上颌扩弓对颞下颌关节应力影响的有限元分析
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河南省医学科技攻关计划(联合共建)项目(LHGJ20190272)


Effects of Maxillary Expansion on Temporomandibular Joint Stress: A Finite Element Analysis
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    摘要:

    目的 通过三维有限元法对比扩弓前和放置扩弓器时颞下颌关节(temporomandibular joint, TMJ)内部各组织应力分布情况。方法 根据1名上颌牙弓狭窄患者CBCT影像资料,构建扩弓前和包含扩弓器的TMJ三维有限元模型,对模型加载相同的肌力和边界约束,观察TMJ髁突、关节盘、关节窝的等效应力、最大主应力和最小主应力。结果 扩弓前TMJ等效应力主要分布在下颌支前缘、髁突前斜面、关节盘中间带和后带以及关节窝顶部。放置扩弓器时,TMJ应力分布特征与扩弓前基本一致,应力虽然明显增加,但应力分布区域更加均匀;髁突和关节盘应力向前、向外侧移动,髁突后斜面表现出更加均匀的最大主应力分布范围。结论 上颌扩弓器产生的矫形力能够使TMJ应力增加,诱导髁突发生组织改建,协调髁突和关节盘的关系。临床上对于牙弓狭窄的患者应该采用合适的手段进行扩弓矫治。

    Abstract:

    Objective To compare the stress distributions on various tissues in temporomandibular joint (TMJ) before maxillary expansion and with maxillary expander on the maxillary by using the three-dimensional (3D) finite element method. Methods Based on CBCT image data from a patient with maxillary transverse deficiency, the finite element models of TMJ before maxillary expansion and with maxillary expander were reconstructed. The same muscle force and boundary constraint were applied on the two models, and then the von Mises stress, the maximum and the minimum principal stresse on mandibular condylar, joint disc and glenoid fossa were evaluated. Results The von Mises stress of TMJ model before maxillary expansion was mainly distributed in the anterior of mandibular ramus, the anterior of condyle, the middle of articular disc and the top of articular fossa. The pattern of stress distribution on TMJ with maxillary expander was basically consistent with that before maxillary expansion. The TMJ stress was significantly increased, but the stress concentration areas were more evenly distributed. The stress distribution of mandibular condyle and disc moved more laterally and forward. The posterior of mandibular condyle showed a wider distribution of the maximum principal stress. Conclusions The orthopedic force generated by maxillary expander can increase the TMJ stress, stimulate tissue reconstruction of mandibular condyle, and coordinate the condyle and disc. In clinical practice, the patients with maxillary transverse deficiency should be treated with appropriate means of maxillary expansion.

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徐文华,董浩鑫,王为,王茜.上颌扩弓对颞下颌关节应力影响的有限元分析[J].医用生物力学,2022,37(5):940-945

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  • 收稿日期:2021-10-12
  • 最后修改日期:2021-12-17
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  • 在线发布日期: 2022-10-25
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