Hamata Marcelo Matida, Zuim Paulo Renato Junqueira, Garcia Alicio Rosalino
Department of Dental Materials and Prosthodontics, Dental School of Araçatuba, São Paulo State University, Araçatuba, SP, Brazil.
J Appl Oral Sci. 2009 Jan-Feb;17(1):32-8. doi: 10.1590/s1678-77572009000100007.
Fabrication of occlusal splints in centric relation for temporomandibular disorders (TMD) patients is arguable, since this position has been defined for asymptomatic stomatognathic system. Thus, maximum intercuspation might be employed in patients with occlusal stability, eliminating the need for interocclusal records. This study compared occlusal splints fabricated in centric relation and maximum intercuspation in muscle pain reduction of TMD patients. Twenty patients with TMD of myogenous origin and bruxism were divided into 2 groups treated with splints in maximum intercuspation (I) or centric relation (II). Clinical, electrognathographic and electromyographic examinations were performed before and 3 months after therapy. Data were analyzed by the Student's t test. Differences at 5% level of probability were considered statistically significant. There was a remarkable reduction in pain symptomatology, without statistically significant differences (p>0.05) between the groups. There was mandibular repositioning during therapy, as demonstrated by the change in occlusal contacts on the splints. Electrognathographic examination demonstrated a significant increase in maximum left lateral movement for group I and right lateral movement for group II (p<0.05). There were no significant differences (p>0.05) in the electromyographic activities at rest after utilization of both splints. In conclusion, both occlusal splints were effective for pain control and presented similar action. The results suggest that maximum intercuspation may be used for fabrication of occlusal splints in patients with occlusal stability without large discrepancies between centric relation and maximum intercuspation. Moreover, this technique is simpler and less expensive.
为颞下颌关节紊乱症（TMD）患者制作正中关系位的咬合板存在争议，因为该位置是为无症状的口颌系统定义的。因此，对于咬合稳定的患者，可以采用最大牙尖交错位，无需进行牙合间记录。本研究比较了在正中关系位和最大牙尖交错位制作的咬合板对TMD患者肌肉疼痛减轻的效果。20名肌源性TMD且有磨牙症的患者被分为两组，分别用最大牙尖交错位（I组）或正中关系位（II组）的咬合板进行治疗。在治疗前和治疗3个月后进行临床、电子颌骨描记和肌电图检查。数据采用Student's t检验进行分析。概率水平为5%时的差异被认为具有统计学意义。疼痛症状有显著减轻，两组之间无统计学显著差异（p>0.05）。治疗期间出现了下颌重新定位，这通过咬合板上咬合接触的变化得以证明。电子颌骨描记检查显示，I组的最大左侧侧方运动和II组的最大右侧侧方运动有显著增加（p<0.05）。使用两种咬合板后，静息时的肌电图活动无显著差异（p>0.05）。总之，两种咬合板对疼痛控制均有效且作用相似。结果表明，对于咬合稳定且正中关系位与最大牙尖交错位差异不大的患者，最大牙尖交错位可用于制作咬合板。此外，该技术更简单且成本更低。
