磨牙正锁患者颞下颌关节形态学及咬合应力下髁突三维有限元分析

doi:10.7518/hxkq.2024.2024169

华西口腔医学杂志 ›› 2025, Vol. 43 ›› Issue (1): 114-125.doi: 10.7518/hxkq.2024.2024169

磨牙正锁患者颞下颌关节形态学及咬合应力下髁突三维有限元分析

褚天昊¹^,²(), 张雪颖¹, 王浩丞¹, 马浩杰¹, 刘媛媛¹^,²()

^1.山东第二医科大学口腔医学院，潍坊 261053
^2.山东第二医科大学附属医院口腔科，潍坊 261000

收稿日期:2024-05-02 修回日期:2024-08-05 出版日期:2025-02-01 发布日期:2025-01-22
通讯作者: 刘媛媛 E-mail:1072615131@qq.com;liuyuan113@sina.com
作者简介:褚天昊，住院医师，硕士，E-mail：1072615131@qq.com
基金资助:
潍坊市卫生健康委员会项目(WFWSJK-2023-377)

Three-dimensional finite element feature analysis of the mandible and morphology and position of temporomandibular joint in patients with unilateral and bilateral molar scissor bite

Chu Tianhao¹^,²(), Zhang Xueying¹, Wang Haocheng¹, Ma Haojie¹, Liu Yuanyuan¹^,²()

^1.School of Stomatology, Shandong Second Medical University, Weifang 261053, China
^2.Dept. of Stomatology, Affilia-ted Hospital of Shandong Second Medical University, Weifang 261000, China

Received:2024-05-02 Revised:2024-08-05 Online:2025-02-01 Published:2025-01-22
Contact: Liu Yuanyuan E-mail:1072615131@qq.com;liuyuan113@sina.com
Supported by:
Weifang Health Commission Program(WFWSJK-2023-377)

摘要/Abstract

摘要：

目的通过测量单、双侧磨牙正锁患者的双侧颞下颌关节的形态及位置并模拟咬合时下颌骨受力变形情况，旨在为单、双侧磨牙正锁患者的颞下颌关节紊乱病的诊断提供依据。方法本研究为回顾性研究，根据纳入标准，选择成人安氏Ⅰ类错患者20例作为对照组，10例单侧磨牙正锁患者（单侧组）、10例双侧磨牙正锁患者（双侧组）作为实验组。患者拍摄锥形束CT，通过测量关节窝宽度、关节窝高度、关节结节倾斜度、髁突长轴、髁突短轴、髁突水平角及颞下颌关节间隙的大小，比较颞下颌关节形态和位置。利用软件模拟患者咬合情况，进行下颌骨形态三维有限元分析，评估下颌骨的受力变形情况，进一步探讨下颌骨形态受力与患者可能存在的颞下颌关节紊乱症状的关系。结果比较对照组左侧、单侧组锁侧、双侧组左侧颞下颌关节，结果显示关节上间隙单侧组小于对照组（P<0.05）；髁突长轴单、双侧组均小于对照组（P<0.05），且单侧组大于双侧组（P<0.05）；髁突短轴双侧组小于对照组（P<0.05）；髁突水平角单、双侧组均大于对照组（P<0.05）。对比对照组右侧、单侧组正常侧、双侧组右侧关节形态和位置，结果显示关节上间隙单、双侧组均小于对照组（P<0.05），髁突长轴双侧组小于对照组（P<0.05），髁突短轴单侧组正常侧大于双侧组。三维有限元分析：后牙正锁患者的髁突是咬合变形集中区域，锁侧第一磨牙咬合时，X轴与Z轴方向上，变形最大区位于髁突。X轴方向上，髁突变形量锁侧大于正常侧，在Z轴方向，正常侧大于锁侧。X轴方向局部变形最大值点在锁侧髁突内极横嵴前后，而局部变形最小值点在正常侧髁突内极中1/3前斜面处；Z轴方向局部变形最大值点位于正常侧髁突外极及外极下方；对不同咬合情况进行模拟发现，髁突X轴变形值在正常侧磨牙咬合、Y轴变形值在正常侧前磨牙咬合以及Z轴变形值在正中咬合最大，髁突变形值在锁时并不最为显著。结论单、双侧磨牙正锁髁突形态短小，双侧组相对单侧组存在更加短小的髁突形态。磨牙正锁患者的髁突是不良咬合变形集中区域，其变形最大点位分布于髁突内外极横嵴附近。不良咬合情况对髁突变形值有影响，但不能说明二者之间是否有明确因果关系。

关键词: 正锁牙合, 颞下颌关节, 形态, 有限元分析

Abstract:

Objective The objective of this study is to measuring the morphology and position of bilateral temporomandibular joints in patients with unilateral and bilateral molar scissor bite and simulating the deformation of the mandible during occlusion, in order to provide thesis for the diagnosis of temporomandibular joint disease in patients with unilateral and bilateral molar scissor bite. Methods This study was a retrospective study. A total of 10 patients with unilateral molar scissor bite (the unilateral molar scissor bite group) and 10 patients with bilateral molar scissor bite (the bilateral molar scissor bite group) were selected as the experimental group, and 20 adult patients with classⅠ of angle classification of similar ages were selected as the control group. All patients underwent cone beam computed tomography scans, by measuring the width of the fossa, height of the fossa, articular eminence inclination, long axis of the condyle, minor axis of the condyle, horizontal angle of the condyle and the space of the temporomandibular joint, compare temporomandibular joint morphology and position. The three-dimensional finite element analysis of the mandible morphology was carried out to evaluate the force and deformation of the mandible by using software to simulate the occlusion of the patients. It was further explored the relationship between the force of the mandible morphology and the possible temporomandibular joint disorder symptoms of the patients. Results Intergroup comparisons for the unilateral molar scissor bite group and left sides of the other groups revealed that the superior articular space in the group with unilateral molar scissor bite was shorter than that in the control group (P<0.05); the long axis of the condyle in the unilateral and bilateral molar scissor bite group were both shorter than that of the control group (P<0.05); among which the unilateral group was larger than the bilateral group, and the minor axis of the condyle in bilateral molar scissor bite group was smaller than in the control group (P<0.05), and the unilateral and bilateral condylar groups were larger than the control group (P<0.05); and the condylar horizontal angle in the unilateral and bilateral groups were larger than that in the control group (P<0.05). The normal sides of the unilateral molar scissor bite group and right sides of the other groups had smaller superior articular space than the control group (P<0.05); and the condylar long-axis in bilateral group was smaller than the control group (P<0.05); and the normal side of the condylar short-axis unilateral group was larger than that of the bilateral condylar group. Three-dimensional finite element analysis: the condyle of patients with molar scissor bite was a concentrated area of deformation during the bite of the mandible, when the first molar occlusion of the scissors bite side was simulated, the maximum deformation was located in the condyle in the X-axis and Z-axis directions. The amount of deformation was greater than that of the scissor bite side in the X-axis direction, while in the Z-axis direction, the normal side was greater than the scissor bite side. The maximum sites of local deformation in the X-axis direction were located in anterior and posterior the transverse crest of scissor bite side, and the minimum sites of local deformation was at 1/3 of the anterior slope of the inner pole of the normal side, the maximum local deformation sites in the Z-axis direction were located in the outer pole and below the outer pole of the normal side. The X-axis deformation value was the largest in the molars occlusion on the normal side, the Y-axis deformation value was in the premolars occlusion on the normal side, and the Z-axis deformation value was the largest in the centric occlusion, the deformation value of the condyle was not most significant in molar scissor bite. Conclusion Unilateral and bilateral molar scissor bite resulting in a short condyle morphology, and the bilateral group had a shorter condylar morphology than the unilateral group. The condyle of the patient with molar scissor bite is a concentrated area of poor occlusal deformation, and the largest sites of deformation are distributed near the transverse ridge of the inner and outer poles of the condyle. Different occlusion conditions have an effect on condylar deformation values, but do not indicate whether there is a clear association between them.

Key words: scissor bite, temporomandibular joint, morphology, finite element analysis

中图分类号:

R782.6

褚天昊, 张雪颖, 王浩丞, 马浩杰, 刘媛媛. 磨牙正锁患者颞下颌关节形态学及咬合应力下髁突三维有限元分析[J]. 华西口腔医学杂志, 2025, 43(1): 114-125.

Chu Tianhao, Zhang Xueying, Wang Haocheng, Ma Haojie, Liu Yuanyuan. Three-dimensional finite element feature analysis of the mandible and morphology and position of temporomandibular joint in patients with unilateral and bilateral molar scissor bite[J]. West China Journal of Stomatology, 2025, 43(1): 114-125.

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名称	英文	测量项目含义
关节窝宽度	width of the fossa，WF	在垂直于髁突长轴的矫正斜矢状位下，连接关节窝后壁最下点和关节结节最下点，此连线位于关节窝内的部分为关节窝宽度
关节窝高度	height of the fossa，HF	在垂直于髁突长轴的矫正斜矢状位下，连接关节窝后壁最下点和关节结节最下点，关节窝最上点到此连线的垂直距离为关节窝高度
关节结节倾斜度	articular eminence inclination，AEI	关节结节最下点与关节窝最上点连线与关节结节最下点与关节窝后壁最下点连线的交角
髁突长轴	long axis of the condyle，LAC	在髁突面积最大的横断面上测量髁突的最大内外径
髁突短轴	minor axis of the condyle，MAC	在髁突面积最大的横断面上测量髁突的最大前后径
髁突水平角	horizontal angle of the condyle，HAC	髁突长轴与冠状水平线间的夹角
关节前间隙	anterior joint space，AJS	过关节窝顶点向髁突前斜面作切线，切点与关节结节后斜面的最短距离
关节上间隙	superior joint space，SJS	关节窝顶点与髁突顶点连线的距离
关节后间隙	posterior joint space，PJS	过关节窝顶点向髁突后斜面作切线，切点与关节窝后壁的最短距离

组别	安氏Ⅰ类	安氏Ⅱ类	安氏Ⅲ类	其他
单侧组	7/70.0	2/20.0	0/0.0	1/10.0
双侧组	5/50.0	3/30.0	1/10.0	1/10.0.

组别	骨性Ⅰ类	骨性Ⅱ类	骨性Ⅲ类
单侧组	7/70.0	3/30.0	0/0.0
双侧组	4/40.0	6/60.0	0/0.0
对照组	9/45.0	11/55.0	0/0.0

项目	左侧	右侧	P值
关节上间隙/mm	3.91±1.12	3.92±0.92	0.975
关节前间隙/mm	2.61±0.96	2.95±1.50	0.435
关节后间隙/mm	1.97±0.39	2.09±0.43	0.639
髁突长轴/mm	20.94±2.11	20.97±2.17	0.943
髁突短轴/mm	8.66±1.01	8.35±0.76	0.111
关节窝高度/mm	5.82±1.43	5.57±0.95	0.503
关节窝宽度/mm	15.29±1.86	16.47±0.80	0.180
关节结节斜度/°	35.86±7.37	35.57±10.78	0.948
髁突水平角/°	15.23±4.95	17.94±6.36	0.374

项目	锁侧	正常侧	P值
关节上间隙/mm	2.48±0.44	2.64±0.20	0.234
关节前间隙/mm	2.48±0.85	2.24±0.61	0.603
关节后间隙/mm	1.80±0.44	1.76±0.38	0.852
髁突长轴/mm	18.76±2.11	18.55±3.57	0.807
髁突短轴/mm	8.02±1.43	7.99±1.49	0.932
关节窝高度/mm	6.33±1.08	5.85±1.08	0.157
关节窝宽度/mm	16.73±1.73	16.74±2.79	0.984
关节结节斜度/°	35.60±6.48	36.02±7.80	0.872
髁突水平角/°	23.32±7.93	21.71±7.66	0.421

磨牙正锁患者颞下颌关节形态学及咬合应力下髁突三维有限元分析

Three-dimensional finite element feature analysis of the mandible and morphology and position of temporomandibular joint in patients with unilateral and bilateral molar scissor bite

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项目	左侧	右侧	P值
关节上间隙/mm	2.94±0.74	2.66±0.78	0.344
关节前间隙/mm	2.44±0.68	2.64±1.12	0.720
关节后间隙/mm	2.04±0.45	1.73±0.33	0.239
髁突长轴/mm	16.71±1.43	19.28±2.26	0.419
髁突短轴/mm	6.83±1.11	6.64±1.25	0.675
关节窝高度/mm	6.10±0.92	6.57±0.42	0.305
关节窝宽度/mm	15.76±2.25	15.91±1.38	0.871
关节结节斜度/°	34.78±2.93	36.79±2.62	0.292
髁突水平角/°	25.44±7.40	25.71±8.67	0.888

项目	对照组左侧	单侧组锁侧	双侧组左侧	F值/H值^*	P值
关节上间隙/mm	3.91±1.12	2.48±0.44^a	2.94±0.74	6.297^*	0.031^*
关节前间隙/mm	2.61±0.96	2.48±0.85	2.44±0.68	0.306^*	0.858^*
关节后间隙/mm	1.97±0.39	1.80±0.44	2.04±0.45	0.628	0.544
髁突长轴/mm	20.94±2.11	18.76±2.11^a,c	16.71±1.43^b	7.777	0.003
髁突短轴/mm	8.66±1.01	8.02±1.43	6.83±1.11^b	3.725	0.043
关节窝高度/mm	5.82±1.43	6.33±1.08	6.10±0.92	0.354	0.706
关节窝宽度/mm	15.29±1.86	16.73±1.73	15.76±2.25	1.071	0.363
关节结节斜度/°	35.86±7.37	35.60±6.48	34.78±2.93	0.062	0.940
髁突水平角/°	15.23±4.95	23.32±7.93^a	25.44±7.40^b	3.706	0.044

项目	对照组左侧	单侧组锁侧	双侧组左侧	F值/H值^*	P值
关节上间隙/mm	3.92±0.92	2.64±0.20^a	2.66±0.78^b	9.2185^*	0.010^*
关节前间隙/mm	2.95±1.50	2.24±0.61	2.64±1.12	1.488	0.251
关节后间隙/mm	2.09±0.43	1.76±0.38	1.73±0.33	1.749	0.201
髁突长轴/mm	20.97±2.17	18.55±3.57	19.28±2.26^b	4.319	0.028
髁突短轴/mm	8.35±0.76	7.99±1.49^c	6.64±1.25	3.458	0.052
关节窝高度/mm	5.57±0.95	5.85±1.08	6.57±0.42	2.240	0.134
关节窝宽度/mm	16.47±0.80	16.74±2.79	15.91±1.38	0.480^*	0.787^*
关节结节斜度/°	35.57±10.78	36.02±7.80	36.79±2.62	0.043	0.958
髁突水平角/°	17.94±6.36	21.71±7.66	25.71±8.67	1.656	0.217

咬合方式	定向变形	X轴	Y轴	Z轴
前牙咬合	最大定向变形值	0.002 7	0.007 7	0.002 7
前牙咬合	最小定向变形值	\|-0.005 9\|	\|-0.011\|	\|-0.021\|
正中咬合	最大定向变形值	0.002 7	0.005 5	0.004
正中咬合	最小定向变形值	\|-0.002 9\|	\|-0.007 3\|	0.017
锁侧磨牙咬合	最大定向变形值	0.001 8	0.003 4	0.001 6
锁侧磨牙咬合	最小定向变形值	\|-0.003 2\|	\|-0.004 4\|	\|-0.011\|
正常侧磨牙咬合	最大定向变形值	0.008 4	0.002 2	0.002 6
正常侧磨牙咬合	最小定向变形值	\|-0.007 7\|	\|-0.003\|	\|-0.007 2\|
锁侧前磨牙咬合	最大定向变形值	0.002 1	0.005 8	0.001 9
锁侧前磨牙咬合	最小定向变形值	\|-0.004 1\|	\|-0.006 1\|	\|-0.015\|
正常侧前磨牙咬合	最大定向变形值	0.007 7	0.005 1	0.002
正常侧前磨牙咬合	最小定向变形值	\|-0.004 2\|	\|-0.01\|	\|-0.016\|

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