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肌肉性颞下颌关节紊乱症管理中的微创技术:一项五年观察性研究。

Minimally invasive techniques in the management of muscular temporomandibular joint disorders: A five-year observational study.

作者信息

Homem Mario-Roberto, Backer Debora-Lemos, Floriani Franciele, Jurado Carlos A, Afrashtehfar Kelvin I

机构信息

DDS, MSc. Clinical Professor, Department of Prosthodontics, Brazilian Association of Dentistry, UniABOSC.

DDS. Private Practice, Brasilia, Brazil.

出版信息

J Clin Exp Dent. 2024 May 1;16(5):e602-e609. doi: 10.4317/jced.61618. eCollection 2024 May.

Abstract

BACKGROUND

To evaluate the effectiveness of three minimally invasive techniques for managing patients with myofascial pain dysfunction, determine their association with sociodemographic factors, habits, medication usage, comorbidities, treatment history, pain duration, complaint intensity, and diagnosis limitations.

MATERIAL AND METHODS

This five-year observational study scrutinized 1,000 medical records from individuals treated at the TMD Orofacial Dental Research Center. TMD treatments were organized into Group 1 (thermotherapy, exercises, and CBT), Group 2 (Group 1 plus intramuscular manual therapy), and Group 3 (Group 1 and Group 2 plus occlusal appliances) and correlated with sociodemographic factors, habits, prior medication usage, comorbidities, history of prior treatments, duration of pain, intensity of complaint, and diagnosis limitations or without limitations regarding the symptoms of muscular temporomandibular disorders (TMD).

RESULTS

Treatment durability was proportionally higher in Groups II and III (<0.05). Although no significant differences were found for habits (= 0.051) and pain duration (= 0.001), clenching was more prevalent in Groups II n= 77 (57.0%) and III n= 39 (63.9%) and among those with therapy duration equal to or greater than 6 months for n=102 (59.3%). Statistically significant correlations were noted between age and education (rho=-0.198; <0.001) and between pain duration and treatment durability (rho=0.317; <0.001).

CONCLUSIONS

Intraoral devices do not constitute the primary treatment for myofascial pain. For cases of prolonged pain, comorbidities, limited mouth opening, and a history of prior medication or treatments, a splint combined with other therapies is recommended for effective management. Temporomandibular disorders, myofascial pain, occlusal appliances, clinical diagnosis, thermotherapy, exercise therapy, cognitive behavioral therapy.

摘要

背景

评估三种微创技术治疗肌筋膜疼痛功能障碍患者的有效性,确定其与社会人口统计学因素、习惯、药物使用、合并症、治疗史、疼痛持续时间、主诉强度及诊断局限性之间的关联。

材料与方法

这项为期五年的观察性研究对颞下颌关节紊乱病(TMD)口面部牙科研究中心治疗的1000例患者的病历进行了审查。TMD治疗分为第1组(热疗、运动疗法和认知行为疗法)、第2组(第1组加肌肉手法治疗)和第3组(第1组和第2组加咬合器),并与社会人口统计学因素、习惯、既往药物使用情况、合并症、既往治疗史、疼痛持续时间、主诉强度以及肌肉型颞下颌关节紊乱病(TMD)症状的诊断局限性或无局限性进行关联分析。

结果

第2组和第3组的治疗持久性相对较高(<0.05)。尽管在习惯(=0.051)和疼痛持续时间(=0.001)方面未发现显著差异,但紧咬牙在第2组(n=77,57.0%)和第3组(n=39,63.9%)以及治疗持续时间等于或大于6个月的患者中更为普遍(n=102,59.3%)。年龄与教育程度之间(rho=-0.198;<0.001)以及疼痛持续时间与治疗持久性之间(rho=0.317;<0.001)存在统计学显著相关性。

结论

口内装置并非肌筋膜疼痛的主要治疗方法。对于疼痛持续时间长、合并症、张口受限以及有既往用药或治疗史的病例,建议使用夹板联合其他疗法进行有效管理。颞下颌关节紊乱病、肌筋膜疼痛、咬合器、临床诊断、热疗、运动疗法、认知行为疗法。

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