Department of Stomatology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, People's Republic of China.
Department of Orthodontics, Faculty of Dentistry, Aden University, Aden, Republic of Yemen.
BMC Oral Health. 2023 Jan 13;23(1):18. doi: 10.1186/s12903-023-02720-w.
Three-dimensional (3D) detailed evaluations of the mandibular mediolateral position, mandibular condylar position, and temporomandibular joint (TMJ) spaces following stabilization splints (SS) therapy in patients with temporomandibular joint disorders (TMD) and mandibular deviation (MD) have not been reported in the available literature. Accordingly, this study aimed to three-dimensionally analyze the skeletal and bony temporomandibular joint changes following stabilization splint therapy in adult patients with temporomandibular joint disorders and mandibular deviation.
This study is a retrospective clinical study that enrolled 26 adult patients with TMD and MD with a mean age of 24.86 years. The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) was used to diagnose TMD. SS was adjusted weekly until occlusal contact stabilization occurred, and then adjusted monthly, patients were instructed to wear it at night for at least 10 h. The SS was removed after the elimination of TMD symptoms (TMJ/muscle pain on palpation, muscle spasm, and clicking) and having both condyles completely seated in a musculoskeletally stable position. Pre- and post-therapeutic Cone Beam Computed Tomography (CBCT) was analyzed. Mandibular mediolateral position, TMJ spaces, and mandibular condyle position were analyzed three-dimensionally using Mimics 21.0 software. Paired t-test or Wilcoxon rank-sum test was performed, and the significance level was considered at P < 0.05.
The treatment period with SS therapy was 10.07 ± 3.1 months. The deviated chin was improved in 69.23% of the sample; the range of improvement was > 0 mm ≤ 3.9 mm. The mandibular rotation was significantly decreased from 3.58 ± 2.02° to 3.17 ± 1.60. The deviated side's superior and posterior joint TMJ spaces were significantly increased from 2.49 ± 0.88 mm and 1.25 ± 0.79 mm to 2.98 ± 1.02 mm and 1.86 ± 0.72 mm, respectively. The value of the difference from the bilateral condyle head position to the X and Z axes significantly decreased from 2.50 ± 1.56 mm and 2.30 ± 1.57 mm to 1.64 ± 1.58 mm and 1.82 ± 1.11 mm, respectively.
The main positional effect of the stabilization splint treatment in TMD patients with MD includes considerable correction of mandibular deviation, improving facial asymmetry, and moving the condyle into a stable condylar position; these were done by promoting the mandible to rotate around the Z (roll) and Y (yaw) axes and by forward, downward, and outward condylar movement on the deviated side, respectively.
三维（3D）详细评估下颌侧向位置、下颌髁突位置和颞下颌关节（TMJ）空间在稳定夹板（SS）治疗后在患有颞下颌关节紊乱（TMD）和下颌偏斜（MD）的患者中的变化尚未在现有文献中报道。因此，本研究旨在三维分析成人 TMD 和 MD 患者接受稳定夹板治疗后的骨骼和颞下颌关节变化。
这是一项回顾性临床研究，纳入了 26 名平均年龄为 24.86 岁的 TMD 和 MD 成年患者。使用颞下颌关节紊乱诊断标准（DC/TMD）诊断 TMD。每周调整 SS，直到咬合接触稳定，然后每月调整一次，指导患者每晚至少佩戴 10 小时。当 TMD 症状（TMJ/触诊时肌肉疼痛、肌肉痉挛和咔哒声）消失且双侧髁突完全位于稳定的肌骨位置时，将 SS 去除。治疗前和治疗后进行锥形束计算机断层扫描（CBCT）分析。使用 Mimics 21.0 软件对下颌侧向位置、TMJ 空间和下颌髁突位置进行三维分析。使用配对 t 检验或 Wilcoxon 秩和检验进行分析，显著性水平设为 P < 0.05。
SS 治疗的治疗期为 10.07±3.1 个月。在样本中，69.23%的偏斜颏得到改善；改善范围为>0mm≤3.9mm。下颌旋转明显减少，从 3.58±2.02°减少到 3.17±1.60°。患侧的上关节 TMJ 空间和后关节 TMJ 空间分别从 2.49±0.88mm 和 1.25±0.79mm 显著增加到 2.98±1.02mm 和 1.86±0.72mm。双侧髁突头位置与 X 和 Z 轴的差值从 2.50±1.56mm 和 2.30±1.57mm 显著减少到 1.64±1.58mm 和 1.82±1.11mm。
在 MD 患者中，SS 治疗的主要位置效应包括下颌偏斜的明显矫正，改善面部不对称和将髁突移动到稳定的髁突位置；这些是通过促进下颌围绕 Z（滚转）和 Y（偏航）轴旋转以及在患侧向前、向下和向外移动髁突来实现的。
