前牙功能性反咬病人進行矯正治療過程中下顎運動的變化; The change in mandibular movements during orthodontic treatment for anterior functional crossbite patients

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Title:	前牙功能性反咬病人進行矯正治療過程中下顎運動的變化;The change in mandibular movements during orthodontic treatment for anterior functional crossbite patients
Authors:	林志杰;Chin-Chieh Lin
Contributors:	中國醫藥大學：臨床醫學研究所碩士班
Keywords:	下顎運動;咀嚼;前牙反咬;mandibular movement;chewing;anterior crossbite
Date:	2008-06-19
Issue Date:	2009-08-12 14:23:35 (UTC+8)
Abstract:	隨著社會風氣的改變以及經濟的發展，口腔健康的維持及良好咬合關係的重要性開始被人們所認知，對於一位牙醫師的臨床治療而言，最主要的目的是維持自然齒列的健康及重建缺損牙齒，為患者提供理想的咀嚼功能，因此一個方便、合理、正確反映出個體咀嚼的測試工具對於判斷臨床治療成功與否，有其重要的價值。本研究旨在建立對於食物咀嚼效率之有效評估方法以期在面對不正咬合治療及功能評估方面能有所助益。本研究以私立中國醫藥大學附設醫院牙醫部齒顎矯正科五位功能性前牙反咬的病人為研究對象，以固定式矯正器配合改良型超彈性鈦鎳合金線進行治療，在治療前以及治療過程中以影像的方式蒐集下顎運動以及咀嚼運動的運動軌跡，並以影像分析軟體DigiGnatho V1.3進行分析。結果顯示，就成人的功能性反咬而言，利用固定式矯正器以及配合超彈性鈦鎳合金線可以在短期（4~12週）利用反咬弓（crossbite arch）將前牙咬好改正，並且可在一年之內將治療結束。當下顎邊際運動反咬改正當下，垂直方向的位移會有減少的趨勢，但是在反咬改正後至咬合穩定後，在垂直方向以及前後的位移上會增加，但是在側方的移動上則沒有增加的趨勢。反咬改正後至咬合穩定的這段時期在咀嚼的路徑上，只有在垂直方向上有增大的趨勢，而在水平以及前後的位移量上則無明顯的差異。反咬改正後至咬合穩定的這段時期在咀嚼的開閉口最大速率上會有明顯增加的趨勢，而且開閉口最大速度的發生位置會往下方移動；另外咀嚼的平均速度亦是會增加的。總結即是在咬合的型態改正之後，會立即性地影響咀嚼的功能，所評估眾多參數當中，最明顯的就是咀嚼的速度會明顯增加。 Introduction With the change of the society common practice and the development of the economy, the importance of maintaining oral hygiene and achieving a fine occlusal relationship are perceived by public. For the clinical treatment of the dentist, to maintain the health of the natural dentition, to reconstruct the deficient teeth and to provide normal chewing function are the goal. A testing tool which could be reflected the individual chewing function conveniently, correctly in the judgment of the clinical treatment is important. The goal of this research is to establish an efficient method in chewing food evaluation and hope to get some help in the treatment of malocclusion and functional assessment. Materials and methods Five volunteers, who struggled with functional anterior crossbite and they were treated with edgewise appliance and Improved super-elastic Ti-Ni arch wire in the Orthodontic Department of China Medical University Hospital. We collected the digital images at the different period of treatment and measured the trajectory of the mandibular border movement and chewing movement with DigiGnatho V1.3. For all the patients, the anterior functional crossbite were corrected around 12 weeks, and the whole treatment duration was finished within 1 years. Results The vertical distance of the mandibular border movement was decreased when the anterior functional crossbite were corrected. The vertical and anterior-posterior displacements were increased from the bite-corrected to the stable occlusion was establishes. However for the horizontal direction, there was no significant different in the displacement among different steps of the treatment. The trajectory of the chewing movement was wider in the vertical direction, but no significant difference in horizontal and anterior-posterior direction during the bite-corrected to the stable occlusion established. The maximum velocity of the mouth opening and closing while chewing was increased significantly, the maximum velocity position was displaced inferiorly, and the average velocity was also increased during the bite-corrected to the stable occlusion established. Conclusion After the treatment of functional anterior crossbite, the chewing function was changed immediately, and the obvious outcome was shown in the increase of the chewing velocity.
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