封闭疗法结合咬合板治疗颞下颌关节紊乱综合征器质性破坏类的…

采用封闭疗法结合咬合板治疗颞下颌产节紊乱综合征器质性破坏类患者５２例，男１２例，女４０例，年龄１４～７３岁，平均４０岁，关节下腔注射了塞米松和利多卡因混合液，根据病因选用前方调位咬合板或稳定型咬合板，治疗６个月后显效４６例（８８．５％）有效６例（１１．５％）Ｘ线示原骨质破坏处有修复出现，认为封闭与咬合板相结合是针对症状和病因的综合治疗方法，该方法治疗效果明显，无不良反应，有普及应用价值。     

微型咬合板治疗颞下颌关节紊乱病的临床研究

采用微型咬合板治疗颞下颌关节紊乱病（ＴＭＤ）８８例,男２５例,女６３例,年龄１４～４８岁,平均２７．５岁．结果：症状完全消失４０例（４５．５％）,症状改善４５例（５１．１％）,症状无变化３例（３．４％）．结果表明微型咬合板是治疗ＴＭＤ的一种简便而有较好疗效的保守疗法     

咬合板对颞颌关节内压影响的实验研究

目的　探讨咬合板对颞颌关节（ Ｔ Ｍ Ｊ） 内压力（ Ｉ Ａ Ｐ） 的影响。方法　采用多道生理记录仪分别测量戴板前及戴入咬合板后，紧咬状态下３ 只成年家犬的 Ｔ Ｍ Ｊ上腔内压力。结果　戴板前紧咬时关节上腔内压力为６ ．４ Ｋｐａ±１ ．５ Ｋｐａ ，戴入咬合板后紧咬时为０ ．６ Ｋｐａ ±０ ．２ Ｋｐａ，两者有显著差异（ Ｐ＜ ０ ．０１） 。结论　咬合板对颅颌功能紊乱者的治疗机理之一是对 Ｔ Ｍ Ｊ内压异常增高者降低关节内压，从而发挥治疗作用     

尖牙高He型咬合板治疗磨牙症的远期疗效观察

采用自行设计的尖牙高Ｈｅ型咬合板治疗磨牙症，对６８例患者进行６年以上随访观察。结果３０人治愈（４４．１％）、２２人显效（３２．４％）、１６人有效（２３．５％）。成年患者的颌位及咬合关系无改变。认为尖牙高Ｈｅ型咬合板是治疗磨牙症的有效疗效的方法。     

咬合板治疗颞下颌关节盘移位的疗效评价

目的：对临床使用咬合板治疗颞下颌关节盘移位病例进行疗效评价，比较稳定性咬合板和再定位咬合板疗效。方法：使用稳定性咬合板治疗的病例66人（男19人，女47人），再定位咬合板29人（男9人，女20人）。以上病例均是通过临床检查、颞下颌关节许勒位片和关节上腔造影确诊为颞下颌关节盘前移位。研究设计与统计：分别对两组用咬合板治疗前后的关节弹响，疼痛指数，压痛的程度，以及病人对治疗的满意程度进行统计，对部分人治疗后的关节造影及许勒位进行评价，用SPSS建立数据库，用卡方检验比较两组治疗效果有无显著性差异。结果：95例患者中，经过咬合板治后，关节弹响的消失的有69例，消失为72．63％。关节弹响减轻有17例，治疗弹响的有总的效率为90．5％。两种咬合板的分组对照，在两组在弹响治疗效果上没有差异（χ^2值为0．138，P=0．719）。在治疗前有疼痛的患者41名中，经过咬合板治疗后有34名患者疼痛消失，其比率为82．96％，其它7名患者均表示疼痛较治疗前有改善，在两种咬合板治疗的分组统讲计中，疼痛的治疗效果没有显著性差异（χ^2值为0．005，P=0．967）。结论：两种咬合板治疗关节盘前移位均有疗效，当稳定性咬合板无法消除的弹响用再定位咬合板治疗也可以达到很好的疗效。     

尖牙高型咬合板治疗磨牙症的临床研究(附210例报告)

采用尖牙高型咬合板治疗磨牙症２１０例，男１２１例，女８９例，年龄１２～６５岁，平均２７．９岁，疗程１～３年，平均１５个月。结果所有患者的磨牙症状均得到了有效的控制，磨动的幅度和磨损程度逐渐减小，１１６人治愈（５５．２％）、５９人显效（２８．１％）、３５人有效（１６．７％）。讨论了磨牙症的病因和尖牙高型咬合板治疗磨牙症的机理，认为该咬合板设计科学、制作简单、戴用方便、效果明显，有推广应用价值。     

磨牙根纵折65例诊治体会

作者自１９８７年以来，对牙体完整，牙根纵折的６５例６９牙进行了治疗和总结，现报道如下：１ 临床资料１．１ 一般资料 ６５例患者共６９个牙齿，男性３９例，占６０％，女性２６例，占４０％。患者性别比为１．５：１。年龄 ３５～７２岁。其中４０～６０岁共４８例，占７３．８５％。患牙牙位及根分布见表１。 有１例６ ６均发生了根纵折，１例 ７６ 先后发生了根纵折，２例６ 近远中根同时发生了根纵折。本组病例中未发现上颌腭侧根纵折者。１．２ 临床症状及检查 临床常以咬合疼痛和牙髓症状来就诊。出现咬合疼痛４８牙（占６９．５…     

再定位咬合板和稳定性咬合板治疗颞下颌关节紊乱病的临床疗效观察

目的：应用再定位和稳定性咬合板治疗颞下颌关节紊乱病（TMD），研究不同咬合板对不同TMD症状的疗效对比。方法：TMD患者随机分为2组，分别采用再定位咬合板和稳定性咬合板进行治疗，在佩戴后第1、2、4、6月复查并调磨，同时做影像学检查，记录患者疼痛指数、关节弹响及张口度的变化。结果：稳定性咬合板对治疗关节疼痛效果优于再定位咬合板（P＜0．05）；再定位咬合板对治疗关节弹响效果明显高于稳定性咬合板（P＜0．01）；两种咬合板治疗6个月后张口度与治疗前比较才有效果（P＜0．05），且两种咬合板疗效差别无统计学意义（P＞0．05）。结论：稳定性咬合板治疗关节疼痛效果较好，再定位咬合板对治疗关节弹响效果好，两种咬合板对改善颞下颌关节病的张口度稍有作用，两种咬合板都能使咬合紊乱的牙齿脱离接触而达到新的咬合关系，使髁突复位到关节窝的最佳位置。     

枢轴咬合板治疗颞下颌关节紊乱综合征的临床观察

采用以枢轴咬合板为主要方法治疗颞下颌关节紊乱综合征患者５０例，其中关节盘不可复性前移位３０例，部分可复性前移位１２例，髁突上移位８例。对治疗前后的张口度和关节间隙进行了测量分析，按照国际已有的标准判断疗效，结果表明枢轴咬合板对向下调整髁突位置有明显效果。５０例中，治愈３６例（７２％），好转１４例（２８％）。经３年随访观察，原有的症状无复发。作者认为，枢轴咬合板是治疗上述３种原因所致颞下颌关节紊乱综合征的有效方法     

鼻咽癌放疗后张口困难及嚼肌痉挛的咬合板治疗

目的放射线引起颢下颌关节及咀嚼肌损伤在鼻咽癌放疗的患者中十分常见。本研究旨探讨采用咬合板治疗鼻咽癌患者放射线治疗后出现的张口困难及嚼肌痉挛症状及其治疗效果。方法2001～2006年，在中山大学附属口腔医院颞下颌关节疾病诊疗中心就诊患者中．以咬合板治疗鼻咽癌放疗后张口困难共67例．根据张口困难的程度决定治疗方案．每个患者均需制作基础咬合板，轻度张口困难，可直接取印模制作V型咬合板：中度张口困难，可分步骤制取印模和基础咬合板，待张口度有所改善时制作V型咬合板；重度张口困难，可先取分离印模，制作分离咬合板，待张口度有所改善时，合成基础咬合板，条件允许时制作V型咬合板。结果治疗1．5年．67例患者张口困难及咀嚼肌痉挛的症状得到明显改善，张口困难改善率94．0％．轻度困难、中度困难及重度困难的改善率分别为88．9％、100％及86．7％，张口度平均增加1．2cm。肌痉挛改善率100％．其中轻度肌痉挛治愈率为63．9％，明显改善率33．3％，中度肌痉挛治愈率为23．5％．明显改善率41．2％，重度肌痉挛明显改善率为28．6％．改善率71．4％。结论通过咬合板的松弛治疗．可明显改善鼻咽癌放疗后张口困难患者的张口困难及嚼肌痉挛。     

Efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for treating RDC/TMD axis I patients: a randomised controlled trial

Stabilisation splint therapy has long been thought to be effective for the management of temporomandibular disorders (TMD). However, the superiority of stabilisation splint therapy compared to other TMD treatments remains controversial. The aim of this study was to determine the efficacy of stabilisation splint therapy combined with non‐splint multimodal therapy for TMD. A total of 181 TMD participants were randomly allocated to a non‐splint multimodal therapy (NS) group (n = 85) or a non‐splint multimodal therapy plus stabilisation splint (NS+S) group (n = 96). Non‐splint multimodal therapy included self‐exercise of the jaw, cognitive–behavioural therapy, self‐management education and additional jaw manipulation. Three outcome measurements were used to assess treatment efficacy: mouth‐opening limitation, oro‐facial pain and temporomandibular joint sounds. A two‐factor repeated‐measures analysis of variance (anova ) was used to evaluate the efficacy of the two treatment modalities (NS vs. NS+S), and Scheffe's multiple comparison test was used to compare the treatment periods. Subgroup analyses were performed to disclose the splint effects for each TMD diagnostic group. All three parameters significantly decreased over time in both groups. However, there were no significant differences between the two treatment groups in the total comparison or subgroup analyses; an exception was the group with degenerative joint disease. No significant difference between the NS and NS+S treatment approaches was revealed in this study. Therefore, we conclude that the additional effects of stabilisation splint are not supported for patients with TMD during the application of multimodal therapy.     

软性垫和硬性垫治疗夜磨牙或紧咬牙的临床效果观察

目的：观察硬性垫和软性垫治疗夜磨牙或紧咬牙的临床效果。方法对58例夜磨牙或紧咬牙患者随机采用硬性垫或软性垫进行治疗,28例使用硬性垫,30例使用软性垫。患者每天佩戴垫8h以上,睡眠时佩戴,佩戴垫后1个月、2个月、3个月、6个月复诊,问诊并记录肌肉酸痛症状,以及夜磨牙或紧咬牙习惯与佩戴前是否有变化。对佩戴垫6个月时的治疗有效率用SPSS 17.0软件行卡方检验。结果治疗6个月时软性垫和硬性垫的治疗有效率分别为93.33%、82.14%,差异无统计学意义（c2=1.709,P=0.191）。结论硬性垫和软性垫的临床治疗效果均较好,软性垫因制作简便、佩戴舒适,更易被患者接受。     

Clinical comparison between two different splint designs for temporomandibular disorder therapy

OBJECTIVE: To compare splint therapy in temporomandibular disorder (TMD) patients using two splint designs. MATERIAL AND METHODS: In a double-blind randomized parallel trial, 40 consenting patients were selected from the dental faculty pool of TMD patients. Two splint designs were produced: an ordinary stabilization (Michigan type) and a NTI (Nociceptiv trigeminal inhibition). The differences in splint design were not described to the patients. All patients were treated by one operator. A separate, blinded, examiner assessed joint and muscle tenderness by palpation and jaw opening prior to splint therapy, and after 2 and 6 weeks' and 3 months' splint use during night-time. The patients reported headache and TMD-related pain on a visual analog scale before and after splint use, and were asked to describe the comfort of the splint and invited to comment. RESULTS: Thirty-eight patients with mainly myogenic problems were observed over 3 months. A reduction of muscle tenderness upon palpation and self-reported TMD-related pain and headache and an improved jaw opening was seen in both splint groups (p < 0.05; paired t-test and Wilcoxon signed-ranks tests). There were no changes for TM joint tenderness upon palpation. No differences were noted between the two splint designs after 3 months for the chosen criteria of treatment efficacy (p > 0.05; Mann-Whitney U-test). CONCLUSION: No differences in treatment efficacy were noted between the Michigan and the NTI splint types when compared over 3 months.     

Effect of occlusal splint on interleukin 6, malondialdehyde and 8-hydroxydeoxyguanosine levels in the synovial fluid of patients with temporomandibular disorders

The actual role of splint therapy in preventing excessive loading of the temporomandibular joint (TMJ) is still debated. Lower intra-articular pressure levels have been measured in patients wearing occlusal splints, which may also reduce oxidative stress in the articular spaces. The aim of this study was to determine whether splint therapy reduces oxidative stress and inflammation in TMJ internal derangement patients by measuring interleukin 6 (IL-6), malondialdehyde (MDA), and 8-hydroxydeoxyguanosine (8-OHdG) levels in the synovial fluid (SF). Twenty-four patients with a temporomandibular disorder (TMD) were included in the study. TMJ SF samples were obtained prior to arthrocentesis. Twelve patients used a 2-mm hard acrylic, maxillary stabilization-type splint for 3 months after arthrocentesis. Twelve patients had no treatment after the SF aspiration. Second SF samples were obtained from all patients at 3 months post arthrocentesis. IL-6, MDA, and 8-OHdG levels in the samples were evaluated. All patients showed a significant symptomatic improvement after treatment (P < 0.005). No statistical correlation was found between the two groups concerning pre-treatment and 3-month SF levels of MDA, 8-OHdG, and IL-6. Although splint therapy was found to be successful in eliminating clinical symptoms of TMD, the results showed no beneficial effect on inflammation and oxidative stress markers in the synovial fluid.     

Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. II. A 1-year follow-up study.

Eighty patients, of whom 22 were men and 58 women, participated in a 1-year follow-up study. All participants in the study showed signs and symptoms of craniomandibular disorders (CMD) and had had pain for more than 6 months at treatment start. The patients were randomly assigned to either acupuncture or occlusal splint therapy. Those patients who did not respond to either of the treatment modes were offered various additional therapies. The result showed that 57% of the patients who received acupuncture and 68% of the patients treated with occlusal splint therapy benefited subjectively (p < 0.01) and clinically (p < 0.001) from the treatment over a 12-month period. No statistically significant difference was found between the two groups as to the assessment variables. Those patients who received various additional therapies after acupuncture and/or occlusal splint therapy responded favorably to additional treatment in only a few instances. The study showed that acupuncture gave positive results similar to those of occlusal splint therapy in patients with primarily myogenic CMD symptoms over a 1-year follow-up period.     

Acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. Part I. A comparative study.

One hundred and ten patients, 23 males and 87 females, participated in a comparative study of the effect of acupuncture and occlusal splint therapy. All the patients exhibited signs and symptoms of craniomandibular disorders (CMD) and had had pain for more than six months. The participants were randomly assigned to three groups; acupuncture treatment, occlusal splint therapy or control. The patients were evaluated before and immediately after treatment/control time. Ten different subjective and/or clinical assessment variables were used in the evaluation of the treatment effects. Both acupuncture and occlusal splint therapy reduced the symptoms as compared with the control group in which the symptoms remained essentially unchanged. In this short-term study, acupuncture gave better subjective results (p < 0.001) than the occlusal splint therapy.     

The effects of an occlusal splint on the electromyographic activities of the temporal and masseter muscles during maximal clenching in patients with a habit of nocturnal bruxism and signs and symptoms of craniomandibular disorders

The effects of a full arch maxillary plane occlusal splint on the level of electromyographic (EMG) activity in the anterior temporal and masseter muscles during maximal clenching were studied in 31 patients with a habit of nocturnal bruxism and signs and symptoms of craniomandibular disorders, before and after occlusal splint therapy. The results showed, before treatment, that the occlusal splint changed significantly (in 71% of patients) the level of EMG activity during maximal clenching. However, these changes were not consistent and differed between patients and even, in some patients, between muscles. After long-term occlusal splint therapy and improvement of the signs and symptoms of craniomandibular disorders, the number of patients who had an identical level of EMG activity during maximal clenching in the intercuspal position and on the occlusal splint tended to increase. Moreover, in these patients the level of symmetry of action in pairs of muscles during maximal clenching was strong, and the splint did not change this level of symmetry.     

Conservative therapy in patients with anterior disc displacement without reduction using 2 common splints: a randomized clinical trial.

PURPOSE: We performed a comparative evaluation of different types of splint therapy for anterior disc displacement without reduction (ADDWR) of the temporomandibular joint. PATIENTS AND METHODS: Seventy-four patients agreed to participate (65 females and 9 males). All patients were examined using a clinical temporomandibular joint disorder examination protocol, including muscle palpation, mandibular range-of-motion measurement, and joint sound detection. Additionally, the patients marked their pain (during chewing, mandibular movements, and rest position) and limitation levels on a visual analog scale. Bilateral magnetic resonance images were acquired, confirming ADDWR in at least one joint. After clinical examination and imaging, randomized splint therapy was provided: 38 patients received a centric splint, while 36 received a distraction splint. After 1, 3, and 6 months of therapy, outcome was evaluated using the Wilcoxon signed rank test for matched pairs. Success after 6 months was defined as improvement in active mouth opening of greater than 20% and pain reduction (on chewing) of at least 50%. Success was statistically verified using logistic regression test. RESULTS: The improvements in mouth opening were significant in both groups. The improvements in pain on chewing, pain during other functions, pain at rest, functional limitation on chewing, and other functions were also comparable in both groups. However, the logistic regression test suggested that patients using centric splints were treated more successfully than the others (confidence interval, 1.014 to 8.741, odds ratio = 2.785). CONCLUSIONS: Centric splints seem to be more effective than distraction splints. Therefore, before the surgical treatment of ADDWR, centric splints should be used instead of distraction splints.     

Efficacy of Appliance Therapy on Temporomandibular Disorder Related Facial Pain and Mandibular Mobility: A Randomized Controlled Study

There is limited evidence supporting the role of occlusal splints in Temporomandibular disorder (TMD) therapy. The aim of this randomized controlled clinical trial was to assess the efficacy of stabilization splint therapy on TMD related facial pain and mandibular mobility. The sample of study consisted of eighty consecutive patients diagnosed with TMD. Patients were randomly assigned into two groups: a splint group (n = 40) comprising of patients treated with stabilization splint, councelling and masticatory muscle exercises, and a control group (n = 40), comprising of patients treated with councelling and masticatory muscle exercises alone. Data from both the groups were collected at the beginning of the study and after a 6-month follow up. The outcome variables were visual analogue scale on facial pain intensity and clinical findings for TMD (anterior maximal opening, mandibular right laterotrusion, mandibular left laterotrusion, mandibular protrusion, and number of painful muscle sites). Changes within the splint and control groups (before treatment and 6 months after treatment) were analyzed using paired samples t test. Differences in change between the splint and control groups were analyzed using independent samples t-test. The level of significance was set at p < 0.05. Facial pain and number of painful muscle sites decreased, and the mandibular mobility increased significantly in both groups after treatment; however the differences in changes in VAS or clinical TMD findings between the two groups were not statistically significant. The findings of this study show that stabilization splint treatment in combination with counselling and masticatory muscle exercises has no additional benefit in relieving facial pain and increasing the mobility of the mandible than counselling and masticatory muscle exercises alone over a 6-months’ time interval.     

Comparison of effects of electromyographicbiofeedback and occlusal splint therapy on mandibular dysfunction

Abstract – In order to evaluate and compare the effects of biofeedback and occlusal splint therapy on mandibular dysfunction, 30 patients were randomly divided into two treatment groups. The patients were women aged 20–40 years without any obvious organic- reasons for their symptoms. There were no signiGcant differences between the two groups before the start of treatment in respect of signs and symptoms of mandifoiaiar dysfunction. One group used full coverage splints at night for 6 weeks. The other group received biofeedback training up to six times, 30 min per session. One month after completion of the therapy the patients were re-examined. Both groups showed a significant reduction in symptoms, both subjectively and clinically. No significant differences between the groups were found. The two treatments were thus equally effective in the short-term perspective in patients with signs and symptoms of mandibuiar dysfunction.