Department of Orthodontics, Center of Dental Medicine, University Hospital Jena, An der alten Post 4, 07743 Jena, Germany.
Department of Oral and Maxillofacial Surgery/Plastic Surgery, University Hospital Jena, Am Klinikum 1, 07747 Jena, Germany.
Medicina (Kaunas). 2024 Aug 16;60(8):1336. doi: 10.3390/medicina60081336.
The objective of this study was to compile the currently available evidence regarding the functional and morphologic outcomes of functional orthodontic therapy for mandibular condyle fracture. We performed searches in PubMed and Google Scholar as well as manually (IOK issues 2008-2019) using the keywords "trauma", "TMJ", "activator", "condylar fracture", "fracture", "mandibular condylar fracture", "occlusal splint" and "functional appliance". Screening and analysis of study eligibility were performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search strategy identified 198 studies published between 1971 and 2018, with 93 studies remaining after removing duplicate hits. Of the 93 studies, 19 were included in this study, considering the inclusion criteria. There were 12 follow-up, 4 prospective, and 3 purely retrospective studies. Some of the studies showed good functional results of mandibular condyle fracture treatment, in addition to subjective patient satisfaction. The incisal edge difference could be increased to physiological ranges of >35 mm by means of activator therapy. Partial mandibular deviations to the fractured side remained post-therapy, especially after unilateral fractures. Fractures without significant dislocation and luxation showed radiographic changes in shape, described as hypoplastic and ellipsoid, in addition to good morphologic results. One study found that collum length shortened twofold after a luxated fracture compared with fractures without significant dislocation, despite activator therapy. Straightening of the fragment occurred only in the low-dislocated fragments. Overall, children showed a higher remodeling potential than adult patients. Several studies observed an improved clinical outcome for functional therapy after mandibular condyle fracture. The outcome is essentially determined by fracture type, fracture height, and age. Further studies, especially prospective studies, are necessary to improve the evidence of functional orthodontic therapy for mandibular condyle fractures.
本研究的目的是整理关于下颌骨髁突骨折功能性正畸治疗的功能和形态学结果的现有证据。我们在 PubMed 和 Google Scholar 中进行了检索，并使用关键词“创伤”、“TMJ”、“激活器”、“髁突骨折”、“骨折”、“下颌骨髁突骨折”、“咬合夹板”和“功能性矫治器”在 IOK 问题 2008-2019 中进行了手动检索（IOK 问题 2008-2019）。使用系统评价和荟萃分析的 Preferred Reporting Items（PRISMA）进行了筛选和分析研究资格。该搜索策略确定了 1971 年至 2018 年期间发表的 198 项研究，在去除重复项后，仍有 93 项研究。在考虑纳入标准的情况下，共有 19 项研究被纳入本研究。其中有 12 项为随访研究、4 项为前瞻性研究和 3 项为纯回顾性研究。一些研究显示下颌骨髁突骨折治疗的功能结果良好，除了患者主观满意度外。通过激活器治疗，切缘差异可增加到生理范围>35mm。治疗后，尤其是单侧骨折后，仍会出现下颌骨向骨折侧的部分偏斜。无明显脱位和错位的骨折在影像学上表现为形状改变，呈发育不良和椭圆形，形态学结果良好。一项研究发现，与无明显脱位的骨折相比，脱位性骨折的髁突长度在治疗后缩短了两倍，尽管进行了激活器治疗。只有低脱位的骨折发生了碎片的伸直。总体而言，儿童的重塑潜力高于成年患者。几项研究观察到功能性治疗对下颌骨髁突骨折的临床结果有所改善。结果主要由骨折类型、骨折高度和年龄决定。需要进一步的研究，特别是前瞻性研究，以提高功能性正畸治疗下颌骨髁突骨折的证据水平。
