髁状突参考位与TMD患者的重建

咬合重建是颞下颌关节病(TMD)永久性修复治疗的方法之一,关键在于重建时如何确定最适颌位。但是,由于对口腔修复中所采用的最适颌位的概念,尚无统一的定义标准,对髁状突运动中心及基本颌位下,髁位的稳定性及位置的研究存在争议,对髁位重建后的口腔功能还不能进行客观的评价。本文就有关最适颌位的概念、髁状突参考位与重建的关系、TMD患者的重建等问题作一综述。提出尽管正中关系位(CR)是生理性的最适髁位,可以用于建,但TMD病人的最大牙尖交错位(MI)也可能是生理性的。有些情况下,应采用生理性的MI建。若MI不是生理性的,应首先调整肌肉的状态,然后再选在CR位或适应性正中位建。合牙合牙合牙合牙合牙     

髁突形态与覆(牙合)深度关系的研究

目的探讨髁突形态与不同覆(牙合)深度的关系.方法选择正常(牙合)者、开(牙合)畸形患者、覆(牙合)正常的错(牙合)畸形患者和深覆(牙合)畸形患者各50人,均为18至26岁成人.应用曲面断层片研究左右两侧的髁突形态,分别测量并计算上部髁突高度/升支高度比(UCH/RH)和髁突高度/宽度比(TCH/CW).将髁突形态分为四种类型:直立型(类A),前倾型(类B),后倾型(类C)和尖型(类D).结果开(牙合)组的上部髁突高度相对升支高度明显小于其他各组(P＜0.001).正常(牙合)组的髁突形态比较粗壮,高度宽度比明显小于其他各组(P＜0.001).类A和类B属于正常髁突形态,占正常(牙合)组的99%.类C和类D属于异常髁突形态,且在开(牙合)组中的比例明显高于正常覆(牙合)组或深覆(牙合)组.另外,只有开(牙合)组中显示上部髁突高度两侧不对称(P＜0.05).结论开(牙合)组髁突形态与其他各组相比明显不同.     

髁突参考位与髁位重建

(牙合)重建就是用牙齿(牙合)面的修复体或替代物恢复(牙合)面的解剖形态,恢复牙尖交错(牙合)和牙列生理功能的过程,关键在于确定最适颌位。最适颌位必须保证口颌系统能够发挥最大的咀嚼效能,使髁位具有可重复性,无颞下颌关节的不适和功能异常。但是,目前对口腔修复中所采用的最适颌位的概念尚无统一的定义标准,对髁突运动中心及基本颌位下髁位的稳定性及位置的研究存在争议。对髁位重建后的口腔功能还不能进行客观的评价。本文就建(牙合)中确定最适颌位存在争议的因素、有关髁突运动轴的研究、髁位的可重复性与髁位重建等问题作一综述。     

髁突参考位与髁位重建

He重建就是用牙齿He面的修复体或替代物恢复He面的解剖形态，恢复牙尖交错He和牙列生理功能的过程，关键在于确定最适颌位。最适颌位必须保证口颌系统能够发挥最大的咀嚼效能，使髁位具有可重复性，无颞下颌关节的不适和功能异常。但是，目前对口腔修复中所采用的最适颌位的概念尚无统一的定义标准，对髁突运动中心及基本颌位下髁位的稳定性及位置的研究存在争议，对髁住重建后的口腔功能还不能进行客观的评价。本文就建He中确定最适颌住存在争议的因素、有关髁突运动轴的研究、髁位的可重复性与髁位重建等问题作一综述。     

钛合金人造髁状突治疗颞下颌关节强直临床报告

材料和形态 本组为1977年以来临床应用钛合金人造髁突治疗患者,男6女1,年龄12～32岁。患病时间8～15年。 所用植入体为国产钛合金(T_(c4)),直径2厘米的棒材,经机械加工成形。 人造髁状突形态(见图1)分为髁状突、颈部、连接杆三部分。髁状突和颈部的形态与正常人解剖形状相似,但体积略小,连接杆与与下颌升枝相连接的部分,其厚度为1.5毫米,宽度为1.2厘米,其长度大小不一,可选择使用。连接杆中央为萎形孔眼,     

安氏Ⅱ类1分类错(牙合)功能矫治前后患者髁突运动轨迹特征初探

目的：探讨功能矫治对安氏Ⅱ类1分类错[牙合]患者颞下颌关节功能的影响。方法：患者组（安氏Ⅱ类1分类错[牙合]）20例和对照组（安氏Ⅰ类）20人，记录患者组功能矫治前后及对照组开闭口运动时髁突运动状况，对结果进行秩和检验。结果：①相比对照组，患者组矫治前髁突轨迹明显垂直化，髁突垂直向位移[左侧为2．21（1．01）mm，右侧为1．12（1．02）mm]及倾斜度[左侧为12．89（9．12）°，右侧为12．12（8．89）°]偏大（P〈0．05）；②矫治后髁突轨迹在各个方向上的位移及倾斜度接近正常（P〉0．05）。结论：多数安氏Ⅱ类1分类错[牙合]患者的髁突运动轨迹有较稳定且可重复的特征；功能矫治对安氏Ⅱ类1分类错[牙合]患者的颞下颌关节功能调整有积极的作用。     

骨性Ⅲ类偏颌患者髁突与(牙合)平面特征的CBCT研究

目的 利用锥形束CT(CBCT)测量分析骨性Ⅲ类偏颌患者髁突及(牙合)平面特征。方法 选取符合纳入标准的骨性Ⅲ类成年患者40例,所有个体按照颏下点偏离正中矢状面距离进行分组,分别测量各组左右两侧(牙合)平面角、髁突位置及形态,并对数据进行统计学分析。结果 骨性Ⅲ类偏颌患者的偏侧与对侧相比,(牙合)平面角、关节前间隙、关节上间隙、关节外间隙及髁突内外径差异有统计学意义(P<0.05),偏侧关节后位所占比例较大,下颌骨偏移量与偏侧髁突前间隙及对侧(牙合)平面角均呈正相关(P<0.01)。骨性Ⅲ类非偏颌患者的左右两侧(牙合)平面角、髁突位置及形态指标之间差异均无统计学意义(P>0.05),关节以前位、中位为主。结论 骨性Ⅲ类偏颌患者左右两侧(牙合)平面角、髁突位置及形态不对称,偏侧(牙合)平面角及髁突内外径较小,髁突向后下内方移位,且偏颌程度与(牙合)平面角及髁突位置之间存在相关性。     

成人开牙合患者髁突形态的CBCT观察研究

目的探讨成人开牙合患者髁突形态的差异,研究咬合与髁突形态之间的相关性。方法随机选取正常覆牙合,开牙合患者各20人,均为18~36岁成人。拍摄患者双侧颞下颌关节CBCT,分别测量并计算髁突上部高度与升支高度比(UCH/RH)及髁突高度与宽度比(CW/TCH)。将髁突形态分为四种类型:A型-直立型;B型-后倾型;C型-前倾型;D型-尖型,观察开牙合患者髁突形态的差异。结果 1开牙合组患者UCH/RH及CW/TCH均小于正常牙合组(P<0.05);2A类与C类属于正常髁突形态,占正常覆牙合组的73%。B类和D类属于异常髁突形态,在开牙合组患者中占26.7%;3开牙合组患者两侧髁突高度也显示不对称(P<0.05)。结论开牙合组患者髁突高度相对正常覆牙合人群较短,且两侧髁突高度的对称性低,髁突形态异常比例较高。     

下颌髁突重建的研究进展

颞下颌关节(TMJ)是颌面部唯一的活动关节,手术重建下颌髁突,是恢复TMJ功能的基本要求。 一、髁突重建的适应症 任何原因造成髁突骨性部分或完全丧失、髁突与关节凹、关节结节之间骨性粘着并有临床症状,如关节疼痛、杂音和功能丧失以及颌面部和牙颌畸形等,均需行髁突重建。髁突重建主要见于以下几种情况:     

老年人颞下颌关节紊乱病的(牙合)重建治疗

目的:观察(牙合)重建治疗老年人颞下颌关节紊乱病的临床疗效.方法:采用暂时性咬合板治疗26例因后牙缺失或重度磨耗所导致的老年TMD患者,3个月后待症状缓解时以金属烤瓷冠桥或可摘局部义齿对其进行永久性(牙合)重建治疗,随访时间(牙合)重建后3个月至3年.结果:戴暂时性咬合板3个月时,患者疼痛、弹响、张口受限症状消失分别为80.7%、56.5%和70.6%;永久性(牙合)重建后随访以上各项指标为88.4%、69.6%和82.3%.结论:(牙合)重建治疗对于老年人因后牙缺失及重度磨耗所致的TMD是一种有效的保守治疗方法.     

Long-term follow-up of clinical symptoms in TMD patients who underwent occlusal reconstruction by orthodontic treatment

Fifty-eight patients (mean age 18.4 years) who had received splint therapy for internal derangement of the temporomandibular joint (TMJ) were examined retrospectively to investigate the efficacy of occlusal reconstruction by orthodontic treatment. The subjects were divided into three groups: 18 patients (mean age 18.6 years) who underwent orthodontic treatment combined with the use of splints (ST group); 27 patients (mean age 18.2 years) who underwent orthodontic treatment without the use of splints (NST group); and 13 patients (mean age 17.9 years) who received only splint therapy for temporomandibular joint disorders (TMD; control group). TMJ sound, pain on movement and restriction of mandibular movement were examined at the initial examination (T1), at the end of the splint therapy for TMD or beginning of orthodontic treatment (T2), at the end of orthodontic treatment (T3), and at recall or 1 year after orthodontic treatment (T4). The following results were found. (1) The percentage of patients with no joint sound at T2 was 20-30 per cent. The percentage of such patients in both the ST and NST groups increased to over 50 per cent at T3, but slightly decreased to 39-50 per cent at T4. There were no significant inter-group differences at any time point. (2) The number of patients who had no pain on movement at T2 was 60-80 per cent. The percentage of such patients in both the ST and NST groups increased to over 90 per cent at T3, but then slightly decreased to 80 per cent at T4. There were no significant inter-group differences at any time point. (3) None of the patients showed restriction of movement of the TMJ at T2 or T4. One patient in the ST group was found to have restriction at T3. There were no significant inter-group differences at any time point. (4) The most frequent type of malocclusion in both ST and NST groups was anterior open bite. These results suggest that TMD symptoms that have been eliminated by splint therapy are not likely to recur due to subsequent orthodontic treatment, but it cannot be concluded that orthodontic treatment itself had a positive effect on TMD symptoms. The results also indicate that there is a relationship between anterior open bite and TMD.     

颞下颌关节紊乱病患者咬合稳定性的研究

目的研究颞下颌关节紊乱病(tempromandibular disorders,TMD)患者的咬合稳定状况。方法应用T-ScanII咬合分析仪对34例TMD患者进行牙尖交错位的咬合检查并与正常组对照。结果TMD患者的力不对称指数、力中心点最大位移、干扰指数均明显高于对照组,但总力值与对照组无显著性差异。结论与正常人群相比,TMD患者咬合的稳定性及平衡性均下降。     

He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He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He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He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。     

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。     

垫治疗青少年颞下颌关节紊乱病的临床疗效分析

目的:考察垫对青少年颞下颌关节紊乱病患者临床症状的改善情况。方法:采用稳定性垫或再定位垫治疗71例颞下颌关节紊乱忠者,比较治疗前后张口度、颌面部疼痛和关节弹响的变化情况。结果:治疗组51例患者中疼痛34例,张口受限15例,疼痛伴张口受限14例,单纯性疼痛20例,治疗后疼痛及张口受限均得到缓解,缓解率为100%。治疗前疼痛指数和张口度分别为7.5±2.09和26.5±5.12mm,治疗后分别为2.4±1.58和40.1±5.03mm,差异均有显著性(P<0.05);关节弹响41例,治疗后18例弹响消失,16例弹响减轻。对照组中有2例弹响自行消失,3例疼痛自行缓解,其余无变化,差异有统计学意义(P<0.05)。结论:垫对颞下颌关节紊乱病患者的临床症状有显著缓解作用。     

垫治疗青少年颞下颌关节紊乱病的临床疗效分析

目的：考察[牙合]垫对青少年颞下颌关节紊乱病患者临床症状的改善情况。方法：采用稳定性[牙合]垫或再定位[牙合]垫治疗71例颞下颌关节紊乱患者，比较治疗前后张口度、颌面部疼痛和关节弹响的变化情况。结果：治疗组51例患者中疼痛34例，张口受限15例，疼痛伴张口受限14例，单纯性疼痛20例，治疗后疼痛及张口受限均得到缓解，缓解率为100％。治疗前疼痛指数和张口度分别为7．5±2．09和26．5±5．12mm，治疗后分别为2．4±1．58和40．1±5．03mm，差异均有显著性（P〈0．05）；关节弹响41例，治疗后18例弹响消失，16例弹响减轻。对照组中有2例弹响自行消失，3例疼痛自行缓解，其余无变化，差异有统计学意义（P〈0．05）。结论：[牙合]垫对颞下颌关节紊乱病患者的临床症状有显著缓解作用。     

Management of pain in TMD patients: Bio-oxidative ozone therapy versus occlusal splints

Objective: To compare the effects of bio-oxidative ozone application with occlusal splints in temporomandibular disorder (TMD) patients with pain.

Methods: Forty participants were selected after the diagnosis of TMD and randomly divided into two groups: ozone group (OG, n = 20) and occlusal splint group (OCSG, n = 20). Ozone was applied to patients three times per week, for a total of six sessions. Patients in the OCSG were instructed to use occlusal splints every night over a period of four weeks.

Results: Mandibular movements showed significant differences for the time factor in OG and OCSG. Pressure pain thresholds of the temporal and masseter muscles at follow-up were significantly higher in the OCSG group. Both treatments statistically decreased the visual analog scale (VAS) scores. However, no statistically significant difference was observed between groups after the application of treatments.

Discussion: Occlusal splint treatment is still the gold treatment modality for objective pain relief in patients with TMD pain.     

EMG and pain severity evaluation in patients with TMD using two different occlusal devices

PURPOSE: The purpose of this study was to compare the electromyographic (EMG) activity level and signs and symptoms in patients with myogenous temporomandibular disorders (TMD) treated with two different types of occlusal devices. MATERIALS AND METHODS: Eleven TMD patients were treated with maxillary occlusal devices. The first group received a flat-plane stabilization occlusal device, while the second group received an anatomic occlusal device that maintained the anatomy of the original occlusal surfaces. The severity of signs and symptoms and the masseter EMG activity were recorded and evaluated before treatment and at 72 hours, 2 weeks, and 4 weeks following the delivery of the occlusal device. EMG activity was measured during maximum clenching and during chewing on the right and left sides. The EMG was also recorded for seven normal subjects as a control group. RESULTS: All patients showed reduction of reported and clinically found muscle pain, with no statistically significant differences between the two groups. A reduction in the EMG activity level at maximum clenching was seen in both patient groups, but was significant only with the anatomic occlusal device. Mean EMG activity during chewing was highly variable within and between groups. CONCLUSION: The subjective and objective improvements with both types of occlusal devices suggest that either type of occlusal device can be beneficial to TMD patients.