Management of Temporomandibular Disorders with Low Level Laser Therapy

Purpose

To evaluate the efficacy of low level laser therapy (LLLT) in the treatment of temporomandibular disorders (TMD) in relation to pain intensity, tender points, joint sounds and jaw movements.

Materials and Methods

Twenty patients received 6 sessions of LLLT (3 times a week for 2 weeks) with semiconductive diode laser (gallium arsenide; 904 nm, 0.6 W, 60 s, 4 J/cm²). Pain intensity, number of tender points, joint sounds and active range of motion were assessed before and immediately after each session and after 1, 2 weeks, 1, 3 and 6 months.

Results

Statistically significant results were achieved in all study parameters.

Conclusion

LLLT promoted satisfactory results in reducing the pain intensity, number of tender points, joint sounds and improvement in the range of jaw motion. Hence it is an effective and efficient treatment method for TMDs.     

(牙合)重建对偏侧咀嚼大鼠颞下颌关节影响的研究

目的：研究[牙合]重建对偏侧咀嚼大鼠颞下颌关节（tempommandibular joint,TMJ）的影响。方法：40只大白鼠随机分为4组,所有动物间断磨除右上、下颌磨牙牙冠至龈下,实验1组第3周、实验2组第9周停止磨除牙冠,任其自行萌出,恢复咬[牙合]关系。对照组不停止磨除牙冠,饲养条件相同。实验1组磨除牙冠后10周末、实验2组磨除牙冠后16周末处死动物,取其双侧TMJ进行光镜、扫描电镜切片检查,结果与对照组对照。结果：实验1组双侧TMJ基本恢复正常,实验2组双侧TMJ结构有受损病理变化。对照1、2组双侧TMJ均出现受损的病理变化。结论：早期胎重建可恢复偏侧咀嚼大鼠TMJ的损害。     

颞下颌关节紊乱病磁共振诊断的研究

目的:研究MRI对颞下颌紊乱病诊断的准确性和可信性.方法:利用MRI对19例单侧关节疼痛颞下颌关节紊乱病(TMD)患者38侧关节完成开闭口斜矢状位T1和T2加权成像,观察盘突关系、盘形态改变及关节腔内积液情况.利用关节镜诊断为金标准判定MRI诊断的准确率.同期行灌洗术治疗,分析治疗前后不同时期患者的疼痛值(疼痛直观模拟标尺VAS)变化.结果:MRI检查结果显示在患侧89.47%(17/19)显示不可复性关节盘移位,10.53%(2/19)显示可复性关节盘移位,47.37%(9/19)关节上腔前隐窝出现积液.在健侧15.79%(3/19)显示可复性关节盘移位,无不可复性关节盘移位和腔内积液出现.通过关节镜手术对患侧进行检查,关节盘移位在MRI片上均得到证实,MRI检查的准确率为100%,灌洗术后疼痛100%有显著缓解(P<0.001).结论:颞下颌关节紊乱病与关节盘移位和腔内积液密切相关,通过MRI检查可以准确有效的对颞下颌紊乱病进行诊断,灌洗术对关节疼痛治疗效果显著.     

认知行为疗法治疗颞下颌关节紊乱病的系统评价

目的:评价认知行为疗法治疗颞下颌关节紊乱病的疗效。方法:计算机检索PubMed(1990～2009)、OV-ID(1960～2009)、EMbase(1974～2009)、Cochrane图书馆临床对照试验资料库(2009年第3期)、中国生物医学文献数据库(CBM,1978～2009),和中国期刊全文数据库(CNKI,1994～2009),收集认知行为疗法治疗颞下颌关节紊乱病的随机对照试验和半随机对照试验。由两名评价者独立评价研究质量和提取数据,对同质研究采用RevMan5.0软件进行Meta分析,对异质性研究不能进行Meta分析者,则进行描述性的定性分析。结果:共检索到相关文献323篇,评价后纳入5个研究,其中3个随机对照试验和2个半随机对照试验。质量评价结果为2个研究被评为B级,3个研究被评为为C级,纳入研究的方法学质量普遍不高。由于纳入研究存在疗程不一,随访期不一,以及对照组干预措施等临床异质性,无法用Meta分析方法合并效应量,只做了描述性的定性分析。分析结果显示CBT对TMD的治疗效果较其对照组并无明显优势,各研究随访结果也有差异,其疗效还无法确定。结论:基于目前的证据无法得出CBT治疗TMD的确切疗效。因此尚需要开展设计严谨,方法学质量更高的临床试验以获得更可靠的证据。     

Informed Consent for the Prosthodontic Patient With Temporomandibular Disorders

The prosthodontic treatment of patients with a history of temporomandibular disorders presents unique risk-management problems because of the varied nature, uncertain prognosis, and frequent recurrence of these disorders. Patients with temporomandibular disorders frequently require managed treatment over extended periods of time and may complicate the delivery and outcome of prosthodontic treatment. Informed consent is needed to protect both the patient and the prosthodontist because it facilitates proper communication, goal setting, and cooperation. The purpose of this article is to discuss the essential elements of informed consent and to present an informed consent program useful in the prosthodontic treatment of patients with temporomandibular disorders.     

成人颞下颌关节紊乱病与颈椎姿势的相关性研究

目的：探讨颞下颌关节紊乱病成人患者颈椎姿势与健康者的差异,研究颞下颌关节紊乱病与颈椎姿势的相关性。方法：对20例成人颞下颌关节紊乱病患者及20例成人健康者拍摄自然头位时的头颅定位侧位片,进行投影测量及统计学分析。结果：成人颞下颌关节紊乱病组的颈椎弯曲度大于健康对照组而颈椎倾斜度小于健康对照组,颈椎齿突切线、颈椎切线分别与前颅底平面及水平线交角减小,表明成人颞下颌关节紊乱病患者头呈前倾、前伸位。结论：头颈姿势位与颞下颌关节紊乱病存在明显相关性,颞下颌关节紊乱病患者头呈前倾、前伸位。     

微型咬合板治疗颞下颌关节紊乱病的临床研究

采用微型咬合板治疗颞下颌关节紊乱病（ＴＭＤ）８８例,男２５例,女６３例,年龄１４～４８岁,平均２７．５岁．结果：症状完全消失４０例（４５．５％）,症状改善４５例（５１．１％）,症状无变化３例（３．４％）．结果表明微型咬合板是治疗ＴＭＤ的一种简便而有较好疗效的保守疗法