深覆与颅颌功能紊乱

为探讨深覆的致病机理,对56例伴深覆的颅颌功能紊乱患者从临床,X线摄影。下颌运动及治疗等方面进行了研究,得出结果:①弹响以开口初、闭口末居多(75.61％);髁突以后位居多(76.79％);②有31例临床上表现牙位与肌位不一致;③下颌运动轨迹描记,深覆(牙合)患者自然开闭口及由姿势位闭合至ICO时下颌向后运动的人数显著多于非深覆(牙合)患者,但戴咬合板由姿势位闭合至ICO下颌则呈前上方向运动;④经肌位咬合板治疗,患者症状消失,但牙位与肌位仍不一致.结果提示深覆(牙合)的主要致病机理:①切道斜度大,下颌运动受限、下颌后退导致髁突后位,盘突关系不协调;②导致牙位与肌位不一致,造成关节内微小创伤。肌位咬合板可消除或减轻症状。     

垂直距离减小和下颌后移对颞下颌关节的创伤分析

目的咬合因素作为颞下颌关节紊乱(TMD)发病的重要因素,目前其致病机理仍不是十分清楚.研究咬合因素对颞下颌关节的创伤过程,将有助于我们对其诊断和治疗.方法将临床上收集的,明确有不良咬合因素的颞下颌关节紊乱的病例共49例,根据其不同的咬合因素归类并临床分期,然后作统计学分析,同时解剖测量分析7具尸体颞颌关节盘和髁状突的前后斜面.结果病理性的(牙合)垂直距离减小对TMD发病的影响最大,病理性的(牙合)垂直距离减小和病理性下颌后移(牙合)关系之间无显著性的差异.结论不良咬合关系通过改变颞颌关节正常的受力方式,使颞颌关节长期处于微创伤运动中,而产生关节结构间的紊乱,并反过来加重关节组织的损伤过程.     

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。     

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。     

偏侧咀嚼对颌骨、咀嚼肌及颞下颌关节结构的影响

偏侧咀嚼是一种常见的口腔不良习惯,是引起口颌肌群功能紊乱的重要因素,口颌系统是包括牙体、牙列咬合、颞下颌关节、颌面部肌肉及其神经、血管等的一个功能整体。长期的偏侧咀嚼将对颌骨、咀嚼肌及颞下颌关节结构产生影响,本文就此方面进行综述。     

颌间弹性牵引技术在颞下颌关节外科中的应用

颌间弹性牵引是一种常用的调整及重建咬合关系的方法,利用颌间交互支抗的原理,通过持续的弹性牵引力来建立良好稳定的(牙合)关系。颞下颌关节与(牙合)之间存在密切联系,关节局部结构的改变可能造成咬合关系的改变,这种(牙合)关系的矫正,可以考虑采用颌间弹性牵引技术。本文就颌间弹性牵引技术的原理、与颞下颌关节的关系,及其在颞下颌关节外科中的应用进行综述。     

垂直距离减小和下颌后移对颞下颌关节的创伤分析

目的 :咬合因素作为颞下颌关节紊乱 (TMD)发病的重要因素 ,目前其致病机理仍不是十分清楚。研究咬合因素对颞下颌关节的创伤过程 ,将有助于我们对其诊断和治疗。方法 :将临床上收集的 ,明确有不良咬合因素的颞下颌关节紊乱的病例共 49例 ,根据其不同的咬合因素归类并临床分期 ,然后作统计学分析 ,同时解剖测量分析 7具尸体颞颌关节盘和髁状突的前后斜面。结果 :病理性的垂直距离减小对TMD发病的影响最大 ,病理性的垂直距离减小和病理性下颌后移关系之间无显著性的差异。结论 :不良咬合关系通过改变颞颌关节正常的受力方式 ,使颞颌关节长期处于微创伤运动中 ,而产生关节结构间的紊乱 ,并反过来加重关节组织的损伤过程     

颞下颌关节疾病

颞下颌关节紊乱病关节液中尿纤溶酶原激活物及其受体的表达，TMD患者咬合板治疗后[牙合]接触变化的研究，颞下颌关节腔内基因转染的生物安全性实验研究,hIL-1Ra基因体内转染兔颞下颌关节骨关节病模型的免疫组化研究.     

稳定型咬合板用于颞下颌关节紊乱病的疗效评价

目的:研究稳定型咬合板用于颞下颌关节紊乱病治疗的症状改善情况及其咬合面磨耗特征分析。方法:对28例颞下颌关节紊乱病患者(5例男性,23例女性)运用稳定型咬合板进行治疗,分别在治疗后的1、3、6、10周复诊,观察患者症状变化情况以及咬合板上的磨耗情况并对磨耗面进行评价分析。结果:有25例(89%)患者咬合板上出现磨耗面,其中双侧向型者14例(56%),小侧向型者8例(32%),单侧向型者3例(12%)。无磨耗的3例(12%),未发现有前伸磨耗型患者。10周后患者的症状显著性改善。结论:大多数颞下颌关节紊乱病患者都有如磨牙症一类的功能异常活动,且以侧向型为主。稳定型咬合板能显著改善颞下颌关节紊乱病的临床症状。     

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。     

Relationship between occlusal curvatures and mandibular deviation in orthodontic patients with temporomandibular disorders

The aim of this study was to investigate the relationships between occlusal curvature (OC) and frontal craniofacial morphology in patients with and without temporomandibular disorders (TMD), using frontal cephalograms and a sophisticated measuring device (XYZAX S400A). Thirty-seven female orthodontic patients (mean age 24.0 years) were divided into a TMD group (n = 25) and no-TMD group (n = 12). In the TMD group, the lateral OCs of the mandibular second premolar, and first and second molars were significantly deeper on the deviated side than on the non-deviated side, and the anteroposterior OCs of the mandibular second premolar and first molar were also significantly shallower on the deviated side. In the no-TMD group, however, there were no significant differences in OCs between deviated and non-deviated sides. The differences between right and left lateral OCs in the mandibular second premolar and first and second molars, as well as the anteroposterior OCs in the mandibular first and second molars, showed significant correlations with mandibular deviation in the TMD group. On the other hand, in the no-TMD group, there was no significant correlation between OCs and mandibular deviation. The above results suggest that OCs might try to compensate for mandibular deviation in patients with TMD.     

Facial asymmetry in temporomandibular joint disorders

In order to investigate skeletal deviation in patients with internal derangement of the TMJ, facial asymmetry was examined by the frontal cephalogram and compared with a control group of asymptomatic subjects. It was demonstrated that mandibular lateral displacement in the patients was significantly greater than that in the controls. The degree of displacement was significantly related to the cant of the frontal occlusal plane and the frontal mandibular plane, indicating the reduced vertical dimension of the posterior occlusal level and the ramus height on the mandibular displaced side. It is concluded that facial asymmetry due to mandibular lateral displacement is a relatively common problem in patients with internal derangement of TMJ. The cant of the frontal occlusal plane seems to be an important occlusal characteristic related to temporomandibular joint dysfunction.     

He夹板治疗作用的生物力学评价

目的 分析Ｈｅ夹板对髁突在关节窝位置及受力状况的影响，探讨Ｈｅ夹板的生物力学的治疗机制。方法 采用ＣＴ扫描、Ａｕｔｏ－ＣＡＤ技术、计算机图像分析方法及有限元法对颞下颌关节紊乱病患者民未戴Ｈｅ夹板时颞下颌关节髁突位置及其应力分布特征进行对比。结果 戴Ｈｅ夹板后颞下面关节前间隙变窄，上、后间隙变宽，髁突向前下称位；髁突应务明显降低，主要表现在功能承载区前斜面及外侧；双侧髁突应力对称性有所改善。结论 改     

全牙列接触型垫在口腔修复临床中的应用

目的分析和总结全牙列接触型垫在颞下颌关节疾病治疗中的作用和治疗效果。方法选择近年来口腔修复科门诊由咬合异常引发的颞下颌关节疾病患者5例,制作垫后观察患者咬合状态、咬合关系等临床症状的改变。结果5例患者在戴入垫2~3周后关节疼痛、下颌运动异常等症状缓解,1个月后临床症状消失。结论全牙列接触型垫是治疗因咬合异常引起的颞下颌关节疾病的有效方法。     

髁状突纵形骨折及he夹板治疗时对翼外肌影响的光镜和电镜观察

目的：观察翼外肌下头和嚼肌在髁状突纵形骨折后及舱夹板治疗时的改变。方法：幼年小型猪18头，平均分3组，纵形骨折木治疗组，纵形骨折he夹板治疗组和正常对照组。建立髁状突纵形骨折和he夹板治疗模型。分别在实验后3周、6周和12周取材，进行光镜、电镜观察。结果：骨折后3周，骨折侧的翼外肌下头肌纤维间水肿较重，个别部位出现肌核增多和内移。he夹板治疗组翼外肌肌纤维间的水肿较轻。对侧翼外肌下头以及骨折后6周，12周以及双侧嚼肌肌纤维末见异常。电镜下纵形骨折后3周，可见骨折侧翼外肌下头肌纤维间隙增大，线粒体变圆、增大，数量增多，对侧翼外肌下头以及骨折后6周，12周双侧翼外肌下头以及双侧嚼肌肌纤维未见异常。纵形骨折he夹板治疗组3周可见翼外肌下头肌纤维线粒体轻度变圆、数量稍有增多。结论：幼年小型猪髁状突纵形骨折后，骨折侧的翼外肌下头肌纤维在形态有变化，但翼外肌具有较强的适应能力，he夹板治疗能减轻咀嚼肌的改变。     

The treatment of painful temporomandibular joint clicking with oral splints: a randomized clinical trial

BACKGROUND: The authors compared the efficacy of bilateral balanced and canine guidance (occlusal) splints in the treatment of temporomandibular joint (TMJ) pain in subjects who experienced joint clicking with a nonoccluding splint in a double-blind, controlled randomized clinical trial. METHODS: The authors randomly assigned 57 people with signs of disk displacement and TMJ pain into three groups according to the type of splint: bilateral balanced, canine guidance and nonoccluding. The authors followed the groups for six months using analysis of a visual analog scale (VAS), palpation of the TMJ and masticatory muscles, mandibular movements and joint sounds. They used repeated analysis of variance and a chi(2) test to test the hypothesis. RESULTS: The type of guidance used did not influence the pain reduction, yet both occlusal splints were superior to the nonoccluding splint, on the basis of the VAS. Despite similar outcomes in relation to opening, left lateral and protrusive movements, TMJ and muscle pain on palpation, subjects who used the occlusal splints had improved clinical outcomes. The frequency of joint noises decreased over time, with no significant differences among groups. Subjects in the groups using the occlusal splints reported more comfort. CONCLUSION: The type of lateral guidance did not influence the subjects' improvement. All of the subjects had a general improvement on the VAS, though subjects in the occlusal splint groups had better results that did subjects in the nonoccluding splint group.     

2种不同牙合垫治疗颞下颌关节紊乱病的临床疗效分析

目的:对比分析稳定型牙合垫和再定位牙合垫对治疗颞下颌关节紊乱病的临床疗效。方法:对采用牙合垫治疗的32例颞下颌关节紊乱病患者进行随访分析,其中使用稳定型牙合垫治疗的病例18人,再定位牙合垫14人,对比分析2组患者在治疗前、治疗后、治疗后3个月、6个月、12个月时关节弹响、疼痛程度(VAS)的变化。结果:2组患者治疗后疼痛程度及关节弹响状况与术前比较均明显改善,差异均有统计学意义(P<0.05),两种牙合垫对关节弹响的治疗效果无显著性差异,稳定型牙合垫组患者治疗后及治疗后3个月、6个月、12个月时的VAS低于再定位牙合垫组,差异有统计学意义(P<0.05)。结论:2种牙合垫均可有效地治疗颞下颌关节紊乱病,再定位牙合垫主要用于治疗可复性关节盘前移位,稳定型牙合垫治疗关节疼痛的疗效优于再定位牙合垫。     

Preprosthetic therapy utilizing a temporary occlusal acrylic splint: a case report.

This case report describes the complex occlusal rehabilitation of a patient with signs and symptoms of temporomandibular disorders with utilization of an occlusal acrylic splint as a means of initial treatment for neuromuscular reprogramming and repositioning of the condyle within the mandibular fossa for occlusal stability, thus allowing adaptation to a new occlusal vertical dimension.     

咬合板加局部激光照射治疗颞下颌关节紊乱病的临床研究

目的:研究咬合板加局部激光照射对颞下颌关节紊乱病(TMD)的临床治疗效果。方法:TMD患者225例,随机分为咬合板+局部激光照射组、局部封闭治疗+局部激光照射组、局部激光照射组,每组75人。局部封闭治疗:2%利多卡因1 mL+醋酸强的松龙混悬液2 mL行痛点封闭,每周1次,3～5次为一疗程。咬合板治疗:夜间佩戴下颌平面抬高约4 mm的咬合板。激光治疗:用MDC-500IP型半导体激光治疗机照射颞下颌关节区,1次/d,10 d为一疗程。结果:总有效率"咬合板+局部激光照射组"为93.33%,"局部封闭治疗+局部激光照射组"为85.02%,"局部激光照射组"为70.67%。组间差异有统计学意义(P<0.05)。结论:"咬合板+局部激光照射"治疗TMD较为有效,值得推广。     

下颌三维定位技术指导下稳定型殆垫治疗颞颌关节紊乱病的疗效分析

目的：探讨超声三维下颌定位技术指导下修正性调磨的骀垫对TMD的临床疗效。方法：本研究从北京口腔医院颞颌关节门诊2003年3月～2008年12月就诊的患者选用40例（男12例女28例）颞颌关节病并有关节绞锁的患者，超声三维下颌定位仪中的髁突运动中心电子位置分析（electronicpositionanalysis，EPA）检测指导下进行修正性调磨骀垫治疗后，比较治疗前后下颌运动程度如张口度、关节绞锁运动、弹响和下颌运动疼痛的变化情况。结果：本研究发现超声三维下颌定位技术指导下修正性调磨的殆垫治疗后，下颌运动明显改善，张口运动及被动最大张口度治疗前后均有显著性差异；绞锁运动症状明显改善。并有统计学差异。结论：超声三维下颌定位技术指导下修正性调磨的黯垫治疗TMD，能够改善TMD症状，在治疗绞锁运动方面有显著疗效。