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颞下颌关节紊乱病（TMD）是一种由关节结构、咬合、肌功能异常及精神心理等多种因素综合作用形成的口颌面部疾病。闭锁型深覆[牙合]、个别前牙与后牙反[牙合]、后牙锁[牙合]、一侧后牙反[牙合]、下颌偏斜、磨牙伸长、磨牙倾斜等是诱发TMD的高危险[牙合]因素。从整体分析,正畸治疗与TMD并无密切相关性,但部分病例TMD的发生仍可能与正畸治疗不当有关。良好的牙齿排列、正常的前牙覆[牙合]与覆盖关系及后牙尖窝对应关系、牙位与肌位一致、下颌前伸与侧[牙合]平衡是有效预防与缓解TMD的可靠保证。本文对错[牙合]畸形及正畸治疗与TMD的相关性研究文章进行系统回顾,结合正畸临床实际,分析错[牙合]畸形与TMD的内在联系,以及正畸治疗中TMD的风险和防治策略。

Risk and treatment strategy of temporomandibular disorders during orthodontic treatment

Temporomandibular disorders （TMD） is a complex syndrome correlated with morphology of TMJ,occlusion,oral-facial muscle function and mentality. Closed deep bite,unilateral cross bite,over extrusion and tipping of molars,deviation of the mandible related to occlusal interference are the risk factors related to TMD. No significant evidence in dicated that there was close relationship between the orthodontic treatment and TMD. However,the error in orthodontic treatment may also results in TMD. Good alignment of teeth,normal over bite and over jet,central occlusion consistent to central relation,and the balance of mandibular anterior-posterior and lateral movement are needed to the health of TMJ. This article discusses the malocclusion and TMD,the risk of TMD and its treatment strategy during orthodontic treatment.