牙齿重度磨耗患者咬合重建的临床评估和颞下颌关节影像分析

摘要

目的:探讨采用固定或可摘局部义齿对牙齿重度磨耗患者进行咬合重建修复的临床效果及影像学变化.方法:选择2015年3月至2017年1月牙齿重度磨耗需咬合重建的患者20例,按照修复方式的不同分为两组,10例固定义齿修复设为A组,10例可摘局部义齿修复设为B组.选择10名正常(牙合)成年人作为对照组(C组).比较A、B组修复前后关节症状、关节间隙和髁突位置、咀嚼效率变化,同时与C组指标进行对比.结果:修复后A、B组部分关节症状明显改善,但组间差异无统计学意义(P＞0.05).修复前A、B组关节前间隙增大,后间隙减小,上间隙略减小,与C组相对应的关节间隙进行比较,差异有统计学意义(P＜0.05),髁突向后上移位;咬合重建升高咬合后,关节前间隙减小,后间隙增加,上间隙略增加,三组关节间隙差异无统计学意义(P＞0.05),髁突向前下移位.修复前A、B组咀嚼效率较C组低,差异有统计学意义(P＜0.05);咬合重建后A、B组咀嚼效率较修复前显著增大,同时三组间差异有统计学意义(P＜0.05).结论:采取固定义齿和可摘局部义齿对牙齿重度磨耗患者进行咬合重建,两者均能改善关节症状,恢复牙列完整性,改变髁突位置,提高咀嚼功能.%Objective:To investigate the clinical effect and imaging changes of fixed or removable partial denture in occlusal reconstruction for patients with severe tooth abrasion.Methods:20 patients with severe tooth abrasion and indicated for occlusal reconstruction were recruited,and divided into two groups according to different repair methods.10 patients with fixed denture repair were set as Group A,and 10 patients with removable partial denture were set as Group B.10 normal adults with normal occlusion were selected as the control group (Group C).Changes of joint symptoms,joint space,condylar position,and chewing efficiency in Groups A and B before and after treatments were evaluated.by comparing with Group C.Results:Partial joint symptoms of Groups A and B were improved after treatments,but there was no significant difference between the groups (P＞0.05).Before treatments,the anterior joint space,posterior joint space and upper joint space of Groups A and B increased,decreased and slightly decreased respectively,and their differences with the corresponding joint space of Group C were statistically significant (P＜0.05).And the condyles were shifted up and backward;There was no significant difference in the joint space between the three groups after increasing the occlusion through occlusal reconstruction (P＞ 0.05).The anterior joint space,posterior joint space and upper joint space respectively decreased,increased and slightly increased,and the condyles moved forward and downward.The chewing efficiency of group A and group B were lower than those of Group C before Treatment,the difference was statistically significant (P＜0.05);After occlusal reconstruction,the chewing efficiencies of Groups A and B were significantly higher than those before repair,and the difference between the three groups was statistically significant(P＜0.05).Conclusion:Using fixed and removable partialdentures for the occlusal reconstruction of patients with severe tooth abrasion both can relieve joint symptoms,restore dentition integrity,change the condyle position and improve chewing function.