclination increased significantly following treatment. The left anterior, right anterior, and left superior joint spaces decreased, whereas the posterior joint spaces increased bilaterally. The right posterior slope angle decreased, while the condylar protrusive trajectory angle decreased bilaterally. No significant changes were observed in incisal protrusion, lateral excursion, or mouth opening and closing distances.
CONCLUSIONS: Orthodontic treatment was associated with adaptive TMJ remodeling in adult patients with Class II malocclusion. Patients with Class II Division 1 malocclusion showed overall structural stability with limited functional changes, although exploratory analyses suggested modest remodeling patterns across different extraction subgroups. In contrast, patients with Class II Division 2 malocclusion exhibited more pronounced changes in condylar dimensions, sagittal inclination, joint spaces, and protrusive condylar trajectory. Overall, changes in mandibular functional movements were limited. Because extraction-pattern subgroup analyses were exploratory and based on relatively small samples, these results should not be overinterpreted as definitive evidence of extraction-related TMJ remodeling.
出处
Clinical oral investigations 2026;30(9). DOI: 10.1007/s00784-026-07082-5.
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