Bruguiere Fanny, Sciote James J, Roland-Billecart Thomas, Raoul Gwénaël, Machuron François, Ferri Joël, Nicot Romain
Department of Oral and Maxillofacial Surgery, CHU Lille, University of Lille, Lille, France.
Department of Orthodontics, Temple University, Philadelphia, Pennsylvania.
J Oral Rehabil. 2019 Apr;46(4):321-329. doi: 10.1111/joor.12749. Epub 2018 Dec 26.
Temporomandibular disorders (TMDs) are frequent and disabling, and hence, preventing them is an important health issue. Combining orthodontic and surgical treatments for malocclusions has been shown to affect temporomandibular joint (TMJ) health. However, publications regarding the risk factors that predict negative TMJ outcomes after orthognathic surgery are scarce.
Present prospective cohort study was conducted to identify an association between pre-operative dysfunctional/parafunctional oral habits and the presence of TMD symptoms after orthognathic surgery.
We included 237 patients undergoing orthodontics and surgical treatment for malocclusions associated with dentofacial deformities within the Department of Oral and Maxillofacial Surgery of the University of Lille. Their parafunctional and dysfunctional oral habits were recorded through clinical examination along with the presence of TMD symptoms before and after the surgery. According to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) classification, the TMD symptoms studied were myalgia, arthralgia, disc displacement with or without reduction.
Multivariate analysis revealed significant associations among bruxism (odds ratio [OR] 3.17 [1.066; 9.432]), lingual interposition (OR 4.241 [1.351; 13.313]), as well as primary swallowing (OR 3.54 [1.225; 10.234]) and the presence of postoperative symptoms of myalgia. Moreover, a significant association was observed between the presence of any dysfunctional oral habit and postoperative disc displacement with reduction (OR 4.611 [1.249; 17.021]).
Bruxism and dysfunctional oral habits were shown to be risk factors for the presence of TMD symptoms also after combined orthodontic and surgical treatment. Treating such habits before orthognathic surgery should help prevent TMD.
颞下颌关节紊乱病（TMDs）常见且会导致功能障碍，因此预防TMDs是一个重要的健康问题。已表明正畸与外科联合治疗错牙合畸形会影响颞下颌关节（TMJ）健康。然而，关于正颌外科手术后预测TMJ不良预后的危险因素的文献较少。
进行本前瞻性队列研究以确定术前功能失调/副功能口腔习惯与正颌外科手术后TMD症状的存在之间的关联。
我们纳入了里尔大学口腔颌面外科接受正畸和外科联合治疗牙颌面畸形相关错牙合畸形的237例患者。通过临床检查记录他们的副功能和功能失调口腔习惯以及手术前后TMD症状的存在情况。根据颞下颌关节紊乱病研究诊断标准（RDC/TMD）分类，所研究的TMD症状为肌痛、关节痛、伴或不伴复位的盘移位。
多因素分析显示磨牙症（比值比[OR] 3.17 [1.066；9.432]）、舌置入（OR 4.241 [1.351；13.313]）以及原发性吞咽（OR 3.54 [1.225；10.234]）与术后肌痛症状的存在之间存在显著关联。此外，观察到任何功能失调口腔习惯的存在与术后伴复位的盘移位之间存在显著关联（OR 4.611 [1.249；17.021]）。
磨牙症和功能失调口腔习惯被证明也是正畸与外科联合治疗后出现TMD症状的危险因素。在正颌外科手术前治疗这些习惯应有助于预防TMD。
