稳定性（he）垫治疗颞下颌关节可复性盘前移位的疗效分析

目的分析稳定性(牙合)垫治疗颞下颌关节可复性盘前移位的疗效.方法使用Michigan型稳定性(牙合)垫治疗颞下颌关节盘前移位患者32例,疗程为3个月,采用Fricton指数来评价治疗效果.治疗前后均拍摄许勒位X线片以及行关节上腔造影.结果统计学分析表明治疗前后存在有显著性差异(P=0.02),Fricton颞下颌关节紊乱指数(CMI)从治疗前的0.21±0.04下降到治疗后的0.09±0.03.但造影显示并非所有弹响消失患者的盘-突关系均恢复正常.结论稳定性牙合垫治疗颞下颌关节可复性盘前移位取得了良好的治疗效果,能有效地消除弹响,缓解疼痛,改善患者的下颌运动功能.     

稳定性(牙合)垫治疗颞下颌关节可复性盘前移位的疗效分析

目的:分析稳定性(牙合)垫治疗颞下颌关节可复性盘前移位的疗效.方法:使用Michigan型稳定性(牙合)垫治疗颞下颌关节盘前移位患者32例,疗程为3个月,采用Fricton指数来评价治疗效果.治疗前后均拍摄许勒位X线片以及行关节上腔造影.结果:统计学分析表明治疗前后存在有显著性差异(P=0.02),Fricton颞下颌关节紊乱指数(CMI)从治疗前的0.21±0.04下降到治疗后的0.09±0.03.但造影显示并非所有弹响消失患者的盘-突关系均恢复正常.结论:稳定性牙合垫治疗颞下颌关节可复性盘前移位取得了良好的治疗效果,能有效地消除弹响,缓解疼痛,改善患者的下颌运动功能.     

2种不同牙合垫治疗颞下颌关节紊乱病的临床疗效分析

目的:对比分析稳定型牙合垫和再定位牙合垫对治疗颞下颌关节紊乱病的临床疗效。方法:对采用牙合垫治疗的32例颞下颌关节紊乱病患者进行随访分析,其中使用稳定型牙合垫治疗的病例18人,再定位牙合垫14人,对比分析2组患者在治疗前、治疗后、治疗后3个月、6个月、12个月时关节弹响、疼痛程度(VAS)的变化。结果:2组患者治疗后疼痛程度及关节弹响状况与术前比较均明显改善,差异均有统计学意义(P<0.05),两种牙合垫对关节弹响的治疗效果无显著性差异,稳定型牙合垫组患者治疗后及治疗后3个月、6个月、12个月时的VAS低于再定位牙合垫组,差异有统计学意义(P<0.05)。结论:2种牙合垫均可有效地治疗颞下颌关节紊乱病,再定位牙合垫主要用于治疗可复性关节盘前移位,稳定型牙合垫治疗关节疼痛的疗效优于再定位牙合垫。     

再定位咬合板治疗颞下颌关节盘可复性前移位疗效观察

目的评价再定位咬合板治疗颞下颌关节盘可复性前移位的临床疗效。方法选择28名颞下颌关节盘可复性前移位患者。患者戴用再定位咬合板治疗后3个月、6个月、1年、2年复诊,行关节常规检查并拍x线片,评价治疗效果。结果经过再定位咬合板治疗,18名弹响患者中13名（72．22％）弹响完全消失,10名疼痛患者中8名（80．00％）疼痛消失,14名下颌运动异常患者中10名（71．43％）转为正常。26名患者认为治疗有效（92．86％）。结论再定位咬合板对治疗颞下颌关节盘前移位具有较好的疗效。     

下颌稳定型(牙合)垫治疗可复性盘前移位的临床评价

目的 探讨下颌稳定型(牙合)垫治疗颞下颌关节可复性盘前移位的疗效.方法 对32例(34侧)关节盘可复性前移位患者,采用下颌稳定型(牙合)垫治疗,疗程为3个月,采用Fricton指数及疼痛量化表来评价治疗效果.结果 统计学分析表明治疗前后的差异有统计学意义(P＜0.05),Fricton颞下颌关节指数(CMI)从治疗前的...     

弹响消除试验在颞下颌关节可复性关节盘前移位诊断中的信度和效度分析

目的: 分析弹响消除试验在颞下颌关节可复性关节盘前移位诊断中的信度和效度。方法: 选择2019年7月—2019年12月因关节弹响于上海交通大学医学院附属第九人民医院颞下颌关节康复门诊就诊的患者102例。先后接受A、B 2名评估者独立进行弹响问诊与体格检查以及弹响消除试验检查,初步判断患者是否存在可复性关节盘前移位;然后行双侧颞下颌关节磁共振成像;根据磁共振成像诊断关节盘移位的影像学标准,将关节盘位置关系分为正常盘-髁关系、可复性关节盘前移位、不可复性关节盘前移位3类。以磁共振成像诊断结果为金标准,计算弹响消除试验的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比;Kappa检验计算A、B 2名评估者之间弹响消除试验结果的Kappa系数。采用SPSS 13.0软件包对数据进行统计学分析。结果: A、B评估者弹响消除试验的阳性率分别为35%（72/204）、37%（76/204）。评估者A弹响消除试验的敏感度为71%、特异度为91%、阳性预测值为85%、阴性预测值为81%、阳性似然比为7.61、阴性似然比为0.32（P<0.01）;评估者B弹响消除试验的敏感度为76%、特异度为91%、阳性预测值为86%、阴性预测值为84%、阳性似然比为8.11、阴性似然比为0.27（P<0.01）。A、B评估者之间的Kappa系数为0.873±0.036（P<0.01）。结论: 颞下颌关节弹响消除试验简单、易操作,对判断颞下颌关节可复性关节盘前移位有较好的诊断价值。     

颞下颌关节盘可复性前移位患者咬合接触特征的研究

目的观察颞下颌关节盘可复性前移位患者的咬合接触特征并比较其与正常人的差异。方法采用T-ScanⅡ咬合分析系统记录30名颞下颌关节盘可复性前移位患者和30名正常人于牙尖交错位和后退接触位时的咬合接触信息并进行统计分析。结果颞下颌关节盘可复性前移位患者在牙尖交错位可出现力中心较大的偏移、两侧接触点不平衡、两侧力不对称、弹响侧接触点数目多于非弹响侧;在后退接触位颞下颌关节盘可复性前移位患者双侧接触点数目有显著差异,单侧接触者显著增多。结论颞下颌关节盘可复性前移位患者咬合接触情况与正常人有显著的差异,提示咬合因素与颞下颌关节盘可复性前移位有密切的关系。     

用下颌前移位垫治疗青少年颞颌关节内素乱症后的最终处理

对颞颌关节内紊乱症常用下颌前移位(牙合)垫使前移的关节盘复位。此疗法虽然有效,但复发率较高,其原因是除去(牙合)垫后颌位不能保持稳定。作者对青少年颞颌关节内素乱症在使用了下颌前移位(牙合)垫治疗后,采取让后牙升高的最终处理方法,保持颌位稳定,临床观察弹响不再出现。对象 1986年4月～1987年3月,5例诊断为可复性关节盘前移位伴深覆(牙合)的男性患者,年龄12～17岁。X线检查无明显关节部硬组织异常。方法给患者装戴常规的下颌前移位(牙合)垫,使关节盘复位,颌位做开闭口动作无弹响出现。(牙合)垫最好24小时戴着,饭后取下清洁。一周后复诊检查,戴(牙合)垫时做开闭口动作应无弹响,此时稍调整(牙合)垫,诱导下颌后退,确认弹响无再出现后,每隔2～3周调整一次,直至髁状     

手法复位辅助

目的 探讨关节腔扩张后手法复位辅助再定位垫治疗颞下颌关节紊乱病急性不可复性盘前移位.方法 2%局麻药2～3 ml 注入关节上腔,手法复位解除不可复性前移位的关节盘,复位后即刻戴用再定位垫保持良好的盘-突关系.结果近期临床观察表明①开口度恢复,最大开口度从治疗前的25.8 mm增大到46.6 mm;②疼痛症状消失,疼痛分值视觉模拟尺从治疗前的2.62下降到0.43; ③颞下颌关节功能改善,Fricton关节功能障碍指数和颞下颌关节紊乱指数分别从治疗前的0.337和0.185下降到0.021和0.011.结论颞下颌关节紊乱病急性不可复性盘前移位药物治疗和理疗无效的情况下,关节盘复位辅助定位垫是一有效的治疗方法.远期效果如何尚需进一步观察.     

稳定咬合板和再定位咬合板治疗青少年颞下颌关节盘间断性锁结的临床疗效评价

目的:比较稳定咬合板和再定位咬合板进行治疗对于青少年颞下颌关节盘间断性锁结患者的临床应用疗效。方法:将40例青少年颞下颌关节盘间断性锁结患者,随机分为两组,分别戴用稳定咬合板和再定位咬合板进行治疗3-6个月,记录治疗前后关节疼痛指数、关节弹响及主动开口度;并比较MRI影像检查中关节盘-髁突距离在治疗前、后的变化。结果:两组治疗均可明显缓解关节疼痛和增加主动开口度,两组间没有显著性差异。稳定咬合板治疗组,治疗前疼痛指数为6.75±0.40,治疗后为2.80±0.20,治疗前开口度为27.20±1.20,治疗后为39.50±1.50;再定位咬合板治疗组,治疗前疼痛指数为6.50±0.20,治疗后为2.60±0.30,治疗前开口度为28.50±1.30,治疗后为40.60±1.40;在治疗关节弹响方面,戴用稳定咬合板的患者中大多数患者的关节弹响无明显改变,戴用再定位咬合板的患者中关节弹响得到了明显改善;MRI检查显示,再定位咬合板较稳定咬合板能更加明显的缩小患者的盘-突距离。戴用稳定咬合板治疗的患者,治疗前盘-突为6.34±2.13,治疗后为3.65±1.56;再定位咬合板治疗组,治疗前盘-突距离为6.45±2.15,治疗后为1.15±1.55。结论:稳定咬合板和再定位咬合板在缓解关节疼痛和增加张口度方面均有良好效果,在治疗关节弹响和恢复正常盘突出关系时,再定位咬合板效果较稳定咬合板更优,但本研究随访时间较短,两种咬合板的长期疗效还有待我们进一步发展观察分析研究。     

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??Objective    To compare the efficacy of repositioning splint therapy made with average values articulator and full-adjustable articulator for anterior discdisplacement. Methods    Totally 46 patients were with anterior disc displacement with reduction. They went to TMD Department of Dalian Stomatological Hospital from Jun??2010 to Jun??2016. They were divided into two groups randomly. Group ??n=23??used repositioning splint made with average values articulator and group ??n=23??used full-adjustable articulator. After wearing splint all patients were examined using clinical temporomandibular joint disorder examination protocol??including muscle palpation and occlusion adjustment. Record the number of the occlusion adjustment. Results    All of the patients had no joints clicks in both groups. The pains of 80% patients disappeared in group ?? and the pains of 95% patients disappeared in group ??. The  opening degree of all patients was increased in both groups. The average number of the occlusion adjustment was 8±0.73 in group ?? and 4±0.67 in group ??. Conclusion    The repositioning splint made by full-adjustable articulator for anterior disc displacement with reduction is more effective??such as less further consultation and occlusion adjustment??short treatment process and high patient satisfactions.     

Internal derangements of the temporomandibular joint. III. Anterior repositioning splint therapy

A bstract — Over a four-year period, anterior repositioning (REPO) splint therapy was used to treat 241 temporomandibular joint pain patients for whom a clinical diagnosis of anterior disc displacement had been made. Following an initial six months of active REPO therapy, the response to treatment over the ensuing twelve months was generally encouraging, control of joint noise and discomfort being achieved in 70 per cent of the treated sample. This figure had decreased to 53 per cent at the two-year follow-up and, by the end of three years, only 36 per cent were considered successfully treated.
It is suggested that REPO splint therapy for anterior disc displacement should not be lightly undertaken by the general dental practitioner but that a more conservative approach should be adopted for the vast majority of TMJ pain patients.     

Natural course of disc displacement with reduction of the temporomandibular joint: changes in clinical signs and symptoms.

PURPOSE: The goal of this study was to examine the natural course of disc displacement with reduction in the temporomandibular joint (TMJ). PATIENTS AND METHODS: This retrospective study involved 24 patients who had been diagnosed with disc displacement with reduction of the TMJ, but who had not undergone any treatment. The extent of maximal mouth opening, protrusion, lateral excursions, noise of the TMJ, pain of the TMJ, and tenderness of masticatory muscles were recorded monthly for a mean of 25.8 months. RESULTS: Maximal mouth opening, protrusion, and lateral excursions remained unchanged during follow-up. TMJ pain decreased by 15.7% (P >.05). Clicking decreased by 20.8% (P <.05), and tenderness of masticatory muscles decreased by 33.3% (P <.05). Reciprocal clicking remained unchanged in 19 patients (79.2%) and disappeared in 5 patients (23.8%). Four patients (16.7%) in whom clicking disappeared had a normal mouth opening, but locking developed in 1 patient (4.2%). CONCLUSIONS: In patients with disc displacement with reduction who do not undergo treatment, range of movement remains unchanged over time. Tenderness of masticatory muscles tended lessen, but reciprocal clicking and TMJ pain tended to remain. Clicking did not progress to locking in most patients.     

Arthroscopic discopexy technique with anchors for treatment of temporomandibular joint internal derangement: Clinical and magnetic resonance imaging evaluation

PurposeThe objective of this study was to describe a technique of arthroscopic discopexy with anchors used to treat temporomandibular joint internal derangement.Materials and methodsThis study involved patients with unilateral temporomandibular dysfunction refractory to conservative treatment, and whose magnetic resonance imaging (MRI) examinations showed internal derangement of the temporomandibular disc, with anterior disc displacement. Maximal interincisal opening (MIO), joint pain, joint noise, and disc position were the variables assessed by clinical examination and MRI before and 6 months after the surgery.ResultsThe sample consisted of 20 patients. In the postoperative evaluation, MIO had increased from 33.8 ± 4.83 mm to 35.1 ± 4.08 mm (p = 0.04), while joint pain had decreased from 7.5 ± 1.42 points to 2.05 ± 1.47 points (p = 0.001). With regard to joint noise, 19 of the patients had presented with clicking or crepitation but after 6 months these were completely absent. Disc repositioning was complete in 15 of the patients and partial in the other five.ConclusionThe technique of arthroscopic discopexy with anchors was shown to be effective in treating temporomandibular internal derangement, with good clinical results.     

Follow-up Examination of the Temporomandibular Joint Disk After Splint Therapy by Magnetic Resonance Imaging—A Case Report

A 38-year-old female patient presented with temporomandibular joint (TMJ) pain, bilateral clicking and intermittent locking. The patient was treated with a splint in order to decrease the symptoms and to obtain a proper disk-condyle relationship. The effect of the splint therapy was investigated after one month and after one year and five months using magnetic resonance imaging (MRI) with splints in place. After treatment for one year and six months, the clicking sound of the right TMJ disappeared, and she became free from locking. With the aid of MRI, it was found that the disk of the right TMJ had changed from an anterior position with reduction to a superior position. In the left TMJ, the disk changed from an anterior position without reduction to an anterior position with reduction. MRI gave important information on the disk position and the efficacy of the splint therapy.     

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??Anterior repositioning splints ??ARS?? have been proven to be the most effective conservative management of disc displacement with reduction of the temporomandibular joint. This paper covers the detailed contents of ARS therapy for disc displacement with reduction of the temporomandibular joint??including the precise mechanism of ARS treatment??condylar remodeling accompanying ARS therapy??current issues on ARS therapy such as unsatisfactory long-term effect and the comparison between ARS and stabilization splint.