| 摘要: | 研究背景
矯正治療已廣為現代社會所接受，深咬不正咬合是矯正治療常見的難症。既往的研究，對深咬的描述及成因大多著重於齒列排列狀況與顎骨間位置，對於咬合機能較少著墨。如何從咬合機能的角度介入治療，治療後會造成什麼效應，目前尚無定論。針灸對於顏面部疼痛改善的效果已廣為討論，但是對於咬合機能變化並無太多的探討。本研究的主要目的是探討深咬對象在針灸治療後的咬合力分佈變化及下顎邊際運動變化，以釐清針灸治療對於深咬對象之下顎運動與咬合力分佈的影響。
材料方法
受試者來自中國醫藥大學牙醫系大學部學生，以及附設醫院門診患有深咬不正咬合之患者。在針灸治療前以及針灸後，個別以咬合力分佈感應器T-Scan （Tekscan Inc., Boston, MA, USA）及下顎運動影像分析軟體DigiGnatho Ver1.3 （Rise Corporation , Sendai, Japan）比較針灸前後的咬合力分佈及下顎運動變化。咬合力分佈之分析項目為第一大臼齒區所佔總咬合力比例，下顎運動變化則包括最大張口運動，下顎左右邊際運動，以及下顎前後邊際運動。使用SPSS統計軟體，以Wilcoxon signed rank test進行檢定。?
結果
咬合力分佈之結果發現，最大咬合力比較起50%咬合力，第一大臼齒區所佔的總咬合力比例較高。深咬患者於針灸治療後，受試者之咬合力分佈皆有更偏向大臼齒區的趨勢。下顎運動變化之結果發現，下顎運動範圍在針灸治療前後並無明顯差異，皆屬於正常範圍。
結論
較大的咬合力會造成第一大臼齒區所佔總咬合力比例上升，這可能跟肌肉收縮機能改變造成些微顎骨形變及牙齒位移有關。過往的研究可知針灸治療有助於顳顎關節症候群患者緩解症狀，改善下顎運動範圍受限。本研究利用針灸治療深咬患者之研究結果，雖然下顎運動範圍於針灸治療前後無顯著差異，但針灸治療後大臼齒區所佔總咬合力比例顯著增加。針灸治療對於咬合機能作用等機制，仍需進一步的研究釐清。
Introduction
Orthodontic treatment has already been widely accepted in clinics. For the population with deep bite malocclussion, overbite is difficult to achieve. In the past, treatment for deep bite malocclusion was often focused on the dentition and the relationship between jaws rather than the function of occlusion. Only a few studies investigated the occlusal function of the patients with deep bite malocclusion. Since acupuncture is a well-known treatment for pain relief and muscle relaxation, the use of acupuncture might change the occlusal forces and mandibular movements. However, until now there is little or no study evaluating the effect of acupuncture treatment in the mandibular movement and distribution of occlusal force especially for deep bite patients. The purpose of this research is to evaluate the distribution of occlusal force and the border movement of lower jaw (Mandibular Kinesiograph MKG) from subjects with deep bite malocclusion before and after acupuncture treatment.
Materials and Methods
Seventeen subjects were all with deep bite malocclusion aged between 20 and 30 years and volunteered from China Medical University Hospital. Before and after acupuncture treatment, the locations of tooth contacts and the distribution of bite force were measured by T-scan system (Tekscan Inc., Boston, MA, USA) and the mandibular movement was received by DigiGnatho Ver 1.3 (Rise Corporation, Sendai, Japan). After the measurement, the indices including the portion of occlusal force at the first molar, maximum mouth opening, lateral border, and anterior-posterior border movements were evaluated and statistically analyzed by Wilcoxon signed rank test and SPSS.
Results
There is a tendency of an increase in the proportion of biting forces at the first molar area during maximum biting force than 50% of maximum biting force. The proportion of biting force at the first molar area after the acupuncture treatment was increased. Before and after acupuncture treatment, there is no significant difference between mandibular movement and both are within the normal range.
Conclusion
The greater the biting force becomes, there is a greater portion of biting force at the first molar area. It might be the result of mandible slightly mandible deformity while imposing more pressure on it. Previous studies suggested that acupuncture treatment can relieve temporomandibular disorders. In the present study, the portion of biting forces at the first molar area were increased after the acupuncture treatment, but no significant difference was found between the mandibular border movements. The mechanism about occlusal functional changes still requires for further investigation. |
