颞下颌关节紊乱综合征患者的髁突位置及对称性

目的:探讨伴有颞下颌关节紊乱综合征(temporomandibular disorders,TMD)的错(牙合)畸形患者的髁突位置及对称性.方法:在就诊的错(牙合)畸形患者中,选取有TMD症状的15例患者纳入实验组,并选取15例无症状患者作为对照组.分别对实验组和对照组行双侧颞下颌关节CT扫描,选取适当的断层并测量其关节间隙及对称性.采用SPSS17.0软件包对数据进行统计学处理.结果:实验组患者的髁突位置明显偏后位,而对照组患者的髁突位置稍前位.实验组患者患侧髁突水平倾斜角较健侧大(P＜0.05),而垂直倾斜角较健侧小(P＜0.05),两侧髁突内外径、前后径、髁突长轴、髁突中心至正中矢状面距离、两侧髁突前后距均无显著差异.结论:颞下颌关节紊乱综合征患者的髁突位置明显偏后位,且两侧髁突存在垂直向不对称.     

成人下颌偏斜患者颞下颌关节形态变化与TMD的关系

目的:研究下颌偏斜患者颞下颌关节形态、位置的变化与颞下颌关节紊乱病的关系.方法:拍摄21例下颌偏斜患者和20例个别正常(牙合)志愿者的颞下颌关节中位断层片,选择描述髁突位置及髁突和关节窝形态的17个指标进行测量及统计分析,将有变化的指标与Fricton颞下颌关节紊乱指数(CMI)进行相关性分析.结果:成人下颌偏斜患者偏斜侧关节前间隙(A)、关节前后间隙面积比(X/Y)及对侧关节上间隙(S)、髁突高度(TCH)的变化与Fricton颞下颌关节紊乱指数(CMI)有相关性.结论:成人下颌偏斜患者偏斜侧髁突在关节窝中的位置后移,对侧髁突在关节窝中的位置向前下移位,对侧髁突高度增高与其出现的关节症状有一定相关性.     

安氏Ⅲ类错(牙合)正畸前后颞下颌关节形态变化的研究

目的探讨骨性和功能性Ⅲ类错(牙合)在正畸前、后颞下颌关节形态变化与颞下颌关节紊乱病(TMD)之间的关系.方法利用矫正薛氏位X线片在正畸前后对Ⅲ类骨性错(牙合)正畸前19例和正畸后11例、功能性错(牙合)正畸前20例和正畸后18例的双侧颞下颌关节的髁突居关节窝中的位置(前移、居中、后移),从上述两类错(牙合)患者中各选5例做双侧颞下颌关节矢状位核磁共振扫描,观察正畸前、后关节盘的位置及形态变化.结果正畸前Ⅲ类功能性和骨性错(牙合)髁突居关节窝前位;正畸后Ⅲ类功能性错(牙合)髁突居关节窝中位,Ⅲ类骨性错(牙合)髁突仍居关节窝前位.正畸前、后功能性Ⅲ类错(牙合)关节盘位置及形态均基本正常;Ⅲ类骨性错(牙合)正畸后有少部分患者髁突明显前移,关节盘形态异常.结论正畸前后功能性Ⅲ类错(牙合)颞下颌关节结构基本正常,与TMD关系不密切;骨性Ⅲ类错(牙合)正畸后关节结构表现出异常,提示与TMD有关,对于已过生长期的Ⅲ类骨性错(牙合)不能单纯考虑正畸治疗.     

安氏Ⅱ类错正畸前后颞下颌关节形态变化的研究

通过研究安氏 1和 2错在正畸前、后颞下颌关节形态变化情况探讨这两类错与颞下颌关节紊乱病(TMD)之间的关系。利用矫正薛氏位 X线片在正畸前对 1错 16人和正畸后其中 14人及 2错正畸前 17人和正畸后其中 15人双侧颞下颌关节髁突居关节窝的位置进行评价 ;并依据正畸前患者髁突居关节窝中的位置 (前移、居中、后移 )从上述两类错患者中各选 5人做双侧颞下颌关节矢状位核磁共振扫描 ,观察正畸前后关节盘的位置及形态变化。正畸前后 1错髁突居关节窝中位置无明显变化 :为髁突居中位 ,但有前移倾向。 2错正畸前髁突居关节窝后位 ,正畸后变为居中位。正畸前后 1错关节盘位置和形态基本没变化 ,均基本正常 ,而 2错部分患者在正畸前关节盘位置和形态异常经正畸治疗后关节盘位置和形态恢复正常。安氏 1错与 TMD关系不密切 ,而 2错与 TMD关系密切。对 2错尽早进行正畸治疗 ,可以防治 TMD的发生和发展。     

安氏Ⅲ类错正畸前后颞下颌关节形态变化的研究

目的　探讨骨性和功能性Ⅲ类错牙合在正畸前、后颞下颌关节形态变化与颞下颌关节紊乱病 (TMD)之间的关系。方法　利用矫正薛氏位X线片在正畸前后对Ⅲ类骨性错牙合正畸前 19例和正畸后 11例、功能性错牙合正畸前 2 0例和正畸后 18例的双侧颞下颌关节的髁突居关节窝中的位置 (前移、居中、后移 ) ,从上述两类错牙合患者中各选 5例做双侧颞下颌关节矢状位核磁共振扫描 ,观察正畸前、后关节盘的位置及形态变化。结果　正畸前Ⅲ类功能性和骨性错牙合髁突居关节窝前位 ;正畸后Ⅲ类功能性错牙合髁突居关节窝中位 ,Ⅲ类骨性错牙合髁突仍居关节窝前位。正畸前、后功能性Ⅲ类错牙合关节盘位置及形态均基本正常 ;Ⅲ类骨性错牙合正畸后有少部分患者髁突明显前移 ,关节盘形态异常。结论　正畸前后功能性Ⅲ类错牙合颞下颌关节结构基本正常 ,与TMD关系不密切 ;骨性Ⅲ类错牙合正畸后关节结构表现出异常 ,提示与TMD有关 ,对于已过生长期的Ⅲ类骨性错牙合不能单纯考虑正畸治疗     

北京地区正常（牙合）成人颞下颌关节形态特点的研究

目的:了解北京地区形态正常（牙合）人群颞下颌关节的形态特点.方法:自3700人中筛选出正常（牙合）成人75例,(其中男34例,女41例,年龄17-24岁)通过严格的TMJ临床检查将之分为健康关节组和TMD患者组,利用计算机技术对其ICP位颞下颌关节标准薛氏位片进行测量分析.结果:正常（牙合）成人髁突位置及关节窝形态性别差异不明显,双髁突位置及关节窝形态基本对称,使用张震康法时,健康关节组1n(P/A)均值为0.1639,TMD组1n(P/A)均值为0.0522;使用Cohlmia法时,健康关节组1n(P/A)均值为0.1939,TMD组1n(P/A)均值为0.0079,且两组间均存在显著性差异,关节窝形态在健康关节组与TMD患者组不存在显著差异.结论:有TMD症状的正常成人髁突在关节窝中的位置比具有健康颞下颌关节的正常（牙合）成人显著偏后.前者髁突多接近居中位,而后者的髁突多为稍偏前位.但两者均存在较大变异.     

安氏Ⅱ类错(牙合)关节窝、髁突、关节盘位置及关节盘形态变化的研究

目的:为探讨安氏Ⅱ1、Ⅱ2错(牙合)与颞下颌关节紊乱病之间的关系.方法:利用矫正薛氏位X线片对Ⅱ1错(牙合)16人,Ⅱ2错(牙合)17人的双侧颞下颌关节的髁突居关节窝的位置进行评价,并依据髁突居关节窝中的位置(前移、居中、后移),从上述两类错(牙合)中各选5人做双侧颞下颌关节矢状位核磁共振扫描,观察关节盘的位置及形态变化.结果:每一类型错(牙合)髁突居关节窝中的位置并不一致:Ⅱ1错(牙合)髁突居关节窝中位,但轻度前移;Ⅱ2错(牙合)髁突居关节窝后位.当髁突居前位及中位时:关节盘位置在正常范围且形态表现为正常的双凹形;髁突居关节窝后位时:部分关节盘位置明显前移,且形态也表现出异常的前带增厚.结论:大多数Ⅱ1错(牙合)颞下颌关节结构基本正常;而Ⅱ2错(牙合)部分患者表现出颞下颌关节结构异常,提示与颞下颌关节紊乱病关系密切.     

稳定垫治疗颞下颌关节紊乱病的疗效分析

目的观察采用稳定垫治疗颞下颌关节紊乱病(TMD)的临床疗效分析。方法选取2016年5月—2017年5月大连市口腔医院颞下颌关节门诊接诊的156例颞下颌关节紊乱病患者,比较采用稳定垫治疗前后临床疗效、颞下颌关节功能指数和髁突影像学改变(CBCT)。结果经过3～6个月治疗后,94.87%患者原有的颞下颌关节症状均得到改善; Fricton颞下颌关节紊乱指数明显下降; 70.51%的患者髁突骨质增生硬化,出现适应性改建。结论稳定垫可以作为有效治疗颞下颌关节紊乱病的方法之一。     

颞下颌关节曲面体层的投照技术及临床应用

30例TMD患者同时拍摄颞下颌关节曲面体层片及髁状突经咽侧位片.结果显示:TMJ曲面体层摄影术显示髁状突骨质改变优于经咽侧位且投照技术容易掌握,作者建议使用TMJ曲面体层摄影术观察TMD患者的髁状突骨质改变.     

颞下颌关节紊乱病关节盘与髁突改变的MRI表现及相关性研究现状

正常的关节盘–髁突关系对于颞下颌关节的健康十分重要，它的改变在临床上具有重要意义。磁共振成像（MRI）被认为是颞下颌关节盘–髁突关系紊乱及软组织形态成像的金标准，被广泛地用于颞下颌关节特征的评估、协助诊断以及治疗方式的选择中。目前多数研究表明颞下颌关节紊乱病（TMD）早期阶段可能表现为关节盘的前外侧移位、双凹形态的改变。关节盘形态、位置的改变进一步导致髁突长度、高度及旋转角度等发生变化，使疾病向更严重的阶段发展。TMD患者关节盘的位置和形态改变、髁突的解剖学变化与关节盘移位具有相关性，被认为引起是TMD最常见的原因。     

Irrigation fluid volume requirement for conventional arthrocentesis of the temporomandibular joint: a cadaver study

Temporomandibular joint (TMJ) arthrocentesis is considered an effective and minimally invasive procedure for certain conditions related to temporomandibular disorders. The ideal irrigation volume for arthrocentesis lavage has not yet been defined. Therefore, the aim of this study was to evaluate the efficacy of different saline solution volumes in removing methylene blue from the TMJ space of fresh human cadavers. Nineteen cadavers were selected and 1 ml of 10 μM methylene blue solution was injected into the upper joint space unilaterally. Conventional arthrocentesis was then conducted by infusion of 300 ml of 0.9% saline solution, collecting a 1-ml sample from the drained quantity for every 25 ml injected. Finally, the samples were assayed by measuring photo absorbance of the methylene blue solution. There was a statistically significant difference between the irrigation volumes regarding the removal of methylene blue solution from the joint space (P < 0.001), specifically between the first 25 ml and 200 ml (P = 0.014), 225 ml (P = 0.001), 250 ml (P < 0.001), and 275 ml (P = 0.001). Based on this ex vivo study, a 25-ml perfusion volume appears to be sufficient for joint lavage in conventional arthrocentesis of the TMJ.     

Characteristics of a group of patients with temporomandibular joint disorders

ABSTRACT Information concerning social, medical and dental characteristics was obtained from a group comprising 406 patients, 103 men and 303 women, all with some temporomandibular joint (TMJ) disorder. Median age for the men was 27 years, and for the women 33 years. Individuals belonging to the middle and upper social classes were clearly overrepresented. Self-reports on general health indicated no obvious deviation from levels which might be expected to prevail in the general population. Dental health tended to be slightly ahead of Norwegian general standards. Eighty-two percent of the group were found to have a mandibular pain dysfunction syndrome (MDS), 11 % had chronic osteoarthritis, and 7 % suffered from other arthropathies of traumatic as well as rheumatologic origin. The proportion of patients with MDS was inversely related to age, and after the age of 40, the relative frequency of MDS also fell slightly with the lowering of social class. Presumably the social composition of the clientele reflected differences in the seeking of treatment, rather than in the “true” disease prevalences. No indication was found for assuming that dental factors had played major and independent roles in the development of the disorders.     

Correlation between direction and severity of temporomandibular joint disc displacement and reduction ability during mouth opening

The most common temporomandibular joint (TMJ) internal derangement is an abnormal relationship of the disc with respect to the mandibular condyle, articular eminence and glenoid fossa‐disc displacement. The aim of our study was to analyse the correlation between partial/complete disc displacement in the intercuspal position (IP) and its reduction in the open‐mouth position (OMP) in both oblique sagittal and coronal planes on magnetic resonance imaging (MRI) in patients with temporomandibular disorders. Multisection MRI analysis of 382 TMJs was conducted in 191 patients with disc displacement according to the RDC/TMD criteria (148 women, 43 men; aged 14‐60 years). The disc position was evaluated on all oblique sagittal and coronal images in the IP and the OMP. Univariate logistic regression analysis showed that the severity of disc displacement in the sagittal plane is a statistically significant predictor of reduction ability during mouth opening (B = 3.118; P < .001). Moreover, the severity of disc displacement in both planes is also a significant predictor of disc reduction in OMP (B = 2.200; P < .05). In conclusion, reduction ability during mouth opening is associated with the severity of disc displacement in IP, in both sagittal and coronal planes. Multisection analysis of all MR images allows distinguishing the correct disc position from disc displacement and can improve the ability to distinguish between various stages of TMJ internal derangement.     

Management of temporomandibular disorders: a rapid review of systematic reviews and guidelines

Temporomandibular disorders (TMD) impact a significant proportion of the population. Given the range of management strategies, contemporary care should be evidence-informed for different TMD types. A knowledge-to-action rapid review of systematic reviews published in the past 5 years and guidelines published in the past 10 years concerning the management of TMD was conducted. The Cochrane, Embase, MEDLINE, PEDro, and PubMed databases were searched. A qualitative data analysis was undertaken, with quality assessment completed using the AMSTAR 2 checklist. In total, 62 systematic reviews and nine guidelines considering a range of treatment modalities were included. In concordance with current guidelines, moderate evidence supports a multi-modal conservative approach towards initial management. Contrary to existing guidelines, occlusal splint therapy is not recommended due to a lack of supporting evidence. The evidence surrounding oral and topical pharmacotherapeutics for chronic TMD is low, whilst the evidence supporting injected pharmacotherapeutics is low to moderate. In concordance with current guidelines, moderate quality evidence supports the use of arthrocentesis or arthroscopy for arthrogenous TMD insufficiently managed by conservative measures, and open joint surgery for severe arthrogenous disease. Based on this, a management pathway showing escalation of treatment from conservative to invasive is proposed.     

Effect of turban use on temporomandibular joint problems

The aim of this study was to evaluate the effects of daily turban wear on temporomandibular joint (TMJ) problems. This cross-sectional study was carried out on 249 female patients. Of these, 119 patients were using turban daily, while 130 patients did not use. Patients were asked questions to ascertain the signs of TMJ problems. Thereafter, the TMJ region was examined clinically. Cross-tabulations and Chi-square statistics were computed in accordance with Bonferroni correction for multiple comparisons. To investigate the association between continuous turban wear and temporomandibular disorder symptoms, logistic regression analysis was performed. Limited mouth opening, deviation, pain on TMJ palpation and mouth opening were not affected with turban usage. However, turban users more frequently demonstrated pain during palpation of the masticatory muscles than non-users (P = 0.001). Duration of the turban usage did not affect clinical examination findings except pain on masticatory muscles during palpation (P = 0.001). Complaint of pain on masticatory muscles are more frequently seen among the turban users.     

A technique to verify adequacy of eminectomy for recurrent temporomandibular joint dislocation

Recurrent dislocation of the temporomandibular joint (TMJ) can be highly debilitating, especially if the dislocation cannot be reduced by the patient. Despite being regarded as a ‘gold standard’ or ‘salvage’ procedure for refractory TMJ dislocations, complete mediolateral removal of the articular eminence can still lead to recurrences. A technique aimed at intraoperatively verifying the adequacy of osseous reduction in order to minimize the risk of re-dislocation of the TMJ is described.     

The prevalence of oral stage dysphagia in adults presenting with temporomandibular disorders: a systematic review and meta-analysis

Objective: Temporomandibular disorders (TMDs) are the most commonly experienced non-dental orofacial pain disorders, with pain and dysfunction potentially resulting in oral stage dysphagia (OD). However, limited research has been conducted on this condition, with potential negative effects on clinical practice. Therefore, the aim of this study was to determine the prevalence of OD in adults presenting with TMDs, diagnosed as per the Research Diagnostic Criteria for Temporomandibular Disorders or the Diagnostic Criteria for Temporomandibular Disorders protocols.

Material and methods: A systematic review of the literature was completed. Nine electronic databases were searched from inception to January 2017, with no date/language restriction applied. Grey literature, conference proceedings, and reference lists were also searched. Studies presenting original data regarding OD prevalence in adults presenting with TMDs were included if they investigated impaired swallowing, mastication, masticatory pain or fatigue, or weight loss. Study eligibility and quality were assessed by two independent reviewers. Methodological quality was assessed using the Down’s and Black tool.

Results and conclusions: This search yielded 20 eligible studies. Swallowing itself was impaired in only 9.3% of patients with TMDs. A range of additional OD signs and symptoms were also commonly reported (e.g. masticatory pain (87.4%) and fatigue (62%)). Study limitations included the small number of studies which were eligible for inclusion. As signs and symptoms of OD are frequently reported by patients with TMDs, psychometrically robust prospective research is warranted to determine current and optimal management of this condition.     

Reconstruction of the temporomandibular joint: a comparison between prefabricated and customized alloplastic prosthetic total joint systems

The implantation of an alloplastic total temporomandibular joint (TMJ) prosthesis is an innovative approach for the treatment of end-stage TMJ disorders. Two types of system exist: prefabricated (stock) and customized computer-aided design/computer-aided manufacturing (CAD/CAM) devices. A clinical study was performed to evaluate the effectiveness of these two designs. Twenty-eight patients treated between 2015 and 2017 were included and assigned to two groups: stock prostheses (group 1) and customized CAD/CAM prostheses (group 2). Clinical evaluations were performed at five time-points up to 6 months postoperative. Parameters included maximum interincisal opening, pain, diet, complications, and subjective well-being at the end of follow-up. Differences between pre-surgery and 6-month post-surgery values were highly significant (P < 0.001). No patient required a liquid diet at the end of treatment, and 66% of group 1 patients and 100% of group 2 patients reported improved well-being. Complications were observed in 32% of patients and included temporary paralysis of the facial nerve. In conclusion, clinical outcomes of stock and CAD/CAM prostheses suggested great improvements in mouth opening and reduction of pain as a result of the rehabilitation of TMJ function. Results showed comparable data for the two types of prosthesis design at 6 months postoperative.     

Response to an offer of consultation concerning TMJ-disorder

abstract – Based on the assumption that there is a correlation between myofascial pain dysfunction (MPD), headache and/or back pain, this study intended to assess the occurrence of MPD among persons reporting pain in their head or back. Another main purpose was to measure the response to an offer of free examination of teeth and jaws and, if needed, also free treatment of TMJ-disorder. In an electrotechnical company comprising 698 employees, a total of 27 persons attended for examination after the offer had been presented to two groups selected by two different sampling methods. Of the attendants; women, middle-aged persons, and persons from the upper social strata were overrepresented. These same categories were also the most likely to report headache and/or back pain. Ten individuals out of the 27 attendants claimed to have experienced some TMJ-disorder., and these individuals tended also to complain about headache and back pain. A major finding was that the response to the offer was clearly affected by social background. The response pattern was much like that known about the seeking of treatment for MPD — and for dental treatment generally.