School of Dentistry, Faculty of Medical Sciences, University of Sydney, & Specialist private practice, Sydney, New South Wales, Australia.
School of Dentistry, Faculty of Health and Behavioural Sciences, University of Queensland, & Specialist private practice, St Lucia, Queensland, Australia.
J Prosthodont. 2021 Apr;30(S1):43-51. doi: 10.1111/jopr.13328.
The impact of mediotrusive (MT) occlusal contacts has been a topic of controversy and confusion in both clinical practice and in the dental literature. The purpose of this Best Evidence Consensus Statement was to explore whether MT interferences are harmful in the natural or therapeutic occlusion directed by 4 focus questions relating to prevalence, jaw function, jaw dysfunction and biomechanical models.
An electronic search in October 2020 sought evidence in MEDLINE (Ovid) using (mediotrus* OR nonworking side OR nonworking contact OR balancing side OR interfer* side OR premature contact) in the multipurpose (.mp) search field; and in Google Scholar using permutations of the above. Supplementary articles were sourced from the associated reference lists. There was no language restriction. The search yield was reviewed in duplicate.
The electronic search identified 420 articles. Following screening, 164 were selected for eligibility assessments. Of these, 47 were included in the current paper.
Non-standardized nomenclature and methodology is used to identify MT interferences in patient populations, with resultant prevalence varying from 0% to 77%, (median = 16%). MT interferences may alter the biomechanics of mandibular function. Together with the presence of repeated high loads resultant strain can manifest as pathophysiology of the temporomandibular joint and associated muscle structures. MT interferences should be avoided in any therapeutic occlusal scheme to minimize pulpal, periodontal, structural and mechanical complications or exacerbation of temporomandibular disorders (TMDs). Naturally occurring molar MT interferences should be eliminated only if signs and symptoms of TMDs are present. Literature supports there being a biomechanical basis which can explain how MT interferences may affect temporomandibular joint morphology and jaw function.
在临床实践和牙科文献中，关于正中关系（MT）咬合接触的影响一直存在争议和混淆。本最佳证据共识声明的目的是探讨 MT 干扰在自然或治疗性咬合中是否有害，这是通过与流行率、颌功能、颌功能障碍和生物力学模型相关的 4 个焦点问题来探究的。
2020 年 10 月，通过在 MEDLINE（Ovid）中使用（mediotrus*或非工作侧或非工作接触或平衡侧或干扰侧或早接触）在多用途（.mp）搜索字段中进行电子搜索，以及在 Google Scholar 中使用上述词的排列进行搜索，来寻找证据。从相关的参考文献中获取补充文章。无语言限制。对搜索结果进行了重复审查。
电子搜索共确定了 420 篇文章。经过筛选，有 164 篇被选作资格评估。其中，有 47 篇被纳入本研究。
在患者人群中，使用非标准化的命名法和方法来识别 MT 干扰，其流行率从 0%到 77%不等（中位数=16%）。MT 干扰可能改变下颌功能的生物力学。加上反复出现的高负荷，应变会表现为颞下颌关节和相关肌肉结构的病理生理学。在任何治疗性咬合方案中，都应避免 MT 干扰，以尽量减少牙髓、牙周、结构和机械并发症，或加重颞下颌关节紊乱（TMDs）。只有在存在 TMDs 的症状和体征时，才应消除自然发生的磨牙 MT 干扰。文献支持存在一个生物力学基础，可以解释 MT 干扰如何影响颞下颌关节形态和颌功能。
