颞下颌关节和咀嚼肌周围的慢性疼痛通常是颞下颌关节紊乱病(temporomandibular disorders,TMD)患者的主诉,由于疼痛是大脑的反应,TMD慢性疼痛的形成与中枢神经系统的变化密切相关,但其复杂的神经病理机制尚未阐明,导致治疗难度较大。功能磁共振成像(functional magnetic resonance imaging,fMRI)是一种可测量大脑活动的非侵入性方法,现已广泛应用于研究包括疼痛在内的多个领域。文章就疼痛性TMD相关脑功能改变的任务态与静息态fMRI研究进展做一综述,并结合疼痛性TMD的常用治疗方法--咬合板治疗对脑激活模式的影响,为理解TMD产生口面部疼痛的机制提供神经影像学视角,为临床诊疗疼痛性TMD提供参考。
在正畸治疗方案的制定过程中,无论采用何种矫治技术,目标位的确定必须充分考虑个体的牙移动生物学限制。牙槽骨的厚度在一定程度上决定了正畸牙齿移动的限度,超过这一限度可能导致牙周支持组织损伤,严重时甚至引发骨开窗、骨开裂、牙龈萎缩等并发症。因此,在制定正畸治疗方案时,应特别关注唇颊/舌腭侧牙槽骨厚度,尤其是在进行上前牙大量移动时,需对上颌前牙牙槽骨厚度进行全面评估。上前牙区牙槽骨厚度可能受性别、年龄、咀嚼功能与垂直骨面型、矢状骨面型与前牙倾斜度、牙龈表型、地理环境与种族、鼻腭管、牙周炎等多种因素的影响。本文旨在综述上前牙区牙槽骨厚度影响因素的研究进展,以期为临床实践提供参考。In the formulation of orthodontic treatment plans, regardless of the type of corrective technique employed, the determination of the target position must take into full consideration the individual biological limitations of tooth movement. The thickness of the alveolar bone largely dictates the extent of orthodontic tooth movement;exceeding this limit may result in damage to the periodontal supporting tissues, potentially leading to complications such as bone fenestration, bone fractures, and gingival recession in severe cases. Therefore, special attention should be paid to the buccal/lingual alveolar bone thickness when developing orthodontic treatment plans, particularly during significant movements of the anterior teeth, necessitating a comprehensive assessment of the alveolar bone thickness in the maxillary anterior region. The alveolar bone thickness in this area may be influenced by various factors, including gender, age, masticatory function, vertical and sagittal skeletal patterns, inclination of the anterior teeth, gingival phenotype, geographic environment and ethnicity, nasopalatine canal, and periodontal disease. This paper aims to review the research progress on the factor
目的·利用锥形束CT(cone-beam computed tomography,CBCT)比较上颌前牙倾斜性内收(retraction adjunct with tip,R&Tp)和控根性内收(retraction adjunct with torque,R&Tq)产生的牙槽骨改建反应差异。方法·选取40例符合纳入标准的安氏Ⅱ类1分类青少年患者,根据牙齿实际内收方式对纳入对象所有160颗上颌切牙进行标准化分组(分为倾斜内收组和控根内收组),利用CBCT影像结合三维测量软件对2组牙齿内收情况以及相关牙槽骨高度和厚度变化进行测量分析和比较。结果·2组前牙均实现较大范围内收和直立,倾斜内收组牙冠内收距离及内收角度均明显大于控根内收组(均P=0.000)。倾斜内收组L3、P1厚度显著减小(均P=0.000),控根内收组P1、P2厚度显著减小(均P=0.000)。倾斜内收组T1厚度减小(P=0.000),控根内收组各水平牙槽骨总厚度均减小(均P=0.000)。2组唇侧(P=0.000)、腭侧(P=0.000)牙槽嵴高度均下降,且腭侧牙槽嵴高度降低更显著。结论·安氏Ⅱ类1分类青少年患者上颌前牙在较大范围内收时,倾斜内收组唇侧根尖区、腭侧牙槽嵴区以及控根内收组腭侧牙根颈部及中部区域均为牙槽骨吸收高风险区。
