咬合板治疗颞下颌关节盘移位的疗效评价

目的：对临床使用咬合板治疗颞下颌关节盘移位病例进行疗效评价，比较稳定性咬合板和再定位咬合板疗效。方法：使用稳定性咬合板治疗的病例66人（男19人，女47人），再定位咬合板29人（男9人，女20人）。以上病例均是通过临床检查、颞下颌关节许勒位片和关节上腔造影确诊为颞下颌关节盘前移位。研究设计与统计：分别对两组用咬合板治疗前后的关节弹响，疼痛指数，压痛的程度，以及病人对治疗的满意程度进行统计，对部分人治疗后的关节造影及许勒位进行评价，用SPSS建立数据库，用卡方检验比较两组治疗效果有无显著性差异。结果：95例患者中，经过咬合板治后，关节弹响的消失的有69例，消失为72．63％。关节弹响减轻有17例，治疗弹响的有总的效率为90．5％。两种咬合板的分组对照，在两组在弹响治疗效果上没有差异（χ^2值为0．138，P=0．719）。在治疗前有疼痛的患者41名中，经过咬合板治疗后有34名患者疼痛消失，其比率为82．96％，其它7名患者均表示疼痛较治疗前有改善，在两种咬合板治疗的分组统讲计中，疼痛的治疗效果没有显著性差异（χ^2值为0．005，P=0．967）。结论：两种咬合板治疗关节盘前移位均有疗效，当稳定性咬合板无法消除的弹响用再定位咬合板治疗也可以达到很好的疗效。     

Temporomandibular Joint: Disorders,Treatments, and Biomechanics

Temporomandibular joint (TMJ) is a complex, sensitive, and highly mobile joint. Millions of people suffer from temporomandibular disorders (TMD) in USA alone. The TMD treatment options need to be looked at more fully to assess possible improvement of the available options and introduction of novel techniques. As reconstruction with either partial or total joint prosthesis is the potential treatment option in certain TMD conditions, it is essential to study outcomes of the FDA approved TMJ implants in a controlled comparative manner. Evaluating the kinetics and kinematics of the TMJ enables the understanding of structure and function of normal and diseased TMJ to predict changes due to alterations, and to propose more efficient methods of treatment. Although many researchers have conducted biomechanical analysis of the TMJ, many of the methods have certain limitations. Therefore, a more comprehensive analysis is necessary for better understanding of different movements and resulting forces and stresses in the joint components. This article provides the results of a state-of-the-art investigation of the TMJ anatomy, TMD, treatment options, a review of the FDA approved TMJ prosthetic devices, and the TMJ biomechanics.     

The prevalence of temporomandibular disorders in patients with late whiplash syndrome who experience orofacial pain: A case-control series study

BackgroundThe authors conducted a study to compare the frequency of specific temporomandibular disorder (TMD) diagnoses in patients who had late whiplash syndrome (LWS) with that in a control group.MethodsThe authors recruited 65 patients who had orofacial pain and a previous diagnosis of LWS and 65 age- and sex-matched control patients who had chronic orofacial pain without a history of whiplash injury (WI) for a case-control series study. All patients completed a questionnaire pertaining to the Research Diagnostic Criteria for Temporomandibular Disorders and underwent a clinical examination.ResultsThe authors compared the frequency of TMD diagnoses in case patients with that in control patients by using a χ² test; they set the α level a priori at .05. The number of patients diagnosed with myofascial pain (MP) and disk displacement with reduction (DDWR) was significantly higher in the case group than in the control group (P = .002 and P = .001, respectively).ConclusionsThe results of this study show a higher frequency of MP and DDWR in patients with LWS than in patients with chronic orofacial pain and no history of WI.Practical ImplicationsClinicians should be knowledgeable about the correlation between WI and TMD so they can inform and treat patients accurately.     

Improvement in patients with a TMD‐pain report. A 6‐month follow‐up study

Even though chronic TMD pain tends to persist in most patients, some chronic patients show improvement. It is largely unknown which factors contribute to the improvement of chronic pain. The aim of this study is to investigate which factors, from a biopsychosocial perspective, help to predict improvement in patients with a report of TMD pain. Methods: Subjects with a report of TMD pain were recruited in seven TMD clinics. They received a baseline questionnaire which included a wide range of possible predictors for improvement. After 6 months they received a follow‐up questionnaire which included a measure to determine which participants were ‘improved’ or ‘not improved’. To study which predictive variables were associated with improvement, multiple regression models were built. Results: From the 129 patients who responded to the baseline questionnaire, 100 patients also filled in the follow‐up questionnaire (85% women, mean age (years) ± s.d. = 46·0 ± 13·8). Fifty percentage of these subjects had improved at the 6‐month follow‐up. Pain duration was the strongest (negative) predictor for 6‐month improvement (P = 0·009). Also the number of care providers (P = 0·017) and the degree of hindrance on function (P = 0·045) helped to predict improvement. Conclusions: The duration of the TMD‐pain complaint, the number of care practitioners attended and the degree of hindrance on function (negatively) helped to predict 6‐month improvement. No evidence is found to support the role of psychological or social factors on the improvement in patients with a report of TMD pain.     

Adverse effects of orthodontic treatment: A clinical perspective

Orthodontic treatment is associated with a number of adverse effects, such as root resorption, pain, pulpal changes, periodontal disease, and temporomandibular dysfunction (TMD). Orthodontists should be aware of these effects and associated risk factors. Risk factors linked to root resorption include the duration of treatment, length, and shape of the root, trauma history, habits, and genetic predisposition.     

Genetic diversity of Porphyromonas gingivalis and its possible importance to pathogenicity

During recent years much effort has been put into understanding the genetic composition of the oral populations of black-pigmented anaerobic bacteria. One of them, Porphyromonas gingivalis, is a putative periodontopathogenic organism considered to be particularly relevant in the etiology of adult periodontitis. It has been shown in studies using molecular typing methods that most bacterial populations consist of numerous genetic clones, and that only a small proportion of these clones cause disease. Elucidation of a possible association of genotypic profiles with either disease or clinical healthy condition is important for understanding the pathogenic characteristics of bacteria. Studies addressing this issue as it relates to P. gingivalis are reviewed in the present article. Genotypic characterization of P. gingivalis strains has revealed extensive heterogeneity in natural populations of this bacterium. Some of the potential virulence factors of P. gingivalis have been purified and cloned and methods have been established to identify their genes. Although no studies have clearly defined the relationship between a specific genotype of P. gingivalis and periodontal status of the host, it seems that molecular typing tools, which are undergoing rapid improvements, will allow us to distinguish between virulent and avirulent strains of the same species in the near future.     

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。     

Biomechanical and biochemical outcomes of porcine temporomandibular joint disc deformation

ObjectiveThe structure–function relationship in the healthy temporomandibular joint (TMJ) disc has been well established, however the changes in dysfunctional joints has yet to be systematically evaluated. Due to the poor understanding of the etiology of temporomandibular disorders (TMDs) this study evaluated naturally occurring degenerative remodeling in aged female porcine temporomandibular joint (TMJ) discs in order to gain insight into the progression and effects on possible treatment strategies of TMDs.DesignSurface and regional biomechanical and biochemical properties of discal tissues were determined in grossly deformed (≥Wilkes Stage 3) and morphologically normal (≤Wilkes Stage 2) TMJ discs.ResultsCompared to normal disc structure the deformed discs lacked a smooth biconcave shape and characteristic ECM organization. Reduction in tensile biomechanical integrity and increased compressive stiffness and cellularity was found in deformed discs. Regionally, the posterior and intermediate zones of the disc were most frequently affected along with the inferior surface.ConclusionsThe frequency of degeneration observed on the inferior surface of the disc (predominantly posterior), suggests that a disruption in the disc-condyle relationship likely contributes to the progression of joint dysfunction more than the temporodiscal relationship. As such, the inferior joint space may be an important consideration in early clinical diagnosis and treatment of TMDs, as it is overlooked in techniques performed in the upper joint space, including arthroscopy and arthrocentesis. Furthermore, permanent damage to the disc mechanical properties would limit the ability to successfully reposition deformed discs, highlighting the importance of emerging therapies such as tissue engineering.