Effect of maxillary protraction on temporomandibular joint changes in skeletal class III children: a correlation analysis

doi:10.12307/2023.100

Abstract

Abstract: BACKGROUND: Maxillary protraction treatment can effectively change the craniofacial structural relationship and the temporomandibular joint structure of children with skeletal Class III malocclusion. However, there are no definitive findings regarding the correlation between changes in the temporomandibular joint and craniomaxillofacial changes after maxillary protraction.
OBJECTIVE: To analyze the correlation between dentofacial changes and temporomandibular joint changes in children with skeletal class III malocclusion before and after maxillary protraction and to investigate the effect of maxillary protraction on the temporomandibular joint of children.
METHODS: A total of 29 children with skeletal class III malocclusion, including 16 boys and 13 girls, aged 8-11 years, were treated by maxillary protraction. The changes of dentofacial and temporomandibular joint were subjected to cephalometric analysis and coordinate system positioning measurement. Paired t-test, Mann-Whitney test and Pearson correlation analysis were conducted.
RESULTS AND CONCLUSION: The sagittal relationship of the jaw changed obviously before and after maxillary protraction. The glenoid fossa and condyle changed significantly in the X axis but not in the Y axis. The posterior space of the temporomandibular joint was significantly reduced. Correlation analysis revealed a moderate correlation between the temporomandibular joint and dentofacial structural changes. To conclude, after maxillary protraction, both dentofacial and temporomandibular joint structures have significant changes, and there is a moderate correlation between temporomandibular joint remodeling and dentofacial changes, but no close correlation exists between them.

Key words: temporomandibular joint, maxillary protraction, skeletal class III, late mixed dentition, correlation analysis

CLC Number:

Zhang Haolin, Wang Yalin, Liu Yafei, Zuo Yanping, Zhang Xiaohuan. Effect of maxillary protraction on temporomandibular joint changes in skeletal class III children: a correlation analysis[J]. Chinese Journal of Tissue Engineering Research, 2023, 27(11): 1641-1646.

Figures/Tables 4

前牵引治疗前后上下颌骨发生明显改变，治疗后蝶鞍点-鼻根点-上齿槽座点角(SNA)、上齿槽座点-鼻根点-下齿槽座点角(ANB)、颌突角(NA-PA)明显增大，分别增加2.41°(P < 0.001)，4.76°(P < 0.001)，9.02°(P < 0.01)。蝶鞍点-鼻根点-下齿槽座点角(SNB)、面角(NP-FH)明显减小2.09°(P < 0.001)，1.50°(P < 0.01)。A点垂直向位置A-Y明显上移0.672 mm(P < 0.01)。治疗后下颌平面与前颅底平面的交角(MP-SN)、下颌平面与眼耳平面的交角(FH-MP)均明显增加了1.92°(P < 0.001)，3.02°(P < 0.01)。前牵引的上下前牙突距上中切牙切缘到鼻根点-上牙槽座点连线的距离(U1-NA mm)、下中切牙切缘到鼻根点-下牙槽座点连线的距离(L1-NB mm)在治疗后均无明显改变(P > 0.05)。上前牙突度明显增大，上切牙长轴与鼻根点-上牙槽座点连线的交角(U1-NA)、上中切牙长轴与SN平面相交的交角(U1-SN)分别增加2.28°(P < 0.05)，3.63°(P < 0.01)。下前牙突度明显减小，下中切牙长轴与下颌平面相交的交角(L1-MP)减小了2.22°(P < 0.001)。上下前牙的夹角(U1-L1)也明显减小了5.52°(P < 0.01)。 2.4 治疗前后颞下颌关节改变见表1。颞下颌关节窝的坐标系指标改变为：在 X 轴上， S点到Ae点在X轴上投影的距离(S-Aex)，S点到Fs点在X轴上投影的距离(S-Fsx)，S点到Fp点在X轴上投影的距离(S-Fpx)分别增加0.06 mm(P < 0.01)，1.18 mm(P < 0.01)，1.03 mm(P < 0.01)，说明前牵引矫治后颞下颌关节窝前缘、上缘及后缘的位置均明显后移；在 Y 轴上，S点到Ae点在Y轴上投影的距离(S-Aey)，S点到Fs点在Y轴上投影的距离(S-Fsy)，S点到Fp点在Y轴上投影的距离(S-Fpy)的变化无统计学意义(P > 0.05)，说明前牵引矫治后颞下颌关节窝在垂直方向上位置改变均不明显。髁状突的坐标系指标改变为：在 X 轴上，S点到髁状突Ci点在X轴上投影的距离(S-Cix)、S点到Co点在X轴上投影的距离(S-Cox )及S点到T4点在X轴上投影的距离(S-T4x)分别增加0.84 mm(P < 0.05)，0.88 mm(P < 0.01)、1.20 mm(P < 0.01)，说明前牵引矫治后髁状突发生整体后移；在 Y 轴上，髁状突前缘(S-Ciy)增大0.39 mm(P < 0.05)，而髁状突上缘(S-Coy)及后缘(S-T4y)距离变化均无统计学意义(P > 0.05)，说明前牵引矫治后髁状突前缘发生下移，而髁状突上缘及后缘的位置无明显改变。颞下颌关节间隙的坐标系指标改变为：前方牵引矫治后，关节后间隙距离减小0.52 mm(P < 0.05)，具有显著性差异；而关节前间隙、上间隙的改变均无显著性(P > 0.05)。 2.5 治疗后头影测量指标与颞下颌关节指标的Pearson相关分析见表2。 "

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