Lindfors Erik, Nilsson Håkan, Helkimo Martti, Magnusson Tomas
Department of Stomatognathic Physiology, The Institute for Postgraduate Dental Education, Jönköping, Sweden.
Swed Dent J. 2008;32(1):9-16.
The aim of this study was to evaluate the treatment effect of a combined treatment with a stabilisation appliance and a soft appliance in the opposing jaw in patients refractory to previous TMD treatment. During a 5-year-period, 2001-2005, a total of 98 patients received the combined treatment at the Department of Stomatognathic Physiology, the Institute for Postgraduate Dental Education, Jönköping, Sweden. Before the patients received the combined treatment, they had already been given several different TMD treatments during a long period of time, either before referral or at the specialist clinic, with only minor or no effect on their TMD symptoms. The patients were followed prospectively (n=10), or analysed retrospectively (n=88). The data registered were gender, age, main indication for TMD treatment, number of visits to the clinic before and after the introduction of the combined treatment, as well as according to a clinical (Di) and anamnestic (Ai) dysfunction index. The most common causes for treatment in the retrospective material were problems of muscular origin and problems of both muscular and TMJ origin. In the prospective material, most of the patients had mainly muscular symptoms. Both the clinical and anamnestic dysfunction index decreased statistically significantly in the retrospective material after the introduction of the combined treatment. There was a numerical improvement of both indices also in the prospective material. In conclusion, the present investigation showed that a combined treatment with a hard acrylic stabilisation appliance and a soft appliance in the opposing jaw seems to give a remarkable improvement of TMD signs and symptoms in apparently therapy resistant TMD patients. General conclusions should, however, be made with caution due to the fact that the study did not include any control group. There is an obvious need for randomized controlled studies concerning the efficacy and effectiveness of the combined treatment presented in this study.
本研究的目的是评估在先前颞下颌关节紊乱病（TMD）治疗效果不佳的患者中，联合使用稳定矫治器和对颌软矫治器的治疗效果。在2001年至2005年的5年期间，共有98例患者在瑞典延雪平牙科研究生教育学院口腔颌面生理学系接受了联合治疗。在患者接受联合治疗之前，他们在转诊前或专科诊所已经接受了长时间的几种不同的TMD治疗，但对其TMD症状仅有轻微影响或没有影响。对患者进行前瞻性随访（n = 10）或回顾性分析（n = 88）。记录的数据包括性别、年龄、TMD治疗的主要指征、联合治疗前后到诊所就诊的次数，以及根据临床（Di）和记忆性（Ai）功能障碍指数。回顾性资料中最常见的治疗原因是肌肉源性问题以及肌肉和颞下颌关节源性问题。在前瞻性资料中，大多数患者主要有肌肉症状。在回顾性资料中，联合治疗后临床和记忆性功能障碍指数均有统计学显著下降。前瞻性资料中的两个指数也有数值上的改善。总之，本研究表明，在明显对治疗有抵抗性的TMD患者中，联合使用硬丙烯酸稳定矫治器和对颌软矫治器似乎能显著改善TMD的体征和症状。然而，由于该研究未包括任何对照组，因此应谨慎得出一般性结论。显然需要对本研究中提出的联合治疗的疗效和有效性进行随机对照研究。
