咬合板对颞下颌关节紊乱病相关颌面部疼痛的影响

颞下颌关节紊乱病（temporomandibular disorders, TMD）是口颌面部慢性痛的主要来源,严重干扰日常活动。咬合板是颞下颌关节紊乱病的最常用的治疗方法之一,但其疗效尚未完全明了。学者们多年来致力于对咬合板的作用机制、疗效的研究,但至今尚未得出统一的结果。该文将对咬合板的作用机制、咬合板的分类、TMD相关疼痛的种类与咬合板的选择、TMD的其他保守治疗与咬合板的关系四个方面对于咬合板治疗颞下颌关节紊乱病相关颌面部疼痛的疗效进行进行综述。     

咬合调整对颞下颌关节紊乱病的影响

目前医学界对咬合因素与颞下颌关节紊乱病（temporomandibular disorders,TMD）的相关性仍存在争议,但咬合调整作为常见的口腔临床治疗手段被广泛应用于改善颞下颌关节相关症状,主要包括调(牙合)、正畸治疗、修复治疗、正颌治疗与(牙合)板治疗等。文章回顾既往文献,梳理常见咬合调整治疗方式及其与TMD之间的关联,为咬合源性颞下颌关节相关疾病的诊疗提供新的视角与思路。     

氦-氖激光与关节上腔封闭治疗颞下颌关节紊乱病疗效观察

目的:总结He-Ne激光照射与关节上腔加翼外肌痛点封闭交替治疗颞下颌关节紊乱病的临床疗效。方法:采用低功率He-Ne激光照射与关节上腔加翼外肌痛点封闭交替治疗颞下颌关节紊乱病80例,分析治疗效果。并与传统的翼外肌痛点封闭治疗40例进行疗效对比观察。结果:激光结合关节上腔加翼外肌痛点封闭的治疗效果(95`0％)明显优于传统的翼外肌痛点封闭治疗组(80.0％),两组间痊愈率及总有效率统计学差异显著(P<0.05)。结论:He-Ne激光照射与关节上腔加翼外肌痛点封闭交替进行是治疗颞下颌关节紊乱病的有效方法。     

颞下颌关节紊乱病的非手术治疗方法

颞下颌关节紊乱病(temporomandibular disorders,TMD)的治疗方法有许多,但主要可分为手术治疗和非手术治疗两大类。一般在手术治疗前应作一定的非手术治疗,因此,TMD非手术治疗的临床应用非常广泛。TMD的非手术治疗方法主要可分为可逆性治疗和不可逆性治疗,稳定型咬合板治疗属于可逆性治疗方法,可逆性治疗还包括理疗,局部封闭,肌功能锻炼,关节腔冲洗以及药物治疗等;不可逆性治疗主要包括调、修复、正畸等咬合治疗。在未明确病因诊断之前,原则上应予以可逆性治疗。除咬合板治疗外,可逆性治疗主要是对症治疗。一、咬合板治疗1.治疗用咬合…     

改良稳定咬合板治疗颞下颌关节紊乱病54例疗效观察

目的 观察改良稳定咬合板用于治疗颞下颌关节紊乱病的治疗效果。方法 选择54例非器质性病变引起颞下颌关节紊乱的病人,戴用经改良的稳定咬合板治疗12周,评价治疗效果。结果 经过改良稳定咬合板治疗,显效19例,有效29例,无效6例。结论 改良稳定咬合板是一种可行的改善TMD肌功能紊乱和结构紊乱治疗方法。     

老年人颞下颌关节紊乱病的临床研究

目的 :研究老年人颞下颌关节紊乱病 (TMD)的临床表现、诊断和治疗的特点。方法 :对56例60岁以上的TMD患者进行治疗观察 ,对临床资料进行总结分析。结果 :老年人TMD占同期TMD患者总数的 9.9%。男女之比为 1∶1.7。经采用综合措施治疗 ,结果显效39.3%、有效53.6%、无效7.1%。结论 :老年人TMD器质变化型明显增多 ,牙齿缺失与磨损是老年人TMD的重要病因 ,治疗应采取综合措施 ,咬合板、封闭和义齿修复是主要的治疗方法。     

稳定咬合板短期治疗颞下颌关节紊乱病的临床疗效观察

颞下颌关节紊乱病（temporomandibular disorders，TMD）足口颌系统的常见病和多发病，临床上主要表现为颢下颌关节区疼痛、异常关节音、下颌运动功能障碍等三大症状。由于其病因复杂，目前尚缺少有效的治疗方法。稳定咬合板作为一种保守、可逆、无创性的治疗方法被广泛的应用在TMD的治疗上，但是，对于稳定咬合板的疗效尚有争议。本试验采用随机、对照的试验方法，用客观、统一、定量的标准Fricton指数评估稳定咬合板短期治疗TMD的临床疗效，结果显示，稳定咬合板短期内可有效缓解TMD患者肌肉和关市的疼痛。     

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。     

颞下颌关节疾病

颞下颌关节紊乱病关节液中尿纤溶酶原激活物及其受体的表达，TMD患者咬合板治疗后[牙合]接触变化的研究，颞下颌关节腔内基因转染的生物安全性实验研究,hIL-1Ra基因体内转染兔颞下颌关节骨关节病模型的免疫组化研究.     

不同类型咬合板缓解TMD疼痛症状的研究

目的:研究松弛型咬合板和稳定型咬合板缓解颞下颌关节紊乱病(TMD)疼痛症状的疗效。方法:选择TMD患者68例(急性期30例,慢性期38例),每组又分两个亚组,分别戴用松弛型咬合板和稳定型咬合板,使用视觉模拟量表评价患者治疗前后疼痛强度的变化。结果:①戴咬合板后静息状态下急、慢性组患者疼痛指数均较戴咬合板前明显下降(P<0.05),两种咬合板缓解疼痛的程度无明显差异;②戴咬合板后功能状态下急、慢性组患者疼痛指数均较戴咬合板前明显下降(P<0.05),但急性组戴松弛型咬合板疼痛缓解程度更显著。结论:松弛型和稳定型咬合板能缓解TMD疼痛,松弛型咬合板缓解TMD急性患者疼痛症状更显著。     

Effect of occlusal splint and transcutaneous electric nerve stimulation on the signs and symptoms of temporomandibular disorders in patients with bruxism

A crossed-design experimental study has been made involving simple blind paired data and random assignment to treatment, with the aim of evaluating the action of an occlusal splint with transcutaneous electric nerve stimulation (TENS) upon the manifestations of temporomandibular disorders (TMD) in patients with bruxism. The prevalence of TMD in the 24 patients with bruxism was 62.5%%; the corresponding severity, as determined by the pantographic reproducibility index (PRI), was mild (mean value: 20.71). Clicking and pain in the lateral pterygoid muscle were the most frequent clinical manifestations. The occlusal splint and TENS did not significantly improve the signs and symptoms of TMD in these patients with bruxism.     

EVALUATION OF MICROCURRENT ELECTRICAL NERVE STIMULATION (MENS) EFFECTIVENESS ON MUSCLE PAIN IN TEMPOROMANDIBULAR DISORDERS PATIENTS

The effect of Microcurrent Electrical Nerve Stimulation (MENS) was evaluated and compared with occlusal splint therapy in temporomandibular disorders (TMD) patients with muscle pain. Twenty TMD patients were divided into four groups. One received occlusal splint therapy and MENS (I); other received splints and placebo MENS (II); the third, only MENS (III) and the last group, placebo MENS (IV). Sensitivity derived from muscle palpation was evaluated using a visual analogue scale. Results were submitted to analysis of variance (p<0.05). There was reduction of pain level in all groups: group I (occlusal splint and MENS) had a 47.7% reduction rate; group II (occlusal splint and placebo MENS), 66.7%; group III (MENS), 49.7% and group IV (placebo MENS), 16.5%. In spite of that, there was no statistical difference (analysis of variance / p<0.05) between MENS and occlusal splint therapy regarding muscle pain reduction in TMD patients after four weeks.     

Efficiency of occlusal appliance therapy in secondary otalgia and temporomandibular disorders

In clinical practice, it is commonly assumed that occlusal splints have therapeutic value in the treatment of temporomandibular disorders CTMD), but the evidence based on randomized controlled trials is scarce. This study evaluated the short-term (10-week) efficacy of a stabilization splint in subjects with recurrent secondary otalgia and active TMD treatment need using a randomized, controlled, double-blind design. Thirty-six subjects were randomly allocated to the two treatment groups: the stabilization splint and the control splint group. After 10 weeks' treatment, the intensity of secondary otalgia, measured on a VAS scale (from 0 to 100 mm), decreased statistically significantly in the stabilization splint group (t 2.12; P 0.006), but not in the control group. Improvement in active TMD treatment need in subjects showing moderate or severe signs and symptoms of TMD was reported significantly more often in the stabilization splint group than in the control splint group (chi2 5.71; P.017). A statistically significant decrease in the Helkimo clinical dysfunction index was seen in the subjects with stabilization splint (Z-2.63; P.009), but not in the subjects with control splint. The results indicate that the use of a stabilization splint is beneficial with regard to secondary otalgia and active TMD treatment need.     

义齿式(牙合)板治疗颞下颌关节紊乱病伴牙列缺损磨损探讨

目的 探讨用义齿式牙合板治疗伴有牙列缺损和牙体磨损的颞下颌关节紊乱病的效果.方法 对15例由于牙列缺损、余牙严重磨损等原因导致颞下颌关节紊乱病患者,应用义齿式牙合板修复缺牙,以恢复正常息止颌间隙、改善咀嚼功能.结果 经1～8年临床追踪,12例患者颞下颌关节症状消失,3例患者颞下颌关节症状明显减轻,全部病例均恢复咀嚼功能,治疗和修复效果满意.结论 义齿式牙合板可有效地治疗伴有牙列缺损和牙体磨损的颞下颌关节紊乱病病例.     

Contact sensitivity reactions in the oral mucosa

In clinical practice, it is commonly assumed that occlusal splints have therapeutic value in the treatment of temporomandibular disorders (TMD), but the evidence based on randomized controlled trials is scarce. This study evaluated the short-term (10-week) efficacy of a stabilization splint in subjects with recurrent secondary otalgia and active TMD treatment need using a randomized, controlled, double-blind design. Thirty-six subjects were randomly allocated to the two treatment groups: the stabilization splint and the control splint group. After 10 weeks' treatment, the intensity of secondary otalgia, measured on a VAS scale (from 0 to 100 mm), decreased statistically significantly in the stabilization splint group (t 2.12; P 0.006), but not in the control group. Improvement in active TMD treatment need in subjects showing moderate or severe signs and symptoms of TMD was reported significantly more often in the stabilization splint group than in the control splint group (χ² 5.71; P .017). A statistically significant decrease in the Helkimo clinical dysfunction index was seen in the subjects with stabilization splint (Z -2.63; P .009), but not in the subjects with control splint. The results indicate that the use of a stabilization splint is beneficial with regard to secondary otalgia and active TMD treatment need.     

He夹板治疗作用的生物力学评价

目的 分析Ｈｅ夹板对髁突在关节窝位置及受力状况的影响，探讨Ｈｅ夹板的生物力学的治疗机制。方法 采用ＣＴ扫描、Ａｕｔｏ－ＣＡＤ技术、计算机图像分析方法及有限元法对颞下颌关节紊乱病患者民未戴Ｈｅ夹板时颞下颌关节髁突位置及其应力分布特征进行对比。结果 戴Ｈｅ夹板后颞下面关节前间隙变窄，上、后间隙变宽，髁突向前下称位；髁突应务明显降低，主要表现在功能承载区前斜面及外侧；双侧髁突应力对称性有所改善。结论 改     

(牙合)夹板对颞下颌关节紊乱病患者下颌骨应力分布的影响

目的　探讨夹板治疗颞下颌关节紊乱病 (temporomandibularjointdisorders,TMD)的生物力学机制。方法　采用三维有限元法模拟分析TMD患者夹板治疗前后下颌骨应力分布特征的变化。结果　夹板影响了TMD患者下颌骨的应力分布特征 ,使其下颌骨各部位最大、最小主应力明显降低 ,尤其是患侧髁突应力降低更为显著 ,使两侧髁突应力分布趋于一致 ,而下颌骨各部位应力对称性亦有所改善。结论　夹板通过改善颞下颌关节的应力分布状况 (应力大小、性质和对称平衡性 )减轻甚至消除对其的损伤 ,使失衡的关节内环境得到调整和恢复 ,此为夹板治疗TMD的最主要的生物力学机制之一。     

稳定型咬合板治疗颞下颌关节紊乱病疼痛症状的研究

目的：探讨稳定型咬合板治疗颞下颌关节紊乱病（TMD）疼痛的疗效。方法：TMD疼痛患者61例，急性组28例（男11例，女17例）；慢性组33例（男18例，女15例）。记录治疗前后疼痛指数，双侧颞肌前束（temporal anterior，TA）和咬肌（masseter muscle，MM）牙尖交错位最大紧咬时电位及最大紧咬时咬合接触情况。结果：（1）2组治疗后1月疼痛指数均明显低于治疗前（P〈0．05），治疗前后疼痛强度差值及显效率2组之间无显著差异（P〉0．05）。（2）治疗后无论是急性组还是慢性组TA及MM最大紧咬电位症状侧均较治疗前明显升高（P〈0．05），而非症状侧治疗前后无明显差异（P〉0．05）。（3）治疗后急性组TA和MM肌电不对称指数与治疗前相比均明显降低（P〈0．05）。治疗后肌电不对称指数TA慢性组明显高于急性组（P〈0．05），而MM无明显差异（P〉0．05）。（4）2组治疗前后左、右两侧咬合接触点数、以及咬合接触不对称指数无明显差异（P〉0．05）。结论：稳定型咬合板治疗可以明显缓解TMD疼痛，但对急、慢性疼痛的缓解程度无明显差异。其机制可能与肌功能活动情况易于得到明显改善等生理学基础有关。     

A change of occlusal conditions after splint therapy for bruxers with and without pain in the masticatory muscles

Bruxism has been suggested as an initiating or perpetuating factor in a certain subgroup of temporomandibular disorders (TMD), however, the exact association between bruxism and TMD remains unclear. This study aimed to demonstrate the difference in responses between bruxism and a subgroup of TMD to a full-arch maxillary stabilization splint from the standpoint of an occlusal condition. This study was conducted to verify the null hypothesis that there were no differences between bruxer groups with and without myofascial pain (MFP) with respect to the changes in occlusal conditions after the use of a splint. Thirty bruxers with MFP and 30 without MFP participated. Occlusal conditions were examined before and after splint therapy, and occlusal changes following the use of a splint were compared between the two groups. The frequency of occlusal changes after splint therapy was significantly higher in the MFP bruxer group than the non-MFP bruxer group (p < 0.05) for the occlusal conditions investigated in the present study. However, no statistical differences were found with regard to each occlusal condition. This result may show the variety of splint effects and may demonstrate a heterogeneous aspect to bruxism and myofascial pain.