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。     

2种咬合板治疗颞下颌关节紊乱病的临床疗效分析

目的：研究松弛型咬合板和稳定型咬合板治疗颞下颌关节紊乱病(TMD)的疗效。方法：选择以口颌面部疼痛为主诉的TMD患者68例(急性30例,慢性38例),每组分别戴用松弛型咬合板和稳定型咬合板,比较分析治疗前、后颞肌前束(TA)、咬肌(MM)肌电值及关节疼痛强度的变化。采用SPSS 11.0 软件包对数据进行方差分析和t检验。结果：①静息状态下,2种咬合板治疗后,患者双侧TA及MM肌电电位均较治疗前显著下降(P<0.05)。②紧咬状态下,松弛型咬合板治疗的急性组患者双侧TA及MM肌电电位均较治疗前显著上升,而慢性组患者仅双侧MM肌电电位较治疗前显著上升(P<0.05);稳定型咬合板治疗组患者双侧TA肌电电位治疗前后无显著差异,仅双侧MM肌电电位较治疗前显著上升。③2种咬合板治疗后,患者疼痛指数均较治疗前显著下降;但松弛型咬合板治疗后,在功能状态下,急性组患者疼痛缓解的程度更显著。结论：松弛型和稳定型咬合板均对咀嚼肌有松弛作用,能缓解TMD疼痛,但松弛型咬合板治疗急性TMD患者的疗效更加显著。     

稳定性咬合板治疗颞下颌关节紊乱病的咀嚼肌肌电图研究

目的：通过对颞下颌关节紊乱病（Temporomandibular disorders,TMD）患者进行稳定性咬合板的可逆性咬合治疗,然后利用肌电图仪测量治疗前后患者的咀嚼肌（TA和MM）的肌电情况,分析探讨用稳定性咬合板对颞下颌关节紊乱病患者咀嚼肌肌电图的影响。方法：选取来我院就诊的10例咀嚼肌功能紊乱患者,在稳定性咬合板治疗前和治疗后3个月时,分别用肌电图仪对其咀嚼肌（TA和MM）进行肌电检查,并通过比较治疗前后的咀嚼肌活动不对称指数情况。结果：戴入稳定性咬合板3个月后,颞肌前束与咬肌的MPP和ICP高电位降低（P〈0.05）;最大紧咬时双侧咀嚼肌总体不对称性指数（Astot）、双侧颞肌不对称性指数（ASTA）和双侧咬肌不对称性指数（ASMM）均降低（P〈0.05）。结论：颞下颌关节紊乱病患者通过稳定性咬合板进行咬合治疗后,使患者双侧咀嚼肌的MPP和ICP高电位较治疗前有明显的降低,最大紧咬时双侧咀嚼肌活动不对称性得到明显的改善。     

视觉反馈诱导下升颌肌不同水平主动收缩的表面肌电研究

目的:探索持续紧咬、咬合力水平和视觉反馈三因素对正中紧咬时颞肌前束和咬肌的肌电活动水平是否存在协同作用。方法:应用T-Scan III咬合分析仪和BioEMG III肌电图仪同步记录25例健康正常成年人以轻度、中等、最大咬合力做正中紧咬时双侧颞肌前束(TA)和咬肌(MM)的肌电活动,并以多因素方差分析方法分析咬合力水平、力值视觉反馈和维持因素对肌电活动的影响。结果:析因分析结果显示,双侧TA和MM的肌电活动水平均随咬合力增高以及力量维持而增强(P<0.001),而且咬合力水平与维持因素之间存在交互作用(P<0.01),力值视觉反馈下仅一侧肌电(右侧TA和左侧MM)维持在目标水平(P>0.05)。结论:维持一定的咬合力水平将增加咬肌和颞肌前束的肌电活动,维持努力与咬合力水平之间存在交互作用。咬合力水平视觉反馈对降低肌电活动水平有一定的作用。     

单侧咬合接触对咬肌和颞肌正中咬合最大紧咬电位的影响

目的 :检测单侧咬合接触状态下最大紧咬时 ,双侧咬肌和颞肌前束的电位活动 ,探讨此二肌的功能特点。方法 :9名正常男性大学生 ,采用EM2型肌电仪检测自然状态下正中最大紧咬和单侧咬合接触 (一侧咬棉条 ,另一侧咬合不接触 )状态下正中最大紧咬时 ,双侧咬肌和颞肌前束的电位。结果 :自然状态下正中最大紧咬时 ,双侧颞肌前束肌、双侧咬肌肌电值均无显著差异 (P >0 0 5 ) ;单侧咬合接触正中最大紧咬时 ,咬合接触对侧颞肌前束肌电值明显降低 (P <0 0 5 ) ,咬肌肌电值无明显变化 (P >0 0 5 )。结论 :正中咬合时 ,是否有咬合接触关系对颞肌前束的肌电活动有明显影响 ,而对咬肌的肌电活动无明显影响。     

稳定型咬合板治疗颞下颌关节紊乱病疼痛症状的研究

目的：探讨稳定型咬合板治疗颞下颌关节紊乱病（TMD）疼痛的疗效。方法：TMD疼痛患者61例，急性组28例（男11例，女17例）；慢性组33例（男18例，女15例）。记录治疗前后疼痛指数，双侧颞肌前束（temporal anterior，TA）和咬肌（masseter muscle，MM）牙尖交错位最大紧咬时电位及最大紧咬时咬合接触情况。结果：（1）2组治疗后1月疼痛指数均明显低于治疗前（P〈0．05），治疗前后疼痛强度差值及显效率2组之间无显著差异（P〉0．05）。（2）治疗后无论是急性组还是慢性组TA及MM最大紧咬电位症状侧均较治疗前明显升高（P〈0．05），而非症状侧治疗前后无明显差异（P〉0．05）。（3）治疗后急性组TA和MM肌电不对称指数与治疗前相比均明显降低（P〈0．05）。治疗后肌电不对称指数TA慢性组明显高于急性组（P〈0．05），而MM无明显差异（P〉0．05）。（4）2组治疗前后左、右两侧咬合接触点数、以及咬合接触不对称指数无明显差异（P〉0．05）。结论：稳定型咬合板治疗可以明显缓解TMD疼痛，但对急、慢性疼痛的缓解程度无明显差异。其机制可能与肌功能活动情况易于得到明显改善等生理学基础有关。     

OSAHS患者戴用下颌前移矫治器后咀嚼肌肌电活性变化的研究

目的:探讨OSAHS患者戴用下颌前移矫治器对咀嚼肌肌电活性的初期影响。方法:随机选取37例使用下颌前移矫治器治疗的OSAHS患者,分别在戴用前和戴用1周后利用Bio-EMGⅢ肌电图仪记录在息止位、最大紧咬位时颞肌前束、咬肌的表面肌电图,对比分析左、右侧同名肌肉的不对称指数,以及颞肌前束/咬肌的活动指数在戴用前后的变化。结果:戴用下颌前移矫治器后在息止位和最大紧咬位:1)各组肌肉肌电幅值均未见明显变化;2)各咀嚼肌的不对称指数均未见明显变化;3)颞肌前束/咬肌的活动指数明显增加(P<0.05)。结论:OSAHS患者戴用下颌前移矫治器1周后出现了颞肌前束相对咬肌肌电活动强度增加的变化,应对其进行长期随访。     

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。     

磨牙症患者咀嚼肌肌电特征的研究

目的探讨磨牙症对咀嚼肌功能的影响以及咀嚼肌受损的肌电表现。方法收集24例磨牙症患者和16例无磨牙症学生分别作为磨牙症组和正常组。用Bio PAK口颌功能诊疗系统测量双侧颞肌前束（TA）、咬肌（MM）、二腹肌前腹（DA）和胸锁乳突肌（SCM）在姿势位、牙尖交错位（ICP）最大紧咬和吞咽时的表面肌电活性。结果磨牙症组姿势位时TA和MM的肌电幅值明显高于正常组,而ICP最大紧咬时TA和MM的肌电幅值明显低于正常组,以上差异均有统计学意义（P<0.05）;吞咽时2组各肌肉的肌电幅值没有明显差别。磨牙症组ICP最大紧咬时TA和MM的不对称指数与正常组无统计学差异（P>0.05）。结论磨牙症患者的咀嚼肌功能紊乱主要表现为颞肌前束和咬肌在姿势位呈高电位,而在ICP最大紧咬时呈低电位。     

口颌面痛激光照射与Myomonitor治疗的比较研究

目的：比较激光照射（A法）与Myomonitor（B法）治疗口颌面痛的疗效。方法：TMD疼痛病例70例,分A、B治疗组,分别用A法和B法治疗。疼痛视觉分析指数（VAS）评价疼痛,记录牙尖交错位最大紧咬时双侧颓肌前束（TA）及咬肌（MM）肌电,以咬合膜片记录咬合接触。结果：①治疗后两组VAS值均降低,但B法慢性组显效率较高（P〈0.05）。②A法治疗后急性组TA及MM,B法治疗后急性组TA、MM及慢性组MM电位对称性增高（P〈0．05）。③咬合接触点数仅B法治疗后急性组有所增加（P〈0．05）。结论：激光照射与myomonitor治疗均可缓解TMD疼痛,但对慢性疼痛Myomonitor疗效更明显。TMD疼痛与双侧肌功能不协调有关。     

Influence of occlusal stabilization splints and soft occlusal splints on the electromyographic pattern, in basal state and at the end of six weeks treatment in patients with bruxism

The aim of this study is to assess the electrical activity generated in temporal and masseter muscles during voluntary muscular contraction of patients with bruxism, as a result of the use of two types of occlusal splints (occlusal stabilization splint and soft occlusal splint) in which 2 groups of 8 patients were evaluated -12 women and four men aged 19 to 40 years, who used a single type of occlusal splint for 46 to 60 days. The splints were made from sheets of rigid acetate plus heat-cured acrylic (occlusal stabilization splint, control group) and sheets of flexible acetate (soft occlusal splint, experimental group). Two electromyographic tests (EMG) were performed on each patient; one before placing the splint and another at the end of the treatment. The statistical analysis used was computerized variance ANOVA analysis with F distribution (P < or = 0.025). In the control group, muscle electrical activity increased significantly in 5 patients and decreased slightly in 3. In the experimental group, there was considerable reduction of such activity in 6 patients and a slight increase in 2. There is a statistically significant difference (P < or = 0.025) between the muscle electrical activity generated in the control group and in the experimental group. The increase in muscle electrical activity in the control group may have been due to a neuromuscular recovery process; while the decrease in the experimental group might have been due to a negative or decremental process of muscular organization to prevent the recruitment of new motor units. Occlusal stabilization splints are therefore considered better than soft occlusal splints.     

Effect of occlusal splints on the electromyographic activities of masseter and temporal muscles during maximum clenching.

OBJECTIVES: Despite the broad use of occlusal splints in the treatment of temporomandibular disorders, the efficacy of splints is a source of controversy. In this study, the effectiveness of occlusal splints on the electromyographic activity of the masseter and temporal muscles in healthy individuals was investigated. METHOD AND MATERIALS: An occlusal splint was made for 25 healthy individuals. Surface electromyographic recordings were done during maximum clenching without the splint and immediately after application of the splint. The relative level of activity in the masseter and temporal muscles was quantified by means of activity index. Paired t test and Wilcoxon signed-rank tests were used for data analysis. RESULTS: The mean electromyographic activities of masseter and temporal muscles (in mV/s) were 0.7712 and 1.0488 without the splint and 0.8396 and 0.9276 immediately after application of the splint. There was no significant difference between the electromyographic activities of both muscles before and after insertion of the splints. The activity index increased after application of the occlusal splints. This increase was also insignificant. CONCLUSION: Immediate application of occlusal splints has no significant effect on the activity of masseter and temporal muscles. It could decrease the relative activity of the temporal to the masseter muscle (increasing the activity index).     

The effect of intermittent use of occlusal splint devices on sleep bruxism: a 4‐week observation with a portable electromyographic recording device

This randomised controlled study investigated the effect of intermittent use of occlusal splints on sleep bruxism compared with that of continuous use by measuring masseter muscle electromyographic activity using a portable electromyographic recording system. Twenty bruxers were randomly allocated to the continuous group and intermittent group. Subjects in the continuous group wore stabilisation splints during sleep for 29 nights continuously, whereas those in the intermittent group wore splints during sleep every other week, that is they used splints on the 1st–7th, 15th–21st and 29th nights. Electromyographic activity of the masseter muscle during sleep was recorded for the following six time points: before (baseline), immediately after, and 1, 2, 3 and 4 weeks after the insertion of a stabilisation splint. The number of nocturnal masseter electromyographic events, duration and the total activity of sleep bruxism were analysed. In the continuous group, nocturnal masseter electromyographic events were significantly reduced immediately and 1 week after the insertion of the stabilisation splint, and duration was reduced immediately after the insertion (P < 0·05, Dunnett's test), but no reduction was observed at 2, 3 and 4 weeks after insertion. In the intermittent group, nocturnal masseter electromyographic events and duration were significantly reduced immediately after and also 4 weeks after insertion of the stabilisation splint (P < 0·05, Dunnett's test). The obtained results of the present exploratory trial indicate that the intermittent use of stabilisation splints may reduce sleep bruxism activity for a longer period compared with that of continuous use.     

Immediate effect of the resilient splint evaluated using surface electromyography in patients with TMD

The aim of this study was to analyze the immediate effect of resilient splints through surface electromyography testing and to compare the findings with the electromyographic profiles of asymptomatic subjects. The participants were 30 subjects, 15 patients with TMD (TMD Group) and 15 healthy subjects (Control Group), classified according to Research Diagnostic Criteria (RDC/TMD) Axis I. A resilient occlusal splint was made for each patient in the TMD Group from two mm thick silicon to cover all teeth. The EMG examination was performed before and immediately after installing the splint. Three tests were performed as follows: 1. Maximum Voluntary Contraction (MVC) using cotton rolls (standards test); 2. MVC in maximal intercuspation position; and 3. MVC with the splint in position. The EMG signal was recorded for five seconds. EMG indices were calculated to assess muscle symmetry, jaw torque, and impact. There was a statistically significant difference when comparing the results among the study groups. The symmetry index values in the Control Group were higher than the TMD Initial Group and similar to the TMD Group after the installation of the splint. The index values of torque were higher in TMD Initial Group when compared with the Controls. Impact values were lower than normal values in the TMD Initial Group and restored upon installation of the splint. The resilient occlusal splints may be used as complementary or adjunctive treatment of temporomandibular disorders.     

Influence of vertical dimension on masseter muscle electromyographic activity in patients with mandibular dysfunction

Occlusal splints were adjusted to different vertical heights and used to single out the influence of vertical dimension of occlusion in increments on BT-EMG activity of the masseter muscle in patients with mandibular dysfunction. The vertical dimension of least EMG activity was determined for each of 60 patients, who were randomly divided into three groups according to the vertical dimension at which the occlusal splint was adjusted: group No. 1, 1 mm from occlusal vertical dimension; group No. 2, mean vertical dimension, 4.25 mm; group No. 3, mean vertical dimension, 8.25 mm. Results showed a significant reduction of masseter BT-EMG activity (series A and B) at the end of the 3-week treatment period for patients in group Nos. 2 and 3 in comparison with group No. 1. Furthermore, the short-term use of occlusal splints with a vertical height that exceeded the so-called physiologic interocclusal distance did not result in an increase in masseter BT-EMG activity. This study suggests that an increase of vertical dimension of occlusion to or near the vertical dimension of least EMG activity by means of occlusal splints can be an effective way to obtain a reduction in masseteric muscle activity.     

Effect of muscle relaxation splint therapy on the electromyographic activities of masseter and anterior temporalis muscles

The purpose of this study was to compare the effectiveness of splint therapy on the electromyographic activity of masticatory muscles (anterior temporalis and masseter) before and after the application of a muscle relaxation splint. Electromyography recordings from the masseter and anterior temporalis muscles were analyzed quantitatively during maximal biting in the intercuspal position both before and after treatment without a splint. Fourteen patients whose chief complaint was masticatory muscle pain were selected for the study. After the initial evaluations muscle relaxation splints were applied, and the patients were instructed to use the splints for 6 weeks. Surface electromyographic recordings were taken from each patient before the beginning of clinical therapy and after 6 weeks of wearing the splints. The data obtained were analyzed through paired sample t tests and Wilcoxon's signed rank tests. The results of the study were as follows: (1) the electromyographic activity of the two muscles during maximal biting was not markedly changed after the muscle relaxation splint was used; and (2) the changes observed in electromyographic activity of the involved and noninvolved sides were insignificant as well.     

EVALUATION OF MICROCURRENT ELECTRICAL NERVE STIMULATION (MENS) EFFECTIVENESS ON MUSCLE PAIN IN TEMPOROMANDIBULAR DISORDERS PATIENTS

The effect of Microcurrent Electrical Nerve Stimulation (MENS) was evaluated and compared with occlusal splint therapy in temporomandibular disorders (TMD) patients with muscle pain. Twenty TMD patients were divided into four groups. One received occlusal splint therapy and MENS (I); other received splints and placebo MENS (II); the third, only MENS (III) and the last group, placebo MENS (IV). Sensitivity derived from muscle palpation was evaluated using a visual analogue scale. Results were submitted to analysis of variance (p<0.05). There was reduction of pain level in all groups: group I (occlusal splint and MENS) had a 47.7% reduction rate; group II (occlusal splint and placebo MENS), 66.7%; group III (MENS), 49.7% and group IV (placebo MENS), 16.5%. In spite of that, there was no statistical difference (analysis of variance / p<0.05) between MENS and occlusal splint therapy regarding muscle pain reduction in TMD patients after four weeks.     

[牙合]垫对牙齿重度磨耗患者口颌功能影响的临床研究

目的：研究殆垫对牙齿重度磨耗患者口颌功能的影响。方法：用殆垫恢复10例牙齿重度磨耗患者的垂直距离,分别检测治疗前、治疗后1个月、3个月、6个月的咬合平衡性、咬肌及颞肌前束的肌电幅值、颌位及殆的稳定性以及边缘运动的平滑度及对称性的变化。结果：①咬合平衡性、颌位及胎的稳定性以及边缘运动轨迹的平滑度及对称性在治疗后呈逐渐改善趋势,治疗6个月后80％的患者恢复正常;②治疗后各组的息止位肌电幅值均较治疗前显著降低（P〈0．05）,正中颌位紧咬时肌电幅值在治疗后3个月组和6个月组较治疗前显著增加（P〈O．05）。结论：通过6个月的治疗和观察,聆垫对重度磨耗患者的口颌功能的影响呈现持续改善趋势。     

The immediate effects of a stabilization splint on the muscular symmetry in the masseter and anterior temporal muscles of patients with a craniomandibular disorder

In 36 myogenous craniomandibular disorder patients, the immediate effects of a stabilization splint on the symmetry in the activities of the masseter and anterior temporal muscles during submaximal clenching at five clenching levels were investigated electromyographically. After the adjustment of the splint necessary at the time of delivery, 20 splints remained free from occlusal interferences throughout the treatment period and thus needed no further adjustment. These splints caused an immediate improvement in masseter muscle symmetry at the time of delivery (p less than 0.01). However, 16 splints needed further adjustment for occlusal interferences at the first recall, 2 weeks after delivery of the splint. These splints resulted in a small but statistically significant worsening in masseter muscle symmetry at the 10% clenching level (p less than 0.01). No such response was found for temporal muscle activity. The immediate changes in masseter muscle activity suggest that muscular symmetry is an objective basis in the evaluation of the treatment provided.