利用咬合力计指导调(牙合)治疗颞下颌关节紊乱病

目的:用咬合力计指导调(牙合)并评价调(牙合)对治疗TMD的疗效.方法:随机选取10例因TMD来我院就诊的患者,取观测模型,分析其咬合,并进行调(牙合).根据调骀治疗前后其临床症状改善情况,进行疗效分析.结果:3个月后多数患者的颌面部肌肉酸痛、无力、关节弹响、开口型异常等症状缓解或消失.结论:(1)调(牙合)是治疗TMD的一种有效的治疗方法.(2)咬合力计能够客观、真实、准确地反应出咬合接触点的详细情况.     

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     

上颌咬合板治疗颞下颌关节紊乱病

为寻找治疗颞下颌关节紊乱病的有效方法。方法 对３４例颞下颌关节紊乱病伴前牙深覆 Ｈｅ患者给予上颌Ｈｅ板治疗。结果 上颌咬合板对颞下凳关节疼痛，弹响以及张口受限等临床症状有明显缓解作用。结论上颌咬合板可作为治疗颞下颌关节乱紊乱病的方法之一。     

颞下颌关节紊乱病患者的三维咬合接触观察

目的 :探讨颞下颌关节紊乱病 (TMD)患者的咬合异常特征。方法 :2 3名无症状全牙列大学生志愿者和 10 1名全牙列TMD患者 ,取研究模 ,从垂直向、颊舌向、近远中向三维方向观察、记录并以指数评价咬合特征 ;TMD患者摄许勒片及侧位体层片 ,弹响关节摄造影片 ,分析咬合指数与颞下颌关节 (TMJ)影像变化的关系。结果 :66.3 %的TMD患者有垂直向咬合异常 ,其垂直向咬合指数明显高于对照组 (P <0 .0 5 ) ;垂直向咬合异常与TMJ影像结果间未见明显相关性 (P >0 .0 5 )。结论 :垂直向咬合异常与TMD临床表现有密切关系。     

颞下颌关节紊乱病的治疗

关于 因素是否颞下颌关节紊乱病（ＴＭＤ）病因之一,以及ＴＭＤ的 治疗,现存在着各种争议。本文回顾了有关研究及观点。目前,无论是动物实验研究,还是临床实验研究,都不足以作出 因素是ＴＭＤ病因之一的结论。但是, 治疗在ＴＭＤ临床治疗中占有重要地位,且发挥重要作用：调 能有效地缓解慢性头痛,颈痛及肩部痛; 治疗对减轻ＴＭＤ患者的肌肉疼痛也显示理想效果：调位咬合板能消除一部分关节弹响。进一步探索ＴＭＤ的 因素,正确掌握ＴＭＤ 治疗的适应证及客观科学地评价 治疗的临床效果是我们今后研究的课题。     

颞下颌关节紊乱病的咬合夹板治疗探讨

目的：探讨咬合夹板治疗颞下颌关节紊乱病的疗效。方法：采用不同的咬合夹板治疗31例TMD患。结果：疾病、弹响、张口受限治疗3个月后的总治愈率分别为：86．6％、54．5％和60．0％。6个月后总治愈率分别为：93．3％，72．7％和80％。结论：临床采用咬合夹板治疗上颌关节紊乱病是行之有效的方法。     

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。     

上颌咬合板治疗颞下颌关节紊乱病

目的为寻找治疗颞下颌关节紊乱病的有效方法。方法对34例颞下颌关节紊乱病伴前牙深覆患者给予上颌板治疗。结果上颌咬合板对颞下颌关节疼痛、弹响以及张口受限等临床症状有明显的缓解作用。结论上颌咬合板可作为治疗颞下颌关节紊乱病的方法之一。     

调改咬合治疗颞颌关节紊乱病的方法

颞颌关节紊乱病 (temporomandibulardisorders,TMD)是最常见的被许多学者认为需要进行调改咬合 (简称调牙合 ,occlu sionadjustment)治疗的疾病之一 ,其机制是建立在牙合原性病因的基础之上。有关其调牙合治疗目的的论述 ,概括起来有以下两方面 :1)调除咬合干扰[1～ 4] ;2 )建立稳定的咬合接触关系[5] 。这里所说的咬合干扰 ,是指 :(1)RCP -ICP咬合干扰 :即下颌由后退接触位 (retrudedcontactposition ,RCP)向牙尖交错位 (intercuspalposition ,ICP)滑行过程中出现的咬合干扰 ,具体是指 :①RCP时单侧后牙接触点 ;②引导下颌从RCP向…     

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颞下颌关节紊乱病的咬合病因至今存在很大争议。本文介绍了我们关于该病的咬合病因研究成果,包括临床病例咬合分析、动物实验、生物力学分析、下颌运动轨迹描记以及咬合治疗措施等五个方面的内容,提出并初步论证了渐进性咬合紊乱可作为独立的致病因素导致颞下颌关节退行性改变的论点,并对今后的研究提出展望。     

应用T-Scan II系统对TMD患者调治疗的分析研究

目的 :探讨对TMD患者进行调牙合治疗的意义。方法 :应用先进的T ScanII咬合接触测定分析系统 ,在患有TMD的患者调牙合前后分别进行咬合接触检测 ,结合疼痛症状分析表来进行综合评价。结果 :调牙合治疗后咬合接触点明显增加 ,且双侧趋于平衡接触 ,VAS指数明显降低 ,由原来 5 .3降为 1.9,临床症状得到明显改善。结论 :调牙合治疗对TMD具有积极的治疗作用     

Occlusal adjustment for treating and preventing temporomandibular joint disorders

To assess the effectiveness of occlusal adjustment (OA) for treating temporomandibular disorders (TMD) in adults and preventing TMD. The Cochrane Controlled Trials Register, MEDLINE and EMBASE were comprehensively searched using the Cochrane methods. Reports and review articles were retrieved. Unpublished reports or abstracts were considered from the SIGLE database. All randomized or quasi-randomized controlled trials comparing OA with placebo, reassurance or no treatment in adults with TMD. The outcomes were global measures of symptoms, pain, headache and limitation of movement. Data collection and analysis followed the Cochrane Oral Health Group's statistical guidelines. Results showed no difference between OA and control group in symptom-based outcomes for treatment or incidence of symptoms for prevention. There is no evidence that OA treats or prevents TMD. OA cannot be recommended for the management or prevention of TMD. Future trials should use standardized diagnostic criteria and outcome measures when evaluating TMD.     

Association of tightly locked occlusion with temporomandibular disorders

The association between teeth loss and temporomandibular disorders (TMD) is still inconclusive. A kind of secondary changes of the occlusion after teeth lose called the tightly locked occlusion (TLO), defined as the occluding contact that delivers angled occlusal force on the drifted neighbour and/or the tipped antagonists of the lost posterior teeth, was hypothesized to be association with TMD. The study aimed at investigating the association between the TLO and TMD. A total of 113 posterior-teeth losing patients, 64 with TMD symptoms (group of TMD) and 49 without (group of TMD-Free) were included. Study casts and joint radiographs were made to diagnose the TLO and joint morphological changes. The simultaneous contribution of the potential variables of gender, age, tooth losing number, the TLO, joint symmetry and signs of osteoarthrosis shown on radiographs were tested through binary logistic regression analysis. In women, the TLO entered into logistic model, and had an effect on the incidence of TMD (P = 0.008). The odds ratio of with-TLO versus without-TLO is 2.6 (95% CI: 1.2, 5.8) after controlling for the effect of gender. Age, tooth lose number, joint asymmetry or osseous changes had no effect on the incidence of TMD. The tightly locked occlusion is associated with some signs and symptoms of TMD. Randomized controlled trials will be needed in further studies to test the hypothesis that treatment of a TLO, as defined in the present study, will have a beneficial effect on the signs and symptoms of TMD.     

Paradigmatic shifts in occlusion and temporomandibular disorders

There are several terms that identify proposed paradigms for the way things ought to be carried out in the health sciences: evidence-based, cause-and-effect, diagnostic gold-standard, patient-centred-outcomes, risk assessment, cost/benefit/risk, and efficacious/effective. Collectively these paradigms exhibit varying degrees of interdependence, and have the potential for changing the way dentistry is practiced. A paradigm can be thought of as a standard by which research and health science ought to be conducted and evaluated. In this sense scientists and clinicians try to figure out how to account for various observations and phenomena dictated by paradigms or models of health care; however, it may become necessary to shift to new paradigms that are more consistent with scientific and clinically reality. Some of the potential effects of these shifting paradigms on the practice and teaching of occlusion and temporomandibular disorders are considered.     

The role of orthodontics in temporomandibular disorders

Summary Temporomandibular Disorder (TMD) is the main cause of pain of non‐dental origin in the oro‐facial region including head, face and related structures. The aetiology and the pathophysiology of TMD is poorly understood. It is generally accepted that the aetiology is multifactorial, involving a large number of direct and indirect causal factors. Among such factors, occlusion is frequently cited as one of the major aetiological factors causing TMD. It is well known from epidemiologic studies that TMD‐related signs and symptoms, particularly temporomandibular joint (TMJ) sounds, are frequently found in children and adolescents and show increased prevalence among subjects between 15 and 45 years old. Aesthetic awareness, the development of new aesthetic orthodontic techniques and the possibility of improving prosthetic rehabilitation has increased the number of adults seeking orthodontic treatment. The shift in patient age also has increased the likelihood of patients presenting with signs and symptoms of TMD. Because orthodontic treatment lasts around 2 years, orthodontic patients may complain about TMD during or after treatment and orthodontists may be blamed for causing TMD by unsatisfied patients. This hypothesis of causality has led to legal problems for dentists and orthodontists. For these reasons, the interest in the relationship between occlusal factors, orthodontic treatment and TMD has grown and many studies have been conducted. Indeed, claims that orthodontic treatment may cause or cure TMD should be supported by good evidence. Hence, the aim of this article is to critically review evidence for a possible association between malocclusion, orthodontic treatment and TMD.     

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颞下颌关节紊乱病(TMD)病因复杂,目前尚不很清楚。最初提出、且目前仍认为比较正确的是因素学说。20世纪60年代初提出精神心理因素学说,被很多学者认可,但却无法被完全认同。后来又提出创伤因素学说、自身免疫因素学说、解剖因素学说等,这些学说都有不足之处。现在一般认为是多种因素引起TMD。     

调(牙合)对TMD慢性疼痛治疗效果的临床评价初探

目的：探讨调[牙合]治疗颞下颌关节紊乱病（TMD）慢性疼痛的疗效。方法：TMD伴慢性口颌面痛患者21例,盲法随机分为治疗组（10例）和对照组（11例）,治疗组予以本课题组所报道的方法进行调[牙合]治疗,以建立平稳咬合接触为目标,对照组作模拟调[牙合]。检测治疗前、治疗后即刻和治疗1月时疼痛指数（VAS）、开口度及咬合力水平。结果：治疗组VAS降低（p=0．000）,开口度增加（p=0．008）,咬合力有所增加（p=0．050）,与对照组相差显著。对照组治疗前后无明显差异。结论：以建立自然牙列稳定咬合接触关系为目的的调[牙合]治疗可以明显缓解TMD慢性疼痛。     

Attitude of Chinese orthodontists towards the relationship between orthodontic treatment and temporomandibular disorders

OBJECTIVE: To determine the attitude of some Chinese orthodontists towards the relationship between orthodontic treatment and temporomandibular disorders (TMDs). SUBJECTS AND METHODS: 25 orthodontists, in six public hospitals (Xi'an, the capital of Shaanxi Province, China), were asked to complete a 10-item questionnaire concerning orthodontics/TMD. RESULTS: 84% of orthodontists often asked their patients about the signs and symptoms of TMD before orthodontic treatment and 92% reported examining the TMJ region. 76% of orthodontists thought orthodontic treatment may possibly lead to a greater incidence of TMD, while 84 per cent claimed that orthodontic treatment might prevent TMD. Methods of orthodontic treatment, patient's age, and occlusal interference were regarded as risk factors leading to increased incidence of TMD. CONCLUSIONS: Some Chinese orthodontists realise the importance of the relationship between orthodontic treatment and TMD. Most thought that unsuitable orthodontic treatment might increase the development of TMD and that orthodontic treatment could prevent TMD.