Objective:To observe the clinical effect of articular cavity injection combined with bite splint therapy for the treatment of anterior disc displacement without reduction(ADDWoR).Methods:The research subjects for this...Objective:To observe the clinical effect of articular cavity injection combined with bite splint therapy for the treatment of anterior disc displacement without reduction(ADDWoR).Methods:The research subjects for this study were 30 patients with ADDWoR treated in the temporomandibular joint specialist outpatient clinic from November 2018 to November 2019,with a disease duration of 1 to 6 months.The treatment group was treated with an articular cavity injection of sodium hyaluronate+bite splint.The control group was treated with a simple articular cavity injection of sodium hyaluronate.The two groups were followed up once every 2 weeks to evaluate the treatment effect and observe the clinical efficacy of the two groups.Statistical analysis was carried out using SPSS 24.0.t-test and general linear regression analysis were carried out to compare the data of both groups,andχ^(2)-test and binary logistic regression analysis were performed for pain index comparison.Results:There was no significant difference in terms of the efficacy of the treatment received by both groups.The mouth opening and joint pain of patients in both groups were significantly improved after treatment(P<0.001).Conclusion:Articular cavity injection of sodium hyaluronate and occlusal splint therapy are both effective and safe methods for treating ADDWoR.展开更多
Anterior repositioning splint(ARS)therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders(TMDs),which account for a large proportion of TMD cases.Ow...Anterior repositioning splint(ARS)therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders(TMDs),which account for a large proportion of TMD cases.Owing to the wide application of this therapy,the exact mechanism of remission has increasingly drawn attention.Given that practitioners have different views on ARS therapy,its indications are broadened,and operating methods diverged.This review attempts to provide an overview of ARS therapy and helps practitioners establish indications and suitable operating methods.Representative views in the past 10 years were summarised,and conclusions were drawn as follows:The mechanism of ARS therapy is mainly attributed to internal derangement correction,improvement of stress distribution and recently reported joint remodeling.It has an evident effect in the short term,and the most prevalent operating methods are protruding the mandible to the edge-to-edge position and wearing the ARS for 24 hours daily for 3-6 months.However,long-term stability is not optimal,and thus indications should be selected carefully.Notably,most of the clinical studies in this field are case analyses with low-quality evidence.Well-designed RCTs are required to further validate relevant theories.展开更多
In this manuscript, the authors have studied the Disc Displacement (DD) status of patients with acute Closed Lock (CL) to determine differences between DD with Reduction (DDwR) and DD without Reduction (DDwoR). Among ...In this manuscript, the authors have studied the Disc Displacement (DD) status of patients with acute Closed Lock (CL) to determine differences between DD with Reduction (DDwR) and DD without Reduction (DDwoR). Among the acute CL patients who visited our hospital within 2 weeks of the onset of CL, we studied 10 patients whose CL was released (DDwR) and 13 patients whose CL was not released (DDwoR). The DDwoR group was significantly older than the DDwR group. Although the mouth opening distance was significantly greater in the DDwoR group than in the DDwR group, the two groups were identical in the duration of CL. Sagittal MRI images showed no significant differences between the two groups in disc length and disc thickness (anterior band, intermediate zone, and posterior band). Multisection sagittal and coronal images identified lateral DD in 7 of the 10 patients in the DDwR group, although no specific direction of the DD was observed in the DDwoR group. Furthermore, deformation of the medial disc was common in the DDwoR group but uncommon in the DDwR group.展开更多
Posterior disc displacement of the temporomandibular joint is rare. We present a unique treatment method and magnetic resonance (MR) images of this condition. The patient was a 43-year-old male with a chief complaint ...Posterior disc displacement of the temporomandibular joint is rare. We present a unique treatment method and magnetic resonance (MR) images of this condition. The patient was a 43-year-old male with a chief complaint of abnormal occlusion. Regarding the present status, there was no occlusion on the right side. No temporomandibular joint pain, myalgia, or clicking were observed while mouth opening. On MR images, the posterior disc displacement without reduction on the right was observed and it was assumed that occlusal abnormality was due to this condition. We treated him with the following methods. After injection into the superior articular cavity with 2% lidocaine, a sodium hyaluronate preparation was injected followed by intermaxillary traction applied using rubber. The recovery of occlusion was confirmed in follow-up at 5 days after treatment. In the 13th days, the intermaxillary traction was removed. On MR images, the right disc condition was changed to anterior disc displacement with reduction. We consider our treatment methods are effective for this clinical condition.展开更多
Purpose::The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint(TMJ)disc with intracapsular condylar fracture.Methods...Purpose::The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint(TMJ)disc with intracapsular condylar fracture.Methods::From October 2018 to October 2019,21 patients(31 sides)with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology,Sichuan University were included.The selection criteria were:(1)mandibular condylar fractures accompanied by displacement of the TMJ disc,confirmed by clinical examination,CT scan and other auxiliary examinations;(2)indication for surgical treatment;(3)no surgical contraindications;(4)no previous history of surgery in the operative area;(5)no facial nerve injury before the surgery;(6)informed consent to participate in the research program and(7)complete data.Patients without surgical treatment were excluded.The employed patients were followed up at 1,3,6 and 12 months after operation.Outcomes were assessed by success rate of operation,TMJ function and radiological examination results at 3 months after operation.Data were expressed as number and percent and analyzed using SPSS 19.0.Results::All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles.The articular disc sufficiently covered the condylar head after the fixation.The fixation remained stable when the mandible was moved in each direction by the surgeons.No complications occurred.The functions of the TMJ were well-recovered postoperatively in most cases.CT scan revealed that the screws were completely embedded in the bone without loosening or displacement.Conclusion::Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.展开更多
目的:通过Meta分析,比较手法复位联合咬合板治疗颞下颌关节盘不可复性前移位患者疼痛与最大张口度疗效是否优于仅进行手法或仅进行咬合板治疗。方法:计算机检索Web of Science、PubMed、Cochrane Library、维普(VIP)、中国知网(CNKI)、...目的:通过Meta分析,比较手法复位联合咬合板治疗颞下颌关节盘不可复性前移位患者疼痛与最大张口度疗效是否优于仅进行手法或仅进行咬合板治疗。方法:计算机检索Web of Science、PubMed、Cochrane Library、维普(VIP)、中国知网(CNKI)、万方中手法复位联合咬合板治疗颞下颌关节盘不可复性前移位的随机对照试验(RCTs)文献,并参考Cochrane手册评估文献质量,运用RevMan5.4软件分析结局指标。结果:本研究纳入6个RCTs,患者共计393例。Meta分析结果显示,对于颞下颌关节盘不可复性前移位患者,观察组进行手法复位联合咬合板治疗,在降低疼痛评分[SMD=-0.34,95%CI(-0.54,-0.13),P=0.001]与改善最大张口度[SMD=0.51,95%CI(0.31,0.71),P<0.00001]方面疗效均比对照组较优,差异具有统计学意义(P<0.05)。结论:手法复位联合咬合板治疗改善颞下颌关节盘不可复性前移位患者疼痛和最大张口度疗效优于单独使用手法复位或单独佩戴咬合板。展开更多
目的通过MRI评估稳定型咬合板治疗伴偏侧咀嚼单侧不可复性盘前移位患者的疗效。方法选取在解放军总医院第一医学中心口腔科就诊,经过临床检查及影像学检查诊断为单侧不可复性颞下颌关节盘前移位患者34例,根据其是否存在偏侧咀嚼习惯,将...目的通过MRI评估稳定型咬合板治疗伴偏侧咀嚼单侧不可复性盘前移位患者的疗效。方法选取在解放军总医院第一医学中心口腔科就诊,经过临床检查及影像学检查诊断为单侧不可复性颞下颌关节盘前移位患者34例,根据其是否存在偏侧咀嚼习惯,将其分为伴偏侧咀嚼组(17例)和无偏侧咀嚼组(17例),分析患者最大开口度、疼痛指数、关节盘长度、盘分界角、关节盘位置以及翼外肌特点。采用SPSS25.0软件对结果进行统计分析。结果稳定型咬合板治疗前,伴偏侧咀嚼(chewing side preference,CSP)组患者同侧关节盘-髁突角度(61.13±10.54°)大于无CSP组(51.12±17.27°);伴CSP组同侧、对侧关节盘-髁突角度差值(52.52±10.91°)大于无CSP组差值(41.26±17.78°);伴CSP组同侧、对侧翼外肌下头面积差值(-0.43±3.66mm2)小于无CSP组同侧、对侧翼外肌下头面积差值(0.288±4.57mm2),差异均有统计学意义(P<0.05)。经稳定型咬合板治疗后两组患者疼痛及最大开口度均有改善,差异有统计学意义(P<0.05),组间比较两组治疗后疼痛及最大开口度无明显统计学差异(P>0.05);稳定型咬合板治疗后两组患者关节盘-髁突角度、关节盘长度减小,差异均有统计学意义(P<0.05),组间比较无明显统计学差异(P>0.05)。两组稳定型咬合板治疗后翼外肌上、下头长度、厚度和面积的平均值接近,差异无统计学意义(P>0.05)。Logistic回归分析显示,MMO(OR=0.743)与偏侧咀嚼存在相关性(P<0.05)。结论MRI能无创诊断ADDWoR,伴CSP的单侧ADDWoR患者患侧关节移位更加显著,且单侧ADDWoR患者MMO与CSP存在相关性,通过稳定型咬合板治疗能显著改善ADDWoR患者开口度及疼痛症状,缓解关节盘受压及关节盘移位程度。展开更多
目的:探讨义齿咬合板联合综合物理疗法治疗颞下颌关节盘不可复性前移位(anterior disc displacement without reduction,ADDwoR)的疗效。方法:选择2019年1月—2020年12月衡水市人民医院口腔正畸修复科就诊的牙列缺损或牙重度磨耗并诊断...目的:探讨义齿咬合板联合综合物理疗法治疗颞下颌关节盘不可复性前移位(anterior disc displacement without reduction,ADDwoR)的疗效。方法:选择2019年1月—2020年12月衡水市人民医院口腔正畸修复科就诊的牙列缺损或牙重度磨耗并诊断为ADDwoR患者60例,根据治疗方法不同,随机分为义齿咬合板组(A组)和义齿咬合板+综合物理疗法组(B组)。治疗前、治疗时每3周记录患者最大主动开口度(maximum mouth opening,MMO)、视觉模拟量表疼痛评分(visual analog pain score,VAS)。治疗前及治疗后3个月拍摄锥形束CT(CBCT),分析2组患者治疗前、后临床疗效指标变化及颞下颌关节CBCT三维数据差异。采用SPSS 26.0软件包对数据进行统计学分析。结果:治疗后3周,2组VAS和治疗前相比差异有统计学意义(P<0.05)且B组VAS降低较多;治疗后3周起,B组MMO、VAS和治疗前相比差异有统计学意义(P<0.05)。治疗后9周起,A组MMO与治疗前相比差异有统计学意义(P<0.05),但A组与B组MMO、VAS无统计学差异(P>0.05)。CBCT显示,治疗后关节前间隙变窄,关节后间隙增宽,关节上间隙增大,髁突水平角减小,关节结节斜度、髁突高度增大(P<0.05);关节窝深度、髁突前后径、内外径相比差异无统计学意义(P>0.05)。与A组相比,B组治疗后关节前、上、后间隙,髁突水平角,关节结节斜度差异有统计学意义(P<0.05)。结论:义齿咬合板可有效改善ADDwoR症状,义齿咬合板联合综合物理疗法能迅速改善患者开口度,减轻患者关节区疼痛。展开更多
Background The urokinase plasminogen activator system is believed to play an important role in degradation of the extracellular matrix associated with cartilage and bone destruction; however its precise roles in temp...Background The urokinase plasminogen activator system is believed to play an important role in degradation of the extracellular matrix associated with cartilage and bone destruction; however its precise roles in temporomandibular disorders have not yet been clarified. The aims of this study were to investigate the gene expression of fibrinolytic factors urokinase plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) in the articular cartilage of rabbit temporomandibular joint (TMJ) with disc displacement (DD) and to probe the relationship between fibrinolytic activity and cartilage remodeling. Methods Disc displacement of right joints was performed in 36 of 78 rabbits under investigation. The animals were sacrificed at 4 days and 1, 2, 4, 8 and 12 weeks after surgery, respectively. The right joints of these animals were harvested and processed for the examination of mRNA expression of uPA and PAI-1 in articular cartilage using in situ hybridization techniques. Results The expression of uPA and PAI-1 was co-expressed weakly in the chondrocytes from transitive zone to hypertrophic zone and mineralized zone, while no hybridizing signals were shown in proliferative zone and superficial zone in control rabbits. The most striking was the up-regulation of uPA and PAI-1 mRNA in 4-day rabbits postoperatively at the onset of cartilage degeneration. The strongest hybridizing signals for uPA and PAI-1 were seen in 2-week rabbits postoperatively. After 2 weeks, the expression of uPA and PAI-1 began to decrease and reached nearly normal level at 12 weeks. Conclusions The expression of the uPA/PAI-1 system coincides with the pathological changes in condylar cartilage after DD. The uPA/PAI-1 system may be one of the essential mediators in articular cartilage remodeling.展开更多
文摘Objective:To observe the clinical effect of articular cavity injection combined with bite splint therapy for the treatment of anterior disc displacement without reduction(ADDWoR).Methods:The research subjects for this study were 30 patients with ADDWoR treated in the temporomandibular joint specialist outpatient clinic from November 2018 to November 2019,with a disease duration of 1 to 6 months.The treatment group was treated with an articular cavity injection of sodium hyaluronate+bite splint.The control group was treated with a simple articular cavity injection of sodium hyaluronate.The two groups were followed up once every 2 weeks to evaluate the treatment effect and observe the clinical efficacy of the two groups.Statistical analysis was carried out using SPSS 24.0.t-test and general linear regression analysis were carried out to compare the data of both groups,andχ^(2)-test and binary logistic regression analysis were performed for pain index comparison.Results:There was no significant difference in terms of the efficacy of the treatment received by both groups.The mouth opening and joint pain of patients in both groups were significantly improved after treatment(P<0.001).Conclusion:Articular cavity injection of sodium hyaluronate and occlusal splint therapy are both effective and safe methods for treating ADDWoR.
文摘Anterior repositioning splint(ARS)therapy is considered one of the most effective therapies for treating disc displacement-related temporomandibular disorders(TMDs),which account for a large proportion of TMD cases.Owing to the wide application of this therapy,the exact mechanism of remission has increasingly drawn attention.Given that practitioners have different views on ARS therapy,its indications are broadened,and operating methods diverged.This review attempts to provide an overview of ARS therapy and helps practitioners establish indications and suitable operating methods.Representative views in the past 10 years were summarised,and conclusions were drawn as follows:The mechanism of ARS therapy is mainly attributed to internal derangement correction,improvement of stress distribution and recently reported joint remodeling.It has an evident effect in the short term,and the most prevalent operating methods are protruding the mandible to the edge-to-edge position and wearing the ARS for 24 hours daily for 3-6 months.However,long-term stability is not optimal,and thus indications should be selected carefully.Notably,most of the clinical studies in this field are case analyses with low-quality evidence.Well-designed RCTs are required to further validate relevant theories.
文摘In this manuscript, the authors have studied the Disc Displacement (DD) status of patients with acute Closed Lock (CL) to determine differences between DD with Reduction (DDwR) and DD without Reduction (DDwoR). Among the acute CL patients who visited our hospital within 2 weeks of the onset of CL, we studied 10 patients whose CL was released (DDwR) and 13 patients whose CL was not released (DDwoR). The DDwoR group was significantly older than the DDwR group. Although the mouth opening distance was significantly greater in the DDwoR group than in the DDwR group, the two groups were identical in the duration of CL. Sagittal MRI images showed no significant differences between the two groups in disc length and disc thickness (anterior band, intermediate zone, and posterior band). Multisection sagittal and coronal images identified lateral DD in 7 of the 10 patients in the DDwR group, although no specific direction of the DD was observed in the DDwoR group. Furthermore, deformation of the medial disc was common in the DDwoR group but uncommon in the DDwR group.
文摘Posterior disc displacement of the temporomandibular joint is rare. We present a unique treatment method and magnetic resonance (MR) images of this condition. The patient was a 43-year-old male with a chief complaint of abnormal occlusion. Regarding the present status, there was no occlusion on the right side. No temporomandibular joint pain, myalgia, or clicking were observed while mouth opening. On MR images, the posterior disc displacement without reduction on the right was observed and it was assumed that occlusal abnormality was due to this condition. We treated him with the following methods. After injection into the superior articular cavity with 2% lidocaine, a sodium hyaluronate preparation was injected followed by intermaxillary traction applied using rubber. The recovery of occlusion was confirmed in follow-up at 5 days after treatment. In the 13th days, the intermaxillary traction was removed. On MR images, the right disc condition was changed to anterior disc displacement with reduction. We consider our treatment methods are effective for this clinical condition.
基金The National Natural Science Foundation of China(81670951)the Applied and Basic Research Programs of Sichuan Science and Technology Commission(2020YJ0278).
文摘Purpose::The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint(TMJ)disc with intracapsular condylar fracture.Methods::From October 2018 to October 2019,21 patients(31 sides)with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology,Sichuan University were included.The selection criteria were:(1)mandibular condylar fractures accompanied by displacement of the TMJ disc,confirmed by clinical examination,CT scan and other auxiliary examinations;(2)indication for surgical treatment;(3)no surgical contraindications;(4)no previous history of surgery in the operative area;(5)no facial nerve injury before the surgery;(6)informed consent to participate in the research program and(7)complete data.Patients without surgical treatment were excluded.The employed patients were followed up at 1,3,6 and 12 months after operation.Outcomes were assessed by success rate of operation,TMJ function and radiological examination results at 3 months after operation.Data were expressed as number and percent and analyzed using SPSS 19.0.Results::All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles.The articular disc sufficiently covered the condylar head after the fixation.The fixation remained stable when the mandible was moved in each direction by the surgeons.No complications occurred.The functions of the TMJ were well-recovered postoperatively in most cases.CT scan revealed that the screws were completely embedded in the bone without loosening or displacement.Conclusion::Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.
文摘目的:通过Meta分析,比较手法复位联合咬合板治疗颞下颌关节盘不可复性前移位患者疼痛与最大张口度疗效是否优于仅进行手法或仅进行咬合板治疗。方法:计算机检索Web of Science、PubMed、Cochrane Library、维普(VIP)、中国知网(CNKI)、万方中手法复位联合咬合板治疗颞下颌关节盘不可复性前移位的随机对照试验(RCTs)文献,并参考Cochrane手册评估文献质量,运用RevMan5.4软件分析结局指标。结果:本研究纳入6个RCTs,患者共计393例。Meta分析结果显示,对于颞下颌关节盘不可复性前移位患者,观察组进行手法复位联合咬合板治疗,在降低疼痛评分[SMD=-0.34,95%CI(-0.54,-0.13),P=0.001]与改善最大张口度[SMD=0.51,95%CI(0.31,0.71),P<0.00001]方面疗效均比对照组较优,差异具有统计学意义(P<0.05)。结论:手法复位联合咬合板治疗改善颞下颌关节盘不可复性前移位患者疼痛和最大张口度疗效优于单独使用手法复位或单独佩戴咬合板。
文摘目的通过MRI评估稳定型咬合板治疗伴偏侧咀嚼单侧不可复性盘前移位患者的疗效。方法选取在解放军总医院第一医学中心口腔科就诊,经过临床检查及影像学检查诊断为单侧不可复性颞下颌关节盘前移位患者34例,根据其是否存在偏侧咀嚼习惯,将其分为伴偏侧咀嚼组(17例)和无偏侧咀嚼组(17例),分析患者最大开口度、疼痛指数、关节盘长度、盘分界角、关节盘位置以及翼外肌特点。采用SPSS25.0软件对结果进行统计分析。结果稳定型咬合板治疗前,伴偏侧咀嚼(chewing side preference,CSP)组患者同侧关节盘-髁突角度(61.13±10.54°)大于无CSP组(51.12±17.27°);伴CSP组同侧、对侧关节盘-髁突角度差值(52.52±10.91°)大于无CSP组差值(41.26±17.78°);伴CSP组同侧、对侧翼外肌下头面积差值(-0.43±3.66mm2)小于无CSP组同侧、对侧翼外肌下头面积差值(0.288±4.57mm2),差异均有统计学意义(P<0.05)。经稳定型咬合板治疗后两组患者疼痛及最大开口度均有改善,差异有统计学意义(P<0.05),组间比较两组治疗后疼痛及最大开口度无明显统计学差异(P>0.05);稳定型咬合板治疗后两组患者关节盘-髁突角度、关节盘长度减小,差异均有统计学意义(P<0.05),组间比较无明显统计学差异(P>0.05)。两组稳定型咬合板治疗后翼外肌上、下头长度、厚度和面积的平均值接近,差异无统计学意义(P>0.05)。Logistic回归分析显示,MMO(OR=0.743)与偏侧咀嚼存在相关性(P<0.05)。结论MRI能无创诊断ADDWoR,伴CSP的单侧ADDWoR患者患侧关节移位更加显著,且单侧ADDWoR患者MMO与CSP存在相关性,通过稳定型咬合板治疗能显著改善ADDWoR患者开口度及疼痛症状,缓解关节盘受压及关节盘移位程度。
文摘Background The urokinase plasminogen activator system is believed to play an important role in degradation of the extracellular matrix associated with cartilage and bone destruction; however its precise roles in temporomandibular disorders have not yet been clarified. The aims of this study were to investigate the gene expression of fibrinolytic factors urokinase plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) in the articular cartilage of rabbit temporomandibular joint (TMJ) with disc displacement (DD) and to probe the relationship between fibrinolytic activity and cartilage remodeling. Methods Disc displacement of right joints was performed in 36 of 78 rabbits under investigation. The animals were sacrificed at 4 days and 1, 2, 4, 8 and 12 weeks after surgery, respectively. The right joints of these animals were harvested and processed for the examination of mRNA expression of uPA and PAI-1 in articular cartilage using in situ hybridization techniques. Results The expression of uPA and PAI-1 was co-expressed weakly in the chondrocytes from transitive zone to hypertrophic zone and mineralized zone, while no hybridizing signals were shown in proliferative zone and superficial zone in control rabbits. The most striking was the up-regulation of uPA and PAI-1 mRNA in 4-day rabbits postoperatively at the onset of cartilage degeneration. The strongest hybridizing signals for uPA and PAI-1 were seen in 2-week rabbits postoperatively. After 2 weeks, the expression of uPA and PAI-1 began to decrease and reached nearly normal level at 12 weeks. Conclusions The expression of the uPA/PAI-1 system coincides with the pathological changes in condylar cartilage after DD. The uPA/PAI-1 system may be one of the essential mediators in articular cartilage remodeling.
