352名无牙颌老年人颞下颌关节紊乱病调查

目的 对无牙颌老年人颞下颌关节紊乱病( temporomandibular disorders,TMD)的情况进行调查并初步探讨相关的危险因素.方法 352名北京市无牙颌老年人参加本次调查,男性198人,女性154人.根据Helkimo指数设计调查表,由专业培训人员对受试者进行颞下颌关节相关症状和体征的检查并记录.根据性别以及是否进行全口义齿修复分别统计分析.结果本组人群TMD查体阳性率为43.2％(152/352),其中阳性体征以关节弹响多见,占34.1％( 120/352);下颌运动偏斜次之,占18.2％(64/352),关节区及咀嚼肌触痛则发生较少,下颌运动痛最少.男性TMD查体阳性率为36.9％(73/198),女性为51.3％(79/154),两者差异有统计学意义(P =0.0067 ＜0.01);行全口义齿修复的无牙颌老人TMD查体阳性率为38.6％(91/236),未修复者TMD查体阳性率为52.6％(61/116),两者差异有统计学意义(P =0.0125 ＜0.05),其OR值为1.767(1.130～2.763).结论 性别因素及不良咬合均可能是影响老年无牙颌者TMD患病率的危险因素.     

两种(牙合)型全口义齿对老年无牙颌患者颞下颌关节紊乱病影响的比较

目的 观察舌侧集中(牙合)型与解剖验型全口义齿对牙槽嵴低平的老年无牙颌患者颞下颌关节紊乱病(tempromadibular joint disorders,TMD)的疗效,以期为临床全口义齿修复的(牙合)型选择提供依据.方法 采用随机数字表法随机选取剩余牙槽嵴低平的老年无牙颌TMD患者中拟行舌侧集中(牙合)型(A组)与解剖(牙合)型(B组)全口义齿修复的患者各35例.检查并记录患者修复前和修复后3、6个月的TMD情况,采用Fricton颞下颌关节功能临床检查表评价TMD改善效果,选用t检验和秩和检验分析修复前后的差异.结果 全口义齿修复3个月后,A组患者颞下颌关节指数(craniomandibular index,CMI)下降值(0.064±0.022)显著高于B组(0.043±0.018) (P＜0.01)；修复6个月后,A组CMI下降值(0.084±0.020)显著高于B组(0.070±0.021) (P =0.011 ＜0.05).结论 对于伴有TMD症状的牙槽嵴低平的老年无牙颌患者,采用舌侧集中(牙合)型全口义齿修复更有利于关节症状的缓解.     

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。     

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提要：全口义齿修复是较为困难的修复方法。临床上容易发生的问题较多,影响修复效果,处理不当甚至可导致修复失败,对口腔组织结构及生理功能造成损害。全口义齿的问题主要有固位不良、疼痛、黏膜损伤、发音障碍、恶心、咬颊、咬舌等,而在全口义齿戴用一段时间后还可出现黏膜溃疡、 咀嚼无力、舌面磨平、义齿性口炎、垂直距离减低、颞下颌关节紊乱病（TMD）等。应根据不同的原因,采取不同的治疗方法处理,及时进行修改,以保护口腔组织的健康和恢复口腔功能。本文就全口义齿常见的病因及处理做一介绍。     

上海市老年人义齿修复状况抽样调查及影响因素分析

目的:评估上海市老年人的义齿修复情况及其影响因素,为政府有关部门制定相关政策提供依据.方法:采厍多阶段分层等容量随机抽样方法,调查上海市788名6574岁老年人的口腔及义齿修复情况,对其中325人的社会经济信息和生活健康信息进行问卷调查.应用Logistic回归模型分析影响缺牙老人是否进行义齿修复的相关因素.结果:该样本组缺牙患者义齿修复率仅为61.37%,牙列缺损患者义齿修复率显著低于牙列缺失患者(P<0.01).固定义齿、活动义齿、固定+活动义齿、全口义齿和非正规固定桥分别为21.94%、41.58%、5.87%、20.92%和9.69%.郊区老人全口义齿、固定义齿及非正规固定桥的比例显著高于城区(P<0.01).Logistic回归分析显示,缺牙位置、性别和缺牙数量是影响缺牙老人是否进行义齿修复的主要因素.结论:上海老年人缺牙患者义齿修复率普遍较低,提示政府有关部门应采取积极措施,强化居民口腔保健意识,提高老年患者义齿修复的及时性和有效性.     

颞颌关节功能紊乱的牙合垫式义齿治疗

目的 观察(牙合)垫式义齿在老年牙列缺损伴(牙合)磨耗引起TMD的修复效果。方法 87例TMD病例,男54例,女33例,年龄58～75岁。面下1/3变短,深覆(牙合)且伴有TMD症状,经升高咬合后采用(牙合)垫式义齿修复,并对治疗前后关节间隙变化进行统计学分析。结果 用(牙合)垫式义齿修复能使TMJ,(牙合),肌肉协调一致,治疗TMD效果好。结论 部分牙列缺损伴有重度(牙合)磨耗的TMD患者,(牙合)垫式义齿修复是一种有效的治疗方法。     

CBCT在义齿修复后颞下颌关节疾病诊治中的应用

目的 探讨锥形束CT (cone beam CT,CBCT)在义齿修复后颞下颌关节紊乱病(temporomandibular joint disorder,TMD)诊治中的应用效果.方法 20例义齿修复后出现TMD患者作为研究对象,进行CBCT检查,测定患者修复前后颞下颌关节(temporomandibular joi...     

38例全口义齿修复复诊原因分析

目的 分析全口义齿修复复诊的原因.方法 收集38例全口义齿修复患者的复诊资料,分析复诊原因.结果 38例复诊病例中因为义齿压痛而复诊的有26例,由于义齿固位不良、颌位关系不正确、恶心、义齿形态不满意的分别有7例、 2例、 2例和1例.结论 全口义齿修复中细致、准确的操作和与患者良好的交流,可降低全口义齿修复复诊率.     

颞颌关节功能紊乱的He垫式义齿治疗

目的：观察He垫式义齿在老年牙列缺损伴He磨耗引起TMD的修复效果。方法：87例TMD病例，男54例，女33例，年龄58—75岁。面下1／3变短，深覆He且伴有TMD症状，经升高咬合后采用He垫式义齿修复，并对治疗前后关节间隙变化进行统计学分析。结果：用He垫式义齿修复能使MJ，He，肌肉协调一致，治疗TMD效果好。结论：部分牙列缺损伴有重度He磨耗的TMD患者，He垫式义齿修复是一种有效的治疗方法。     

生物功能性修复系统应用于下颌低平牙槽嵴的修复效果初探

目的 比较生物功能性修复系统(Bio-functionnal Prothetic System,BPS)和传统方法对下颌低平牙槽嵴修复效果的影响.方法 选择10例口颌系统基本正常,下颌牙槽嵴重度吸收的无牙颌患者,分别采用BPS和传统方法进行全口义齿修复,随机选择戴用顺序,在修复后1、3、6个月后分别对义齿的固位力、咀嚼效能进行测定,并在戴用义齿1个月时进行满意度问卷调查.结果 在修复后1、3、6个月,BPS全口义齿的下颌义齿固位力高于传统全口义齿,差异具有统计学意义(P<0.05);2种全口义齿吸光度值作比较,在各个检测时期,BPS组吸光度值保持稳定,均高于传统全口义齿(P<0.05),传统全口义齿在3个月和6个月后吸光度值有所回升,与第1个月相比具有统计学意义,但仍低于同时期的BPS组(P<0.05);问卷调查显示,BPS组的主观满意度明显高于传统组;6个月后,10位患者均表示BPS全口义齿更舒适,不容易脱落.结论 采用BPS完成的义齿修复应用于下颌低平牙槽嵴的无牙颌患者时,能取得更好的修复效果.     

The role of dental loss and denture status on clinical signs of temporomandibular disorders

Studies concerning the role of denture status on in temporomandibular disorders (TMD) are scarce. The aim of this study was to evaluate the association of tooth loss and denture status with clinical findings of TMD. The data were obtained from 6316 subjects aged ≥30 years from the Finnish Health 2000 Survey. The associations between clinically assessed TMD findings and number of teeth, wearing of removable dentures, need for denture repair and age of the dentures were analysed by means of chi‐square test and logistic regression. Among women after adjusting for age, having fewer teeth or wearing complete dentures associated with restricted maximum interincisal distance and pain on palpation of the temporomandibular joints (TMJ) and masticatory muscles. After adding education level and depression in the model, the associations between TMJ pain and explanatory variables were weakened. Among men, having a higher number of teeth associated with occurence of TMJ crepitation. Subjective need for repair of dentures and having a denture aged ≥5 years associated with pain on palpation in masticatory muscles among women. Among men, both the objective and subjective need for denture repair and having at least one denture aged ≥5 years or been repaired during the past 5 years associated negatively with the presence of TMJ crepitation. It can be concluded that edentulousness, wearing of complete dentures and poor condition of dentures associate with pain‐related TMD findings among women. Psychosocial factors have a modifying effect on these associations.     

Changes in temporomandibular disorders after treatment with new complete dentures

A total of 250 edentulous patients (118 non-denture and 132 denture wearing) awaiting treatment for new complete dentures were examined for signs and symptoms of temporomandibular disorders. Signs and symptoms of temporomandibular disorder (TMD) were evaluated before prosthetic treatment, 3 months and 3 years after denture insertion by means Helkimo's Anamnestic and Clinical Dysfunction Indices. Before treatment began, patients were observed to have a low prevalence of signs and symptoms of TMD. This prevalence decreased, but was not statistically significant, in the 3 months and 3 years after denture insertion. No statistically significant correlations were found between signs and symptoms of TMD and denture retention, stability, occlusal errors, freeway space, age of present denture, or number of sets of dentures.     

牙列缺损伴重度(牙合)面磨损(牙合)重建修复的临床研究

目的 通过对不同类型牙列缺损并伴重度(牙合)面磨损的患者进行修复治疗,探讨(牙合)重建的有关问题.方法 选取牙列缺损并伴重度(牙合)面磨损患者69例,制取修复前研究模型,根据不同的缺损类型进行(牙合)垫式可摘局部义齿、固定义齿或固定-可摘义齿联合修复,随访3个月～4年,观察修复治疗效果.结果 患者的咀嚼功能明显改善,有颞下颌关节症状者,症状得到了缓解,无颞下颌关节症状者在咬合升高后未出现新的颞下颌关节症状.结论 对于牙列缺损伴重度(牙合)面磨损患者,(牙合)垫式可摘义齿及固定义齿修复均是(牙合)重建修复的有效方法.     

雌激素与颞下颌关节紊乱病

颞下颌关节紊乱病的流行病学调查发现女性患病率高于男性,且存在年龄分布,使得雌激素在其发病机制中的作用引起学者的注意。雌激素能够影响颞下颌关节组织结构如骨、软骨、关节盘等多种组织的生长、代谢、改建重建等,并能影响疼痛的调节机制,从而可能在颞下颌关节紊乱病的病理生理过程中起作用。     

Wear of feldspathic ceramic,nano‐filled composite resin and acrylic resin artificial teeth when opposed to different antagonists

The aim of this study was to evaluate the wear of denture teeth and their antagonists produced by two‐body and three‐body wear tests. Three types of denture teeth, namely feldspathic ceramic (FC), nano‐filled composite resin (NCR), and experimental acrylic resin teeth (AR), were tested. For each type two groups of eight upper premolars each were prepared. The first group was tested against cusps from the same material and the second group was tested against human enamel cusps. Each group was loaded with a total of 200,000 chewing cycles (two‐body wear 100,000 cycles and three‐body wear 100,000 cycles). Wear was analyzed by measuring the maximum depth and volume loss of the denture teeth using a laser scanner and by measuring the vertical loss of the antagonists using an optical macroscope. Statistically, there was no significant difference between the following combinations: FC–FC and NCR–NCR regarding the vertical and volume loss; and FC–enamel and NCR–enamel regarding the total vertical substance loss. The combinations AR–AR and AR–enamel showed higher wear values than the other combinations. For complete dentures, composite resin and ceramic teeth showed similar vertical and volume loss, whereas composite resin teeth seemed to be more suitable for partial dentures opposing natural teeth in terms of wear of teeth and antagonists.     

垫式可摘局部义齿修复TMD患者牙列缺损的探讨

目的:观察牙列缺损伴有颞下颌关节症状的老年患者采用垫式可摘局部义齿修复的临床效果。方法:对79例牙列缺损、余留牙重度磨耗、低位咬合同时伴有颞下颌关节症状的老年患者,采用垫式可摘局部义齿修复,并作半年、1 年、3年追踪复查。检查项目为咀嚼功能与颞下颌关节改善情况。结果:有效率分别为98.73%、100%、93.67%,修复效果令人满意。结论:采用垫式可摘局部义齿在恢复缺失牙功能的同时,能有效缓解颞下颌关节症状,改善面容,提高咀嚼功能,固定松动牙,防止食物嵌塞。     

应用CBCT技术对全口义齿再修复时颞下颌关节盘间隙变化的分析

目的 应用CBCT技术,分析全口义齿再修复时颞下颌关节盘的间隙变化,以确定患者一次垂直距离恢复的最大值,为临床提供依据。方法 选择全口义齿使用超过5年的需要再修复患者30例,按常规制作新的全口义齿,根据患者全口义齿垂直距离恢复情况分为3组, A组为恢复1.0mm~2.5mm, B组为恢复2.5mm~5.0mm, C组为恢复大于5.0mm。通过自身对照,观察新旧全口义齿垂直距离改变,并在CBCT下记录颞下颌关节盘间隙变化,结合临床患者资料,分析垂直距离改变和颞下颌关节盘间隙的关系,明确垂直距离恢复程度对关节的影响。结果 A组关节盘上、前、后变化在(0.10~0.50)±0.20mm区间,患者新全口义齿一周内可适应; B组关节盘上、前、后变化在(0.50~1.11)±0.32mm区间,患者新全口义齿适应时间相对长; C组关节盘上、前、后变化在>(1.50±0.50) mm区间,患者新全口义齿失败可能性明显增加。结论 全口义齿再修复时建议一次性恢复垂直距离高度以不超过2.5mm为宜,最大值在5mm以内,以减少全口义齿修复失败和诱导颞下颌关节疾病的可能,大于5mm以上明显存在失败风险。     

Oral hygiene, dental visits and age of denture for prevalence of denture stomatitis

Abstract A representative sample of Finnish denture wearers (n= 3875) aged 30 or over were examined clinically and interviewed about their oral hygiene habits, use of dental services and possible prosthetic treatment during last visit to a dentist. Of these denture wearers, over 80% brushed their dentures at least once a day, and 16% visited a dentist at least once in 2 yr. For denture stomatitis the age-standardized risk ratio decreased with brushing frequency in women and increased in men. For frequency of dental visits the prevalence of denture stomatitis increased in both men and women when visits were made over 2-yr intervals. The prevalence of denture stomatitis was higher in the group with dentures over 1 yr old. It seems that the oral hygiene measures as they are generally carried out and regular dental visits are not effective enough methods in preventing denture stomatitis.     

Variations of clinical rest position in complete denture-wearing subjects

With a view to proposing concrete grounds for the measurement of the rest vertical dimension on the face in the establishment of the vertical dimension of occlusion for edentulous patients, 20 complete denture-wearing subjects were made to take a clinical rest position by 4 different denture-wearing patterns, i.e. setting both dentures (UL), setting maxillary denture only (U), setting mandibular denture only (L) and completely edentulously (O), and were measured for the distance between 2 points on the face by slide calipers masking the reading part. The data were statistically analyzed and the following results were obtained. 1) Rest vertical dimension was largest for L, and significant differences were noted between UL, O, U and L, but not between UL and O, between UL and U and between O and U. 2) No significant difference in rest vertical dimension was noted between subjects of not more than 65 years and those of not less than 65 years. 3) No significant difference in rest vertical dimension was noted between the group of subjects of not more than 6 edentulous years and that of subjects of not less than 6 edentulous years. 4) The above results give suggestions to the measurement and evaluation of the vertical dimension between 2 points on the face when jaws are in the vertical relationship with the clinical rest position, in the establishment of the vertical dimension of occlusion.