不同垫治疗错颌畸形伴颞下颌关节紊乱病患者的对比研究

Different Occlusal Pad for Treatment of Patients with Malocclusion Deformity and Temporomandibular Joint Disorder

目的:对比再定位垫、稳定垫、RW垫治疗错颌畸形伴颞下颌关节紊乱病患者的疗效。方法:选择门诊就诊的错畸形伴颞下颌关节紊乱病患者60例,随机均分为3组,采用再定位垫、稳定垫、RW垫分别进行治疗,在戴用垫后第1月、2月、4月及6月复查并对颌垫进行调磨,记录患者张口度、关节弹响百分比及疼痛指数的变化。结果:三种垫治疗张口度效果无差别(P>0.05),各垫治疗后第6月与治疗前比较才有效果(P<0.05);再定位垫对治疗关节弹响效果明显高于稳定垫和RW垫(P<0.01),后二者无差别(P>0.05);稳定垫和RW垫对治疗关节疼痛效果优于再定位垫(P<0.05),前二者无差别(P>0.05)。结论:三种垫对改善颞下颌关节病的张口度有一定效果且相互之间无差别;再定位垫对治疗关节弹响效果较好,治疗关节疼痛首选稳定垫和RW垫;RW垫对合并关节症状的正畸患者将髁突复位于最佳位置,对正畸前诊断和治疗有非常重要意义。

Objective To compare the effects of relocation occlusal pad,stable occlusal pad and RW occlusal pad on treatment of patients with malocclusion deformity and temporomandibular joint disorder（ TMD）. Methods Total 60 patients with malocclusion deformity and TMD were selected and randomly divided into three groups,and then treated with relocation occlusal pad,stable occlusal pad and RW occlusal pad,respectively. All patients were rechecked at 1,2,4 and 6 months after treatment,and then the occlusal pads were adjusted and burnished. The degree of mouth opening,ratio of joints snap and pain index were recorded. Results The changes of mouth opening degree had no difference during patients treated with three pads（ P 0. 05）,the curative efficacy were observed till treated for 6 months（ P 0. 05）. The efficacy of relocation occlusal pad was superior to stable occlusal pad and RW occlusal pad on treating joint snap（ P 0. 01）,which had no difference between stable occlusal pad and RW occlusal pad（ P 0. 05）. The efficacy of stable occlusal pad and RW occlusal pad were superior to relocation occlusal pad on treating joint pain（ P 0. 05）,which had no difference between stable occlusal pad and RW occlusal pad（ P 0. 05）. Conclusion Three occlusal pads on improving mouth opening degree of patients with TMD have some effect and have no difference between each other. The relocation occlusal pad is suitable for treating joint snap,while the stable occlusal pad and RW occlusal pad are better for treating joint pain. RW occlusal pad which could reduct the condylar process to the best location for orthodontic patients with TMD,and which may have important significance for diagnosis and treatment before orthodontics.