Three-dimensional cone-beam CT study on temporomandibular condylar changes before and after orthodontic treatment in adult female patients with high-angle protrusive malocclusion

doi:10.3877/cma.j.issn.1674-1366.2025.01.006

Abstract

Abstract:

Objective

To investigate the three - dimensional morphological changes of the temporomandibular joint（TMJ）condyle in adult females with high-angle skeletal maxillary protrusion before and after orthodontic treatment using cone-beam computed tomography（CBCT），and to assess the structural adaptation of TMJ induced by orthodontic treatment.

Methods

This controlled study enrolled 27 classⅠand 28 classⅡhigh-angle skeletal maxillary protrusion patients treated between January 2018 and December 2023 in the Sixth Affiliated Hospital of South China University of Technology and the Second People's Hospital of Foshan.Pre- and post-treatment CBCT scans were analyzed for joint spaces，condylar/articular fossa morphology（height/volume/surface area），and skeletal parameters（MP-SN angle，S-Go/N-Me ratio，Y-axis angle）.Paired and independent t-tests were applied for within-and between-group comparisons（α=0.05）.

Results

In classⅠhigh-angle patients，no significant post-treatment changes were observed in TMJ parameters：Superior joint space［（3.19±0.62）mm vs.（3.02±0.67）mm，t=0.998，P=0.328］，anterior joint space［（2.44±0.32）mm vs.（2.52±0.48）mm，t=-0.859，P=0.398］，posterior joint space［（2.48±0.34）mm vs.（2.43±0.28）mm，t=0.603，P=0.552］，condylar apex height［（6.54±0.74）mm vs.（6.69±0.74）mm，t=-0.801，P=0.431］，condylar apex volume［（452.91±35.90）mm³ vs.（472.18±57.97）mm³，t=-1.407，P=0.171］，condylar height［（18.18±2.44）mm vs.（18.92±4.30）mm，t=-0.819，P=0.420］，and condylar volume［（1 690.07±214.94）mm³ vs.（1 754.38±348.92）mm³，t=-0.869，P=0.393）］.Articular fossa morphology and skeletal parameters also remained stable.In classⅡhigh-angle patients，significant post-treatment reductions were observed：Condylar height［（16.28±2.57）mm vs.（14.00±2.56）mm，t=3.168，P=0.004］，condylar volume［（1 512.46±223.50）mm³ vs.（1 360.96±230.94）mm³，t=2.377，P=0.025］，MP-SN angle［（40.99±3.97）° vs.（36.96±4.05）°，t=3.580，P = 0.001］，Y-axis angle［（69.72 ± 3.38）° vs.（62.82 ± 3.36）°，t = 7.145，P＜0.001］，with concurrent adjustments in joint spaces［posterior：（2.23±0.40）mm vs.（2.50±0.36）mm，t=-2.476，P=0.020；anterior：（2.83±0.36）mm vs.（2.55±0.34）mm，t=2.843，P=0.008］.Intergroup comparisons revealed greater post-treatment changes in classⅡfor condylar height（P=0.011），condylar volume（P=0.031），and Y-axis angle（P＜0.001）.

Conclusions

Orthodontic vertical control effectively improved occlusion in high-angle malocclusion patients.In class Ⅰcases，TMJ structures remained stable after treatment，with no significant changes in joint space，condylar morphology，and articular fossa.In contrast，class Ⅱ patients exhibited biomechanical adaptation through anterior - inferior condylar repositioning，accompanied by significant reductions in condylar volume and Y-axis angle.These findings underscored the necessity of individualized treatment strategies to harmonize occlusal function with condylar remodeling，particularly in classⅡhigh-angle maxillary protrusion cases.

Key words: Skeletal protrusive malocclusion, Adult female, High-angle, Temporomandibular joint, Condyle, Cone-beam computed tomography

Hui Huang, Yaqin Wei, Yuting Chen, Minting Wu, Jiahao Lin. Three-dimensional cone-beam CT study on temporomandibular condylar changes before and after orthodontic treatment in adult female patients with high-angle protrusive malocclusion[J]. Chinese Journal of Stomatological Research(Electronic Edition), 2025, 19(01): 41-48.

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Figures/Tables 5

测量项目	定义
关节上间隙（superior joint space，Sjs）	髁突上曲面和通过关节窝最高点的最短距离
关节前间隙（anterior joint space ，Ajs）	髁突前曲面与关节窝前壁之间的最短距离
关节后间隙（posterior joint space，Pjs）	髁突后曲面与关节窝后壁之间的最短距离
髁顶高度（height of condyle head，Hch）	从关节结节最低点平行于眶耳平面做切面，髁突顶点与该切面的垂直距离
髁顶面积（surface area of the condyle head，Sch）	从关节结节最低点平行于眶耳平面做切面，分割出髁顶的三维模型，并测量表面积
髁顶体积（volume of the condyle head，Vch）	从关节结节最低点平行于眶耳平面做切面，分割出髁顶的三维模型，并测量体积
髁突高度（height of the condyle，Hc）	从乙状切迹最低点平行于眶耳平面做切面，髁突顶点与该切面的垂直距离
髁突面积（surface area of the condyle，Sc）	从乙状切迹最低点平行于眶耳平面做切面，分割出髁突的三维模型，并测量表面积
髁突体积（volume of the condyle，Vc）	从乙状切迹最低点平行于眶耳平面做切面，分割出髁突的三维模型，并测量体积
关节窝高度（height of the glenoid fossa，Hgf）	从颞下颌关节窝最外侧缘点平行于眶耳平面做切面，关节窝顶点与该切面的垂直距离
关节窝面积（surface area of the glenoid fossa，Sgf）	从颞下颌关节窝最外侧缘点平行于眶耳平面做切面，分割出关节窝的三维模型，并测量表面积
关节窝体积（volume of the glenoid fossa，Vgf）	从颞下颌关节窝最外侧缘点平行于眶耳平面做切面，分割出关节窝的三维模型，并测量体积
下颌平面角（MP-SN）	下颌平面（MP）与前颅底平面（FH）的交角
后前面高比（S-Go/N-Me）	后面高（S-Go）与全面高（N-Me）的比值
Y轴角（SGn-FH）	蝶鞍中心与颏顶连线（SGn）与眶耳平面（FH）相交的下前角

测量项目	定义
关节上间隙（superior joint space，Sjs）	髁突上曲面和通过关节窝最高点的最短距离
关节前间隙（anterior joint space ，Ajs）	髁突前曲面与关节窝前壁之间的最短距离
关节后间隙（posterior joint space，Pjs）	髁突后曲面与关节窝后壁之间的最短距离
髁顶高度（height of condyle head，Hch）	从关节结节最低点平行于眶耳平面做切面，髁突顶点与该切面的垂直距离
髁顶面积（surface area of the condyle head，Sch）	从关节结节最低点平行于眶耳平面做切面，分割出髁顶的三维模型，并测量表面积
髁顶体积（volume of the condyle head，Vch）	从关节结节最低点平行于眶耳平面做切面，分割出髁顶的三维模型，并测量体积
髁突高度（height of the condyle，Hc）	从乙状切迹最低点平行于眶耳平面做切面，髁突顶点与该切面的垂直距离
髁突面积（surface area of the condyle，Sc）	从乙状切迹最低点平行于眶耳平面做切面，分割出髁突的三维模型，并测量表面积
髁突体积（volume of the condyle，Vc）	从乙状切迹最低点平行于眶耳平面做切面，分割出髁突的三维模型，并测量体积
关节窝高度（height of the glenoid fossa，Hgf）	从颞下颌关节窝最外侧缘点平行于眶耳平面做切面，关节窝顶点与该切面的垂直距离
关节窝面积（surface area of the glenoid fossa，Sgf）	从颞下颌关节窝最外侧缘点平行于眶耳平面做切面，分割出关节窝的三维模型，并测量表面积
关节窝体积（volume of the glenoid fossa，Vgf）	从颞下颌关节窝最外侧缘点平行于眶耳平面做切面，分割出关节窝的三维模型，并测量体积
下颌平面角（MP-SN）	下颌平面（MP）与前颅底平面（FH）的交角
后前面高比（S-Go/N-Me）	后面高（S-Go）与全面高（N-Me）的比值
Y轴角（SGn-FH）	蝶鞍中心与颏顶连线（SGn）与眶耳平面（FH）相交的下前角

指标	Ⅰ类（ $\bar{x}$ ±s）				Ⅱ类（ $\bar{x}$ ±s）				术前组间对照		术后减术前差值组间对照
指标	术前	术后	t值	P值	术前	术后	t值	P值	t值	P值	t值	P值
关节上间隙（mm）	3.19±0.62	3.02±0.67	0.998	0.328	2.91±0.68	3.39±0.77	-2.296	0.030^a	1.570	0.122	-2.394	0.020^a
关节后间隙（mm）	2.48±0.34	2.43±0.28	0.603	0.552	2.23±0.40	2.50±0.36	-2.476	0.020^a	2.424	0.019^a	-2.283	0.026^a
关节前间隙（mm）	2.44±0.32	2.52±0.48	-0.859	0.398	2.83±0.36	2.55±0.34	2.843	0.008^a	-4.187	0.000^a	2.581	0.013^a
关节窝高度（mm）	5.10±0.50	5.10±0.47	0.005	0.996	4.63±0.46	4.57±0.43	0.470	0.642	3.594	0.001^a	0.315	0.754
关节窝面积（mm²）	333.26±35.99	320.22±43.01	1.228	0.231	304.72±40.78	292.47±49.38	1.075	0.292	2.698	0.009^a	-0.051	0.959
关节窝体积（mm³）	671.95±90.16	702.56±119.30	-1.141	0.264	615.33±95.43	589.02±103.10	0.944	0.353	2.219	0.031^a	1.470	0.147
髁顶高度（mm）	6.54±0.74	6.69±0.74	-0.801	0.431	6.04±0.82	5.65±0.77	2.374	0.025^a	2.333	0.023^a	2.172	0.034^a
髁顶面积（mm²）	250.74±36.37	273.04±46.15	-1.900	0.069	271.36±32.69	237.29±45.59	2.837	0.009^a	-2.172	0.034^a	3.354	0.001^a
髁顶体积（mm³）	452.91±35.90	472.18±57.97	-1.407	0.171	422.30±48.74	393.39±46.45	2.593	0.015^a	2.597	0.012^a	2.738	0.008^a
髁突高度（mm）	18.18±2.44	18.92±4.30	-0.819	0.420	16.28±2.57	14.00±2.56	3.168	0.004^a	2.759	0.008^a	2.632	0.011^a
髁突面积（mm²）	811.07±101.66	840.34±115.49	-0.977	0.338	755.59±92.02	679.61±132.48	2.740	0.011^a	2.084	0.042^a	2.581	0.013^a
髁突体积（mm³ ）	1 690.07±214.94	1 754.38±348.92	-0.869	0.393	1 512.46±223.50	1 360.96±230.94	2.377	0.025^a	2.947	0.005^a	2.215	0.031^a
MP-SN（°）	38.72±3.23	38.81±5.07	-0.051	0.960	40.99±3.97	36.96±4.05	3.580	0.001^a	-2.240	0.029^a	2.610	0.012^a
S-Go/N-Me（%）	63.26±1.35	62.67±1.54	1.448	0.160	60.44±1.49	62.16±1.50	-4.018	0.000^a	7.222	0.000^a	-3.892	0.000^a
Y轴角（°）	62.49±2.85	62.17±3.34	0.365	0.718	69.72±3.38	62.82±3.36	7.145	0.000^a	-8.394	0.000^a	5.003	0.000^a

指标	Ⅰ类（ $\bar{x}$ ±s）				Ⅱ类（ $\bar{x}$ ±s）				术前组间对照		术后减术前差值组间对照
指标	术前	术后	t值	P值	术前	术后	t值	P值	t值	P值	t值	P值
关节上间隙（mm）	3.19±0.62	3.02±0.67	0.998	0.328	2.91±0.68	3.39±0.77	-2.296	0.030^a	1.570	0.122	-2.394	0.020^a
关节后间隙（mm）	2.48±0.34	2.43±0.28	0.603	0.552	2.23±0.40	2.50±0.36	-2.476	0.020^a	2.424	0.019^a	-2.283	0.026^a
关节前间隙（mm）	2.44±0.32	2.52±0.48	-0.859	0.398	2.83±0.36	2.55±0.34	2.843	0.008^a	-4.187	0.000^a	2.581	0.013^a
关节窝高度（mm）	5.10±0.50	5.10±0.47	0.005	0.996	4.63±0.46	4.57±0.43	0.470	0.642	3.594	0.001^a	0.315	0.754
关节窝面积（mm²）	333.26±35.99	320.22±43.01	1.228	0.231	304.72±40.78	292.47±49.38	1.075	0.292	2.698	0.009^a	-0.051	0.959
关节窝体积（mm³）	671.95±90.16	702.56±119.30	-1.141	0.264	615.33±95.43	589.02±103.10	0.944	0.353	2.219	0.031^a	1.470	0.147
髁顶高度（mm）	6.54±0.74	6.69±0.74	-0.801	0.431	6.04±0.82	5.65±0.77	2.374	0.025^a	2.333	0.023^a	2.172	0.034^a
髁顶面积（mm²）	250.74±36.37	273.04±46.15	-1.900	0.069	271.36±32.69	237.29±45.59	2.837	0.009^a	-2.172	0.034^a	3.354	0.001^a
髁顶体积（mm³）	452.91±35.90	472.18±57.97	-1.407	0.171	422.30±48.74	393.39±46.45	2.593	0.015^a	2.597	0.012^a	2.738	0.008^a
髁突高度（mm）	18.18±2.44	18.92±4.30	-0.819	0.420	16.28±2.57	14.00±2.56	3.168	0.004^a	2.759	0.008^a	2.632	0.011^a
髁突面积（mm²）	811.07±101.66	840.34±115.49	-0.977	0.338	755.59±92.02	679.61±132.48	2.740	0.011^a	2.084	0.042^a	2.581	0.013^a
髁突体积（mm³ ）	1 690.07±214.94	1 754.38±348.92	-0.869	0.393	1 512.46±223.50	1 360.96±230.94	2.377	0.025^a	2.947	0.005^a	2.215	0.031^a
MP-SN（°）	38.72±3.23	38.81±5.07	-0.051	0.960	40.99±3.97	36.96±4.05	3.580	0.001^a	-2.240	0.029^a	2.610	0.012^a
S-Go/N-Me（%）	63.26±1.35	62.67±1.54	1.448	0.160	60.44±1.49	62.16±1.50	-4.018	0.000^a	7.222	0.000^a	-3.892	0.000^a
Y轴角（°）	62.49±2.85	62.17±3.34	0.365	0.718	69.72±3.38	62.82±3.36	7.145	0.000^a	-8.394	0.000^a	5.003	0.000^a

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