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中华口腔医学研究杂志(电子版) ›› 2020, Vol. 14 ›› Issue (03) : 138 -143. doi: 10.3877/cma.j.issn.1674-1366.2020.03.002

所属专题: 口腔医学 文献

中青年专家笔谈

浅谈颞下颌关节紊乱病的咬合板治疗
张清彬1, 朱明静2, 李传洁3, 刘洪臣3,()   
  1. 1. 广州医科大学附属口腔医院 广州口腔疾病研究所 口腔医学重点实验室 510140;中国人民解放军总医院口腔医学研究所,北京 100853
    2. 广州医科大学附属口腔医院 广州口腔疾病研究所 口腔医学重点实验室 510140
    3. 中国人民解放军总医院口腔医学研究所,北京 100853
  • 收稿日期:2020-02-27 出版日期:2020-06-01
  • 通信作者: 刘洪臣

Discussion on occlusal splint treatment of temporomandibular joint disorders

Qingbin Zhang1, Mingjing Zhu2, Chuanjie Li3, Hongchen Liu3,()   

  1. 1. Stomatological Hospital of Guangzhou Medical University, Guangzhou Institute of Oral Disease, Key Laboratory of Oral Medicine, Guangzhou 510140, China; Institute of Stomatology, Chinese PLA General Hospital, Beijing 100853, China
    2. Stomatological Hospital of Guangzhou Medical University, Guangzhou Institute of Oral Disease, Key Laboratory of Oral Medicine, Guangzhou 510140, China
    3. Institute of Stomatology, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2020-02-27 Published:2020-06-01
  • Corresponding author: Hongchen Liu
  • About author:
    Corresponding author: Liu Hongchen, Email:
  • Supported by:
    Science and Technology Program of Guangdong(2016ZC0147, 2017ZC0267); Science and Technology Program of Guangzhou(201802020018)
引用本文:

张清彬, 朱明静, 李传洁, 刘洪臣. 浅谈颞下颌关节紊乱病的咬合板治疗[J/OL]. 中华口腔医学研究杂志(电子版), 2020, 14(03): 138-143.

Qingbin Zhang, Mingjing Zhu, Chuanjie Li, Hongchen Liu. Discussion on occlusal splint treatment of temporomandibular joint disorders[J/OL]. Chinese Journal of Stomatological Research(Electronic Edition), 2020, 14(03): 138-143.

颞下颌关节紊乱病(TMD)是口腔临床发病率最高的四种疾病之一(龋病、牙周病、TMD、错畸形),是口腔业界公认的疑难杂症,其发病原因不明,治疗效果不确切,还常常与心理因素相关。广州医科大学附属口腔医院颞下颌关节病科通过3万余例TMD患者临床诊疗经验,总结出"序列化、微创化、数字化、舒适化、人文化"的特色诊疗模式。"序列化"即梯度治疗,一般先采用保守治疗,再采用注射治疗,进而采用微创关节镜手术治疗,最后采用开放手术治疗。临床上保守治疗的有效治疗手段之一是颞下颌关节咬合板,其可通过调整咬合关系、肌肉、髁突与关节盘的位置关系,从而逐渐建立起稳定的"盘髁"关系,相应地使关节腔内压力和组织应力发生改变,继而治疗TMD。其中,不同类型的咬合板起到的治疗效果也有所不同。基于此,作者通过此笔谈阐述咬合板对TMD的诊疗意义,以进一步为咬合板的临床应用提供参考依据。

The temporomandibular joint disorder (TMD) is one of the four diseases with the highest clinical incidence in the field of stomatology (caries, periodontal diseases, TMD and malocclusion) with unknown etiology and uncertain treatment effect which is often related to psychological factors. Through more than 30, 000 clinical cases, we summarize the unique diagnosis and treatment model. In general, conservative treatment firstly, then injection treatment, and then minimally invasive arthroscopy treatment, and finally open surgery treatment. One of the effectively conservative treatment is the occlusal splint. It can establish stable "disc-condyle" relation gradually and change intra-articular pressure and tissue stress to treat TMD by adjusting occlusion, muscle, and the position relation of condyle and articular disc. Different types of occlusal splint have different therapeutic effect. Therefore, we expound the function of occlusal splint for further clinical guidance.

图1 人颞下颌关节示意图 A:正常的颞下颌关节盘;B:可复性关节盘前移位;C:不可复性关节盘前移位
图2 颞下颌关节紊乱病关节腔注射透明质酸钠治疗 A:第一步:定点;B:第二步:关节腔冲洗;C:第三步:关节腔注射
图3 颞下颌关节紊乱病关节镜微创治疗 A:治疗前关节镜下所示;B:关节镜下用电刀对病变关节进行灌洗、黏连松解、清除黏连物等治疗;C:治疗后关节镜下所示;D:全套关节镜器械
图4 颞下颌关节紊乱病开放性手术治疗
图5 颞下颌关节、神经、咬合及咀嚼肌之间关系
图9 垫 9A:咬合面观;9B:组织面观
图10 颞下颌关节紊乱病患者戴用咬合板治疗前后锥形束CT(CBCT)影像学表现 A:治疗前;B:治疗后;CBCT结果显示,经咬合板保守治疗(一个疗程即3个月左右)后关节前间隙明显变小,前后间隙基本恢复正常
图11 颞下颌关节紊乱病患者戴用咬合板治疗前后磁共振成像(MRI)影像学表现 A:治疗前闭口位;B:治疗前开口位;C:治疗后闭口位;D:治疗后开口位;MRI结果显示,治疗前可复性关节盘前移位的患者经咬合板保守治疗(一个疗程即3个月左右)后关节盘位置基本恢复正常
[1]
刘洪臣.我国颞下颌关节紊乱病研究和治疗的现状[C]//中华口腔医学会颞下颌关节病学及学专业委员会.第八届全国颞下颌关节病学及学大会论文汇编,北京:中华口腔医学会,2011:1.
[2]
张颖,邓力,曹威,等.关节腔注射透明质酸联合Twin-block治疗颞下颌关节弹响的临床效果[J].实用口腔医学杂志,2018,34(1):88-91. DOI:10.3969/j.issn.1001-3733.2018.01.019.
[3]
王美青.颞下颌关节紊乱病的非手术治疗方法[J].中华口腔医学杂志,2005,40(5):428-430.
[4]
张清彬,管红兵.颞下颌关节紊乱病的"梯度序列治疗" [J].口腔疾病防治,2020,28(1):11-15. DOI:10.12016/j.issn.2096-1456.2020.01.002.
[5]
Baş B, Aksoy A, Atmaca E,et al. Effect of occlusal splint on interleukin 6,malondialdehyde and 8-hydroxydeoxyguanosine levels in the synovial fluid of patients with temporomandibular disorders[J]. Int J Oral Maxillofac Surg,2019,48(12):1558-1563. DOI:10.1016/j.ijom.2019.04.016.
[6]
刘亚蕊,张清彬,冯梓峻,等.颞下颌关节紊乱病在不同年龄群体的调查研究[J].口腔医学研究,2015,31(12):1254-1257. DOI:10.13701/j.cnki.kqyxyj.2015.12.023.
[7]
Candirli C, Korkmaz YT, Celikoglu M,et al. Dentists′ knowledge of occlusal splint therapy for bruxism and temporomandibular joint disorders[J]. Niger J Clin Pract,2016,19(4):496-501. DOI:10.4103/1119-3077.183310.
[8]
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.
[9]
Pficer JK, Dodic S, Lazic V,et al. Occlusal stabilization splint for patients with temporomandibular disorders:Meta-analysis of short and long term effects[J]. PLoS One,2017,12(2):e0171 296. DOI:10.1371/journal.pone.0171296.
[10]
张清彬,张颖,卢锦芬.后牙弓咬合板治疗颞下颌关节盘前移位的临床研究[C]//中华口腔医学会全科口腔医学专业委员会,中国国际科技交流中心.中华口腔医学会第九次全科口腔医学学术会议论文汇编,上海:中华口腔医学会,2018:214.
[11]
Kuboki T, Azuma Y, Orsini MG,et al. The effect of occlusal appliances and clenching on the temporomandibular joint space[J]. J Orofac Pain,1997,11(1):67-77.
[12]
Abekura H, Yokomura M, Sadamori S,et al. The initial effects of occlusal splint vertical thickness on the nocturnal EMG activities of masticatory muscles in subjects with a bruxism habit[J]. Int J Prosthodont,2008,21(2):116-120.
[13]
Pita MS, Ribeiro AB, Garcia AR,et al. Effect of occlusal splint thickness on electrical masticatory muscle activity during rest and clenching[J]. Braz Oral Res,2011,25(6):506-511. DOI:10.1590/s1806-83242011000600006.
[14]
Alajbeg IZ, Valentić-Peruzović M, Alajbeg I,et al. Influence of occlusal stabilization splint on the asymmetric activity of masticatory muscles in patients with temporomandibular dysfunction[J]. Coll Antropol,2003,27(1):361-371.
[15]
Hamata MM, Zuim PRJ, Garcia AR. Comparative evaluation of the efficacy of occlusal splints fabricated in centric relation or maximum intercuspation in temporomandibular disorders patients[J]. J Appl Oral Sci,2009,17(1):32-38. DOI:10.1590/S1678-77572009000100007.
[16]
Akbulut N, Altan A, Akbulut S,et al. Evaluation of the 3 mm Thickness Splint Therapy on Temporomandibular Joint Disorders (TMDs)[J]. Pain Research Management,2018:3756587. DOI:10.1155/2018/3756587.
[17]
Lin SL, Wu SL, Ko SY,et al. Effect of Flat-Plane Splint Vertical Thickness on Disc Displacement Without Reduction:A Retrospective Matched-Cohort Study[J]. J Oral Maxillofac Surg,2017,75(8):1627-1636. DOI:10.1016/j.joms.2016.12.047.
[18]
Hegab AF, Youssef AH, Hameed HIAA,et al. MRI-based determination of occlusal splint thickness for temporomandibular joint disk derangement:a randomized controlled clinical trial[J]. Oral Surg Oral Med Oral Pathol Oral Radiol,2018,125(1):74-87. DOI:10.1016/j.oooo.2017.09.017.
[19]
Seifeldin SA, Elhayes KA. Soft versus hard occlusal splint therapy in the management of temporomandibular disorders (TMDs)[J]. Saudi Dent J,2015,27(4):208-214. DOI:10.1016/j.sdentj.2014.12.004.
[20]
Narita N, Funato M, Ishii T,et al. Effects of jaw clenching while wearing an occlusal splint on awareness of tiredness,bite force,and EEG power spectrum[J]. J Prosthodont Res,2009,53(3):120-125. DOI:10.1016/j.jpor.2009.02.006.
[21]
Okeson JP. The effects of hard and soft occlusal splints on nocturnal bruxism[J]. J Am Dent Assoc,1987,114(6):788-791. DOI:10.14219/jada.archive.1987.0165.
[22]
Ariji Y, Koyama S, Sakuma S,et al. Regional brain activity during jaw clenching with natural teeth and with occlusal splints:a preliminary functional MRI study[J]. Cranio,2016,34(3):188-194. DOI:10.1179/2151090315Y.0000000017.
[23]
Oliveira SSI, Pannuti CM, Paranhos KS,et al. Effect of occlusal splint and therapeutic exercises on postural balance of patients with signs and symptoms of temporomandibular disorder[J]. Clin Exp Dent Res,2019,5(2):109-115. DOI:10.1002/cre2.136.
[24]
刘洪臣.咬合板的临床应用[J].中华老年口腔医学杂志,2004,2(4):227-229. DOI:10.3969/j.issn.1672-2973.2004.04.020.
[25]
胡健来,董研.咬合板治疗颞下颌关节紊乱病的研究进展[J].中华口腔医学杂志,2019,54(4):273-277. DOI:10.3760/cma.j.issn.1002-0098.2019.04.013.
[26]
白露,张丽丽,吴琳.咬合板对颞下颌关节紊乱病相关颌面部疼痛的影响[J].口腔医学,2019,39(5):472-476. DOI:10.13591/j.cnki.kqyx.2019.05.021.
[27]
Alajbeg I, Živković K, Gikić M. The role of stabilization splint in the treatment of temporomandibular disorders[J]. Acta Med Croatica,2015,69(1):33-43.
[28]
Mora MCS, Weber D, Neff A,et al. Biofeedback-based Cognitive-Behavioral Treatment Compared With Occlusal Splint for Temporomandibular Disorder A Randomized Controlled Trial[J]. Clin J Pain,2013,29(12):1057-1065. DOI:10.1097/AJP.0b013e3182850559.
[29]
Song YL, Yap AU. Outcomes of therapeutic TMD interventions on oral health related quality of life:A qualitative systematic review[J]. Quintessence Int,2018,49(6):487-496. DOI:10.3290/j.qi.a40340.
[30]
Algabri RS, Alqutaibi AY. No Evidence Suggests that the Clinical Effectiveness of Conventional Occlusal Splints is Superior to That of Psychosocial Interventions for Myofascial Tempromandibular Disorders Pain[J]. J Evid Based Dent Pract,2017,17(4):399-401. DOI:10.1016/j.jebdp.2017.10.003.
[31]
陈启林,胡孝丽,龙星,等.再定位咬合板和稳定性咬合板治疗颞下颌关节紊乱病的临床疗效观察[J].临床口腔医学杂志,2015,31(7):431-434. DOI:10.3969/j.issn.1003-1634.2015.07.018.
[32]
米热古丽·图尔荪江,李健,龙星,等.稳定性咬合板在颞下颌关节盘穿孔术后的应用研究[J].口腔医学研究,2018,34(3):298-301. DOI:10.13701/j.cnki.kqyxyj.2018.03.021.
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