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。     

肌位板对颌间关系调整作用的研究

目的 :研究肌位板对下颌位置的调整作用。方法 :对 10 2例颅颌功能紊乱 (CMD)患者均戴用肌位板 ,戴板后 1周、2周、1月各复查 1次 ,以后每月复查 1次 ,共戴板 3～ 6月。记录戴板后是否出现咬合不稳 ,若有咬合印迹变化者则磨去原有咬合印迹重垫 ,直至不再变化 ,待症状消失后去除板 ,轻咬至肌接触位 ,记录与颌位是否协调。结果 :戴板期间 66例患者的咬合印迹始终不变 ,3 6例患者出现咬合不稳 ,经重垫后 ,咬合板的关系稳定不变。待症状消失后去板。 10 2例患者中 ,12例表现为肌牙位不一致 ,其中前牙早接触 2例 ,先天性垂直距离不足 1例 ,牙尖交错位 (ICP)偏位 9例。结论 :肌位板对下颌位置的调整作用是调正肌位 ,在肌位正常情况下 ,判断肌牙位是否一致 ,从而检出 ICP异常。     

肌位(s)板对颌间关系调整作用的研究

目的:研究肌位(s)板对下颌位置的调整作用.方法:对102例颅颌功能紊乱(CMD)患者均戴用肌位(s)板,戴板后1周、2周、1月各复查1次,以后每月复查1次,共戴板3～6月.记录戴板后是否出现咬合不稳,若有咬合印迹变化者则磨去原有咬合印迹重垫,直至不再变化,待症状消失后去除(s)板,轻咬至肌接触位,记录与颌位是否协调.结果:戴板期间66例患者的咬合印迹始终不变,36例患者出现咬合不稳,经重垫后,咬合板的(s)关系稳定不变.待症状消失后去板.102例患者中,12例表现为肌牙位不一致,其中前牙早接触2例,先天性垂直距离不足1例,牙尖交错位(ICP)偏位9例.结论:肌位(s)板对下颌位置的调整作用是调正肌位,在肌位正常情况下,判断肌牙位是否一致,从而检出ICP异常.     

肌位He板对颌关关系调整作用的研究

目的；研究肌位Ｈｅ板对下颌位置的调整作用。方法；对１０２例颅颌功能紊乱患者均戴用肌位Ｈｅ板，戴板后１周，２周，１月各复查１次，以后每月复查１次，共戴板３－６月，记录载板是否出现咬合不稳，若有咬合印迹变化者则磨去原有咬合印迹重垫，直至不再变化，待症状消失后去除Ｈｅ板，轻咬至肌接触位，记录Ｈｅ与颌位是否协调。     

肌位咬合板对颅颌功能紊乱者咀嚼肌肌电图的影响

目的：研究肌位咬合板对颅颌功能紊乱（ Ｃ Ｍ Ｄ）患者咀嚼肌肌电的影响,探讨其作用机理。方法：采用美国 Ｅ Ｍ２ 型肌电仪记录１０２ 例患者带咬合板前后的姿势位（ Ｍ Ｐ Ｐ）及牙尖交错位（ Ｉ Ｃ Ｐ）最大紧咬时的肌电变化。结果：（１）即刻戴入咬合板后颞肌前束（ Ｔ Ａ）与嚼肌（ Ｍ Ｍ）的 Ｍ Ｐ Ｐ高电位明显降低（ Ｐ＜ ０．０５）;治疗后不戴咬合板复查, Ｔ Ａ、颞肌后束（ Ｔ Ｐ）和 Ｍ Ｍ 肌紧张缓解。（２）戴咬合板紧咬双侧 Ｔ Ａ、 Ｔ Ｐ 和 Ｍ Ｍ 的肌电活动显著减小（ Ｐ＜ ０．０５）, Ｍ Ｍ 的肌电活动对称性明显提高（ Ｐ＜ ０．０５）,活动指数显著增加（ Ｐ＜０．０５）。结论：肌位咬合板能明显降低升颌肌最大紧咬的肌电活动,提高嚼肌的肌电活动对称性及活动指数。     

咬合板对翼外肌功能紊乱作用的肌电研究

对43例伴翼外肌(LP)功能紊乱的颅颌功能紊乱(CMD)患者戴咬合板前后的LP肌电变化进行研究。结果:戴咬合板后的LP上头姿势位电位及紧咬电位都显著下降,下头电位无显著变化。经咬合板治疗,症状消失或减轻后,关节影像正常者的LP功能多数恢复正常;部分盘前移位者随着盘突关系恢复正常或好转,其LP功能紊乱也恢复正常;大部分不可复位盘前移位及关节盘穿孔者的LP功能紊乱同治疗前。因此,咬合板可使关节正常的CMD患者的LP功能紊乱恢复正常,但对关节内严重结构性紊乱及器质性病变者的LP功能紊乱无明显作用。     

肌位板对磨牙症伴颅颌功能紊乱症状作用的临床与肌电图研究

目的 :观察肌位板对磨牙症伴颅颌功能紊乱 (CMD)症状者最大紧咬时咀嚼肌肌电图及临床症状的影响。方法 :对 31例患者戴板前 ,即刻戴入板后 ,采用EM2肌电仪分别测试最大紧咬时双侧颞肌前束、后束、嚼肌及二腹肌前腹的肌电活动大小。嘱患者夜间戴板 3～ 6月 ,记录临床症状与体征的变化。结果 :肌位板能明显减少升颌肌的肌电活动 (p <0 0 5 ) ,提高嚼肌活动的对称性 (p<0 0 5 )。戴板后仅 4例紧咬牙习惯消失而不能终止夜磨牙 ,但戴板期间CMD症状持续缓解甚至消失。结论 :肌位板可明显减小磨牙症伴CMD症状者升颌肌异常过度活动 ,且提高嚼肌肌电活动的对称性 ,从而使CMD症状持续性缓解     

再定位咬合板治疗颞下颌关节盘可复性前移位疗效观察

目的评价再定位咬合板治疗颞下颌关节盘可复性前移位的临床疗效。方法选择28名颞下颌关节盘可复性前移位患者。患者戴用再定位咬合板治疗后3个月、6个月、1年、2年复诊,行关节常规检查并拍x线片,评价治疗效果。结果经过再定位咬合板治疗,18名弹响患者中13名（72．22％）弹响完全消失,10名疼痛患者中8名（80．00％）疼痛消失,14名下颌运动异常患者中10名（71．43％）转为正常。26名患者认为治疗有效（92．86％）。结论再定位咬合板对治疗颞下颌关节盘前移位具有较好的疗效。     

不同类型咬合板对颞下颌关节紊乱病疼痛患者咀嚼肌肌电的影响

目的:研究松弛型咬合板和稳定型咬合板对急慢性颞下颌关节紊乱病(TMD)疼痛患者颞肌前束(TA)、咬肌(MM)肌电的影响。方法:68例TMD疼痛患者分为急慢性2组,比较分析戴咬合板前和戴咬合板1个月后双侧TA和MM肌电电位。结果:戴板后静息状态下急慢性组患者双侧TA及MM肌电电位均较戴板前明显下降(P<0.05);紧咬状态下急性组戴松弛型咬合板患者双侧TA、MM肌电电位较戴板前明显上升,戴稳定型咬合板患者仅MM肌电电位较戴板前明显上升;慢性组戴松弛型和稳定型咬合板患者MM肌电电位均较戴板前明显上升(P<0.05)。结论:松弛型和稳定型咬合板均对咀嚼肌有松弛作用,松弛型咬合板更能明显缓解TMD急性患者肌紧张。     

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     

牙齿重度磨耗患者下颌运动轨迹的研究

目的:研究重度磨耗对下颌运动乃至口颌系统功能的影响。方法:选取实验组重度磨耗患者30例,对照组个别正常10例,用K6-1系统分别记录下颌叩齿、开闭口及边缘运动轨迹。结果:磨耗组中MPP-ICP不稳定的患者较对照组多(P<0.05);磨耗组下颌开闭口运动速率与对照组比较无统计学差异(P>0.05),但轨迹的平滑度及重复性较对照组差;磨耗组边缘运动轨迹的平滑性及对称性较对照组差,其MMI小于对照组(P<0.05)。结论:重度磨耗可影响下颌运动及功能,但对整个口颌系统健康的影响仍待进一步研究。     

Integrated jaw and neck function in man. Studies of mandibular and head-neck movements during jaw opening-closing tasks

This investigation was undertaken to test the hypothesis of a functional relationship between the human temporomandibular and craniocervical regions. Mandibular and head-neck movements were simultaneously recorded in healthy young adults using a wireless optoelectronic system for three dimensional movement recording. The subjects were seated in an upright position without head support and were instructed to perform maximal jaw opening-closing movements at fast and slow speed. As a basis, a study was undertaken to develop a method for recording and analysis of mandibular and head-neck movements during natural jaw function. A consistent finding was parallel and coordinated head-neck movements during both fast and slow jaw opening-closing movements. The head in general started to move simultaneously with or before the mandible at the initiation of jaw opening. Most often, the head attained maximum velocity after the mandible. A high degree of spatiotemporal consistency of mandibular and head-neck movement trajectories was found in successive recording sessions. The head movement amplitude and the temporal coordination between mandibular and head-neck movements were speed related but not the movement trajectory patterns. Examination of individuals suffering from temporomandibular disorders and whiplash associated disorders (WAD) showed, compared with healthy subjects, smaller amplitudes, a diverse pattern of temporal coordination but a similar high degree of spatiotemporal consistency for mandibular and head-neck movements. In conclusion, the results suggest the following: A functional linkage exists between the human temporomandibular and craniocervical regions. Head movements are an integral part of natural jaw opening-closing. "Functional jaw movements" comprise concomitant mandibular and head-neck movements which involve the temporomandibular, the atlanto-occipital and the cervical spine joints, caused by jointly activated jaw and neck muscles. Jaw and neck muscle actions are elicited and synchronised by neural commands in common for both the jaw and the neck motor systems. These commands are preprogrammed, particularly at fast speed. In the light of previous observations of concurrent jaw and head movements during foetal yawning, it is suggested that these motor programs are innate. Neural processes underlying integrated jaw and neck function are invariant both in short- and long-term perspectives. Integrated jaw and neck function seems to be crucial for maintaining optimal orientation of the gape in natural jaw function. Injury to the head-neck, leading to WAD may derange integrated jaw-neck motor control and compromise natural jaw function.     

Deranged jaw-neck motor control in whiplash-associated disorders

Recent findings of simultaneous and well coordinated head-neck movements during single as well as rhythmic jaw opening-closing tasks has led to the conclusion that 'functional jaw movements' are the result of activation of jaw as well as neck muscles, leading to simultaneous movements in the temporomandibular, atlanto-occipital and cervical spine joints. It can therefore be assumed that disease or injury to any of these joint systems would disturb natural jaw function. To test this hypothesis, amplitudes, temporal coordination, and spatiotemporal consistency of concomitant mandibular and head-neck movements during single maximal jaw opening-closing tasks were analysed in 25 individuals suffering from whiplash-associated disorders (WAD) using optoelectronic movement recording technique. In addition, the relative durations for which the head position was equal to, leading ahead of, or lagging behind the mandibular position during the entire jaw opening-closing cycle were determined. Compared with healthy individuals, the WAD group showed smaller amplitudes, and changed temporal coordination between mandibular and head-neck movements. No divergence from healthy individuals was found for the spatiotemporal consistency or for the analysis during the entire jaw opening-closing cycle. These findings in the WAD group of a 'faulty', but yet consistent, jaw-neck behavior may reflect a basic importance of linked control of the jaw and neck sensory-motor systems. In conclusion, the present results suggest that neck injury is associated with deranged control of mandibular and head-neck movements during jaw opening-closing tasks, and therefore might compromise natural jaw function.     

Kinesiographic study of the mandible in young patients with unilateral posterior crossbite.

It is generally assumed that children with posterior crossbites have abnormal mandibular movements; however, this assumption has not been clearly evaluated. The purpose of this investigation was to study the movements and the resting position of the mandible in 2 samples of 30 subjects, one aged 10 to 14 years with right posterior crossbite, the other aged 10 to 15 years with normal occlusion. Subjects in both groups exhibited a Class I skeletal relationship and mesofacial growth pattern. A mandibular kinesiograph was used to record both the mandibular resting position and dynamic movements. Mandibular movements were recorded during (1) maximum excursions (opening-closing, protrusion, right and left excursions), (2) swallowing, and (3) mastication. The results showed no differences between groups in the extension of the movements during closing and protrusion. However, crossbite patients exhibited a significant lateral shift during these movements. Right and left excursions were also similar between groups. The dimension of the freeway space was similar between groups, but the lateral shift found in centric occlusion was also present in the crossbite group when the mandible was at rest. The crossbite group more frequently showed a pattern of abnormal swallowing. No differences were found in any of the parameters studied during the masticatory cycle. There was no relationship between the side of the crossbite and the masticatory preference side. In conclusion, posterior crossbite patients showed a lateral shift in some movements that persisted when the mandible was at rest.     

再定位牙合垫戴入前后颞下颌关节盘和髁突的位置改变

目的测量再定位牙合垫（ARS）戴入前后关节盘和髁突的位置改变,探讨ARS的治疗机制。方法选择22例单侧或双侧可复性颞下颌关节盘前移位患者进行研究,其中关节盘前移位的关节31侧,设为前移位组;关节盘位置正常的关节13侧,设为正常组。分别在闭口位（ARS戴入前）、对刃位和下颌最少前伸位（ARS戴入后）行磁共振成像扫描,测量不同下颌位置时的2组关节的盘突角度、关节盘和髁突位置的变化。结果1）盘突角度：闭口位时前移位组为54.23°,正常组为9.80°;对刃位和下颌最少前伸位时,前移位组的盘突角度多可回复至正常范围。2）关节盘位置：从闭口位至对刃位或下颌最少前伸位,正常组关节盘位置无明显改变,前移位组关节盘明显向后移动。3）髁突位置：从闭口位至对刃位或下颌最少前伸位,髁突在关节窝中向前下方移动,正常组与前移位组比较的差异无统计学意义（P＞0.05）。结论ARS使髁突向前下方移动,关节盘向后回复。ARS的作用可能是阻止已经向后上方移动而复位的关节盘在闭口过程中再次发生前移位,起到固定作用。     

下颌定位仪指导下颌稳定性垫调磨对髁突运动中心位置的影响

目的:观察垫对髁突运动中心位置的影响,并探讨下颌定位技术测定髁突运动中心电子位置(ele-ctronic position analysis,EPA)指导垫调磨的方法。方法:从3158例颞下颌关节紊乱病患者中,选择46例(92侧关节)有下颌绞锁运动症状的颞下颌关节紊乱病患者,接受下颌稳定垫治疗;常规调磨后,为患者戴入合垫,再用超声三维下颌定位仪(3D-ultrasonic navigator)进行髁突运动中心电子位置及下颌运动功能分析,观察常规方法调磨后垫治疗对髁突运动中心的影响;对引起双侧髁突运动中心不均衡位移的病例,则根据EPA的测试,对垫进行修正性调磨。结果:常规调磨后,67.4%(31/46)的患者双侧髁突运动中心在矢状位的位移距离明显不均衡;63%(29/46)的患者双侧髁突运动中心的位移方向不一致;而根据EPA检测修正性调磨后,91.3%(42/46)的患者双侧髁突运动中心的位移方向达到了一致。常规调磨与修正性调磨对垫引起髁突运动中心位移时双侧的均衡性与方向一致性上的差异均具有统计学意义。结论:稳定垫治疗颞下颌关节紊乱病过程中,超声三维下颌定位仪中的EPA检测指导下进行修正性调磨可以提高双侧髁突运动中心的位移距离和方向的一致性。     

Conservative therapy in patients with anterior disc displacement without reduction using 2 common splints: a randomized clinical trial.

PURPOSE: We performed a comparative evaluation of different types of splint therapy for anterior disc displacement without reduction (ADDWR) of the temporomandibular joint. PATIENTS AND METHODS: Seventy-four patients agreed to participate (65 females and 9 males). All patients were examined using a clinical temporomandibular joint disorder examination protocol, including muscle palpation, mandibular range-of-motion measurement, and joint sound detection. Additionally, the patients marked their pain (during chewing, mandibular movements, and rest position) and limitation levels on a visual analog scale. Bilateral magnetic resonance images were acquired, confirming ADDWR in at least one joint. After clinical examination and imaging, randomized splint therapy was provided: 38 patients received a centric splint, while 36 received a distraction splint. After 1, 3, and 6 months of therapy, outcome was evaluated using the Wilcoxon signed rank test for matched pairs. Success after 6 months was defined as improvement in active mouth opening of greater than 20% and pain reduction (on chewing) of at least 50%. Success was statistically verified using logistic regression test. RESULTS: The improvements in mouth opening were significant in both groups. The improvements in pain on chewing, pain during other functions, pain at rest, functional limitation on chewing, and other functions were also comparable in both groups. However, the logistic regression test suggested that patients using centric splints were treated more successfully than the others (confidence interval, 1.014 to 8.741, odds ratio = 2.785). CONCLUSIONS: Centric splints seem to be more effective than distraction splints. Therefore, before the surgical treatment of ADDWR, centric splints should be used instead of distraction splints.     

Postural and maximum activity in elevators during mandible pre- and post-occlusal splint treatment of temporomandibular joint disturbance syndrome

Electromyograms (EMGs) of the temporal and masseter muscles in sixty patients with temporomandibular joint disturbance syndrome (TMJDS) and thirty controls were recorded and integrated on-line in the postural position and during maximum clenching, before and after occlusal splint therapy. Contrasting with the controls, the myoelectrical activity of the patients was higher in the postural position and lower during maximum clenching, whilst the former in percentage terms increased when compared to the latter. After treatment, the EMG indexes in some patients returned partially, and in others completely, to a normal level. Tenderness in the mandibular elevators, deviated opening and organic change in the TMJ increased the postural myoelectrical activity, in percentage terms, against that of maximum clenching. The myoelectrical activity of the mandibular elevators in the postural position and during maximum clenching was smaller in patients with the occlusal splint than in those without. The results show that the mandibular elevators in the patients with TMJDS were hyperactive and tense, and that the occlusal splint was useful for treating such dysfunction.     

功能板影响错伴特发性髁突吸收正颌术后稳定性的初步研究

目的:探讨特发性髁突吸收（idiopathic condylar resorption, ICR）患者在关节功能板治疗结合正颌-正畸联合治疗后下颌骨及髁突位置的改变,为后期研究提供依据。方法:回顾分析2008—2012年收治的13例特发性髁突吸收患者的临床数据,所有患者均在正颌手术前接受关节功能板治疗7.5±1.5个月。对患者正颌术前(T0)、正颌术后即刻(T1)、正颌术后至少12个月(T2)的咬合、头颅侧位片、MRI检查结果进行测量,采用SPSS 22.0软件包对数据进行统计学分析,评价正颌术后髁突和下颌骨的位置变化。结果:正颌手术(T1)纠正了所有患者的骨性Ⅱ类错畸形,建立了正常的咬合关系、前伸运动及侧方斜导运动。正颌手术平均下颌骨前移量(Y Axis-B, T1-T0)为（5.05±3.54）mm。与T1相比,T2时颞下颌关节间隙参数无显著改变。下颌骨位置参数中, 仅Y轴到B点的距离（Y轴-B）在T2与T1间存在统计学差异,其改变量平均值为（-1.64±2.48）mm,其余参数均无显著差异。13例患者中,11例患者Y轴-B 改变值<2 mm（84.6%）,仅 2例患者出现>2 mm的后退（15.4%）。结论:关节功能板治疗可增加ICR患者正颌手术的稳定性,可能是关节功能板保守治疗能够稳定ICR患者髁突在关节窝内的位置。     

Changes in Vertical Tooth Position and Face Height Related to Long Term Anterior Repositioning Splint Therapy

This study evaluates whether extended full-time wear of a partial coverage mandibular anterior repositioning splint (MORA) causes intrusion of posterior teeth and determines the effect on jaw position. Sixty-four patients from two private orthodontic practices were studied using cephalometric radiographs to measure vertical change in position of the anterior and posterior teeth and the mandible. The splint wear time ranged from a minimum of one half year to a maximum of 4.8 years, with a mean of 1.33 years. No significant change was recorded in the distance from the mandibular molar to the mandibular plane. On average, the maxillary incisor and maxillary molar extruded about 1 mm, while the mandibular molar was unchanged and the mandibular incisor intruded about 0.6 mm. Posterior face height increased an average of 1.6 mm, and anterior face height increased an average of 2.7 mms. In 20% of the patients, intrusion of the mandibular molars of 1 mm or more occurred. In 41%, extrusion of the maxillary incisors of 1 mm or more was noted. Intrusion of the upper molars or extrusion of the lower incisors occurred in only 5% of the patients. The data indicates that only a very small proportion of patients having long term splint therapy using the MORA have clinically significant molar intrusion. Change in mandibular position was expressed in a vertical increase in posterior and anterior face height. Only very small changes occurred in antero-posterior position.