药物注射结合咬合板治疗颞下颌关节紊乱病的临床研究

目的:研究透明质酸钠(sodium hyaluronate, SH)关节腔药物注射法结合佩戴稳定咬合板(stable bite plate, SBP)两种方法在治疗颞下颌关节紊乱病(temporomandibular disorders,TMD)中的应用,并对其效果进行评价。方法:观察组 18例颞下颌关节紊乱病患者给予两种治疗方法联合使用;对照组 18例颞下颌关节紊乱病患者单纯给予SBP治疗。对比分析治疗前后患者颞下颌关节开口指数(Temporomandibular opening index TOI)、疼痛指数(Visual analog scale VAS)及肌肉压痛指数(PI)和关节压诊分值(JP)的变化。结果:治疗后两组患者的OTI、VAS、PI及JP指数比较,观察组明显低于对照组,有显著性差异(P＜0.05)。结论:SH关节腔内注射联合SBP治疗TMD的疗效优于单纯采用SBP治疗。     

咬合板对颞下颌关节紊乱病相关颌面部疼痛的影响

颞下颌关节紊乱病（temporomandibular disorders, TMD）是口颌面部慢性痛的主要来源,严重干扰日常活动。咬合板是颞下颌关节紊乱病的最常用的治疗方法之一,但其疗效尚未完全明了。学者们多年来致力于对咬合板的作用机制、疗效的研究,但至今尚未得出统一的结果。该文将对咬合板的作用机制、咬合板的分类、TMD相关疼痛的种类与咬合板的选择、TMD的其他保守治疗与咬合板的关系四个方面对于咬合板治疗颞下颌关节紊乱病相关颌面部疼痛的疗效进行进行综述。     

颞下颌关节紊乱病咬合特征的初步临床研究

目的 对颞下颌关节紊乱病（temporomandibular disorder,TMD）人群的咬合特征特别是动态咬合特征进行初步临床调查及分析。方法参考颞下颌关节紊乱病分类及诊断标准（Diagnostic Criteria for Temporomandibular Disorders, DC/TMD）收集TMD患者140例,对照组80例,口内检查其静态咬合特征,牙尖交错位（intercuspal position,ICP）与后退接触位（retruded contact position,RCP）协调性,下颌功能运动咬合干扰及牙齿不均匀磨损情况,分析颞下颌关节紊乱病的动态咬合特征。结果 TMD患者可存在多种静态咬合特征;下颌功能运动咬合干扰及牙齿不均匀磨损与TMD具有相关性,而ICP-RCP的协调性与TMD的存在无明显统计学意义。结论 TMD患者静态咬合特征表现为三维方向的复杂多样性;ICP-RCP不协调尚不能作为TMD的敏感因素;当存在下颌功能运动咬合干扰或牙齿不均匀磨损时需警惕TMD的存在。     

下颌运动轨迹分析在颞下颌关节紊乱病诊疗中的应用及展望

近年来,颞下颌关节紊乱综合征(temporomandibular disorder,TMD)患病率越来越高,且病因复杂.下颌运动轨迹观测能够针对颞下颌关节(temporomandibular joint,TMJ)的运动能力及协调性进行诊断分析,广泛应用于口腔正畸、修复及外科治疗过程中,对TMD的诊断分析及疗效评定具有重...     

颞下颌关节紊乱指数临床应用评价

目的 探讨如何采用客观定量的方法评价颞下颌关节功能障碍程度和颞下颌关节紊乱病（temporomandibular disorders,TMD）的治疗效果。方法 分别采用Fricton颞下颌关节紊乱指数和Helkimo临床检查功能障碍指数，定量计算每例患者（共60例）的颞下颌关节紊乱指数，评价不同检查者获得的各项指数的一致性，并应用Fricton颞下颌关节紊乱指数定量评价TMD急性不可复性盘前移位的临床治疗效果。结果 （1）不同检查者获得的各项Fricton紊乱指数值相近；（2）Fricton紊乱指数可明确反映TMD急性不可复性盘前移位治疗后临床功能的改善。结论 评价TMD功能障碍程度或评价TMD治疗效果宜避免使用非客观的、描述性的报告，Fricton紊乱指数是一方便且有效的客观定量指标。     

468例颞下颌关节紊乱病的诊治分析

颞下颌关节紊乱病(temporomandibular disorders，TMD)是一种常见病、多发病。由于颞下颌关节结构较复杂，口颌系统功能又多种多样，往往患病后造成患者生活与精神上的苦恼。本文对10年来诊治的468例TMD患者进行分析。     

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。     

两组成人正畸患者颞下颌关节紊乱表现的对比研究

目的：观察两实验组的错He畸形类型和颞下颌关节紊乱表现存在何种差异。方法：112名18－29岁成人正畸患者根据主诉被分为两实验组,因关节不适而就诊的实验I组和因美观要求而就诊的实验Ⅱ组。实验Ⅰ组50人,男性19人,女性31人。实验组Ⅱ62人,男性22人,女性40人。每位患者治疗前均作详尽的正确临床检查、颞下颌关节临床检查、并拍摄开、闭口薛氏位片。结果：1．实验Ⅰ组TMD发生率明显比Ⅱ组高,分别占72％和25．81％,P＜0．005。2．实验Ⅰ组中安氏Ⅱ、Ⅲ类患者占绝大多数,共占84％;而实验Ⅱ组安氏Ⅰ类患者占多数,51．62％,P＜0．005。3．两实验组依安氏分类TMD发生率大小顺序排列均为：安错Ⅱ类1分类、安错Ⅲ类、安氏Ⅱ类2分类、安氏Ⅰ类。结论：1．某些严重错He畸形如：后牙反He、开He下颌偏斜、深覆盖、严重拥护深覆He（按TMD发生率大小顺序排列）较易发生TMD。2．夜磨牙、牙龄磨耗及幼年颌面外伤与TMD密切相关。     

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。     

颞下颌关节紊乱病诊断标准的研究进展

颞下颌关节紊乱病(temporomandibular disorders,TMDs)是临床常见病但是病因复杂,相应的颞下颌关节紊乱病的诊断标准也在不停演变.本文围绕由RDC/TMD到DC/TMD的改进,DC/TMD的临床应用实施进行综述,并对未来可能的发展进行展望.     

Occlusal interferences and temporomandibular dysfunction

Disagreement exists regarding the relationship between occlusal interferences and temporomandibular joint dysfunction (TMD). This study sought to determine how a balanced occlusion, providing uniform contact in centric relation, would affect signs and symptoms of TMD. A randomly chosen group of 60 patients with occlusal interferences and signs and symptoms of TMD used a mandibular orthotic to balance their occlusions at centric relation (CR). When the occlusions of symptomatic patients were balanced in CR, there was a significant reduction or elimination of TMD complaints, suggesting a relationship between balancing occlusion in CR and optimum management of TMD.     

Prevalence of temporomandibular dysfunction and its association with malocclusion in children and adolescents: an epidemiologic study related to specified stages of dental development

A sample of 4724 children (2353 girls and 2371 boys) (5-17 years old) were grouped not only by chronological age but also by stage of dental development (deciduous, early mixed, late mixed, and permanent dentition). The registrations included functional occlusion (anterior and lateral sliding, interferences), dental wear, mandibular mobility (maximal opening, deflection), and temporomandibular joint and muscular pain recorded by palpation. Headache was the only symptom of temporomandibular dysfunction (TMD) reported by the children. The results showed that one or more clinical signs were recorded in 25% of the subjects, most of them being mild in character. The prevalences increased during the developmental stages. Girls were in general more affected than boys. Significant associations were found between different signs, and TMD was associated with posterior crossbite, anterior open bite, Angle Class III malocclusion, and extreme maxillary overjet.     

Symptoms and signs of temporomandibular disorders before, during and after orthodontic treatment

The relationship between orthodontic treatment and symptoms and signs of temporomandibular disorders (TMD) was studied prospectively and longitudinally in 65 adolescent girls with Class II malocclusion. The subjects received orthodontic fixed appliance treatment with the straight-wire technique combined with or without extractions and were examined for symptoms and signs of TMD before, during, after, and finally one year post-treatment. Both symptoms and signs of TMD showed considerable fluctuations over the three-year period within the individuals. The general tendency was a decreased prevalence of symptoms of TMD over the three years. The prevalence of pain on mandibular movement and tenderness to palpation of the masticatory muscles was significantly less common during and after orthodontic treatment than before. Clinically registered TMJ clicking increased slightly over the three year period. One orthodontic treatment effect when normalizing Class II malocclusions with fixed appliances was a decreased prevalence of functional occlusal interferences. We concluded that the orthodontic treatment either with or without tooth extractions did not increase the risk for TMD or worsen pre-treatment signs of TMD. Subjects with Class II malocclusion and pre-treatment signs of TMD of muscular origin seemed rather to benefit functionally from orthodontic treatment in a three-year perspective.     

A study of the influence of occlusal factors and parafunctional habits on the prevalence of signs and symptoms of TMD

PURPOSE: The purpose of this study was to investigate the prevalence of the clinical signs and symptoms of temporomandibular disorders (TMD) and the relationship between occlusal factors, parafunctional habits, and TMD in a young adult nonpatient population. MATERIALS AND METHODS: A questionnaire including data from a history and clinical functional examination was used in the study. All 230 subjects were male recruits, from 19 to 28 years of age (mean 21.3 years). RESULTS: Thirty-eight percent of the subjects reported at least one symptom, while in 45% of the subjects at least one sign of TMD was recorded. Temporomandibular joint clicking (40%) and pain on palpation (34%) were the most commonly recorded signs. Multivariate logistic regression analysis showed several weak but statistically significant correlations between the occlusal factors, parafunctional habits, and TMD in this nonpatient population. TMD signs were thus weakly correlated with malocclusion traits (angle Classes II/1, II/2, III, and cross bite), interferences in retruded contact position, midline discrepancy > or = 2 mm, < or = 10 contacts during maximal biting pressure, nonworking-side interferences, horizontal overlap > or = 5 mm, and parafunctional habits (teeth clenching and teeth grinding). CONCLUSION: Some association between occlusal factors and TMD signs was found. However, this association cannot be considered unique or dominant in defining subjects with TMD in the population.     

Occlusal risk factors for temporomandibular disorders

OBJECTIVE: To determine the role of occlusal variables (overbite; overjet; number of anterior and posterior teeth; bilateral canine guidance on lateral and protrusive movements; anterior centric slide; Angle Classes I, II, and III malocclusion) as risk indicators for the development of temporomandibular disorders (TMDs). MATERIALS AND METHODS: Seventy-two TMD patients with myofascial pain, with or without limited opening and arthralgia, as well as 30 age- and gender-matched pain-free concurrent controls were included. The association (critical odds ratio [OR] = 2.0) between the significant occlusal variables and TMD was calculated. Confounders were controlled in the inclusion-exclusion criteria as well as in the analysis stage (unconditional logistic regression) by variation in the OR (15%). RESULTS: Angle Class II malocclusion (crude OR = 8.0, confidence interval [CI] = 2.2 to 29.3) and the absence of bilateral canine guidance on lateral excursion (crude OR = 3.9, CI = 1.6 to 9.7) were statistically more common in patients than in controls. Spontaneous pain as well as pain on palpation (Class II or higher) were also statistically worse in TMD patients. Significant confounders (ie, employment, age, cigarette and alcohol consumption) acted as effect modifiers not changing the critical OR (adjusted OR Angle Class II and bilateral canine guidance = 8.3 to 12.4 and 2.2 to 4.1, respectively). CONCLUSIONS: Absence of bilateral canine guidance on lateral excursion and particularly Angle Class II malocclusion were considered important risk indicators for the development of TMD in this investigation, even when some sociodemographic factors were considered as effect modifiers.     

安氏Ⅱ~1错儿童颞下颌关节结构变化与Helkimo指数分析

目的研究安氏Ⅱ1错儿童颞下颌关节(TMJ)髁突移位、关节盘移位等结构变化与临床症状、体征的特点及两者间的关系。方法120例尚未接受正畸治疗的安氏Ⅱ1错患者,进行TMJ的磁共振成像(MRI)检查后测定TMJ中髁突及关节盘位置,同时以Helkimo指数评价TMJ临床表现与功能状况;采用秩和检验(rank sum test)对临床功能检查结果与髁突移位与否、关节盘移位与否进行分析比较。结果120例患者中髁突前位为61例,发病率达50.8%;盘前位为40例,发病率达33.3%。主诉症状指数Ai100%为0,且大部分无临床功能障碍(髁突前位患者中67.2%,盘前位患者中70.0%Di=0)。秩和检验结果表明TMJ临床表现、功能状况在正常组、髁突移位组、关节盘移位组间分布差别无统计学意义。结论安氏Ⅱ1错儿童TMJ存在罹患颞下颌关节紊乱(TMD)风险但临床表现轻微多属无症状期。MRI能为TMD的早期诊断提供可靠依据。     

Clinical and psychological characteristics of TMD patients with trauma history

Oral Diseases (2010) 16 , 188–192 Objective: The purpose of this study was to investigate clinical and psychological characteristics of temporomandibular disorders (TMD) patients with trauma history. Materials and methods: The clinical and psychological characteristics of 34 TMD patients with trauma history were compared with those of 340 TMD patients without trauma history. Craniomandibular index (CMI) was used for clinical characteristics of TMD patients. Symptom severity index (SSI) was used to assess the multiple dimensions of pain. Symptom checklist‐90‐revision (SCL‐90‐R) was used for psychological evaluation. Results: Temporomandibular disorders patients with trauma history displayed significantly higher CMI and palpation index. TMD patients with trauma history also exhibited higher values in duration, sensory intensity, affective intensity, tolerability, scope of symptom, and total SSI score. In addition, these patients showed significantly higher values in symptom dimensions of somatization, depression, anxiety, phobic anxiety, and paranoid ideation. Among the symptom dimensions of SCL‐90‐R, somatization showed the most significant correlations with CMI and SSI. Conclusions: Temporomandibular disorders patients with trauma history displayed more severe subjective, objective, and psychological dysfunction than those without trauma history. Pain of myogenous origin, history of physical trauma, and psychosocial dysfunction were all closely related.     

颏兜对下颌骨及颞下颌关节影响的研究进展

颏兜是安氏Ⅲ类患者的辅助治疗手段之一,通过作用于下颌骨以改善安氏Ⅲ类患者的错(牙合)畸形,颏兜可以对颞下颌关节的形态及下颌骨生长产生作用,本文就近年来颏兜治疗对颞下颌关节影响的相关研究进展进行综述.     

骨性安氏Ⅲ类错[牙合]伴偏颌及与颞下颌关节紊乱病的关联研究进展

骨性安氏Ⅲ类错[牙合]畸形伴偏颌会导致颅骨、下颌骨、上颌骨的旋转和移位,并常伴有口颌面部软组织的不对称改变,影响美观和功能,其常用治疗手段(正畸和正颌手术)存在美学效果的局限性,正确评估形态改变对治疗方案的选择意义重大。骨性安氏Ⅲ类错[牙合]伴偏颌与颞下颌关节形态、功能变化及颞下颌关节紊乱病(temporomandibular disorder,TMD)的发生相关,但因果关系尚存争议。本文就骨性安氏Ⅲ类错[牙合]畸形伴偏颌患者的病因、软硬组织的改变、治疗手段以及其与TMD的关联进行综述。目前研究结果表明,偏颌是一种病因不明确,涉及到颅底、上颌骨、下颌骨形态变化、软组织形态变化、咬合改变以及颌骨旋转移位的复杂疾病,对颞下颌关节及下颌功能运动也会产生影响。偏颌患者中常见骨性安氏Ⅲ类错[牙合]畸形,需要早期治疗;其治疗手段多样,正确评估导致面部不对称的软硬组织形态变化是治疗的前提。正畸?正颌联合治疗(必要时合并软组织的修整)是治疗骨性安氏Ⅲ类错[牙合]伴偏颌的有效手段。此外,偏颌与TMD之间也有紧密的联系,设计治疗方案时需要充分考虑。     

Signs of temporomandibular disorders in girls receiving orthodontic treatment. A prospective and longitudinal comparison with untreated Class II malocclusions and normal occlusion subjects

The aim of this investigation was to prospectively and longitudinally study signs of temporomandibular disorders (TMD) and occlusal changes in girls with Class II malocclusion receiving orthodontic treatment and to compare them with subjects with untreated Class II malocclusions and with normal occlusion subjects. Three groups of age-matched adolescent girls were examined for clinical signs of TMD and re-examined 2 years later. Sixty-five Class II subjects received orthodontic fixed straight-wire appliance treatment (Orthodontic group), 58 subjects were orthodontically untreated (Class II group), and 60 subjects had a normal occlusion (Normal group). In the Orthodontic group, the prevalence of muscular signs of TMD was significantly less common post-treatment. The Class II and the Normal groups showed minor changes during the 2-year period. Temporomandibular joint clicking increased in all three groups over the 2 years, but was less common in the Normal group. The Normal group also had a lower overall prevalence of signs of TMD than the Orthodontic and the Class II groups at both registrations. Functional occlusal interferences decreased in the Orthodontic group, but remained the same in the other groups over the 2 years. In conclusion, orthodontic treatment did not increase the risk for or worsen pretreatment signs of TMD. On the contrary, subjects with Class II malocclusions and signs of TMD of muscular origin seemed to benefit functionally from orthodontic treatment in a 2-year perspective. The Normal group had a lower prevalence of signs of TMD than the Orthodontic and the untreated Class II groups.