错矫治治疗颞下颌关节紊乱病临床疗效分析

目的 分析并评价矫治错(牙合)同时治疗颞下颌关节紊乱病(TMD)的临床效果。方法 采用直丝弓技术矫治各种错(牙合)畸形伴TMD患者42例,详细记录治疗前、治疗6个月、治疗结束、治疗结束后2年的牙(牙合)情况及TMD症状、体征变化、颞下颌关节(TMJ)X线片情况。结果 30例患者TMD症状及体征基本痊愈,占71.4％;好转7例,占16.7％;无效或加重5例,占11.9％。结论 错(牙合)畸形伴TMD的年轻患者经正畸矫治可以恢复咬合或作(牙合)重建,建立(牙合)平衡,使颞下颌关节、下颌回复到正常解剖位置。但已经发生器质性损害或TMJ解剖结构不对称的患者,治疗效果有待于进一步观察。     

错(牙合)矫治治疗颞下颌关节紊乱病临床疗效分析

目的 分析并评价矫治错He同时治疗颞下颌关节紊乱病(TMD)的临床效果。方法 采用直丝弓技术矫治各种错He畸形伴TMD患者42例，详细记录治疗前、治疗6个月、治疗结束、治疗结束后2年的牙He情况及TMD症状、体征变化、颞下颌关节(TMJ)X线片情况。结果 30例患者TMD症状及体征基本痊愈，占71．4％；好转7例，占16．7％；无效或加重5例，占11．9％。结论 错He畸形伴TMD的年轻患者经正畸矫治可以恢复咬合或作He重建，建立He平衡，使颞下颌关节、下颌回复到正常解剖位置。但已经发生器质性损害或TMJ解剖结构不对称的患者，治疗效果有待于进一步观察。     

错[牙合]畸形与颞下颌关节紊乱病

颞下颌关节紊乱病（TMD）是由多因素引起的疾病,其中[牙合]因素是重要的病因。关系异常可以引起TMD的症状,而错[牙合]畸形矫正以后TMD症状明显减轻。亦有认为TMD与[牙合]关系错乱没有直接关系,即所说的没有影响或仅有轻微影响。本文对TMD的临床表现,病因、治疗及预后等方面进展进行综述。     

RW-splint治疗错牙合畸形伴颞下颌关节紊乱病患者的疗效评价

目的探讨RW-splint治疗错牙合畸形伴颞下颌关节病患者后临床症状的变化。方法采用Fricton颞下颌关节紊乱指数对13例错牙合畸形伴颞下颌关节紊乱病患者RW-splint治疗前、后的临床症状进行定量分析。结果与治疗前相比,13例患者治疗后下颌运动分、关节杂音分、功能障碍指数、肌肉压痛指数、颞下颌关节指数均减小,差异均有统计学意义(P<0.05);关节压诊分减小,差异无统计学意义(P>0.05)。结论 RW-splint治疗能有效改善颞下颌关节紊乱病患者临床症状,改善程度从大到小依次是:疼痛、下颌运动、弹响。     

颞下颌关节紊乱病与错(牙合)畸形特征的关系

颞下颌关节紊乱病（temporomandibular disorders,TMD）是累及颞下颌关节区和（或）咀嚼肌及相关结构的一组疾病,临床表现为关节区和（或）咀嚼肌的疼痛、开闭口运动时关节弹响及张口受限。干扰被认为是TMD主要致病因素之一,错(牙合)畸形的许多特征也被认为与TMD相关。文章回顾以往国内外相关领域研究,对TMD与错(牙合)畸形特征的关系做一阐述。     

颞下颌关节紊乱病与正畸病人错(牙合)情况比较

目的：探讨错[牙合]主要类别（安氏错[牙合]及覆[牙合]覆盖关系）在颞下颌关节紊乱病（temporomandib-ulardisorders,TMD）组与正畸病人组间有无明显差别。方法：颞下颌关节紊乱病相关症状为主诉的369例（TMD组）,要求正畸治疗的933例（MAL组）,对两组人群同年龄、同性别配对,取研究模观察。结果：①两组比较安氏错[牙合]类型无明显差异（P〉0.05）;②TMD组深覆[牙合]病例明显高于正畸治疗组,而前牙对刃[牙合]、反[牙合],后牙反[牙合]的比例均明显低于错[牙合]组（P〈0.05）。结论：深覆[牙合]与TMD关系比较密切。     

开(牙合)与颞下颌关节紊乱病

开患者的颜面形态、吞咽模式、咀嚼肌力平衡、下颌运动模式都有特殊之处,目前的研究对开与颞下颌关节紊乱病之间的相互促进作用和因果关系还不完全清楚。本文从开患者的颅面形态、咀嚼肌力、吞咽模式等几个方面对开和颞下颌关节紊乱病的相互关系进行综述。     

正畸治疗与颞下颌关节紊乱病的研究进展

颞下颌关节紊乱病(temporomandibular disorders, TMD)是一组影响颞下颌关节、咀嚼肌系统、牙齿咬合甚至全身多种结构的病症,因其病因机制不清、临床表现复杂,使其成为口腔医学领域的临床难点之一。TMD是正畸初诊患者中的常见症状之一,正畸医生在临床工作中不可避免地会接触到相关问题。因此正畸医生需要积极面对并通过深入地学习,更加深刻地理解TMD的分类、诊断及其发病机制并学习相关的治疗手段,积极应对临床中的TMD相关问题,并努力在TMD的多学科联合治疗中起到更加重要的作用。     

利用咬合力计指导调(牙合)治疗颞下颌关节紊乱病

目的:用咬合力计指导调(牙合)并评价调(牙合)对治疗TMD的疗效.方法:随机选取10例因TMD来我院就诊的患者,取观测模型,分析其咬合,并进行调(牙合).根据调骀治疗前后其临床症状改善情况,进行疗效分析.结果:3个月后多数患者的颌面部肌肉酸痛、无力、关节弹响、开口型异常等症状缓解或消失.结论:(1)调(牙合)是治疗TMD的一种有效的治疗方法.(2)咬合力计能够客观、真实、准确地反应出咬合接触点的详细情况.     

Orthodontic Treatment, Genetic Factors and Risk of Temporomandibular Disorder

Traditionally, four groups of factors have been identified in the etiology of temporomandibular disorder (TMD): anatomical variation in the masticatory system; psychosocial characteristics; pain in other body regions; and demographics. Orthodontic treatment has been variously cited both as a protective and harmful factor in TMD etiology. Recently, a search has begun for a genetic influence on TMD etiology. Genetic markers can be of additional value in identifying gene-environment interactions, that is, isolating population sub-groups, defined by genotype in which environmental influences play a relatively greater or lesser etiological role. This paper reviews concepts and study design requirements for epidemiological investigations into TMD etiology. Findings are presented from a prospective cohort study of 186 females that illustrate an example of gene-environment interaction in TMD onset. Among people with a variant of the gene encoding catechol-O-methyl-transferase, an enzyme associated with pain responsiveness, risk of developing TMD was significantly greater for subjects who reported a history of orthodontic treatment compared with subjects who did not (P=0.04). While further studies are needed to investigate TMD etiology, this genetic variant potentially could help to identify patients whose risk of developing TMD is heightened following orthodontic treatment, hence serving as a risk marker useful in planning orthodontic care.     

正畸治疗安氏Ⅲ类错牙合的临床研究

目的了解正畸治疗安氏Ⅲ类错牙合的机理.方法应用X线头影测量的方法对30例安氏Ⅲ类错牙合正畸治疗前后的头颅定位侧位片进行测量研究.结果安氏Ⅲ类错牙合正畸治疗后下颌平面角增大,上前牙的唇倾度增加,下前牙的唇倾度减少.结论正畸治疗Ⅲ类错牙合的机理是使下颌作顺时针旋转及改变上下前牙的唇倾度.     

Treatment of a Case of Skeletal Class II Malocclusion with Temporomandibular Joint Disorder Using Miniscrew Anchorage

Abstract

At the present time, there are no reports in the literature on the treatment of temporomandibular joint disorder (TMD) by intrusion of molars using mini-screws. This case report describes the treatment for a female patient, aged 19 years seven months, with a TMD and an excessive lower anterior facial height. Overjet and overbite were +5.0 mm and +0.5 mm, respectively. The patient had a history of orthodontic treatment in which her first premolars were all extracted. During the first orthodontic treatment, a clockwise mandibular rotation was observed as a result of the increase of posterior dentoalveolar height. She had temporomandibular joint (TMJ) pain during mouth opening and complained of difficulty in eating due to masticatory dysfunction. The pretreatment Schüller views of both TMJ showed a posterior condyle position. In order to correct the overjet, molar relationship and the mandibular condyle position, a miniscrew was inserted into the palatal region of the upper first molar to intrude the upper posterior teeth. As the upper molars were intruded, the overjet was decreased, and a class I molar relationship was achieved by a counterclockwise mandibular rotation. After one year of treatment, an acceptable occlusion was achieved, and the condyle moved into centric position in the glenoid fossa. The patient’s teeth continued to be stable, and she had no pain in TMJ after a retention period of three years. The result of this treatment showed that molar intrusion using miniscrew anchorage is effective for treatment of a TMD patient with a posterior condyle position.     

颞下颌关节紊乱病伴内倾性深覆正畸治疗前后相关指数分析

目的研究伴有内倾性深覆的颞下颌关节紊乱病患者正畸治疗前后症状的变化,探讨内倾性深覆与颞下颌关节紊乱病的相关性。方法伴内倾性深覆的颞下颌关节紊乱病患者40例,定量计算每例患者正畸治疗前后的Fricton颞下颌关节紊乱指数（craniomandibular index,CMI）,比较其治疗前后的变化。结果伴内倾性深覆的颞下颌关节紊乱病患者经正畸治疗后,内倾性深覆均得到解除,恢复良好的外形及咬合关系,临床症状均得到改善,治疗后2年时评价发现,颞下颌关节功能障碍指数、肌肉压痛指数和CMI分别由治疗前的0.321±0.091、0.020±0.015、0.171±0.053下降为0.062±0.021、0.003±0.004、0.033±0.012,差异均有统计学意义。结论伴内倾性深覆的颞下颌关节紊乱病患者经正畸治疗解除内倾性深覆后,颞下颌关节紊乱症状可明显改善,内倾性深覆与颞下颌关节紊乱病关系较为密切。     

Early Orthodontic Treatment of Class-III Malocclusion in Germany

In order to evaluate current attitudes to early interceptive treatment, 2001 orthodontic offices in Germany were asked to fill in a questionnaire comprising the following topics: indication, appliances for the early correction of Class-III malocclusions, diagnostic records, duration, and benefits to overall therapy. Based on the 677 evaluable questionnaires, the following statistically significant conclusions could be drawn: 92.6% of the orthodontists see Class-III malocclusion as an indication for early treatment. Early treatment of severe crowding, diastemata, Class-II malocclusion, deep bite, increased overjet and impacted incisors was declined by most orthodontists. The interceptive treatment of further malocclusions was controversially discussed. Functional appliances (67.5%), in particular the Fr?nkel III (47.3%), were dominant in correction of Class-III malocclusions. Typical orthodontic records relating to early interceptive treatment include panoramic radiographs, lateral headfilms, photos and dental casts. 2.5% of the orthodontists routinely take a hand-wrist radiograph. Although recently published studies support the use of facial masks in theory, they are rarely used in practice. To what extent early interceptive treatment of Class-III malocclusion influences the overall treatment is the subject of further studies.     

咀嚼运动轨迹与颞下颌关节紊乱病患者症状和咬合异常的关系

目的：探讨颞下颌关节紊乱病（TMD）患者的下颌咀嚼运动轨迹特点,及其与症状和咬合异常的关系。方法：23名无症状大学生志愿者和130名TMD患者,取研究模,记录咀嚼运动[牙合]期轨迹。结果：无症状对照组和TMD组咀嚼运动[牙合]期轨迹的形态没有显著差异（P〉0．05）。TMD组矢状面咀嚼运动轨迹的ICP稳定比例明显低于对照组（P〈0．01）,但冠状面上咀嚼运动轨迹的ICP稳定比例两组间无明显差异（P〉0．05）。TMD组矢状面[牙合]期轨迹分型与近远中向咬合关系的3级计分存在明显相关关系（P〈0．01）,近远中向咬合关系不正常者出现不重合型轨迹的比例较高。疼痛和关节弹响症状与咀嚼运动[牙合]期轨迹形态无关。结论：近远中向咬合关系对咀嚼运动有明显的引导作用。     

骨性安氏Ⅱ类错(牙合)的外科与正畸联合治疗

目的:探讨外科与正畸联合治疗骨性安氏Ⅱ类错(牙合)的方法和特点.方法:总结分析近年来经外科与正畸联合治疗的骨性安氏Ⅱ类错(牙合)病例22例,介绍典型病例治疗过程,着重讨论拔牙时机、术前后正畸治疗特点及术式选择.结果:本研究22例患者经联合治疗后,颌骨关系正常,牙弓形态及(牙合)曲线正常,牙排列整齐,咬合关系好,面形及功能均获明显改善,疗效满意.结论:外科与正畸联合治疗是改正成人骨性安氏Ⅱ类错(牙合)的有效方法,正确的术式选择及合理的正畸治疗是治疗成功的关键.     

Temporomandibular Disorder Treatment Outcomes: Second Report of a Large-Scale Prospective Clinical Study

Longitudinal studies of outcomes for temporomandibular disorder (TMD) treatment are rarely done and even when conducted often suffer methodological weaknesses. These may include the lack of valid outcome measures for symptom changes. This second report of a long-term multi-site study of 2104 treated, 250 untreated, and 44 long-term treated TMD patients is part of a continuing effort to study TMD treatment efficacy in a very large patient population. A validated symptom measurement system, the TMJ Scale, assured a valid and uniform assessment of treatment outcomes across a large number of practices. Data indicate that untreated TMD patients do not improve spontaneously over time and that patients treated with a variety of active modalities achieve clinically and statistically significant levels of improvement with no evidence of symptom relapse after treatment completion. The use of anterior repositioning appliance therapy produced better results than flat plane splint therapy.