稳定性(牙合)垫治疗颞下颌关节可复性盘前移位的疗效分析

目的:分析稳定性(牙合)垫治疗颞下颌关节可复性盘前移位的疗效.方法:使用Michigan型稳定性(牙合)垫治疗颞下颌关节盘前移位患者32例,疗程为3个月,采用Fricton指数来评价治疗效果.治疗前后均拍摄许勒位X线片以及行关节上腔造影.结果:统计学分析表明治疗前后存在有显著性差异(P=0.02),Fricton颞下颌关节紊乱指数(CMI)从治疗前的0.21±0.04下降到治疗后的0.09±0.03.但造影显示并非所有弹响消失患者的盘-突关系均恢复正常.结论:稳定性牙合垫治疗颞下颌关节可复性盘前移位取得了良好的治疗效果,能有效地消除弹响,缓解疼痛,改善患者的下颌运动功能.     

稳定性（he）垫治疗颞下颌关节可复性盘前移位的疗效分析

目的分析稳定性(牙合)垫治疗颞下颌关节可复性盘前移位的疗效.方法使用Michigan型稳定性(牙合)垫治疗颞下颌关节盘前移位患者32例,疗程为3个月,采用Fricton指数来评价治疗效果.治疗前后均拍摄许勒位X线片以及行关节上腔造影.结果统计学分析表明治疗前后存在有显著性差异(P=0.02),Fricton颞下颌关节紊乱指数(CMI)从治疗前的0.21±0.04下降到治疗后的0.09±0.03.但造影显示并非所有弹响消失患者的盘-突关系均恢复正常.结论稳定性牙合垫治疗颞下颌关节可复性盘前移位取得了良好的治疗效果,能有效地消除弹响,缓解疼痛,改善患者的下颌运动功能.     

MRI Study of a Physiotherapeutic Protocol in Anterior Disk Displacement Without Reduction

Disk displacement of the temporomandibular joint (TMJ) without reduction has been considered a fundamental pathophysiologic abnormality of the joint. In this paper there are supportive clinical and MRI evidence of a successful repetitive manipulative technique for the treatment of acute and chronic locking. In 1500 treated cases, documented on videotape, only five cases required surgical intervention. The success of the therapy was confirmed by 13 MRI images of the TMJ of patients with acute and chronic locking before and after therapy. In all cases the anteriorly dislocated disk in closing and opening position was recaptured and repositioned in a normal position in the temporomandibular fossa. Three complete cases are reported with complete clinical and MRI documentation.     

再定位夹板与中切点阻断器联合治疗急性不可复性盘前移位

目的　观察再定位夹板与中切点阻断器联合应用于急性不可复性盘前移位治疗的效果。方法　通过比较颞下颌关节的最大开口度、Mankoski疼痛指数和盘突关系在治疗前后的变化 ,评价再定位夹板与中切点阻断器联合治疗急性不可复性盘前移位的疗效。结果　 15例急性不可复性盘前移位在联合治疗 2周后 ,其开口度均有明显的改善 ,疼痛指数也有明显的下降 ;6个月后 ,其盘突关系正常率为 80 %。结论　再定位夹板与中切点阻断器对急性不可复性盘前移位治疗具有良好的效果     

Horizontal Condylar Path in Patients with Disk Displacement with Reduction

In 32 patients with disk displacement with reduction, the condylar path in the horizontal plane during opening and closing movements of the mandible were analyzed with a computerized axiograph. The horizontal condylar tracings during opening were divided into 15 types. There was no clear relationship between the types and clinical symptoms. The specific correspondence of the types were revealed between the right and left joint. In 21 of 32 patients, the condyle on one side deviated medially, while the contralateral condyle deviated laterally at maximum opening. In most of the patients showing medio-lateral condylar deviation at maximum opening, a straight condylar path was observed from the maximum opening to the position just before the closing click. In some of the patients, the type of horizontal condylar tracing during opening was related to the displacement pattern of the disk assessed by magnetic resonance imaging (MRI).     

Nonsurgical Treatment of Anterior Disk Displacement Without Reduction of the Temporomandibular Joint: A Case Report on the Relationship between Condylar Rotation and Translation

Farrar reported that in chronic anterior disk displacement without reduction (ADD w/o R) of the temporomandibular joint (TMJ), the range of mandibular movement gradually increases and the condylar movement normal-disk is still displaced anteriorly. The relationship between condylar rotation and translation was studied in opening/closing jaw movements before and after joint stabilization splint therapy in a patient with ADD w/o R. Movements were recorded by means of an optoelectronic jaw tracking system (Metropoly, Jaws-3D) consisting of three cameras that register the position of six light-emitting diodes (LEDs) mounted on two target frames separately attached to the upper and lower jaw. A computer produced plots of the condylar paths in the sagittal, frontal, and horizontal plane, as well as the opening angle against the anterior condylar translation. Results indicated some variations in the relationship between condylar rotation and translation during jaw opening movement. In the joint with ADD w/o R an increase in anterior condylar translation was found and the relationship between rotation and translation became more linear after joint stabilization therapy. This study supported a hypothesis of Farrar's that condylar movement in chronic ADD w/o R is similar to that expected in asymptomatic TMJs.     

Orthopedic/Orthodontic Therapy for Anterior Disk Displacement: Unexpected Treatment Findings

Craniomandibular pain dysfunction (CMPD) is of increasing clinical concern to all fields of dentistry, especially orthodontics. One of the more common manifestations of CMPD is anterior disk displacement. Orthodontic/orthopedic treatment for anterior disk displacement using anterior repositioning of the mandible has been suggested by several clinicians as the treatment of choice. Returning the mandible back toward the original occlusion or habit centric has also been suggested by several reports. Functional jaw orthopedic (FJO) appliances would appear to be ideally suited for the treatment of anterior disk displacement due to the anterior repositioning nature of these appliances. In growing individuals, among other changes, the condyle is supposed to grow back into the fossa (which would serve as the walkback procedure). This article presents three young patients who had anterior disk displacement and posterior condylar displacement before treatment. Each patient was treated using a functional appliance and each patient ended treatment still having a posterior condylar displacement and anterior disk displacement. These findings were unexpected and no explanation is offered. This occurrence is rare in the author's practice (approximately 2–3%), but this is a real concern and the patients should be made aware of this possibility before starting treatment, so that their expectations are realistic. These enigmatic findings also emphasize the complexity of TMJ as well as FJO treatment and indicate the need for further research and study.     

Mouth-opening Exercises Produce a Decrease in Pain Perception in Patients with Disk Displacement with Reduction

This study was intended to determine whether mouth-opening exercise reduces pain sensitivity in remote regions as well as in the trigeminal region. Seven female subjects with disk displacement with reduction were asked to perform a three-minute repetitive mouth opening and closing exercise (exercise A) and a three-minute continuous mouth opening exercise (exercise B) on two separate days. Sensory/nociceptive perception thresholds were measured at the point over the right masseter and the skin overlying the volar aspect of the right forearm immediately after exercises A and B, and were compared to data in which no exercise was performed (baseline). Significant elevation in the heat-induced pain threshold was seen as a result of both exercises in the cervical region and in the trigeminal region. Also, a significant elevation in the cold-induced pain threshold was seen after exercise B in the cervical region. Further, there was a tendency toward a higher warm sensation threshold after exercise A in the cervical region. These results indicate that mouth opening training produces non-segmental analgesic effects mediated by C fiber and Adelta fiber.     

History,Clinical Findings,and Outcome of Treatment of Patients with Anterior Disk Displacement

This paper describes patients with clinically diagnosed anterior disk displacement, treated conventionally for craniomandibular disorders. The subjective symptoms and the clinical signs before treatment and one year later are reported. These findings were compared with previous reports of unselected patients at the same clinic who suffered from functional disturbances of the masticatory system, mainly from craniomandibular disorders. Patients with disk displacement exhibited a remarkable number of oral habits, such as bruxism and nail-biting. The outcome of treatment was about the same for patients with anterior disk displacement as for average patients. However, some patients who reported deterioration after one year had severe clinical signs. These patients had a higher frequency of general joint laxity than did the successfully treated patients.     

颞下颌关节不可复性盘前移位危险因素的病例对照研究

目的研究颞下颌关节不可复性盘前移位（anterior disc displacement without reduction,ADDWoR）的危险因素。方法将研究对象分为两组,ADDWoR患者纳入病例组,无ADDWoR症状的其他疾病患者或健康志愿者纳入对照组。分析两组人群面型、咬合因素、精神状况、口腔不良习惯及社会经济等方面的差异,计算各因素的比值比（odds ratio,OR）,比较对该疾病的危险度。结果病例组132人,平均年龄26.55岁;对照组128人,平均年龄26.97岁。病例组和对照组年龄、性别均衡。危险度较大的暴露因素有偏侧咀嚼（OR=3.16）、下颌中线偏斜（OR=3.074）、功能性错畸形（OR=2.917）。结论ADDWoR是多致病因素的疾病,牙功能紊乱是重要的致病因素,而下颌运动异常和不良的咀嚼习惯也是不容忽视的重要因素。     

经颞颌关节镜行关节盘复位及硬化疗法治疗盘移位的临床观察

对１８例患者的２０侧颞颌关节盘移位进行了关节镜下盘复位及硬化疗法，盘移位诊断由体检，关节造影片，下颌运动轨迹图及诊断性关节镜等综合评判。根据手术前后的临床检查，信访问卷和关节造影片综合评判疗效，其访期３４月（１７～５６月），有效率８０％（１６／２０）。本文着重介绍了关节盘复位方法及硬化剂注射方法，并详细分析了手术原理，对影响手术成败诸因素进行探讨。     

Mandibular Range of Movement and Pain Intensity in Patients with Anterior Disc Displacement without Reduction

Objective

Temporomandibular disorders (TMD) are the most common source of orofacial pain of a non-dental origin. The study was performed to investigate the therapeutic effect of the conventional occlusal splint therapy and the physical therapy. The hypothesis tested was that the simultaneous use of occlusal splint and physical therapy is an effective method for treatment of anterior disc displacement without reduction.

Materials and Methods

Twelve patients (mean age =30.5 y) with anterior disc displacement without reduction (according to RDC/TMD and confirmed by magnetic resonance imaging) were randomly allocated into 2 groups: 6 received stabilization splint (SS) and 6 received both physical therapy and stabilization splint (SS&PT). Treatment outcomes included pain-free opening (MCO), maximum assisted opening (MAO), path of mouth opening and pain as reported on visual analogue scale (VAS).

Results

At baseline of treatment there were no significant differences among the groups for VAS scores, as well as for the range of mandibular movement. VAS scores improved significantly over time for the SS&PT group (F=28.964, p=0.0001, effect size =0.853) and SS group (F=8.794, p=0.001, effect size =0.638). The range of mouth opening improved significantly only in the SS&PT group (MCO: F=20.971, p=0.006; MAO: F=24.014, p=0.004) (Figure 2). Changes in path of mouth opening differ significantly between the groups (p=0.040). Only 1 patient in SS&PT group still presented deviations in mouth opening after completed therapy while in the SS group deviations were present in 5 patients after completed therapy.

Conclusion

This limited study gave evidence that during the treatment period lasting for 6 months, the simultaneous use of stabilization splint and physical therapy was more efficient in reducing deviations and improving range of mouth opening than the stabilization splint used alone. Both treatment options were efficient in reducing pain in patients with anterior disc displacement without reduction. Despite of objectively diagnosed disruption of temporomandibular joint anatomy, physiological function was regained.Key words: Temporomandibular Joint, Dislocations, Pain, Occlusal Splints, Exercise Therapy, Physical Therapy Modalities     

稳定牙合垫治疗颞下颌关节不可复性盘前移位临床分析

目的:分析稳定牙合垫治疗颞下颌关节不可复性盘前移位的疗效。方法:使用稳定牙合垫治疗不可复性盘前移位患者36例,疗程3个月,分别记录治疗前后患者疼痛值(VAS)和开口度变化,进行统计学分析。 结果:患者VAS由治疗前的5.66±1.28减小到1.46±1.14;开口度由(26.93±2.64) mm增大到(38.35±2.04) mm, 具有显著性差异(P＜0.001),但治疗后MRI显示关节盘并未复位。结论:稳定牙合垫治疗颞下颌关节不可复性盘前移位有良好的临床效果,但并非恢复关节盘的位置,而是通过促进关节盘双板区的适应性改建来实现的。     

The Science of Anterior Teeth Selection for a Completely Edentulous Patient: A Literature Review

Esthetic replacement and physiological tooth arrangement made the complete denture biologically compatible and desirable. Proper placement of tooth should be functional and esthetically pleasing to enhance the psychology of the patient. This article reviews the evolution of concepts for teeth selection and the recent techniques employed for selecting anterior teeth for complete dentures.     

透明质酸钠治疗颞下颌关节不可复性盘前移位的临床观察

目的 探讨透明质酸钠治疗颞下颌关节不可复性盘前移位的临床疗效.方法 34例颞下颌关节不可复性盘前移位患者随机分为试验组和对照组,各17例.试验组关节上腔内注射透明质酸钠注射液1 mL,对照组关节上腔内注射强的松龙注射液12.5 mg.术后0.5 h、1个月观察患者开口度和疼痛情况.结果 张口度和疗效,术后0.5 h,试验组和对照组差异无统计学意义;术后1个月,试验组和对照组差异有统计学意义.结论 透明质酸钠和强的松龙治疗颞下颌关节不可复性盘前移位短期疗效均较好,但长期疗效,透明质酸钠明显优于强的松龙.     

Bruxism: A Literature Review

Bruxism is a movement disorder characterized by grinding and clenching of teeth. Awake bruxism is found more in females as compared to males while sleep bruxism shows no such gender prevalence. Etiology of bruxism can be divided into three groups psychosocial factors, peripheral factors and pathophysiological factors. Treatment modalities involve occlusal correction, behavioural changes and pharmacological approach. A literature search was performed using National Library of Medicine's (NLM) Medical Subject Headings (MeSH) Database, Pubmed and Google search engines. The search term 'Bruxism' yielded 2,358 papers out of which 230 were review papers. Most of the papers selected were recently published during the period of 1996-2010 and very few of them were published before 1996.     

Immunohistochemical Localization and Distribution of Proliferating Cell Nuclear Antigen in the Rabbit Mandibular Condyle Following Experimental Induction of Anterior Disk Displacement

The purpose of the present study was to identify proliferating cells in control versus experimental condyles two weeks following experimental Induction of anterior disk displacement (ADD) in the rabbit craniomandibular joint (CMJ). The right joint of 15 rabbits was exposed surgically and all diskal attachments were severed except for the posterior attachment. The disk was then repositioned anteriorly and sutured to the zygomatic arch. The left joint served as a sham-operated control. Ten additional joints were used as nonoperated controls. Mandibular condyles were excised two weeks following surgery and processed for proliferating cell nuclear antigen (PCNA) immunostaining. In control and sham operated condyles, PCNA was localized in the nuclei of chondroblasts of the reserve cell layer, chondrocytes of the upper hypertrophic layer and bone marrow cells of the subchondral bone. In contrast to control joints, the PCNA positive cells of the experimental joints were located throughout the osteoarthritic condylar cartilage. In addition, the percentage of PCNA positive cells of the osteoarthritic condylar cartilage was statistically significantly higher when compared to the control group, p < 0.05. It was concluded that surgical induction of ADD in the rabbit CMJ leads to an increase in mitosis of chondrocytes, which lead to cell proliferation and subsequent hyperplasia of the condylar cartilage.