Roth诊断垫治疗颞下颌关节紊乱病的初步探讨

目的:观察使用Roth诊断垫治疗颞下颌关节紊乱病(Temporom-andibular disorder,TMD)的疗效。方法:选取76名TMD患者,随机分成2组。治疗组患者24h佩戴Roth诊断垫;对照组患者仅给予TMD健康指导。观察6个月后,应用Fricton颞下颌关节紊乱指数评价TMD患者临床症状。将治疗组和对照组治疗前后差异进行统计学分析。结果:治疗组与对照组治疗前后Fricton指数减少有显著性差异。结论:使用Roth诊断垫治疗某些颞下颌关节紊乱病有明显效果。     

透明质酸钠关节腔注射联合牙合垫治疗不可复性关节盘前移位的疗效评价

目的:评价关节腔注射透明质酸钠联合稳定性牙合垫治疗颞下颌关节不可复性盘前移位的临床疗效。方法:将在郑州市口腔医院就诊的40例不可复性盘前移位的患者随机分为实验组和对照组,实验组采用关节上腔注射透明质酸钠联合稳定性牙合垫治疗,对照组采用单纯的关节上腔注射透明质酸钠治疗,对比分析两组患者在治疗前、治疗后、治疗后3个月、6个月时的Friction颞下颌关节紊乱指数、疼痛视觉模拟评分(VAS)和最大开口度。结果:两组患者治疗后开口度、疼痛程度及颞下颌关节紊乱症状及体征与术前比较均明显改善,差异均有统计学意义(P<0.05)。实验组与对照组患者治疗后同时点比较,张口度差异不明显(P>0.05)。实验组患者治疗后及治疗后3、6个月时VAS、颞下颌关节紊乱指数(craniomandibular index ,CMI)和颞下颌关节功能障碍指数(dysfunction index , DI)低于对照组,差异均有统计学意义(P<0.05)。结论:关节上腔注射透明质酸钠联合牙合垫治疗颞下颌关节不可复性盘前移位疗效优于单纯的关节上腔注射治疗透明质酸钠。     

鹿瓜多肽关节腔注射治疗颞下颌关节骨关节病的疗效

目的:观察关节腔冲洗加鹿瓜多肽关节腔注射治疗颞下颌关节骨关节病的临床疗效。方法:将符合标准的56例颞下颌关节骨关节病患者随机分为2组,Ⅰ组28例,采用关节腔冲洗加鹿瓜多肽关节腔注射治疗;Ⅱ组28例,采用关节腔冲洗治疗;所有患者均进行颞下颌关节Fricton指数评价,进行术前及术后评分。结果:Ⅰ组28例经关节腔冲洗加鹿瓜多肽关节腔注射治疗的患者,治疗前功能障碍指数DI评分0.45,治疗后DI评分0.19,经统计学处理,有统计学意义(P<0.05);治疗前VAS评分5.16,治疗后VAS评分1.62,经统计学处理,有统计学意义(P<0.05)。对照组单纯关节腔冲洗治疗患者治疗前DI评分0.49,治疗后DI评分0.31,经统计学处理,没有统计学意义;治疗前VAS评分5.38,治疗后VAS评分2.86,经统计学处理,有统计学意义(P<0.05)。2组患者治疗后比较,实验组在降低VAS评分及Fricton功能障碍指数方面较对照组明显,差异有显著性(P<0.05)。结论:关节腔冲洗加鹿瓜多肽关节腔注射治疗下颌关节骨关节病临床疗效满意。     

透明质酸钠对颞下颌关节骨关节病患者关节滑液中基质金属蛋白酶2、3的影响

目的研究颞下颌关节(TMJ)上腔注射透明质酸钠(SH)治疗颞下颌关节骨关节病(TMJOA)前后关节滑液中基质金属蛋白酶2(MMP-2)和MMP-3含量的变化,探讨SH治疗TMJOA的机制。方法将30例TMJOA患者随机分成关节腔冲洗加SH治疗组和单纯关节腔冲洗组两组,6例志愿者为对照组。观察两种方法治疗前后关节滑液中MMP-2、3含量的变化。结果冲洗加SH组的临床疗效优于单纯关节腔冲洗组(开口度比较P<0.01,VAS比较P<0.05);无症状志愿者中1例检测出少量的MMP-2(31.12μg/L)和MMP-3(13.32μg/L);治疗后冲洗加SH组比单纯关节腔冲洗组MMP-2、3含量明显降低(P<0.01)。结论 SH可能通过降低TMJOA患者关节滑液中的MMP-2、3水平,减缓了关节软骨基质破坏速度,从而发挥对TMJOA的治疗作用。     

咬合干扰与颞下颌关节紊乱病的相关性研究

目的:通过临床检查分析安氏Ⅱ类1分类颞下颌关节紊乱(temporomandibular disorders,TMD)患者的咬合特点,探讨咬合干扰与颞下颌关节紊乱的相关性。方法:选取安氏Ⅱ类1分类TMD患者60例为实验组,无TMD安氏Ⅱ类1分类患者60例为对照组。采用目前国际上通用的视觉模拟尺分级评分测量法(visual analog scale VAS)对口面部不舒适程度进行评价;按照Fricton指数所包括的内容计算颞下颌功能障碍指数(temporomandibular dysfunction index DI),[DI=(MM+JN+JP)/26(0~1)],该指数包括下颌运动(MM)、关节杂音(JN)及关节压诊(JP)等。结果:实验组有咬合干扰者45例,对照组有咬合干扰者42例,二组间差异无显著性(P>0.05);实验组中存在咬合干扰的患者与无咬合干扰患者相比较,DI指数以及疼痛相关视觉模拟分数(VAS)均偏高,二者间差异有统计学意义(P<0.01),其中女性患者DI指数高于男性。结论:咬合干扰(occlusal interferences,OI)与TMD虽无直接联系,但OI与TMD共存可加重TMD患者临床症状,OI的存在对口颌系统的健康可能构成威胁。     

CD8~+CD28~-调节性T细胞在颞下颌关节紊乱病中的作用及其与雌激素的相关性

目的初步探讨CD8+CD28-调节性T细胞在颞下颌关节紊乱病(temporomandibular disorders,TMD)发病机制中的作用、其表达与雌激素的相关性以及临床意义。方法 TMD患者随机分为观察组与对照组各30例,对照组仅给予透明质酸钠关节腔注射治疗,观察组在对照组的基础上给予咬合板治疗;另外收集30例健康志愿者血样。采用流式细胞术检测纳入对象外周血、关节液内CD8+CD28-调节性T细胞以及白介素10与转化生长因子β1的含量;放射免疫法检测雌二醇的含量;评价治疗前后颞下颌开口指数及视觉模拟疼痛评分的变化。结果治疗前两组患者外周血雌二醇、CD8+CD28-T细胞、白介素10及转化生长因子β1的百分比均明显高于志愿者(P<0.05),外周血、关节液中以上4项指标在观察组与对照组之间的差异均无统计学意义(P>0.05);治疗后两组以上指标均有不同程度下降,但观察组显著低于对照组(P<0.05)。治疗后观察组颞下颌开口指数及视觉模拟疼痛评分均低于对照组(P<0.05)。相关性分析显示CD8+CD28-T细胞及其细胞因子与雌激素及颞下颌开口指数、视觉模拟疼痛评分呈正相关性(P<0.05)。结论 TMD患者外周血及颞下颌关节液中CD8+CD28-T细胞的含量与雌激素水平呈正相关性,与其临床症状密切相关。     

稳定垫治疗颞下颌关节紊乱病的疗效分析

目的观察采用稳定垫治疗颞下颌关节紊乱病(TMD)的临床疗效分析。方法选取2016年5月—2017年5月大连市口腔医院颞下颌关节门诊接诊的156例颞下颌关节紊乱病患者,比较采用稳定垫治疗前后临床疗效、颞下颌关节功能指数和髁突影像学改变(CBCT)。结果经过3～6个月治疗后,94.87%患者原有的颞下颌关节症状均得到改善; Fricton颞下颌关节紊乱指数明显下降; 70.51%的患者髁突骨质增生硬化,出现适应性改建。结论稳定垫可以作为有效治疗颞下颌关节紊乱病的方法之一。     

透明质酸钠治疗颞下颌关节骨关节病的临床研究

目的研究透明质酸钠关节腔注射对颞下颌关节骨关节病的治疗效果。方法对22例颞下颌关节骨关节病患者进行透明质酸钠关节腔注射治疗,按照颞下颌关节Fricton指数进行治疗前后临床功能障碍指数评价。结果22例颞下颌关节骨关节病患者,治疗前功能障碍指数0.358,治疗后功能障碍指数0.144(P<0.05);治疗前疼痛指数5.96,治疗后疼痛指数1.62(P<0.05)。结论透明质酸钠关节腔注射治疗可减轻临床症状,促进功能恢复。     

颞下颌关节紊乱病关节盘前后界限改变的核磁共振定位研究

目的:通过对关节盘前后界限的测定,确定颞下颌关节紊乱病患者关节盘移位改变的情况,探讨其临床意义.材料与方法:16例经临床确诊为颞下颌关节紊乱病患者行颞下颌关节(TMJ)的核磁共振(MRI)检查与13例正常人的MRI影像进行对比分析.结果:T1图像矢状位时,在TMD组,关节盘前缘位于关节结节最低点垂直线前约0.43mm,而正常组则位于其前约0.13mm,两组间差异无统计学意义,闭口位时在TMD组关节盘后缘与双板区交界处约位于关节四中心垂直线81°处,而正常组则位于其93.31°处,两组间有统计学差异.结论:TMD组在闭口位时,关节盘均可有明显的前移,但前缘前移变化不大,这与关节盘形态改变状况一样均为颞下颌关节紊乱病的重要指征.     

垫式可摘局部义齿联合软牙合垫治疗颞下颌关节紊乱病的疗效观察

目的观察利用垫式可摘局部义齿联合软垫对垂直距离过低的颞下颌关节紊乱病患者进行治疗的临床疗效。方法选择16例垂直距离过低的颞下颌关节紊乱病患者对其采用垫式可摘局部义齿联合软垫的方法进行修复治疗,做3个月和半年的随访,用Fricton指数和临床症状评价效果。结果 16例患者在接受治疗后Fricton指数较治疗前有明显下降,半年较3个月下降更为明显,统计学分析显示治疗3个月和半年与治疗前比较各项数据差异均有显著性(P<0.05),治疗半年与3个月比较JP、MP、PI无统计学意义(P>0.05)。结论 垫式可摘局部义齿可以在修复牙列缺损、恢复垂直距离的同时联合软垫有效治疗颞下颌关节紊乱病。     

关节腔臭氧浴联合物理疗法治疗颞下颌关节不可复性盘前移位的效果评价

目的:探讨关节腔内臭氧浴联合物理疗法治疗颞下颌关节不可复性盘前移位(anterior disc displacement without reduction,ADDwoR)的临床疗效.方法:将54例ADDwoR患者随机分为实验组(27例)和对照组(27例),分别行关节腔臭氧浴和透明质酸钠(sodium hyaluron...     

关节腔注射透明质酸与物理疗法治疗颞下颌关节不可复性盘前移位的临床疗效对比

目的 比较关节腔注射透明质酸和物理疗法治疗颞下颌关节不可复性盘前移（anterior disc displacement without reduction, ADDwoR）的临床疗效。方法 回顾性纳入2018年2月—2020年8月于我院康复科门诊就诊的ADDwoR患者72例,注射组和物理治疗组各36例。比较治疗前、治疗中和治疗结束后的症状和功能情况,包括最大主动开口度（maximum active mouth opening,MMO）、视觉模拟疼痛指数评估（visual analogue pain score,VAS）（0～10分）、下颌功能限制评估量表（jaw functional limitation scale,JFLS）和有效性。应用统计软件SPSS 26.0进行数据分析,采用卡方χ2检验、t检验和单变量方差分析,以P＜0.05为差异有统计学意义。结果 与本组治疗前比较,两种治疗方法在治疗中、治疗后所有指标均有统计学差异（P＜0.05）。组间比较,两种方法在治疗中、治疗后的MMO差异均有统计学意义（F=11.160,P＜0.05;F=6.766,P＜0.05）。与注射组相比,物理治疗组在治疗中和治疗后MMO分别多2.5 mm（95% CI：1.1~4.0,P=0.001）、3.1 mm（95% CI：1.0~5.3,P=0.005）。注射组治疗有效25例（69.4%）,物理治疗组有效27例（75.0%）,组间无统计学差异（χ2=0.277,P>0.05）。结论 物理疗法和关节腔注射透明质酸都可以减轻ADDwoR患者的疼痛,增加MMO,并改善下颌功能,物理疗法对开口度的治疗效果更好。     

光生物调节治疗颞下颌关节紊乱病患者疼痛效果的Meta分析

目的    评价光生物调节治疗颞下颌关节紊乱病患者疼痛效果,为临床提供参考依据。方法    计算机检索PubMed、Embase、Cochrane Library、中国知网、万方、维普等数据库,查找光生物调节治疗颞下颌关节紊乱病相关文献。应用Meta分析评价光生物调节（研究组）与放置激光光纤但不予激光照射（对照组）治疗颞下颌关节紊乱病患者疼痛效果,将视觉模拟评分（visual analogue scale,VAS）、压力疼痛感受阈值（pressure pain threshold,PPT）、最大自由开口度（maximum mouth opening,MMO）、左右侧侧方运动（left lateral excursion,LLE;right lateral excursion,RLE）及前伸运动范围（protrusion excursion,PE）作为评价指标。结果    纳入了7篇相关文献,共8项随机对照研究。Meta分析结果发现,与对照组相比,研究组能明显改善VAS和PPT（均P < 0.05）。但两组在改善患者MMO、LLE、RLE、PE方面,差异无统计学意义（均P > 0.05）。分析其中6项针对慢性颞下颌关节紊乱病疼痛效果的随机对照研究结果显示,光生物调节能显著改善VAS（P < 0.05）。结论    光生物调节治疗能较好地改善颞下颌关节紊乱病患者的疼痛症状,对慢性疼痛患者的疗效也较好,但对于下颌运动障碍的改善不明显。     

Prognostic indicators of the outcome of arthrocentesis with and without sodium hyaluronate injection for the treatment of disc displacement without reduction: a magnetic resonance imaging study

This study analysed the prognostic factors for successful arthrocentesis with and without sodium hyaluronate (SH) injection for the treatment of temporomandibular joint (TMJ) disc displacement without reduction (DDwoR) using clinical and radiological results. 29 TMJs in 25 patients with DDwoR were included. Patients were treated with arthrocentesis or arthrocentesis followed by intra-articular (i.a.) injection of SH. Treatment was evaluated for postoperative range of maximum mouth opening and the degree of postoperative pain on a VAS. Prognostic factors analysed were age, sex, duration of locking, trauma history, previous TMJ treatment, depression, bruxism, malocclusion and missing teeth. Degenerative changes were evaluated as probable prognostic factors. After treatment, 24 joints (83%) fulfilled the criteria for success. Duration of locking and present preoperative degenerative changes were the most significant factors for treatment outcome. The results suggest it is sufficient to use only arthrocentesis in patients without preoperative degenerative changes and arthrocentesis with SH in patients with degenerative changes on their preoperative MRIs, but because there were some significant differences between the two groups preventing the authors from comparing them statistically, they cannot come to that conclusion. To clarify the use of SH in such cases, standardized study groups are necessary for future studies.     

Treatment of temporomandibular disorders among adolescents: a comparison between occlusal appliance, relaxation training, and brief information

In a randomized trial the effects of occlusal appliance and relaxation therapy, each combined with brief information, were compared with brief information only, in adolescents with temporomandibular disorder (TMD) pain. One-hundred-and-twenty-two adolescents (93 F and 29 M aged 12-18 years) were randomly assigned to one of the following 3 groups: brief information + occlusal appliance (BI + OA), brief information + relaxation therapy (BI + RT), or brief information (BI). Included were subjects reporting pain once a week or more often, in addition to receiving a diagnosis of TMD according to the Research Diagnostic Criteria (RDC/TMD). They were evaluated before and after treatment and at a 6-month follow-up by means of self-reports and clinical assessment. The result revealed a significantly higher reduction in frequency of pain, in pain intensity (visual analog scale [VAS]), and in a composite pain index (intensity x frequency) for patients treated with BI + OA compared with those treated with BI alone. In the BI + OA group, 60% of the patients attained a clinically significant improvement (at least 50% or more) on the pain index, a significantly higher proportion compared to that obtained in the other 2 treatment groups. Analgesic consumption was also significantly more reduced in the BI + OA group compared to the BI group. However, no significant differences were found between the treatment groups in jaw opening or in muscle and TMJ tenderness scores. Occlusal appliance was found to be superior to both relaxation therapy and brief information regarding pain reduction and can therefore be recommended when treating adolescents with TMD pain.     

The efficacy of intra-articular sodium hyaluronate in patients with reducing displaced disc of the temporomandibular joint

In this clinical trial, we examined the efficacy of intra-articular hyaluronic acid (HA) treatment in 38 patients with reducing displaced disc of the temporomandibular joint (TMJ). Subjects received two unilateral upper space injections of HA or physiological saline solution with 1 week apart. Efficacy was based on the following measurements: pain and sound intensity of the joint measured by visual analogue scale (VAS), modified Helkimo's clinical dysfunction index and the intensity of joint vibration during opening and closing the mouth measured by accelerometers. These measurements were performed before the first injection and 1 and 6 months after the last injection. In the treatment group (n=19), all measurements improved significantly at month 1 and at month 6 compared with the baseline (P < 0.01). The same measurements, in the placebo group (n=19), did not show any change, except for the pain intensity which improved at month 1 and month 6 (P < 0.05). The change in baseline measurements of all of the efficacy criteria at month 1 and at month 6 in the treatment group was significantly better compared with the change obtained with placebo at the same time intervals. This study demonstrates that intra-articular sodium hyaluronate (Orthovisc) injection into the TMJ is an effective treatment for a reducing displaced disc.     

Pharmacological treatment of oro‐facial pain – health technology assessment including a systematic review with network meta‐analysis

This health technology assessment evaluated the efficacy of pharmacological treatment in patients with oro‐facial pain. Randomised controlled trials were included if they reported pharmacological treatment in patients ≥18 years with chronic (≥3 months) oro‐facial pain. Patients were divided into subgroups: TMD‐muscle [temporomandibular disorders (TMD) mainly associated with myalgia]; TMD‐joint (TMD mainly associated with temporomandibular joint pain); and burning mouth syndrome (BMS). The primary outcome was pain intensity reduction after pharmacological treatment. The scientific quality of the evidence was rated according to GRADE. An electronic search in PubMed, Cochrane Library, and EMBASE from database inception to 1 March 2017 combined with a handsearch identified 1552 articles. After screening of abstracts, 178 articles were reviewed in full text and 57 studies met the inclusion criteria. After risk of bias assessment, 41 articles remained: 15 studies on 790 patients classified as TMD‐joint, nine on 375 patients classified as TMD‐muscle and 17 on 868 patients with BMS. Of these, eight studies on TMD‐muscle, and five on BMS were included in separate network meta‐analysis. The narrative synthesis suggests that NSAIDs as well as corticosteroid and hyaluronate injections are effective treatments for TMD‐joint pain. The network meta‐analysis showed that clonazepam and capsaicin reduced pain intensity in BMS, and the muscle relaxant cyclobenzaprine, for the TMD‐muscle group. In conclusion, based on a limited number of studies, evidence provided with network meta‐analysis showed that clonazepam and capsaicin are effective in treatment of BMS and that the muscle relaxant cyclobenzaprine has a positive treatment effect for TMD‐muscle pain.     

The orthodontic treatment of TMD patients: EMG effects of a functional appliance

The aim of this work was to test the effects of the Function Generator Bite (FGB) on the masticatory muscles of temporomandibular joint dysfunction (TMD) subjects. Two groups were selected for the study. A group of 20 TMD patients (group F) requiring orthodontic treatment and treated with FGB and a group of 10 healthy subjects (group H) were considered. Both groups were evaluated before the therapy began (TO) and then after 18 months of therapy (T1). An electromyographic analysis of the masseter and temporalis anterior muscles and a clinical evaluation according to the Research Diagnostic Criteria for TMD (RDC/TMD) were performed. A statistical difference between the two groups was observed at TO with respect to the activity index. TMD subjects showed a lower value of the index. Further studies are necessary to fully understand the utility of this EMG index as a diagnostic indicator.