Graduate Dental School, Chonnam National University, Gwangju, Republic of Korea.
Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University, Gwangju, Republic of Korea.
PLoS One. 2020 Sep 4;15(9):e0238494. doi: 10.1371/journal.pone.0238494. eCollection 2020.
The purposes of this study were to investigate the influence of the orthodontics-first approach (OFA) and surgery-first approach (SFA) on changes in the signs and symptoms of temporomandibular joint disorders (TMDs) and to compare pre- and postoperative orthodontic treatment duration and total treatment duration between the two approaches. This retrospective study recruited 182 adult patients with malocclusions treated with OFA and SFA and recorded variables such as age, gender, skeletal classification, and signs and symptoms of TMD (clicking and pain disorders) before the start of the surgical-orthodontic treatment and after surgery. Changes in the signs and symptoms of TMD and treatment duration were evaluated within each approach and compared between two approaches. A binary logistic regression was performed to assess the influence of the variables on the postoperative signs and symptoms of TMD. There were no significant postoperative changes in temporomandibular joint (TMJ) pain for OFA and SFA, whereas a significant reduction was found in TMJ clicking after surgery for both approaches. According to binary logistic regression, the type of surgical-orthodontic treatment (OFA or SFA) was not a significant risk factor for postoperative TMJ clicking and pain, and the risk of postoperative TMJ clicking and pain was significant only when TMJ clicking (OR = 10.774, p < 0.001) and pain (OR = 26.876, p = 0.008) existed before the start of the entire treatment, respectively. With regard to the treatment duration, SFA (21.1 ± 10.3 months) exhibited significantly shorter total treatment duration than OFA (34.4 ± 11.9 months) (p < 0.001). The results of this study suggest that surgical-orthodontic treatment using SFA can be a feasible option of treatment for dentofacial deformities based on the equivalent effect on TMD and shorter overall treatment period compared to conventional surgical-orthodontic treatment using OFA.
本研究旨在探讨正畸优先治疗（OFA）和手术优先治疗（SFA）对颞下颌关节紊乱（TMD）症状和体征变化的影响，并比较两种方法的术前正畸治疗时间和总治疗时间。本回顾性研究纳入了 182 名接受 OFA 和 SFA 治疗的错颌成年患者，记录了年龄、性别、骨骼分类以及手术-正畸治疗开始前和手术后 TMD（弹响和疼痛障碍）的体征和症状等变量。在每种方法中评估 TMD 体征和症状的变化，并比较两种方法之间的变化。采用二项逻辑回归分析评估变量对术后 TMD 体征的影响。对于 OFA 和 SFA，TMJ 疼痛在术后没有明显变化，而两种方法在术后 TMJ 弹响均显著减少。根据二项逻辑回归，手术-正畸治疗类型（OFA 或 SFA）不是术后 TMJ 弹响和疼痛的显著危险因素，只有当 TMJ 弹响（OR = 10.774，p < 0.001）和疼痛（OR = 26.876，p = 0.008）在整个治疗开始前存在时，TMJ 弹响和疼痛的术后风险才具有显著意义。关于治疗时间，SFA（21.1 ± 10.3 个月）的总治疗时间明显短于 OFA（34.4 ± 11.9 个月）（p < 0.001）。本研究结果表明，与传统的 OFA 手术-正畸治疗相比，SFA 用于牙颌面畸形的手术-正畸治疗是一种可行的治疗选择，因为它对 TMD 的疗效相当，且总治疗期更短。
