正畸治疗与颞下颌关节症状的相关研究

目的：探讨正畸治疗和颞下颌关节紊乱病（TMD）的关系。方法：设计正畸组、错[牙合]组和正常组的调查表,用Visual Foxpro6．0建立相应的数据库,对173例已正畸治疗者、95例有错[牙合]畸形但未治疗者和32例正常对照进行TMD症状、体征及相关情况的问卷调查和专科检查,所得结果用基于Helkimo指数改良设计的数据库进行分析,采用SPSS10．0软件包进行成组设计两样本比较的秩和检验。结果：正畸组和错[牙合]组在主诉症状指数、临床症状指数和咬合指数的分布上存在显著差异（P〈0．001）;正畸组和正常组在主诉症状指数和临床症状指数的分布上有显著差异（P〈0．001）,但在咬合指数的分布上无显著性差异（P〉0．05）。结论：正畸治疗后患者在一定时期内易出现颞下颌关节紊乱病的症状和体征。     

计算机辅助研究正畸治疗与颞下颌关节紊乱病关系

目的 :探讨正畸治疗和颞下颌关节紊乱病的关系。方法 :设计调查表和相应的数据库 ,对 173例已正畸治疗者和 95例未治疗的错牙合患者进行颞下颌关节紊乱病的症状、体征及相关情况的问卷调查和专科检查 ,所得结果用数据库进行分析和统计。结果 :成功地建立了调查表和数据库 ;正畸组和错牙合组在主诉症状指数、临床症状指数和咬合指数的分布上都有显著性差异 (P <0 .0 0 1)。结论 :数据库在颞下颌关节紊乱病的临床研究中有较大的实用价值 ;正畸治疗后的患者在一定的时期内可能会出现颞下颌关节紊乱病的症状和体征     

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颞下颌关节紊乱病（TMD）是一种由关节结构、咬合、肌功能异常及精神心理等多种因素综合作用形成的口颌面部疾病。闭锁型深覆[牙合]、个别前牙与后牙反[牙合]、后牙锁[牙合]、一侧后牙反[牙合]、下颌偏斜、磨牙伸长、磨牙倾斜等是诱发TMD的高危险[牙合]因素。从整体分析,正畸治疗与TMD并无密切相关性,但部分病例TMD的发生仍可能与正畸治疗不当有关。良好的牙齿排列、正常的前牙覆[牙合]与覆盖关系及后牙尖窝对应关系、牙位与肌位一致、下颌前伸与侧[牙合]平衡是有效预防与缓解TMD的可靠保证。本文对错[牙合]畸形及正畸治疗与TMD的相关性研究文章进行系统回顾,结合正畸临床实际,分析错[牙合]畸形与TMD的内在联系,以及正畸治疗中TMD的风险和防治策略。     

红外偏振光治疗各类颞下颌关节紊乱病的疗效分析

目的:探讨红外偏振光对不同类型颞下颌关节紊乱病的临床疗效,为临床正确选择这种理疗技术的适应证提供依据。方法:对426例颞下颌关节紊乱病患者(657侧关节)进行了红外偏振光理疗。结果:发现红外偏振光理疗对各类型颞下颌关节紊乱病引起的关节或肌肉区的疼痛症状有明显的疗效;对咀嚼肌紊乱疾病类引起的肌肉区疼痛的疗效(94%)高于对有关节结构紊乱疾病类引起的关节疼痛症状为主的疗效(72%);对非绞锁关节张口度的改善具有良好的疗效;经治疗后,在疼痛明显减轻的同时,关节弹响的发生率反而提高;对关节结构紊乱疾病类引起的下颌绞锁运动没有显著疗效,绞锁关节张口度在治疗前后没有显著性差异;近期观察关节内骨关节病类改变没有明显差异。结论:红外偏振光理疗对各类型颞下颌关节紊乱病引起的关节或肌肉区的疼痛症状有良好的疗效,并可以改善张口度。对可能由关节结构紊乱引起的弹响及下颌绞锁运动没有明显疗效,在有下颌绞锁运动的情况下,对张口度的改善亦不明显,对关节内骨关节病类改变没有明显近期疗效。     

利用咬合力计指导调治疗颞下颌关节紊乱病

目的：用咬合力计指导调[牙合]并评价调[牙合]对治疗TMD的疗效。方法：随机选取10例因TMD来我院就诊的患者,取观测模型,分析其咬合,并进行调[牙合]。根据调[牙合]治疗前后其临床症状改善情况,进行疗效分析。结果：3个月后多数患者的颌面部肌肉酸痛、无力、关节弹响、开口型异常等症状缓解或消失。结论：（1）调[牙合]是治疗TMD的一种有效的治疗方法。（2）咬合力计能够客观、真实、准确地反应出咬合接触点的详细情况。     

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牙合因素在颞下颌关节紊乱病（temporomandibular disorders,TMD）的病因和病理中占有重要地位。Spee曲线是评价牙合这一生物力学三维结构中垂直向位置关系的关键指标,该曲线与TMD相关性的研究与分析一直是口腔医学中常做常新的课题。本文从Spee曲线的基本功能、形态特点以及各类影响因素等方面,对该曲线与TMD的相关性研究现状进行综述,并提出相关展望。     

颞下颌关节急慢性操作的(牙合)间矫治

目的:进一步阐明间矫治颞下颌关节急慢性损伤的作用机制,以扩展其应用范围,提高医疗质量。方法:对与颅颌系统间解剖生理关系的复习;对颞下颌关节急慢性损伤病因病变情况分析,对扩展应用病种治疗作用的临床观察及对多项间矫治作用机制实验研究结果的综合分析。结果:间矫治具有较恒定的调整下颌骨与颅骨间的三维关系的作用,从而减轻关节区应力和缓解肌张力,使颌部双侧肌力与关节运动平衡协调,增加其活动度,促进其生理性改建,避免其病理性继发损伤。结论:间矫治是治疗颞下颌关节急慢性损伤不可缺少的重要措施之一,特别是因其无创而又效果肯定,其应用范围尚能进一步开拓与发展。     

双颌前突患者正畸治疗后颞下颌关节紊乱病发生状况及危险因素分析

目的:观察双颌前突患者经正畸治疗后颞下颌关节紊乱病(TMD)的发生情况,探讨造成这一现象的可能因素,以期指导TMD的合理预防.方法:收集2019年3月—2020年10月于河北省人民医院接受正畸治疗的80例双颌前突患者的临床资料进行回顾性分析,参照相关文献判定方法,将其中正畸治疗后发生TMD的患者纳入实验组,其余患者纳入...     

Prevalence of temporomandibular disorders (TMD) among Finnish prisoners: cross-sectional clinical study

Objective: The aim of the present study was to evaluate the prevalence of self-reported temporomandibular disorders (TMD) symptoms and clinically diagnosed TMD among Finnish prisoners.

Material and methods: Altogether 100 prisoners from the Pelso Prison, Vaala, Finland, underwent dental and TMD clinical examinations performed by a calibrated and well-trained dentist. Symptom Questionnaire and clinical examination according to a Finnish pre-final version of the DC/TMD (Diagnostic Criteria for Temporomandibular Disorders) Axis I protocol were used to evaluate the prevalence of TMD sub-diagnoses.

Results: The most common TMD symptoms were facial pain (54.0%), temporomandibular joint noises (43.0%) and headache (37.0%). The prevalence of joint-related TMD diagnoses was four and a half times higher than diagnoses attributed with pain (76.0% vs. 17.0%). The most common TMD diagnoses were degenerative joint disease (33.0%) and disc displacement with reduction (33.0%).

Conclusions: The prevalence of self-reported TMD symptoms and clinical assessed TMD, especially join-related TMD diagnoses, is high among Finnish prisoners. Examination and treatment of TMD should become a common practice also in prison dental care.     

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提要：颞下颌关节紊乱病（TMD）是口腔临床常见病之一,其治疗方法众多。咬合板作为一种保守、可逆的治疗方法被广泛应用在TMD的治疗上。然而,各类咬合板治疗TMD的疗效尚不完全明确,本文结合近年来国内外文献对其进行综述。     

“Management of recurrent temporomandibular dislocation using orthodontic traction screws.”

Temporomandibular joint dislocation is defined as the loss of joint congruency between the mandibular condyle and the glenoid fossa of the temporal bone. Multiple therapeutic options have been proposed for the treatment of recurrent TMJ dislocation. The aim of this paper is to present two recently treated cases with a modification of Wolford's technique, replacing the Mitek anchors with orthodontic screws. Case series: The first case concerns a 36 year-old women with recurrent temporomandibular dislocation, and the second one a 26 year-old patient with the same diagnosis. In both cases, one 8mm orthodontic screw was placed in the lateral pole of mandibular condyle, sutured with PremiCron® 2/0 to a hole made in the root of each zygomatic arch. At twelve-month follow-up (first patient) and at six-month follow-up (second patient), patients had not presented new episodes of mandibular dislocation and mouth opening range remained stable.This technique can be considered as an alternative to Wolford's technique in treating recurrent temporomandibular dislocation when conservative management fails.     

Activator矫治对颞下颌关节的影响及其与颞下颌关节紊乱病的关系

Activator矫治器是较早用于临床的功能矫治器,由Andresen于1908年设计,对安氏Ⅱ类1分类错(牙合)畸形患者有良好的治疗效果,通过前移下颌刺激下颌骨的生长且抑制上颌矢状向生长,从而调节上下颌骨矢状向的关系.目前,关于Activator矫治器的矫治原理还存在较多的分歧,其中之一就有Activator是否能刺...     

Prevalence of temporomandibular disorders in patients seeking orthodontic treatment: A systematic review

The objective of this systematic review was (a) to establish the prevalence of temporomandibular disorders (TMDs) in patients seeking orthodontic treatment and (b) to determine the association between the presence of TMD and sex, age and malocclusion. A systematic literature search was performed according to PRISMA guidelines from 1969 to 2019 using the PubMed and LIVIVO databases. Eight study articles met the inclusion and exclusion criteria. An additional three contributions were identified through manual searching of the reference lists of retrieved articles. The methodological quality of the 11 articles was assessed with the Joanna Briggs Institute Critical Appraisal Checklist for prevalence studies. TMD prevalence ranged from 21.1% to 73.3%. The frequency of painful TMD signs/symptoms varied from 3.4% to 65.7%, while non-painful signs/symptoms ranged from 3.1% to 40.8%. The percentage of males and females presenting with TMD varied from 10.6% to 68.1% and 21.2 to 72.4%, respectively. In all studies, TMD prevalence was higher among females. The majority of articles reported more TMD signs/symptoms in individuals older than 18 years as compared to younger ones (≤18 years). While in four studies no association between TMD and malocclusion was found, another three investigations indicated that TMD may be related to certain occlusal traits. The TMD prevalence in patients seeking orthodontic treatment was high, with many individuals presenting painful TMD signs/symptoms. Female and older patients appear to have a greater occurrence of TMD. Although no strong association between TMD and malocclusion was established, several occlusal traits were implicated.     

关节镜上腔灌洗术治疗中老年颞下颌关节紊乱病的临床研究

目的：评价应用颞下颌关节镜上腔灌洗术治疗临床表现为张口受限合并关节区疼痛的中老年颞颌关节紊乱病患者的临床疗效。方法：对保守治疗无效的16例颞下颌关节紊乱病引起张口受限合并关节疼痛的中老年患者,行颞下颌关节镜上腔灌洗术,分析治疗前后不同时期患者的疼痛值（疼痛直观模拟标尺VAS）、张口度和健侧侧向运动度变化,并通过MRI检测治疗前后关节盘位置的变化。结果：治疗后张口度35mm、健侧侧向运动≥6mm的患者占87．5％（14／16）,不同时期的张口度均较治疗前有显著差异（P〈0．001）,特别在治疗后1个月内增加明显,疼痛亦有显著缓解（P〈0．001）,无并发症的发生。MRI显示,有1例患者的关节盘部分复位。结论：颞下颌关节内窥镜下的上腔灌洗术直视下操作准确,能有效治疗颞下颌关节紊乱病的患者,明显改善张口度和缓解疼痛。颞下颌关节镜治疗技术安全有效,有临床应用价值。     

医源性颞下颌关节紊乱征的临床治疗研究

目的 :对医源性颞下颌关节紊乱征进行综合治疗 ,观察其临床效果。方法 :根据医源性颞下颌关节紊乱征的临床症状及病因 ,采取不同的治疗方法 ,如修复牙列缺损、调整咬合、佩戴牙合垫、局部中药热敷及针灸治疗、按摩咀嚼肌和翼外肌 ,给予心理暗示和安慰等。结果 :综合治疗后 ,患者张口度得到明显改善 ,平均张口度从治疗前的 2 .13cm增大到 4.62cm (P <0 .0 1) ;患者痛苦感觉明显减轻 ,痛苦分值视觉模拟尺从治疗前的 7.3 6下降到2 .14 (P <0 .0 1)。结论 :医源性颞下颌关节紊乱征经过适当的治疗 ,可以改善关节状况 ,取得很好的临床疗效。     

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颞下颌关节紊乱病的咬合病因至今存在很大争议。本文介绍了我们关于该病的咬合病因研究成果,包括临床病例咬合分析、动物实验、生物力学分析、下颌运动轨迹描记以及咬合治疗措施等五个方面的内容,提出并初步论证了渐进性咬合紊乱可作为独立的致病因素导致颞下颌关节退行性改变的论点,并对今后的研究提出展望。     

Prevalence among adolescents in Bergen,Western Norway,of temporomandibular disorders according to the DC/TMD criteria and examination protocol

Objective: The aims of this study were to assess the prevalence of temporomandibular disorders (TMD) among adolescents and to contrast the prevalence of TMD according to the DC/TMD clinical examination protocol versus the prevalence of pain related to TMD according to two screening questions.

Material and methods: Two hundred and ten adolescents living in the county of Bergen, Norway, were offered an additional examination for TMD in connection with their regular dental check-up appointment. Five dental clinics were selected with differing socio-economic patient populations, as reflected by stratification of average levels of DMFT, and an equal number of girls and boys were invited to participate. The participants answered two screening questions for pain related to TMD followed by a clinical examination according to the DC/TMD protocol by five calibrated examiners.

Results: Acceptable calibration results were obtained. Approximately 80% of eligible participants consented to partake. According to the criteria of DC/TMD, the prevalence of TMD among the study participants was 11.9%, with a peak at 16 years of age. According to the self-reported screening questions for pain related to TMD, 7.2% responded positively. Only seven participants with a TMD diagnosis established according to the DC/TMD clinical examination protocol reported also pain related to TMD based on answering the two screening questions.

Conclusion: The prevalence of TMD is higher for girls than for boys and the prevalence of TMD established according to the DC/TMD criteria was higher than the prevalence of pain related to TMD estimated by use of two screening questions for self-reported pain.     

The prevalence and treatment needs of symptoms and signs of temporomandibular disorders among young adult males

A temporomandibular disorder (TMD) screening history and screening examination was performed on 523 young adult males. The screening forms were similar to those TMD forms developed and formulated under the auspices of the American College of Prosthodontists. In turn, the substance of the latter forms was initially derived from the recommendations of the President's TMD Conference of the American Dental Association, with 62 eminent researchers, educators and clinicians as participants. Each subject was given a TMD self-administered screening history form to complete, formatted in a check - the block format. It included all items considered to be classic TMD symptoms. The screening examination was performed extraorally and included (i) range of jaw movement, (ii) digital palpation of selected masticatory muscles and palpation over the pre-auricular temporomandibula joint (TMJ) area and (iii) digital palpation for TMJ sounds during jaw movement. The subjects were categorized into the following four categories: 0 = no symptoms/signs, 1 = insignificant moderate symptoms and/or signs, 2 = significant moderate symptoms and/or signs, and 3 = severe symptoms and/or signs. The overall results showed that 75% of the subjects had TMD symptoms and/or signs. There were 6.9% in category 1, 51.4% in category 2, and 16.7% in category 3. It was recommended that subjects in category 2 and 3 should have a comprehensive TMD evaluation, in order to further identify the recommended need for TMD Therapy.     

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颞下颌关节紊乱病(TMD)的保守治疗方法很多,本文重点介绍了目前临床上常用的有关TMD保守治疗的咬合板的类型、作用和适应证。咬合板治疗是临床治疗TMD的首选疗法,但目前缺乏设计完善的临床试验以证实其疗效。建议推行临床试验透明化,实施临床试验注册制度和高质量的随机对照试验(RCT),以便于总结咬合板治疗TMD的临床证据,提高TMD临床治疗水平。     

Clinical predictive factors for temporomandibular disorders following combined orthodontic and orthognathic surgical treatment in patients with Class III malocclusion

Objective: The aim of this study was to identify clinical factors predisposing to the development or worsening of temporomandibular disorders (TMDs) following orthodontic surgical treatment for Class III malocclusion.

Methods: A retrospective cohort study was performed on 88 patients with Class III malocclusion having undergone a combined orthodontic and orthognathic surgical treatment. Temporomandibular joint and masticatory muscle examinations were available prior to treatment and one year post-operatively. Multivariate logistic regression was used to predict the development of post-operative TMDs, and linear regression was used to predict the worsening of TMDs using Helkimo indices.

Results: Patients with Class III malocclusion presenting with pre-treatment anamnestic TMJ clicking (OR = 5.8; p = 0.03) and undergoing bimaxillary osteotomy procedures (OR = 18.6; p = 0.04) were more at risk for the development of TMDs.

Discussion: TMDs must be evaluated, monitored, and managed with caution in patients with Class III malocclusion presenting with pre-treatment joint clicking and who are planned for bimaxillary osteotomies.