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和形态学评价  

Clinical efficacy and morphological evaluation of temporomandibular joint disc with reducible anterior displacement after treatment by anterior repositioning splint

作　　者：张锦 袁建桥 崔梦琦 赵芳源 吴刚 王星星 张月兰[1] ZHANG Jin;YUAN Jianqiao;CUI Mengqi;ZHAO Fangyuan;WU Gang;WANG Xingxing;ZHANG Yuelan(Department of Orthodontics,the First Affiliated Hospital,Zhengzhou University,Zhengzhou 450052;Department of Clinical Medicine,Shanghai Smartee Denti-Technology Co.,Ltd.,Shanghai 201203)

机构地区：[1]郑州大学第一附属医院正畸科,郑州450052 [2]正雅齿科科技(上海)有限公司临床医学系统,上海201203

出　　处：《郑州大学学报（医学版）》2024年第1期72-77,共6页Journal of Zhengzhou University(Medical Sciences)

基　　金：河南省医学科技攻关计划项目(SBGJ202102170);正雅“S计划”科研合作项目(K20210043)。

摘　　要：目的:观察再定位咬合板对颞下颌关节盘可复性前移位的临床疗效和治疗后颞下颌关节的形态学改变。方法:选取21例颞下颌关节盘可复性前移位患者,共36侧关节盘发生移位,戴用再定位咬合板治疗(6.8±1.4)个月,评价治疗1周和治疗结束时的临床疗效,治疗前和治疗结束时拍摄MRI,治疗前、治疗1周和治疗结束时拍摄CBCT,用于评估颞下颌关节盘形态、位置和关节间隙的改变。结果:治疗1周和治疗结束时关节弹响(有效率分别为80.95%和90.48%)和疼痛(有效率均为88.89%)均改善。治疗后部分关节盘恢复正常形态(双凹型占66.67%),部分(72.22%)关节盘完全复位;盘-髁距离减小(1.87±2.05)mm、盘-髁角度减小(17.75±11.57)°(P<0.05)。治疗1周和治疗结束时关节前间隙较治疗前均减小,上、后间隙均增大(P<0.05);治疗结束时关节前间隙较治疗1周增大,后间隙减小(P<0.05),关节上间隙变化无统计学意义(P>0.05)。结论:再定位咬合板治疗颞下颌关节盘可复性前移位可有效缓解症状,改善关节盘形态和位置,进而协调颞下颌关节盘-髁位置关系。Aim:To observe the clinical efficacy and evaluate the morphology of temporomandibular joint disc with reducible anterior displacement after treatment by anterior repositioning splint.Methods:Twenty-one cases of reducible anterior displacement of temporomandibular joint disc,with 36 sides reducible anterior displacement,were selected to wear repositioning plate for(6.8±1.4)months.MRI before treatment and at the end of treatment,and CBCT before treatment,at one week-treatment,and at the end of treatment were shoot.Clinical efficacy at one week-treatment and the end of treatment was evaluated,and the changes of the shape,position and joint space were assessed.Results:After one week-treatment and at the end of treatment,clicking of joint(80.95%and 90.48%)and pain(88.89%,88.89%)were significantly improved.After treatment,some joint discs recovered normal shape(66.67%),and most joint discs completely returned to normal position(72.22%).The disc-condyle distance decreased by(1.87±2.05)mm,and disc-condyle angle decreased by(17.75±11.57)°(P<0.05).During one week-treatment and at the end of treatment,the anterior joint space decreased,while the upper and posterior spaces increased compared with before treatment(P<0.05).At the end of treatment,the anterior space increased compared with one week-treatment,the posterior space decreased(P<0.05),and the change of upper space was not statistically significant(P>0.05).Conclusion:Anterior repositioning splint could effectively alleviate the symptoms of reducible anterior displacement of temporomandibular joint disc,improve the morphology and position of disc,and thus adjust the relationship of disc-condyle.

关 键 词：颞下颌关节盘可复性前移位 再定位咬合板 形态学评价 

分 类 号：R782.6[医药卫生—口腔医学]