颞颌关节紊乱综合征弹响的临床与 X 线诊断研究

本文总结了157例颞颔关节紊乱综合征(TMJDS)弹响患者的临床和X线诊断资料,目的在于探讨弹响的病因机制、病程特点及规律。根据薛氏位平片(187侧弹响关节)与关节上腔造影(94侧弹响关节)的X线征象,并结合临床病史与各项检查,证实弹响多为 TMJDS 的初发症状,多具有不同程度的关节内结构和(或)器质病变,并以盘前移位和(或)髁后移位最常见。弹响的性质时程与关节内病变的类型、程度密切相关,病程进展与关节内病变的发展相对应,有较明显的临床阶段性特征。弹响主要是由于咬合、肌肉异常因素的影响,最终形成关节内病变所致。     

颞颌关节紊乱综合征158例临床分析

本文对收治的１５８例有颞颌关节弹响、疼痛、下颌运动异常的患者进行统计分析，结果表明：发病年龄以２０岁～组最多，占８６．８％，自觉症状依次为：弹响、疼痛、张口受限。诱发因素依次为：咀嚼过度，张口过大，关节局部外伤、受凉等。有明显异常者行咬合治疗，治愈、好转率各占５０％，对顽固的保守治疗无效及关节器质性病变的患者行关节盘切除术或髁突部分切除术，疗效肯定。     

颞颌关节紊乱综合征疼痛的分析

颞颌关节紊乱综合征的主要症状有疼痛、颞颌关节弹响、张口受限等。这些症状并不一定同时出现,相反,只要有其中一种或二种症状,在排除炎症、外伤、肿瘤、全身疾患之外,     

无牙颌颞颌关节紊乱综合征的特点

通过对123例无牙颌患者TMJDS的调查认为无牙颌类似于自然牙列有较高的TMJDS发病率,全无牙组为28.6％,单颌全无牙组为31.3％。无牙颌TMJDS以TMJ弹响最常见,下颌运动偏斜及翼外肌触诊敏感次之,但TMJ及有关区域疼痛较少发生。髁状突在关节凹内的位置两侧不对称也为其显著特征。而头痛及眼、耳部症状与TMJDS无明显关系。认为这些特点与全无牙后及义齿修复后(牙合)型、(牙合)力及功能运动的变化有关。     

少年儿童颞颌关节紊乱综合征的流行病学调查

长期以来,对颞颌关节紊乱综合征(简称TMJDS)的发病病因和机理的讨论多围绕成年患者。近年来,学者们已经注意到从少年儿童TMJDS入手,可以使TMJDS的病因研究尤其是(牙合)因素研究得以深入,同时可以对TMJDS进行预防和早期治疗。目前,     

无牙颌颞颌关节紊乱综合征的防治特点

本文报道了采用改善总义齿固位，去除总义齿的咬合创伤及Ｈｅ干扰，恢复及增加咬合垂直距离以调查髁状突位置等系列方法，对３９例无牙颌颞颌关节紊乱综合征患者行临床矫治，结果所有患者均获得显疗效，本文对轿形治疗方法及对不同症状体征的矫治效果作了初步探讨，总结了无牙颌颞颌关节紊乱综合征的防治特点为，及时正确的总义齿修复，及早恢复咬合支持，以保持髁状突的位置的稳定；确定准确的Ｈｅ位关系及咬合垂直距离，去除总义齿     

常见颞颌关节紊乱综合征的正畸治疗

正畸治疗是去除牙位、颌位异常的错Ｈｅ所致颞颌关节紊乱综合征（ＴＭＪＤＳ）的有效而稳定的方法。作者通过对经治的８０例患者加以分析，探讨了正畸患者ＴＭＪＤＳ的特点及所采用的正畸治疗方法。８０例患者的平均年龄为１６．８岁，男女性别比４：６。其中，毛氏Ⅰ＾１患者最多，共５６例；关节症状以弹响多见，其次为张口受限、夜磨牙、关节脱位等。关节开闭口片见：３０例开闭口片见：３０例关节间隙有改变，２０列关节凹和关节     

颞颌关节关节内紊乱症

颞颌关节关节内紊乱症是指颞颌关节内部结构结构紊乱，即关节盘与髁状突，关节窝和关节结节之间的关系异常。本病表理为，滑膜炎，关节囊内瘢痕，关节内出血，纤维软骨化生，营养不良性钙化及骨关节炎等，一般认为是关节内进行性器质性病变，多发生于女性，病因主要是关节损伤，症状为炎症及机械运动障碍如关节区疼痛及压痛，关节弹响等，本文描述了本病的分级及其特征，提出了诊断及治疗方法，指出关节镜是诊断及治疗本病的最好方法     

颞颌关节紊乱综合征的影像学诊断现状

颞颌关节紊乱综合征的影像学诊断现状深圳市蛇口联合医院口腔科（邮５１８０６７）夏防汛综述湖北医科大学口腔医学院张雪华审校颞颌关节紊乱综合征（Ｔｅｍｐｏｒｏｍａｎｄｉｂｕｌａｒｊｏｉｎｔｄｉｓｏｒｄｅｒｓ，ＴＭＪＤＳ）是人群中的一种常见病和多发病，它以疼...     

Piroxicam and laser phototherapy in the treatment of TMJ arthralgia: a double‐blind randomised controlled trial

This study aimed to evaluate the efficacy of piroxicam associated with low‐level laser therapy compared with single therapies in 32 patients presenting temporomandibular joint arthralgia in a random and double‐blind research design. The sample, divided into laser + piroxicam, laser + placebo piroxicam and placebo laser + piroxicam groups, was submitted to the treatment with infrared laser (830 nm, 100 mW, 28 s, 100 J cm^?2) at 10 temporomandibular joint and muscle points on each side during four sessions concomitant to take one capsule a day of piroxicam 20 mg during 10 days. The treatment was evaluated throughout four sessions and 30 days follow‐up through visual analogue scale (VAS), maximum mouth opening and joint and muscle (temporal and masseter) pain on palpation. The results showed that all the study groups had a significant improvement in the VAS scores (P < 0·05), and there were no significant group differences. Piroxicam was effective in the reduction of joint and muscle pain on palpation (P < 0·05) and showed the lowest temporal pain (P = 0·02) at the 30‐day follow‐up. The combination of low‐level laser therapy and piroxicam was not more effective than single therapies in the treatment of temporomandibular joint arthralgia. The use of piroxicam was more effective in the following 30 days.     

Predictive factors of hyaluronic acid injections short-term effectiveness for TMJ degenerative joint disease

This study attempted to identify baseline predictors of positive outcome of arthrocenteses plus hyaluronic acid injections in degenerative temporomandibular joint disease (TMJ DJD). Ninety (n=90) consecutive patients with Research Diagnostic Criteria for Temporomandibular Disorders TMJ osteoarthritis (RDC/TMD 1.0 Axis I Group IIIb) underwent a cycle of five arthrocenteses with injections of 1mL hyaluronic acid and were followed up for 3months. Eight potential predictors of positive treatment outcome (sex, age, pain duration, baseline pain at chewing, presence of uni- or bilateral arthritis, presence of other concurrent RDC/TMD diagnoses, type of intervention and tolerability of treatment) were included in a logistic regression model to identify baseline predictors of treatment effectiveness. At follow-up, 85·6% of patients improved with respect to baseline VAS values, and 64·4% had a 50% or more decrease (positive outcomes). Correlation with positive outcomes existed only for unilateral osteoarthritis, and the logistic regression identified the side of arthritis (unilateral/bilateral) as the only predictor of positive treatment outcome (P=0·032). The achievement of any treatment improvement was predicted by high baseline pain levels (P=0·016). The regression models explained only 7·7-15% of the variance in the outcome variable. The attempts to find predictors of positive treatment outcome with HA injections for TMJ degenerative joint disease have been successful only in part. The search for other outcome predictors is likely to benefit from the assessment of psychosocial features associated with TMJ disorders.     

What you can and cannot see in TMJ imaging – an overview related to the RDC/TMD diagnostic system

Summary In the current version (I) of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), imaging of the temporomandibular joint (TMJ) is not required for a diagnosis. Research has shown that radiological findings of the TMJ do not always support the clinical findings of the RDC/TMD diagnosis. But imaging should only be performed when it is known that it could contribute to (i) a proper diagnosis and (ii) treatment with a better prognosis. Several techniques are used to image the TMJ: panoramic radiography, plain radiography, conventional and computed tomography (CT), digital volume tomography or cone‐beam computed tomography (CBCT), arthrography and magnetic resonance imaging (MRI). Osseous changes are best visualized in tomography, and the newly developed CBCT is a promising method but must be evaluated in a comparative analysis with other tomographic techniques. And although MRI is the method of choice for imaging the disc, a systematic review found the evidence grade for the diagnostic efficacy of MRI to be insufficient. Today, there is no clear evidence for when TMD patients should be examined with imaging methods. Future research designs should be randomized controlled trials where various radiological examination findings are analysed in relation to therapeutic outcome. In future versions of the RDC/TMD diagnostic system, recommended radiographic techniques must be evaluated and defined, diagnostic criteria well defined and observers calibrated.     

Relative importance of psychologic and social variables in TMJ Pain Dysfunction Syndrome (PDS) signs

The aim of this study was to measure the relative importance of a number of psychologic and social variables in explaining the severity of signs of functional disturbances of the stomatognathic system. A group of 261 non care seeking patients with respect to pain and dysfunction of the stomatognathic system were examined. The total sample consisted of two subgroups: Group one (n = 130) with a complete natural dentition and Group two (n = 131) wearing complete maxillary and mandibular dentures. Signs of functional disturbances of the stomatognathic system were assessed using the Clinical Dysfunction Index and a Palpation Test. The patients also completed the Hopkins Symptoms Checklist, the Dutch Personality Inventory and a Dutch form of the Minnesota Multiphasic Personality Inventory. Patient education, age and sex were also registered. In both patient subgroups signs of functional disturbances of the stomatognathic system were significantly correlated with patient's sex and a complex of highly intercorrelated psychologic variables: psychoneurotic and somatic symptoms, neuroticism and somatization.     

Relations between TMJ pain dysfunction syndrome (PDS) and some psychologic and biographic variables

A total of 211 persons with a complete natural dentition were examined for signs and symptoms of the TMJ pain dysfunction syndrome. They also answered the questions of the Dutch version of the Hopkins Symptoms Check List (HSCL). Schooling, age and sex were also registered. Signs and symptoms of the TMJ pain dysfunction syndrome proved to be highly correlated to the psychologic and somatic scales of the HSCL with one exception: maximal mouth opening. The total palpation score proved to be a reliable, sensitive, easy and fast predictor for the severity of the TMJ pain dysfunction syndrome.     

Role of psychologic and social variables in TMJ Pain Dysfunction Syndrome (PDS) symptoms

The aim of this study was to measure the relative importance of a number of psychologic and social variables in explaining the severity of symptoms of functional disturbances of the stomatognathic system. 261 non-care seeking patients with respect to pain and dysfunction of the stomatognathic system were examined. The total sample consisted of two subgroups: Group 1 (n = 130) with a complete natural dentition and Group 2 (n = 131) wearing complete maxillary and mandibular dentures. Symptoms of functional disturbances of the stomatognathic system were assessed using two questionnaires. One was derived from the Anamnestic Dysfunction Index and the other was an extended questionnaire which included accessory symptoms frequently mentioned in the literature. The patients also completed the Hopkins Symptom Checklist, the Dutch Personality Inventory, and a Dutch form of the Minnesota Multiphasic Personality Inventory. In both patient subgroups symptoms of functional disturbances of the stomatognathic system were significantly correlated with patient's sex and a complex of highly intercorrelated psychologic variables: psychoneurotic- and somatic symptoms, neuroticism, negativism, and somatization.     

88例错患者矫治前Helkimo指数评价

目的 :了解颞下颌关节紊乱症在错患者中的分布特点。方法 :用 Helkimo指数对 88例矫治前错患者进行评价。结果 :主诉症状指数 Ai 0为 5 0 % ,Ai 为 4 4.3 2 % ,Ai 为 5 .68% ;临床检查指数 Di 0为 3 2 .95 % ,Di 为5 1.14 % ,Di 为 14 .77% ,Di 为 1.14 %。咀嚼肌异常和关节杂音为最多见的症状和体征。结论 :主诉症状指数和临床检查指数 Di的分布在男性和女性无显著性差异 ,在 Angle 类和 类之间的分布也无差异 ,但两者的分级程度有相关性。     

重度磨损患者的临床特点及其对颞下颌关节功能的影响

目的：了解牙列重度磨损患者的临床特点，探讨重度磨损患者的颞下颌关节（temporomandibular joint,TMJ)影像变化特征。方法：对92例（男52例，女40例）关节门诊牙列重度磨损患者的病例资料及其颞下凳关节X线片情况进行统计分析。结果：重度磨损患者中（1）男性多于女性（P＜0．05），30－59岁人群占77．17％。（2）磨牙和颞下颌关节紊乱症（temporomandibular disorders,TMD)发病率之间存在负相关关系（P＜0．05）。（3）各组间颞下颌关节X线改变无显著差异（P＞0．05）。（4）髁状突移位与骨质改变表现呈负相关关系（P＜0．05）。结论：（1）以中年人群为主体的重度磨损与磨牙症、TMD等功能紊乱性疾病的关系并不密切。（2）颞下颌关节X线改变并不规律。     

颞下颌关节上腔囊内粘连的平片造影诊断

目的 :评价X线平片造影对颞下颌关节上腔囊内粘连的诊断价值。方法 :选取临床诊断为关节内错乱患者 10 5例 ( 10 5侧 ) ,进行关节上腔平片造影及关节镜检查。按平片造影影像学诊断标准 ,确定有无粘连 ,分阳性组、可疑组及阴性组 ;并与关节镜诊断结果对比 ,得出真、假阳性 ,真、假阴性例数 ,应用SPSS软件制作ROC曲线 ,计算ROC曲线下面积。同时分析漏诊、误诊的原因。结果 :关节镜诊断囊内粘连为 5 3 .3 3 % ( 5 6/ 10 5 )。平片造影诊断与关节镜诊断对照 :阳性组 40例 ,其中 3 2例真阳性 ,8例假阳性 ;可疑组 18例 ,其中 9例真阳性 ,9例假阳性 ;阴性组 47例 ,3 2例真阴性 ,15例假阴性。造影易检出的粘连部位是外中份 ;易漏诊的部位是内 1/ 3 ;粗大粘连带易于检出。ROC曲线下面积为 0 .73 ( 0 .64 ,0 .82 ) ,P <0 .0 5。结论 :X线平片造影对诊断囊内粘连的整体准确性中等 ,但不失为一种简单、实用的影像学检查方法 ,其漏诊的主要原因与粘连带的大小和部位有关。     

The association between dental status and temporomandibular osseous changes: a morphological study on Roman–Byzantine skeletons

The aim of this study was to evaluate the association between dental status and the prevalence and severity of osseous changes in the temporomandibular joints of human skulls from the Roman–Byzantine period. Fifty‐eight skulls from 36 men and 22 women between the ages of 19 and 63 years were studied, and the following parameters were evaluated: morphological osseous changes in the articular surface of the condyles, tooth wear and molar support. A significant correlation between age and dental wear or loss of molar support was observed, although no correlation was noted between age and morphological osseous changes in the condyles. The loss of molar support was significantly correlated with morphological osseous changes of the condyles, whereas no significant correlation was found between dental wear and condylar changes. This study demonstrates that the loss of molar support can serve as a predictor of osseous changes in the condyle. Reduced molar support may be one of the aetiologies associated with morphological osseous changes in temporomandibular joints. Further studies should to be performed to investigate this potential correlation.