Lundh H, Westesson P L
Department of Stomatognathic Physiology, University of Lund, School of Dentistry, Malmö, Sweden.
Oral Surg Oral Med Oral Pathol. 1989 Jan;67(1):2-10. doi: 10.1016/0030-4220(89)90292-2.
Fifteen patients with temporomandibular joint disk displacement in whom a normal condyle-disk relationship could be established were treated with occlusal changes to maintain the disk in a recaptured position. Occlusal changes were achieved by prosthodontics in 11 patients and by orthodontics in four patients. Follow-up after about 3 years showed that joint function was improved, intensity of pain was reduced, and joint and muscle tenderness were less frequent than before treatment. Intermittent locking, use of analgesics, sleep disturbances, and absence from work because of temporomandibular joint symptoms were also less frequent. Radiographic examination performed in 11 patients at follow-up demonstrated anteroinferior condylar position in the majority of the patients, but only minor hard tissue changes. Arthrography showed the disk to be in a correct position relative to the condyle in 82% (9 of 11) of the patients. These results suggest that permanent change of the occlusion with the objective of eliminating abnormal disk position may be effective treatment for disk displacement when conventional methods of treatment have failed to alleviate the symptoms. The extent of dental treatment needed to maintain the disk in a correct position should, however, be considered relative to the severity of the symptoms.
15例颞下颌关节盘移位患者，通过改变咬合关系使髁突-关节盘关系恢复正常，从而将关节盘维持在复位位置。11例患者采用修复治疗改变咬合关系，4例患者采用正畸治疗。约3年的随访结果显示，关节功能得到改善，疼痛强度减轻，关节和肌肉压痛的发生频率低于治疗前。颞下颌关节症状导致的间歇性绞锁、使用镇痛药、睡眠障碍及旷工情况也减少。随访时对11例患者进行影像学检查，多数患者髁突位于前下位置，但硬组织改变轻微。关节造影显示，82%（11例中的9例）的患者关节盘相对于髁突位置正确。这些结果表明，当传统治疗方法无法缓解症状时，以消除关节盘异常位置为目的的永久性咬合改变可能是治疗关节盘移位的有效方法。然而，为将关节盘维持在正确位置所需的牙科治疗程度应根据症状的严重程度来考虑。
