伴颞下颌关节紊乱病症状的偏侧咀嚼者咬合分析

doi:10.7518/hxkq.2022.04.014

华西口腔医学杂志 ›› 2022, Vol. 40 ›› Issue (4): 457-467.doi: 10.7518/hxkq.2022.04.014

伴颞下颌关节紊乱病症状的偏侧咀嚼者咬合分析

章巧¹(), 黄东宗¹^,², 翟孝庭¹^,², 李鸿波¹, 胡敏¹, 刘洪臣¹, 姜华¹()

^1.解放军总医院第一医学中心口腔科，北京 100853
^2.解放军医学院，北京 100853

收稿日期:2021-12-09 修回日期:2022-04-20 出版日期:2022-07-25 发布日期:2022-07-27
通讯作者: 姜华 E-mail:qiaoyueyiyi@126.com;jh1225@163.com
作者简介:章巧，硕士，E-mail：qiaoyueyiyi@126.com
基金资助:
国家自然科学基金(81970957);解放军总医院医疗大数据与人工智能研发项目(2019MBD-013)

Occlusal analysis of patients with chewing side preference and symptoms of temporomandibular disorders

Zhang Qiao¹(), Huang Dongzong¹^,², Zhai Xiaoting¹^,², Li Hongbo¹, Hu Min¹, Liu Hongchen¹, Jiang Hua¹()

^1.Dept. of Stomatology, The First Medical Center, Chinese PLA General Hospital, Beijing 100853, China
^2.Medical School of Chinese PLA, Beijing 100853, China

Received:2021-12-09 Revised:2022-04-20 Online:2022-07-25 Published:2022-07-27
Contact: Jiang Hua E-mail:qiaoyueyiyi@126.com;jh1225@163.com
Supported by:
The National Natural Science Foundation of China(81970957);Research and Development Project of Medical Big Data and Artificial Intelligence in Chinese PLA General Hospital(2019MBD-013);Correspondence: Jiang Hua, E-mail: jh1225@163.com

摘要/Abstract

摘要：

目的　采用TeeTester数字化咬合系统比较分析伴颞下颌关节紊乱病（TMD）症状的偏侧咀嚼者和非偏侧咀嚼者的咬合情况。方法　根据调查问卷和口腔检查筛查出80名受试者，分为4组：伴TMD症状的偏侧咀嚼者20名，不伴TMD症状的偏侧咀嚼者20名，伴TMD症状的非偏侧咀嚼者20名，不伴TMD症状的非偏侧咀嚼者20名。使用TeeTester数字化咬合系统测定4组对象的全牙列最大接触面积、全牙列最大咬合力、𬌗力不对称指数、咬合力中心点、咬合接触时间、分离时间等。采用SPSS 25.0软件进行统计分析。结果　牙尖交错位时，4组的全牙列最大咬合力、最大咬合接触面积差异有统计学意义（P<0.05）；伴/不伴TMD症状的偏侧咀嚼组习惯侧与非习惯侧咬合力分布比较差异有统计学意义（P<0.05）；4组的咬合力中心点、中心点偏移方向、中心点距中线垂直距离差异有统计学意义（P<0.05）。经Spearman相关性分析，习惯侧最大咬合力、习惯侧最大接触面积、咬合力中心点与偏侧咀嚼呈正相关（P<0.05），全牙列最大咬合力、最大接触面积与TMD呈负相关（P<0.05）。结论　1）伴TMD症状的偏侧咀嚼者和伴TMD症状的非偏侧咀嚼者的咬合特点存在一定的差异，数字化咬合系统为动态评估偏侧咀嚼者的咬合情况提供了客观参数。2）咬合分析指标中习惯侧最大咬合力、最大接触面积、咬合力中心点与偏侧咀嚼呈正相关。偏侧咀嚼引起的异常咬合（全牙列最大咬合力，最大接触面积）与TMD呈负相关。

关键词: 偏侧咀嚼, 数字化咬合系统, 颞下颌关节紊乱病, 咬合

Abstract:

Objective In this study, TeeTester digital occlusal analysis system was used to analyse the occlusal characteristics of chewing side preference (CSP) and non-CSP patients with TMD symptoms. Methods According to the questionnaire and oral examination, 80 subjects were screened and divided into four groups: 20 CSP patients with TMD symptoms, 20 CSP patients without TMD symptoms, 20 non-CSP patients with TMD symptoms, 20 non-CSP patients without TMD symptoms. TeeTester digital occlusal system was applied to measure the occlusal characteristics in all four groups, including total contect area (TCA), total occlution force (TOF), distribution of occlusal force (DOF), asymmetric index of occlusal force (AOF), occlusal time (OT), disclusion time (DT) and center of occlusal force(COF). SPSS 25.0 was used to analyze the statistical data. Results At intercuspal position, the data reveals significant differences in the maximum TOF and TCA among the four groups (P<0.05). There was significant difference in the distribution of occlusal force between the preferred side and the other side of CSP patients with or without TMD symptoms (P<0.05). Among the four groups, there were statistically significant difference in the position of the center point of occlusal force, the direction of the center point of occlusal force, and the vertical distance between the center point of occlusal force and the center line (P<0.05). The COF, maximum TOF and TCA of the preferred side of dentition were significantly positive correla⁃ted with CSP (P<0.05), according to Spearman correlation analysis. However, the maximum TOF and TCA of the both side of dentition were significantly negative correlated with TMD symptoms (P<0.05). Conclusion 1) The occlusal characteristics of CSP patients and non-CSP patients with TMD symptoms are different. TeeTester digital occlusal analysis system provides objective parameters for the dynamic evaluation of occlusion. 2) Among all the occlusal cha⁃racteristics, maximum TOF, TCA and COF of the preferred side of dentition were positively correlated with CSP. The abnormal occlusal characteristics (maximum TOF and TCA of the whole dentition) caused by CSP are related to TMD symptoms.

Key words: chewing side preference, digital occlusal analysis system, temporomandibular disorders, occlusion

中图分类号:

R 782.6

章巧, 黄东宗, 翟孝庭, 李鸿波, 胡敏, 刘洪臣, 姜华. 伴颞下颌关节紊乱病症状的偏侧咀嚼者咬合分析[J]. 华西口腔医学杂志, 2022, 40(4): 457-467.

Zhang Qiao, Huang Dongzong, Zhai Xiaoting, Li Hongbo, Hu Min, Liu Hongchen, Jiang Hua. Occlusal analysis of patients with chewing side preference and symptoms of temporomandibular disorders[J]. West China Journal of Stomatology, 2022, 40(4): 457-467.

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组别	性别		年龄/岁
组别	男	女	年龄/岁
不伴TMD症状的非CSP	16	4	23.9±4.5
不伴TMD症状的CSP	14	6	25.9±5.7
伴TMD症状的 CSP	6	14	26.9±6.0
伴TMD症状的非CSP	6	14	27.3±6.3

组别	TOF/kg	TCA/mm²	咬合力
组别	TOF/kg	TCA/mm²	习惯侧咬合力/%	非习惯侧咬合力/%	t值	P值
不伴TMD症状的非CSP	107.1±14.5	497.5±41.0	50±7.1	50±7.1	0	>0.05
不伴TMD症状的CSP	70.9±5.8	398.7±21.8	65.1±10.6	34.9±10.6	8.96	<0.01
伴TMD症状的CSP	67.1±8.2	382.3±31.8	58.8±12.7	41.2±12.7	4.42	<0.01
伴TMD症状的非CSP	61.7±7.4	335.9±26.3	51.0±10.8	49.0±10.8	0.59	>0.05
F值	4.65	4.79
P值	0.005	0.004

组别	AOF/%	OT/s	DT/s
不伴TMD症状的非CSP	10.6±9.1	0.20±0.03	0.14±0.03
不伴TMD症状的CSP	33.1±15.9	0.32±0.08	0.15±0.04
伴TMD症状的CSP	24.5±18.5	0.27±0.05	0.19±0.04
伴TMD症状的非CSP	15.0±15.3	0.35±0.05	0.16±0.03
F值	8.87	1.30	0.44
P值	<0.01	>0.05	>0.05

组别	COF位置		COF距中线垂直距离/mm	COF偏移方向
组别	灰圈内	灰圈外	COF距中线垂直距离/mm	左侧	右侧	中线
不伴TMD症状的非CSP	18	2	4.49±0.82	5	10	5
不伴TMD症状的CSP	9	11	10.98±1.18	8	12	0
伴TMD症状的CSP	8	12	7.47±0.99	8	12	0
伴TMD症状的非CSP	15	5	5.53±0.94	5	8	7
χ²/F值	14.72（χ²值）		8.29（F值）	15.10（χ²值）
P值	<0.01		<0.01	<0.05

组别	TOF/kg	TCA/mm²	AOF/%	OT/s	DT/s
不伴TMD症状的非CSP	56.1±8.3	325.1±29.7	18.2±14.0	0.55±0.22	0.61±0.13
不伴TMD症状的CSP	38.3±8.3	258.6±33.5	25.9±18.6	0.51±0.09	0.64±0.18
伴TMD症状的CSP	42.5±5.1	281.4±24.3	25.8±18.6	0.86±0.36	1.26±0.37
伴TMD症状的非CSP	44.6±7.9	256.9±30.9	22.2±16.5	0.63±0.13	1.37±0.53
F值	1.03	1.13	0.93	0.490	1.37
P值	0.387	0.340	0.432	0.691	0.26

伴颞下颌关节紊乱病症状的偏侧咀嚼者咬合分析

Occlusal analysis of patients with chewing side preference and symptoms of temporomandibular disorders

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组别	TOF/kg	TCA/mm²	AOF/%	OT/s	DT/s
不伴TMD症状的非CSP	67.9±11.4	358.1±35.8	21.3±18.9	0.26±0.03	0.45±0.10
不伴TMD症状的CSP	51.6±6.6	312.2±25.2	28.5±17.2	0.34±0.05	0.37±0.08
伴TMD症状的CSP	39.3±5.4	270.4±27.1	35.8±23.1	1.06±0.32	1.02±0.28
伴TMD症状的非CSP	49.0±7.2	287.0±30.8	22.0±20.6	0.40±0.10	0.95±0.25
F值	2.22	1.62	2.27	a	a
P值	>0.05	>0.05	>0.05	<0.05	>0.05

组别	TOF/kg	TCA/mm²	AOF/%	OT/s	DT/s
不伴TMD症状的非CSP	68.8±11.5	372.3±36.3	13.7±6.5	0.29±0.05	0.45±0.14
不伴TMD症状的CSP	39.7±5.8	261.1±36.6	22.9±5.1	0.40±0.07	0.44±0.13
伴TMD症状的CSP	32.6±5.2	242.7±23.5	7.0±7.6	1.17±0.39	1.13±0.40
伴TMD症状的非CSP	49.5±7.0	291.0±28.7	11.5±6.3	0.29±0.05	0.67±0.21
F值	4.09	3.85	0.59	a	a
P值	0.010	0.013	0.627	0.054	0.733

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