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。     

错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因素是重要的病因。关系异常可以引起TMD的症状,而错畸形矫正以后TMD症状明显减轻。亦有认为TMD与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。     

颞下颌关节紊乱病诊断标准的研究进展

颞下颌关节紊乱病(temporomandibular disorders,TMDs)是临床常见病但是病因复杂,相应的颞下颌关节紊乱病的诊断标准也在不停演变.本文围绕由RDC/TMD到DC/TMD的改进,DC/TMD的临床应用实施进行综述,并对未来可能的发展进行展望.     

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(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.     

颞下颌关节紊乱病、错(牙合)患者及大学生咬合的比较研究

目的 探讨评价咬合的2项指标（近远中向的安氏错He分类及垂直向和唇（颊）舌向的覆He覆盖关系）在颞下颌关节紊乱病（temporomandibular disorders,TMD)组、大学生志愿者（US）组及错He患者（MAL）组间有无明显差别。方法 100例TMD、100例MAL、268名US，共468人，取研究模观察。结果 ①MAL组安氏I类的比例低于其他2组（P＜0.05)；②MAL组前牙反He和深覆盖比例明显高于其他2组（P＜0.05)；③覆He覆盖异常指数（后牙每1处积5分，前牙每1处积分积3分），MAL组明显高于US组（P＜0.05)，而TMD组与MAL组和US组差异均无显著性（P＞0.05)。结论 影响美观的前牙异常治疗需求高，而咬合异常与TMD未见显著相关关系。     

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。     

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。     

86例颞下颌关节紊乱综合症错儿童的不良习惯分析

本文以 86例颞下颌关节紊乱综合症 (TMJDS)错儿童为对象 ,以问卷调查、关节触诊及薛氏位片等手段对患者的口腔不良习惯、主观症状等进行调查 ,同时对其客观体征、及咬合以及髁状突位置等进行检查 ,以探讨儿童口腔不良习惯、错与 TMJDS之间的关系     

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。     

少年儿童颞下颌关节紊乱综合征的错合特征

本研究以５５０名少年儿童ＴＭＪＤ患者为研究对象，对其特征进行了统计分析。得出：５５０名少年儿童ＴＭＪＤ患者中８０．０％的患者有不同程度的错，其中以＂个别牙齿错位＂所占的百分率最高占４２．４％，其次为高度不调、长度不调和宽度不调；不同牙龄期患者的错又有其特殊性；此外，不同牙龄期患者＂个别牙齿错位＂的情况也不相同。本研究结果可以作为ＴＭＪＤ早期正畸治疗以及治疗时对错的分析和诊断的参考。     

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。     

以按摩为主的综合治疗颞下颌关节紊乱病800例的体会

根据颞下颌关节紊乱病的发病机制,针对功能性肌紧张的咀嚼肌施行分离肌粘连、理顺紧张的肌纤维、痛点及关节区按摩加热敷、心理疏导等方法综合治疗颞下颌关节紊乱病。通过对临床800例患者近20年的观察,结果表明针对早期、病程较短、不伴有关节弹响而病因较明确的颞颌下关节紊乱病的患者采用本法治疗有较显著的疗效,其方法简便易行。     

Relationship between horizontal condylar angle and radiographically detectable morphological changes of the condyle in asymptomatic and symptomatic patients with TMD

BackgroundThe relationship between horizontal condylar angle (HCA) measurements and radiographically detectable morphological changes of the condyle in patients with temporomandibular disorder (TMD) is an area of controversy in dentistry.AimThis study sought to determine the effect of the HCA on radiographically morphological changes in the condyles of asymptomatic and symptomatic patients with TMD.Material & methodsCone beam computed tomography (CBCT) scans were used of patients with 146 temporomandibular joints (TMJ) with and without symptoms of TMD. The reconstructed axial plane was adjusted to depict the condyle in maximum width. The HCA was established and measured as the angle formed between the condylar long axis intersecting with the coronal plane. Each condyle long axial was determined independently from the other joint by two oral and maxillofacial radiologists. The average of the readings from the two examiners was used for statistical analysis.ResultsBased on the clinical symptoms, the mean of the HCA in the symptomatic joint was 27.69°, which was slightly greater than the angle measured in asymptomatic patients of 25.6°; however, this was not a statistical difference. No significant differences existed in the mean of the HCA between the joint with and without radiographic arthritic findings in both groups. In both groups, none of the arthritic findings manifested in the affected joint that had influenced the HCA.ConclusionThe HCA was increased in the symptomatic group but had no direct influence on joint's morphological changes in the asymptomatic and symptomatic patients.     

Research diagnostic criteria for temporomandibular disorders (RDC/TMD) axis I diagnoses in an Italian patient population

The aim of this work was twofold: to evaluate the prevalence of different Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) diagnosis in an Italian population of subjects seeking TMD treatment in a tertiary clinic; and to compare data with those from similar studies in the literature. Participants in this study were 433 consecutive patients seeking TMD treatment at the Section of Prosthetic Dentistry, Department of Neuroscience, University of Pisa, Italy; mean age of patients was 38.8 years, with a female:male ratio of 2.6:1 (276 females, 73.2%; 101 males, 26.8%). RDC/TMD guidelines for examination were adopted to assign axis I diagnosis. The prevalence of RDC/TMD diagnoses was 38.2% (144/377) for group I disorders (muscle disorders), 52.3% (197/377) for group II disorders (disc displacements), and 52.6% (198/377) for group III disorders (arthralgia, osteoarthritis, osteoarthrosis). The present investigation provided findings that, compared and integrated with literature data, can be useful to create a world-wide database, in accordance with the nature of the RDC/TMD classification system.     

Prevalence among adolescents in Bergen,Western Norway,of temporomandibular disorders according to the DC/TMD criteria and examination protocol

Objective: The aims of this study were to assess the prevalence of temporomandibular disorders (TMD) among adolescents and to contrast the prevalence of TMD according to the DC/TMD clinical examination protocol versus the prevalence of pain related to TMD according to two screening questions.

Material and methods: Two hundred and ten adolescents living in the county of Bergen, Norway, were offered an additional examination for TMD in connection with their regular dental check-up appointment. Five dental clinics were selected with differing socio-economic patient populations, as reflected by stratification of average levels of DMFT, and an equal number of girls and boys were invited to participate. The participants answered two screening questions for pain related to TMD followed by a clinical examination according to the DC/TMD protocol by five calibrated examiners.

Results: Acceptable calibration results were obtained. Approximately 80% of eligible participants consented to partake. According to the criteria of DC/TMD, the prevalence of TMD among the study participants was 11.9%, with a peak at 16 years of age. According to the self-reported screening questions for pain related to TMD, 7.2% responded positively. Only seven participants with a TMD diagnosis established according to the DC/TMD clinical examination protocol reported also pain related to TMD based on answering the two screening questions.

Conclusion: The prevalence of TMD is higher for girls than for boys and the prevalence of TMD established according to the DC/TMD criteria was higher than the prevalence of pain related to TMD estimated by use of two screening questions for self-reported pain.     

Diagnostic accuracy of three screening questions (3Q/TMD) in relation to the DC/TMD in a specialized orofacial pain clinic

Objective: To determine the diagnostic accuracy of three screening questions (3Q/TMD) in relation to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), in a specialized clinic.

Material and methods: Consecutive patients,?>18 years, referred with a possible TMD complaint to the Orofacial Pain and Dysfunction clinic, Academic Centre for Dentistry Amsterdam, the Netherlands, were included in the study. All patients (n?=?449; mean age 44 years; 72% females), answered the 3Q/TMD and the DC/TMD questionnaire before a DC/TMD examination. The 3Q/TMD constitutes of two questions on weekly pain from the jaw, face and temple region (Q1), and on function (Q2), and one function-related question on weekly catching and/or locking of the jaw (Q3). Q1 and Q2 were evaluated in relation to a DC/TMD pain diagnosis and Q3 in relation to a subgroup of DC/TMD intra-articular diagnosis, referred to as the reference standard.

Results: In total, 44% of patients received a pain-related DC/TMD diagnosis and 33% an intra-articular reference DC/TMD diagnosis. Sensitivity for the two pain screening questions was high (0.83–0.94), whereas specificity was low (0.41–0.55). For the function-related question, sensitivity was low (0.48), whereas specificity was high (0.96).

Conclusions: In a specialized pain clinic, the two pain questions (Q1, Q2) are positive in most patients with pain-related TMD. Therefore, in case of a positive response, further diagnostic procedures for TMD pain are warranted. For the functional screening question (Q3), a positive response is indicative for an intra-articular DC/TMD diagnosis, while in case of a negative outcome, an intra-articular TMD might still be present.     

Three-dimensional comparative evaluation of articular disc position and other temporomandibular joint morphology in Class II horizontal and vertical cases with Class I malocclusion:: A magnetic resonance imaging study

ObjectiveTo evaluate and compare articular disk position, condylar position, and joint spaces in Class II vertical, Class II horizontal, and Class I cases. The purpose was to assess the potential for development of temporomandibular disorders (TMDs) in the three groups.Materials and MethodsA sample of 75 cases, 25 cases in each group of Class I, Class II vertical, and Class II horizontal, were selected based on inclusion and exclusion criteria. Magnetic resonance imaging (MRI) assessments were made with a 1.5-Tesla basic system with a closed-mouth technique for evaluating articular disk position in the sagittal and transverse planes, condylar position, and joint spaces in the sagittal plane. Philips 3.0 software was used to analyze the MR images.ResultsThere was evidence of alterations in the temporomandibular joint (TMJ) morphology in both Class II vertical and Class II horizontal cases, with maximum discrepancy in Class II vertical cases. MRI evaluation suggested a tendency for antero-medial disk displacement with anteriorly positioned condyles in Class II vertical cases. The discrepancy was milder in the Class II horizontal group.ConclusionsClass II vertical cases are more susceptible to the development of TMDs and should be subjected to TMJ evaluation before starting any orthodontic treatment to intercept and prevent a mild asymptomatic TMD from developing into a more severe form. Class II vertical cases should be subjected to MRI evaluation before starting any orthodontic treatment.     

MRI分期与TMD临床症状相关性的分析

目的 评估颞下颌关节紊乱病(temporomandibular disorder,TMD)磁共振成像(MRI)分期与临床症状的相关性.方法 通过回顾性队列研究,收集2018年12月—2019年12月至我院颌面外科就诊的160例患者的基本信息、MRI影像、数据化测定(VAS)评分表以及张口度.将患者根据年龄分组(12～1...     

青少年重型口疮的临床研究

目的 探讨青少年重型口疮的相关病因和醋酸去炎舒松 A的有效作用。方法 将 77例重型口疮患者随机分为2组,全部采用胸腺肽和复方丹参片治疗,其中47例溃疡局部封闭醋酸去炎舒松A注射液。结果 青少年重型口疮男性发病率明显高于女性,有明显的家族遗传倾向,部分患者血清免疫球蛋白 IgA、IgM以及补体C4异常。结论 不良习惯是青少年重型口疮中不容忽视的因素,醋酸去炎舒松A局部封闭能显著缩短溃疡的发作时间,但对溃疡的发作周期无影响。     

青少年spee曲线深度与颞下颌关节紊乱病的相关性研究

目的:研究青少年spee曲线深度与颞下颌关节紊乱病的相关性.方法:根据颞下颌关节紊乱病诊断标准将选取的在校大学生192人分为两组,测量spee曲线深度.将结果进行Spreaman检验和t检验,以P＜ 0.05为差异有统计学意义.结果:spee曲线深度在0-2mm时与TMD的发生率呈负相关性(r=-0.731,P＜ 0.05),在大于2mm时呈正相关(r=0.786,P＜0.05).TMD组左右两侧spee曲线深度差异有统计学意义P=0.01,对照组左右两侧spee曲线深度差异无统计学意义P=0.1 09,而TMD组与对照组之间spee曲线深度的均值差异无统计学意义P=0.062.结论:过大或过小的spee曲线均会导致TMD的患病风险增加,并且左右两侧的spee曲线深度差异过大也会诱使TMD的发生.