Saueressig Nilton Sodi, Saueressig Hickert Aline Cristina, Keller de Andrade Gilberto, Bittencourt Hélio Radke, Basso Délcio, Saueressig Nilton Gustavo
J Am Osteopath Assoc. 2019 Jun 1;119(6):349-356. doi: 10.7556/jaoa.2019.063.
Occlusal splints are widely used in clinical practice as a noninvasive treatment for patients with temporomandibular disorders (TMDs) and for reduction of TMD-related symptoms. A force diagram allows a health care professional to evaluate the interactions of loads caused by muscular effort, which are sensed by the teeth and the temporomandibular joint during the protrusive movement of the mandible.
To evaluate the efficacy of occlusal splints combined with occlusal adjustment (OA) based on a force diagram in the management of joint sounds (clicking and crepitation).
Patients were examined clinically and administered a questionnaire for the diagnosis of TMD and orofacial pain. Patients were then assigned to 1 of 2 splint therapies: (1) an anterior bite plane of the front-plateau type (FP) or (2) a maxillary muscle relaxation appliance (MRA), both combined with OA based on a force diagram performed at 6 visits, with an interval of 24 to 48 hours between each visit. To measure the effects of treatment, at each of the 6 visits, patients also rated the severity of their TMD-related symptoms on a visual analog scale. Data were dichotomized into presence and absence of symptoms and compared using the McNemar test.
A total of 199 patients were included in the study. At baseline, 38 patients (19.1%) had crepitation and 161 (80.9%) had clicking. A total of 150 patients were treated with FP+OA, with a statistically significant reduction in the number of patients reporting clicking (42.6%, P<.001) and crepitation (42.9%, P<.001). Among patients treated with MRA+OA (n=49), there was a statistically significant reduction in the number of patients reporting clicking (50%, P<.001). All 3 patients with crepitation in the MRA+OA group reported total remission (P>.05).
The 2 treatment strategies, FP+OA and MRA+OA, improved both clicking and crepitation. Both strategies prioritize the concept of mutually protected occlusion, in which all jaw and temporomandibular joint movements must synchronize, which may be conveniently done using the force diagram.
咬合板作为一种非侵入性治疗方法，在临床实践中被广泛应用于颞下颌关节紊乱病（TMD）患者及减轻TMD相关症状。力的示意图可使医疗保健专业人员评估下颌前伸运动过程中，由肌肉力量引起的、牙齿和颞下颌关节所感知的负荷之间的相互作用。
基于力的示意图，评估咬合板联合咬合调整（OA）治疗关节弹响（咔哒声和摩擦音）的疗效。
对患者进行临床检查，并发放问卷以诊断TMD和口面部疼痛。然后将患者分为两种咬合板治疗方法中的一种：（1）前牙平板型前牙咬合板（FP）或（2）上颌肌肉松弛矫治器（MRA），两种方法均联合基于力的示意图进行的OA治疗，共就诊6次，每次就诊间隔24至48小时。为了测量治疗效果，在6次就诊的每次就诊时，患者还需使用视觉模拟量表对其TMD相关症状的严重程度进行评分。将数据分为有症状和无症状两类，并使用McNemar检验进行比较。
本研究共纳入199例患者。基线时，38例患者（19.1%）有摩擦音，161例患者（80.9%）有咔哒声。共有150例患者接受了FP+OA治疗，报告有咔哒声的患者数量（42.6%，P<0.001）和有摩擦音的患者数量（42.9%，P<0.001）均有统计学意义的减少。在接受MRA+OA治疗的患者（n=49）中，报告有咔哒声的患者数量有统计学意义的减少（50%，P<0.001）。MRA+OA组中所有3例有摩擦音的患者均报告完全缓解（P>0.05）。
FP+OA和MRA+OA这两种治疗策略均改善了咔哒声和摩擦音。两种策略都优先考虑相互保护咬合的概念，即所有颌骨和颞下颌关节运动必须同步，这可以使用力的示意图方便地完成。
