下颌前伸再定位治疗在颞下颌关节紊乱病中的应用进展

doi:10.13591/j.cnki.kqyx.2023.10.011

摘要/Abstract

摘要：

在颞下颌关节紊乱病中,下颌前伸再定位治疗是将下颌引导至治疗性前伸位来重建生理性的关节盘-髁突-关节窝关系。前伸再定位咬合板是最常用的矫治器,可促进症状缓解和发挥颞下颌关节结构重塑作用。最近,各类活动或固定功能矫治器也逐渐应用于颞下颌关节病的下颌前伸再定位治疗,但其效果仍存在争议。本文将对不同矫治器在颞下颌关节紊乱病中的应用现状进行总结,并且分析其中盘突关系恢复的意义。

关键词: 颞下颌关节紊乱病, 前伸再定位咬合板, 功能矫治器, 关节盘移位

Abstract:

In temporomandibular disorders (TMD), anterior mandibular repositioning therapy guides the jaw into a therapeutic anterior position to re-establish a physiological disc-condyle-fossa relationship. Anterior repositioning splint (ARS) has been widely used to reduce symptoms and promote structural remodeling of the temporomandibular joint. Recently, various removable/fixed functional appliances have been gradually applied in the mandibular anterior repositioning therapy of TMD, but their effects remain controversial. This paper reviews the current status of different appliances used in TMD and summarizes implications for the restoration of the disc-articular relationship.

Key words: temporomandibular disorder, anterior repositioning splint, functional appliance, disc displacement

中图分类号:

R783.9

汪存艺, 胡济安, 施洁珺. 下颌前伸再定位治疗在颞下颌关节紊乱病中的应用进展[J]. 口腔医学, 2023, 43(10): 920-924.

WANG Cunyi, HU Ji’an, SHI Jiejun. The application progress of anterior mandibular repositioning therapy in temporomandibular disorders[J]. Stomatology, 2023, 43(10): 920-924.

参考文献 48

[1]	Fisch G, Finke A, Ragonese J, et al. Outcomes of physical therapy in patients with temporomandibular disorder:A retrospective review[J]. Br J Oral Maxillofac Surg, 2021, 59(2):145-150. doi: 10.1016/j.bjoms.2020.08.068
[2]	Guo YN, Cui SJ, Zhou YH, et al. An overview of anterior repositioning splint therapy for disc displacement-related temporomandibular disorders[J]. Curr Med Sci, 2021, 41(3):626-634. doi: 10.1007/s11596-021-2381-7
[3]	Kinzinger G, Diedrich P. Skeletal effects in class Ⅱ treatment with the functional mandibular advancer (FMA)?[J]. J Orofac Orthop, 2005, 66(6):469-490. pmid: 16331547
[4]	Tecco S, Festa F, Salini V, et al. Treatment of joint pain and joint noises associated with a recent TMJ internal derangement:A comparison of an anterior repositioning splint, a full-arch maxillary stabilization splint, and an untreated control group[J]. Cranio, 2004, 22(3):209-219. doi: 10.1179/crn.2004.026
[5]	Al-Moraissi EA, Farea R, Qasem KA, et al. Effectiveness of occlusal splint therapy in the management of temporomandibular disorders:Network meta-analysis of randomized controlled trials[J]. Int J Oral Maxillofac Surg, 2020, 49(8):1042-1056. doi: 10.1016/j.ijom.2020.01.004
[6]	Pihut M, Gorecka M, Ceranowicz P, et al. The efficiency of anterior repositioning splints in the management of pain related to temporomandibular joint disc displacement with reduction[J]. Pain Res Manag, 2018, 2018:9089286.
[7]	Huang IY, Wu JH, Kao YH, et al. Splint therapy for disc displacement with reduction of the temporomandibular joint. part Ⅰ:Modified mandibular splint therapy[J]. Kaohsiung J Med Sci, 2011, 27(8):323-329. doi: 10.1016/j.kjms.2011.03.006
[8]	Ma ZG, Xie QY, Yang C, et al. Can anterior repositioning splint effectively treat temporomandibular joint disc displacement?[J]. Sci Rep, 2019, 9(1):534. doi: 10.1038/s41598-018-36988-8 pmid: 30679602
[9]	Ma ZG, Xie QY, Yang C, et al. Changes in the temporomandibular joint space after functional treatment of disk displacement with reduction[J]. J Craniofac Surg, 2015, 26(2):e78-e81. doi: 10.1097/SCS.0000000000001392
[10]	陈慧敏, 傅开元, 李优伟, 等. 再定位牙合垫戴入前后颞下颌关节盘和髁突的位置改变[J]. 华西口腔医学杂志, 2009, 27(4):408-412.
[11]	Liu MQ, Lei J, Han JH, et al. Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement[J]. J Appl Oral Sci, 2017, 25(5):483-489. doi: 10.1590/1678-7757-2016-0471
[12]	Lei J, Yap AUJ, Li Y, et al. Clinical protocol for managing acute disc displacement without reduction:A magnetic resonance imaging evaluation[J]. Int J Oral Maxillofac Surg, 2020, 49(3):361-368. doi: 10.1016/j.ijom.2019.07.005
[13]	Chen HM, Liu MQ, Yap AUJ, et al. Physiological effects of anterior repositioning splint on temporomandibular joint disc displacement:A quantitative analysis[J]. J Oral Rehabil, 2017, 44(9):664-672. doi: 10.1111/joor.12532 pmid: 28600884
[14]	Shen P, Liu XH, Xie QY, et al. The effect evaluation of functional appliance used for class Ⅱ patients with temporomandibular joint anterior disc displacement[J]. J Craniofac Surg, 2019, 30(1):e15-e17. doi: 10.1097/SCS.0000000000004903
[15]	Lei J, Han JH, Liu MQ, et al. Degenerative temporomandibular joint changes associated with recent-onset disc displacement without reduction in adolescents and young adults[J]. J Craniomaxillofac Surg, 2017, 45(3):408-413. doi: S1010-5182(16)30339-0 pmid: 28108240
[16]	Lei J, Liu MQ, Yap AU, et al. Condylar subchondral formation of cortical bone in adolescents and young adults[J]. Br J Oral Maxillofac Surg, 2013, 51(1):63-68. doi: 10.1016/j.bjoms.2012.02.006 pmid: 22410127
[17]	Gupta A, Hazarey PV, Kharbanda OP, et al. Stress distribution in the temporomandibular joint after mandibular protraction:A 3-dimensional finite element study. Part 2[J]. Am J Orthod Dentofacial Orthop, 2009, 135(6):749-756. doi: 10.1016/j.ajodo.2007.12.026
[18]	Gupta A, Kohli VS, Hazarey PV, et al. Stress distribution in the temporomandibular joint after mandibular protraction:A 3-dimensional finite element method study. Part 1[J]. Am J Orthod Dentofacial Orthop, 2009, 135(6):737-748. doi: 10.1016/j.ajodo.2007.12.025
[19]	Liu MQ, Chen HM, Yap AU, et al. Condylar remodeling accompanying splint therapy:A cone-beam computerized tomography study of patients with temporomandibular joint disk displacement[J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 114(2):259-265. doi: 10.1016/j.oooo.2012.03.004
[20]	Yano K, Nishikawa K, Sano T, et al. Relationship between appearance of a double contour on the mandibular condyle and the change in articular disc position after splint therapy[J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2009, 108(4):e30-e34.
[21]	房兵. 骨性Ⅱ类错青少年的颞下颌关节结构异常及其对矫治的影响[J]. 中华口腔医学杂志, 2017, 52(3):152-156.
[22]	Elfeky HY, Fayed MS, Alhammadi MS, et al. Three-dimensional skeletal, dentoalveolar and temporomandibular joint changes produced by Twin Block functional appliance[J]. J Orofac Orthop, 2018, 79(4):245-258. doi: 10.1007/s00056-018-0137-1 pmid: 29663034
[23]	Jiang YY, Sun L, Wang H, et al. Three-dimensional cone beam computed tomography analysis of temporomandibular joint response to the Twin-block functional appliance[J]. Korean J Orthod, 2020, 50(2):86-97. doi: 10.4041/kjod.2020.50.2.86
[24]	LeCornu M, Cevidanes LHS, Zhu HT, et al. Three-dimensional treatment outcomes in Class Ⅱ patients treated with the Herbst appliance:A pilot study[J]. Am J Orthod Dentofacial Orthop, 2013, 144(6):818-830. doi: 10.1016/j.ajodo.2013.07.014
[25]	Popowich K, Nebbe B, Major PW. Effect of Herbst treatment on temporomandibular joint morphology:A systematic literature review[J]. Am J Orthod Dentofacial Orthop, 2003, 123(4):388-394. doi: 10.1067/mod.2003.89
[26]	施洁珺, 曾祥龙. 功能矫治前徙下颌对颞下颌关节盘-突-窝位置关系影响的MRI研究[J]. 中华口腔医学杂志, 2007, 42(11):665-668.
[27]	Kinzinger GSM, Roth A, Gülden N, et al. Effects of orthodontic treatment with fixed functional orthopaedic appliances on the condyle-fossa relationship in the temporomandibular joint:A magnetic resonance imaging study (Part Ⅰ)[J]. Dentomaxillofac Radiol, 2006, 35(5):339-346. doi: 10.1259/dmfr/53048233
[28]	Kinzinger G, Kober C, Diedrich P. Topography and morphology of the mandibular condyle during fixed functional orthopedic treatment:A magnetic resonance imaging study[J]. J Orofac Orthop, 2007, 68(2):124-147. doi: 10.1007/s00056-007-0650-0 pmid: 17372710
[29]	Chavan SJ, Bhad WA, Doshi UH. Comparison of temporomandibular joint changes in Twin Block and Bionator appliance therapy:A magnetic resonance imaging study[J]. Prog Orthod, 2014, 15(1):57. doi: 10.1186/s40510-014-0057-6
[30]	Wadhawan N, Kumar S, Kharbanda OP, et al. Temporomandibular joint adaptations following two-phase therapy:A MRI study[J]. Orthod Craniofac Res, 2008, 11(4):235-250. doi: 10.1111/j.1601-6343.2008.00436.x pmid: 18950321
[31]	Aidar LA, Dominguez GC, Abrahão M, et al. Effects of Herbst appliance treatment on temporomandibular joint disc position and morphology:A prospective magnetic resonance imaging study[J]. Am J Orthod Dentofacial Orthop, 2009, 136(3):412-424. doi: 10.1016/j.ajodo.2007.12.027
[32]	Kinzinger GSM, Roth A, Gülden N, et al. Effects of orthodontic treatment with fixed functional orthopaedic appliances on the disc-condyle relationship in the temporomandibular joint:A magnetic resonance imaging study (Part Ⅱ)[J]. Dentomaxillofac Radiol, 2006, 35(5):347-356. doi: 10.1259/dmfr/70972585
[33]	Pancherz H, Salé H, Bjerklin K. Signs and symptoms of TMJ disorders in adults after adolescent Herbst therapy:A 6-year and 32-year radiographic and clinical follow-up study[J]. Angle Orthod, 2015, 85(5):735-742. doi: 10.2319/072914-530.1 pmid: 25551426
[34]	Toll DE, PopoviĆ N, Drinkuth N. The use of MRI diagnostics in orthognathic surgery:Prevalence of TMJ pathologies in Angle Class Ⅰ, Ⅱ, Ⅲ patients[J]. J Orofac Orthop, 2010, 71(1):68-80. doi: 10.1007/s00056-010-0903-1
[35]	Gökalp H. Disc position in clinically asymptomatic, pretreatment adolescents with Class Ⅰ, Ⅱ, or Ⅲ malocclusion:A retrospective magnetic resonance imaging study[J]. J Orofac Orthop, 2016, 77(3):194-202. doi: 10.1007/s00056-016-0024-6
[36]	Rohida NS, Bhad W. A clinical MRI, and EMG analysis comparing the efficacy of twin blocks and flat occlusal splints in the management of disc displacements with reduction[J]. World J Orthod, 2010, 11(3):236-244. doi: 10.5312/wjo.v11.i1.36
[37]	Simmons HC, Gibbs SJ. Anterior repositioning appliance therapy for TMJ disorders:Specific symptoms relieved and relationship to disk status on MRI[J]. CRANIO, 2005, 23(2):89-99. doi: 10.1179/crn.2005.014
[38]	翟梅, 秦爱萍, 郭燕, 等. 两种不同咬合板治疗颞下颌关节紊乱病的临床效果[J]. 实用临床医学, 2021, 22(1):35-38.
[39]	张颖, 符策广, 卢锦芬, 等. 两种咬合板治疗颞下颌关节紊乱病的临床疗效评价[J]. 口腔医学研究, 2018, 34(3):294-297. doi: 10.13701/j.cnki.kqyxyj.2018.03.020
[40]	Aidar LA, Abrahão M, Yamashita HK, et al. Herbst appliance therapy and temporomandibular joint disc position:A prospective longitudinal magnetic resonance imaging study[J]. Am J Orthod Dentofacial Orthop, 2006, 129(4):486-496. doi: 10.1016/j.ajodo.2005.01.019
[41]	胡欣欣, 朱耀旻, 沈佩, 等. 改良Twin-block治疗颞下颌关节盘可复性前移位[J]. 口腔疾病防治, 2017, 25(6):369-374. doi: 10.12016/j.issn.2096-1456.2017.06.006
[42]	马志贵, 杨驰, 谢千阳, 等. 功能性矫治器治疗青少年可复性盘移位的MRI评价[J]. 中国口腔颌面外科杂志, 2013, 11(2):131-135.
[43]	马志贵, 沈宇清, 杨驰, 等. 功能矫治器复位可复性盘移位后颞下颌关节间隙的改变[J]. 中国口腔颌面外科杂志, 2014, 12(3):233-238.
[44]	Liu Z, Qian YL, Zhang YL, et al. Effects of several temporomandibular disorders on the stress distributions of temporomandibular joint:A finite element analysis[J]. Comput Methods Biomech Biomed Engin, 2016, 19(2):137-143. doi: 10.1080/10255842.2014.996876 pmid: 25587737
[45]	Pathria MN, Chung CB, Resnick DL. Acute and stress-related injuries of bone and cartilage:Pertinent anatomy, basic biomechanics, and imaging perspective[J]. Radiology, 2016, 280(1):21-38. doi: 10.1148/radiol.16142305 pmid: 27322971
[46]	Machon V, Levorova J, Hirjak D, et al. Temporomandibular joint disc perforation:A retrospective study[J]. Int J Oral Maxillofac Surg, 2017, 46(11):1411-1416. doi: 10.1016/j.ijom.2017.05.008
[47]	Li CJ, Zhang QB. Comparison of imaging findings of 714 symptomatic and asymptomatic temporomandibular joints:A retrospective study[J]. BMC Oral Health, 2023, 23(1):79. doi: 10.1186/s12903-023-02783-9
[48]	Gil C, Santos KCP, Dutra MEP, et al. MRI analysis of the relationship between bone changes in the temporomandibular joint and articular disc position in symptomatic patients[J]. Dentomaxillofac Radiol, 2012, 41(5):367-372. doi: 10.1259/dmfr/79317853