Abrahamsson Cecilia
Malmö högskola, 2013, Faculty of Odontology, Department of Orthodontics.
Swed Dent J Suppl. 2013(231):9-85.
About 30% of individuals in the Swedish population will at some stage during life have treatment with orthodontic appliances. In more severe cases, when orthodontic treatment is not considered sufficient enough to correct the malocclusion, the orthodontic treatment is combined with orthognathic surgery. For these cases, a satisfying jaw relation is achieved by surgically moving the maxilla and/or the mandible into a pre-planned position. Patients due to be treated with orthognathic surgery often suffer from an impaired masticatory function, symptoms from the masticatory muscles or temporomandibular joints (temporomandibular disorders), headaches as well as dissatisfaction with their facial aesthetics. Since orthognathic treatment is expensive, in many cases arduous to the patient and not without complications, it is important to assess the treatment outcome and if this is satisfying for the patients. Previous studies that have examined the outcome after orthognathic treatment have had diverging study designs and have come to different conclusions with regard to both temporomandibular disorders and masticatory function. The overall aim of this thesis was to assess and compare the frequencies of temporomandibular disorders and the masticatory function in patients with dentofacial deformities before and after orthognathic treatment. THE THESIS IS BASED ON THE FOLLOWING STUDIES: Paper I is a systematic literature review aiming to, in an evidence-based approach, answer the question whether orthognathic treatment affects the prevalence of signs and symptoms of temporomandibular disorders. The review encompasses the period from January 1966 to April 2006 and was further extended to May 2013 in the frame story of this thesis. CONCLUSIONS IN PAPER I AND THE COMPLEMENTARY SURVEY: There is insufficient scientific evidence for a decrease of sub diagnoses of temporomandibular disorders after orthognathic treatment. There is limited scientific evidence for a reduction of masticatory muscle pain on palpation after orthognathic treatment. There is insufficient scientific evidence for an effect on temporomandibular joint pain on palpation and temporomandibular joint sounds from orthognathic surgery. Further controlled, well-designed studies assessing temporomandibular disorders before and after orthognathic treatment are needed to consolidate strong evidence considering treatment outcomes. Papers II and III are studies comparing frequencies of temporomandibular disorders in patients with dentofacial deformities with a control group. The patients were referred for a combined orthodontic and orthognathic treatment to correct their malocclusion. The control group comprised individuals with normal occlusion or minor malocclusion traits not in need of orthodontic treatment. In Paper III, temporomandibular disorders were longitudinally analysed by assessing and comparing frequencies before and after orthognathic treatment. All individuals in the studies were diagnosed according to the research diagnostic criteria for temporomandibular disorders. CONCLUSIONS IN PAPERS II AND III: Patients due to be treated with orthognathic surgery had more signs and symptoms of temporomandibular disorders and a higher frequency of diagnosed temporomandibular disorders compared with the age- and gender matched control group. Patients with dentofacial deformities, corrected by orthodontic treatment in conjunction with orthognathic surgery, had a positive treatment outcome in respect of myofascial pain and arthralgia. After treatment the frequency of temporomandibular disorders . in the treatment group was low and at an equivalent level of that in the control group. Paper IV evaluates the self-estimated masticatory ability and the masticatory performance before and after orthognathic treatment in the same individuals as in Paper II and III. CONCLUSIONS IN PAPER IV: Masticatory ability and performance increased after orthognathic treatment. The number of occlusal contacts and severity of overall symptoms of TMD influenced both the masticatory ability and performance. Open bite had a negative effect on masticatory performance.
瑞典人口中约30%的人在人生的某个阶段会接受正畸矫治器治疗。在更严重的情况下,当正畸治疗被认为不足以矫正错牙合畸形时,正畸治疗会与正颌外科手术相结合。对于这些病例,通过手术将上颌骨和/或下颌骨移动到预先计划的位置来实现令人满意的颌骨关系。因正颌外科手术而接受治疗的患者通常存在咀嚼功能受损、咀嚼肌或颞下颌关节症状(颞下颌关节紊乱)、头痛以及对面部美观不满意等问题。由于正颌治疗费用高昂,在许多情况下对患者来说很艰巨且并非没有并发症,因此评估治疗结果以及患者是否满意非常重要。以往研究正颌治疗后结果的研究设计各不相同,在颞下颌关节紊乱和咀嚼功能方面也得出了不同的结论。本论文的总体目标是评估和比较牙颌面畸形患者在正颌治疗前后颞下颌关节紊乱的发生率和咀嚼功能。
论文一是一项系统的文献综述,旨在以循证医学的方法回答正颌治疗是否会影响颞下颌关节紊乱体征和症状的患病率这一问题。该综述涵盖了1966年1月至2006年4月的时间段,并在本论文的框架故事中进一步扩展至2013年5月。
没有足够的科学证据表明正颌治疗后颞下颌关节紊乱的亚诊断会减少。
仅有有限的科学证据表明正颌治疗后触诊时咀嚼肌疼痛会减轻。
没有足够的科学证据表明正颌手术对触诊时颞下颌关节疼痛和颞下颌关节弹响有影响。需要进一步进行对照良好、设计合理的研究来评估正颌治疗前后的颞下颌关节紊乱,以巩固关于治疗结果的有力证据。
论文二和论文三是比较牙颌面畸形患者与对照组颞下颌关节紊乱发生率的研究。这些患者因正畸和正颌联合治疗前来矫正错牙合畸形。对照组由咬合正常或有轻微错牙合特征且无需正畸治疗的个体组成。在论文三中,通过评估和比较正颌治疗前后的发生率对颞下颌关节紊乱进行纵向分析。研究中的所有个体均根据颞下颌关节紊乱的研究诊断标准进行诊断。
因正颌外科手术而接受治疗的患者与年龄和性别匹配的对照组相比,有更多的颞下颌关节紊乱体征和症状,且颞下颌关节紊乱的诊断率更高。
通过正畸治疗结合正颌手术矫正牙颌面畸形的患者在肌筋膜疼痛和关节痛方面有积极的治疗结果。治疗后治疗组颞下颌关节紊乱的发生率较低,与对照组处于同等水平。
论文四评估了与论文二和论文三相同个体在正颌治疗前后自我评估的咀嚼能力和咀嚼效能。
正颌治疗后咀嚼能力和效能有所提高。
咬合接触次数和颞下颌关节紊乱总体症状的严重程度对咀嚼能力和效能均有影响。
开牙合对咀嚼效能有负面影响。