临床弹响消失(牙合)位作为调位(牙合)垫治疗(牙合)位的研究

目的　研究临床以弹响消失位作为调位垫治疗位的可行性 ,进一步探讨调位垫的治疗机理。方法　 2 5名接受调位垫治疗的可复性盘前移位患者 ,以弹响消失位制作调位垫 ,在关节造影下验证盘 /突位置改变 ,观察临床治疗效果。结果　 2 5名患者中 ,19人盘 突完全复位 ,5人复位不全 ,1人未复位 ,治疗过程中盘 突复合体运动协调。治疗后关节区舒适 ,开口型改变 ,关节弹响减轻。结论　以临床弹响消失位作为调位垫的治疗位是可行的。调位垫通过改变盘 突位置关系 ,改善盘 突复合体运动的协调性 ,有利于盘后区的机化和盘后带改建 ,从而达到治疗目的     

肌位He板对颅颌功能紊乱者髁突位置及盘突关系异常影响的研究

目的 研究颅颌功能紊乱（ＣＭＤ）者牙尖交错位（ＩＧＰ）的髁位及戴入肌位Ｈｅ板后的改变，对戴入肌位Ｈｅ板后颞颌差了（ＴＭＪ）弹响消失者，观察盘突关系的变化。方法 对１０２例ＣＭＤ者在ＩＣＰ及戴入肌位Ｈｅ板后咬合接触时，在断层深度不变的情况，分别进行双侧ＴＭＪ侧位中层摄反后弹响立即消失者行戴板前、即刻戴入Ｈｅ板后及治疗后，ＴＭＪ上腔迁影的断层摄影。结果 １０２例ＣＭＤ者ＩＣＰ时，髁突一侧后位或双侧后位     

三种He板结合肌松剂治疗可复性关节盘前移位

目的：对松驰型Ｈｅ板，稳定型Ｈｅ板及调位Ｈｅ板结合肌剂Ｍｙｏｎａｌ治疗可复性关节盘前移位的疗效观察。方法：临床分组治疗，随访。结果；松驰型Ｈｅ板，稳定型Ｈｅ板及调位Ｈｅ板分别为９例，１２例和１８例可复性盘前移位病例的弹响消除或明显减弱效果达８８．９％，７５．０１％，１００．０％，结合Ｍｙｏｎａｌ治疗，３９例患者关节疼痛消除或减弱，开口度增大至正常，结论：松驰Ｈｅ板，稳定型Ｈｅ板及调位Ｈｅ板可对复性     

颞颌关节上腔封闭加调位He板综合治疗不可复性盘前移的近期疗效分析

作者对２０名不可盘性盘前移患者，采用常规手法复位失败后，改用颞颌关节上腔封闭与调位Ｈｅ板综合治疗，复位成功率高达９５％，此法操作简单，不用手术无严重并发症，是治疗ＡＤＤ的一种好方法。本文对其方法及复位机制作了初步探讨。     

上腔封闭与调位He板结合治疗不可复性盘前移位20例的近期疗 …

在对２０例颞下颌关节不可复性盘前移患者，常规手法复位失败后，作者采用上腔封闭闭结合自行设计的调位Ｈｅ板结合进行治疗，复位成功率高达９５％，此法操作简单，不用手术，无严重并发症，是治疗不可复性盘前移的有效方法。     

手法复位辅助He垫治疗急性不可复性盘前移位的初步报告

目的：探讨关节腔扩张后手法复位辅助再定位He垫治疗颞下颌关节紊乱病急性不可复性盘前移位。方法：2％局麻药2－3ml注入关节上腔，手法复位解除不可复性前移位的关节盘，复位后即刻戴面再定位He垫保护良好的盘－突关系。结果：近期临床观察表明：（1）开口度恢复，最大开口度从治疗前的25．8mm增大到46．6mm;(2)疼痛症状消失，疼痛分值视觉模拟尺以治疗前的2．62下降到0．43；（3）颞下颌关节功能改善，Fricton关节功能障碍指数和颞下颌关节紊乱指数分别从治疗前的0．337和0．185下降到0．21和0．011。结论：颞下颌关节紊乱病急性不可复性盘前移位药物治疗和理疗无效的情况下，关节盘复位定位He垫是一有效的治疗方法。远期效果如果尚需进一步观察。     

前方调位咬合板治疗颞下颌关节内结构紊乱——附90例8年随访临床报告

采用自行设计的前方调位咬合板治疗颞下颌关节内结构紊乱患者90例,进行了8年随访观察。结果表明这种前方调位咬合板对以往复性弹响为主要特征的可复性盘前移位病例有极好的疗效。去除咬合板后弹响无复发,原有的牙尖交错位无改变,无须作(牙合)重建,而且只在夜间戴用,制作也较容易。     

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.     

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.     

深覆He与颞颌关节形态结构的关系

对４０例前牙重度深覆Ｈｅ患者的薛氏位Ｘ线片进行了测量分析并与正常值进行比较。结果：关节弹响率为７２．５％，牙尖交错Ｈｅ时髁突不在关节凹中央者为８１．２％，关节骨质改变率为５１．２％。深覆Ｈｅ患者的关节结节高度和斜度与正常人无显著性差异，前牙的覆Ｈｅ、覆盖与关节凹宽度和关节结节高度无相关性。提示前牙的覆Ｈｅ、覆盖与颞Ｈｅ关节的骨性解剖形态之间无直接的相关性，深覆Ｈｅ是不良Ｈｅ型容易出现颅颌功能紊乱。     

稳定咬合板和再定位咬合板治疗青少年颞下颌关节盘间断性锁结的临床疗效评价

目的:比较稳定咬合板和再定位咬合板进行治疗对于青少年颞下颌关节盘间断性锁结患者的临床应用疗效.方法:将40例青少年颞下颌关节盘间断性锁结患者,随机分为两组,分别戴用稳定咬合板和再定位咬合板进行治疗3-6个月,记录治疗前后关节疼痛指数、关节弹响及主动开口度;并比较MRI影像检查中关节盘-髁突距离在治疗前、后的变化.结果:...     

Temporomandibular Joint Repositioning and Exercise Performance: A Double-Blind Study

In this study, the effects of temporomandibular joint (TMJ) repositioning by use of an acrylic appliance on maximum and submaximum physiologic and performance measures were evaluated in seven male and four female volunteers with documented TMJ malalignment. In an attempt to remove design inadequacies of previous research in this area, a double-blind strategy was used. Subjects were randomly assigned to each of four conditions: 1) normal, without a bite splint, 2) with a placebo splint with no occlusal contact so as to maintain normal jaw position, 3) with a splint that optimized jaw position, and 4) with a splint that magnified the subject's normal degree of malocclusion. Measurements were taken of visual reaction time and movement time, muscular strength of the grip, elbow flexors, and leg extensors, submaximal and maximal oxygen uptake, perceived exertion, anaerobic power output, and all-out working capacity in both arm and leg exercise on a cycle ergometer. Analysis of variance for repeated measures indicated that in no instance were the differences in mean scores on physiologic and performance measures with TMJ repositioning or placebo statistically significant when compared with the normal condition. This was the case for the group as a whole and when the five subjects with the greatest TMJ dysfunction were analyzed separately. These findings strongly support the contention that the beneficial effects of short-term TMJ repositioning on exercise performance noted in previous reports may be the result of inadequacies in research design and evaluation rather than the true effects of the bite splint.     

再定位垫治疗颞下颌关节盘可复性移位伴间断性 锁结患者的临床观察

目的 观察再定位垫治疗颞下颌关节盘可复性移位伴间断锁结患者的临床疗效。方法 选取2017年12月至2018年6月大连市口腔医院颞下颌关节门诊接诊的34例患者（男9例,女25例,平均年龄31岁）,经MRI确诊为颞下颌关节盘可复性移位伴间断性锁结,采用再定位垫治疗,治疗期限为6个月,治疗后1个月和3个月进行随访,比较戴用再定位垫3个月、6个月,取下垫后1个月和3个月复查时的关节弹响,疼痛程度、颞下颌关节功能障碍指数和紊乱指数。结果 治疗结束时,34例患者中32例（94.12%）弹响完全消失,1个月复查时,弹响消失患者占88.24%,3个月复查时,弹响消失患者占76.46%;治疗开始后3个月患者疼痛主诉与治疗前相比有明显下降;颞下颌关节功能障碍指数、肌肉压痛指数和颞下颌关节功能紊乱指数均有显著下降。结论 再定位垫治疗关节盘移位伴间断性锁结,在短期内可有效消除关节弹响,缓解疼痛症状,解除功能障碍,利于关节盘获得良好的盘突关节。     

Changes in signs and symptoms following temporomandibular joint disc repositioning surgery.

Fifty-one subjects with documented intra-articular pathology refractory to non-surgical therapy underwent temporomandibular joint (TMJ) disc repositioning surgery. Following surgery, subjects were evaluated for 6 months to 6 years by clinical examinations and questionnaires at designated times, and by postsurgical joint imaging. Significant decreases were noted in pain (headache, TMJ pain, ear pain, and neck/shoulder pain), the incidence of joint sounds and locking, and the presence of dietary restrictions. However, 35% of the subjects continued to have residual TMJ pain, and a similar percentage continued to need periodic nonsteroidal anti-inflammatory drugs for analgesia. Some degree of dietary restriction remained in approximately 50% of the subjects, and joint sounds persisted in a similar percentage following surgery. Mean mouth opening was improved by 8 mm, although lateral movements were increased by less than 0.5 mm. Surgery did not decrease the occurrence of jaw deviation, and disc position was unchanged in 86% of the joints imaged at an average of 2 years following surgery. Although TMJ disc repositioning surgery significantly improved pain and dysfunction in TMJ surgery patients, the improvement in disc position was not maintained in most subjects following surgery.     

Effects of splint therapy in TMJ dysfunction: A study using magnetic resonance imaging

This pilot study was undertaken to correlate clinical and MRI diagnoses in seven symptomatic TMJ dysfunction patients and to account, if possible, for the clinical improvement in the signs and symptoms after the use of a maxillary stabilizing splint. The symptomatic TMJs were evaluated by means of MRI prior to splint insertion. Sagittal open/closed, and coronal closed images were obtained with a 0.3 T Fonar MR Scanner. A follow-up MRI was taken after three months of splint therapy for the purposes of a comparative study.
All subjects responded positively even at the early phase of splint treatment. By the end of the three month period, six subjects experienced full remission of pain in the TMJ and associated masticatory muscles with one subject experiencing only partial remission following therapy. Baseline MRI study revealed that only three subjects had anterior disc displacement while the other four subjects had normal disc/condyle relationships and morphology. In the follow-up MRI study, there were no signs of recapture of the three anteriorly displaced discs despite there being evidence of improved jaw movement and remission of pain symptoms.
The use of MRI in this preliminary study indicates that some but not all TMJ pain dysfunction syndromes are caused by internal derangements of the joint. A larger MRI study using the same clinical parameters is indicated for future research.     

Bone SPECT imaging of patients with internal derangement of temporomandibular joint before and after splint therapy

OBJECTIVE: Temporomandibular joint (TMJ) patients with disc displacement without reduction have a misaligned disc-condyle structural relation. As the condition becomes chronic, painful osteoarthritic changes may occur. For these patients, splint therapy may help to position the condyle to a more structurally compatible and functional position and to decrease the loading force of articular surfaces. The aim of this study was (1). to evaluate osseous reactions and pain relief in patients with disc displacement without reduction after splint therapy and (2). to use single photon emission tomography (SPECT) bone imaging to compare the results with the opposite joint of the patient. STUDY DESIGN: Twelve patients, who presented with pain involving the TMJ and limited mouth opening and were confirmed by soft tissue imaging as having disc displacement without reduction, were included in the study. Each patient underwent bone SPECT imaging, after which semiquantitative evaluation of transaxial images was conducted. The ratios of affected TMJ to nonaffected TMJ, affected TMJ to occipital bone, and nonaffected TMJ to occipital bone were calculated. After 6 months of splint therapy, bone SPECT examinations were repeated. RESULTS: Before splint therapy, the ratios of affected TMJ to nonaffected TMJ and of affected TMJ to occipital bone were found to be significantly higher than the ratios after splint therapy (P < 0.005). CONCLUSION: Six-month splint therapy has a positive effect on the osseous reaction and pain related to internal derangements of TMJs.     

The Mitek mini anchor for TMJ disc repositioning: surgical technique and results

This study evaluated our treatment outcomes in 105 patients (188 discs) using the Mitek mini anchor for temporomandibular joint (TMJ) articular disc repositioning surgery, with 88 patients having simultaneous orthognathic surgery. Criteria for inclusion into the study were: (1) Presurgical TMJ disc displacement with salvageable disc; (2) No prior TMJ surgery; (3) TMJ disc repositioning with the Mitek mini anchor; (4) Absence of connective tissue/autoimmune disease; (5) Absence of postsurgical trauma; and (6) Minimum of 12 months postsurgery follow up. Presurgery (T1), immediately postsurgery (T2), and longest follow up (LFU) clinical and radiographic evaluations were performed. The mean age of the patients was 32.6 years (range 14-57 years), and mean follow-up time was 46.2 months (range 14-84 months). Radiographic evaluation at LFU demonstrated no significant condylar resorption or positional changes of the anchors. At LFU, there was a statistically significant reduction in: TMJ pain, facial pain, headaches, TMJ noises and disability, and improvement in jaw function and diet. Maximum incisal opening improved slightly and lateral excursive movements decreased slightly. The Mitek mini anchor provides a predictable method for stabilizing the TMJ articular disc to the condyle and a high success rate in decreasing TMJ dysfunction and pain in patients with no previous TMJ surgery.     

Change of position of the temporomandibular joint disk with insertion of a disk-repositioning appliance

Objective. We report alteration of the temporomandibular joint disk and the condyle position through the construction of a mandibular full-coverage occlusal appliance (often referred to as a disk repositioning appliance).Study design. Forty-five joints with displaced disks with reduction were available for the study. We assessed these joints for disk recapture and the change of disk position with insertion of the appliance using magnetic resonance imaging.Results. Of the 41 joints that had a recaptured disk with insertion of the splint, 25 slid in a posterior direction, although the amount of movement was negligible. No disk slid posteriorly in the joints without splint capture.Conclusions. On the basis of our results, we conclude that many of the occasionally displaced disks might have moved backward with successful treatment involving a disk-repositioning splint. However, the amount of the movement was negligible.