调牙合治疗颞颌关节紊乱病疼痛效果及其可能机制的初步研究

Study on the Effects and Mechanisms of Occlusal Adjustment to TMD Pain

目的:探讨调牙合对TMD疼痛的疗效及可能的机制。方法:TMD疼痛患者58例,将无以下3种咬合表现者归为A组(35例):内倾型深覆牙合、上下后牙同名牙尖相对、反牙合或锁牙合牙≥3处,有其表现者归为B组(23例)。结果:1)A组治疗后即刻及1月时VAS值都降低(P<0.01),B组仅治疗1月后降低(P<0.05);2)治疗1月后咬肌和颞肌前束肌电对称性A组升高(P<0.05),B组无变化(P>0.05);3)治疗1月后A组咬合接触点数及对称性增加(P<0.05),B组无变化(P>0.05);4)上述疗效与TM J病变程度、病程、年龄等因素无密切关系。结论:调牙合治疗可以缓解无明显诱因而发病的TMD疼痛,但其疗效受咬合类型的影响。

Objective： To investigate the effect and possible mechanisms of occlusal adjustment to patients of temporomandibular disorders （TMD） with oral -facial pain. Methods： Fifty -eight patients were divided into two groups, those without any of following three types of occlusions, were assigned to group A （35 cases） and the others were assigned to group B （23 cases）. They were impinging occlusion, occlusion that with posterior cusp- to- cusp contact relationship, or the occlusion with 3 or more in - continuous pairs of cross - bite posterior teeth. Visual Analog Scale （VAS） value, EMG activi- ties of bilateral anterior temporolis （TA） and masseter muscle （MM）, and occlusal contact points （with Dental PresaleTM Occluzer） during biting in intercuspal position were recorded prior to and immediately after occlusal adjustment, then recor- ded one month later. Results： 1 ）In group A , the VAS values decreased remarkably（ P 〈 0.01 ）both immediately after oc- clusal ajustment and one month later, while in group B the decrease of VAS value could only be detected after 1 month of occlusal adjustment （P 〈 0.05 ）. 2） In group A, the symmetry of bilateral activity of TA and MM was improved significantly after 1 month of occlusal adjustment （ P 〈 0.05 ）, but in group B, no similar results were found （ P 〉 0.05 ）. 3 ） In group A, the occlusal contact number increased and more symmetrically distributed after 1 month of occlusal adjustment （ P 〈 0.05 ） but these features were not found in Group B （P 〉 0.05 ）. 4） The treatment effect was not influenced by the degree of TMJ pathological features on radiographs, disease period and age. Conclusion ： Occlusal adjustment could effectively release TMD pain that raised without special cause, although the effect depended on the occlusion type.