Demirovic Kenan, Dzemidzic Vildana, Nakas Enita
Private Practice for Orthodontics and Dentofacial Orthopedics, 71000 Sarajevo, Bosnia and Herzegovina.
Department of Orthodontics, School of Dental Medicine, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina.
Biomedicines. 2024 Oct 3;12(10):2251. doi: 10.3390/biomedicines12102251.
BACKGROUND/OBJECTIVES: The relation between the orthopedic temporomandibular joint (TMJ) instability and temporomandibular disorder (TMD) most commonly remain unrecognized by orthodontists. In this study we aimed to evaluate the dentofacial characteristics and temporomandibular disorder symptomatology of patients with orthopedic instability before and after deprogramming with a stabilization splint.
Sixty patients with the signs and symptoms of TMD were assessed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and underwent stabilization splint therapy to place the condyles in a more stable musculoskeletal position. The extent of condylar displacement was evaluated using the condylar position indicator (CPI). Sixteen angular and linear hard tissue landmarks were traced and compared from lateral cephalograms taken in the maximum intercuspation (MI) position before, and in the centric relation (CR) position after, the splint therapy.
Following the splint therapy, the signs and symptoms of TMD were significantly reduced or completely eliminated in more than 90% of patients. Compared with the values registered before the splint therapy, a significant reduction in the mean values of condylar displacement was observed on both sides of the vertical ( < 0.001), horizontal ( < 0.05), and transverse ( < 0.001) planes of space after the splint therapy. A comparison of pre- and post-splint lateral cephalograms revealed that, following the splint therapy, the mandible moved more posteriorly and rotated in a more clockwise direction.
In patients with orthopedic instability and the signs and symptoms of TMD, muscle deprogramming with a stabilization splint therapy is highly recommended to improve the health of the temporomandibular joint and masticatory structures and contribute to a more correct orthodontic diagnosis.
背景/目的：正畸医生通常未认识到正畸性颞下颌关节（TMJ）不稳定与颞下颌关节紊乱病（TMD）之间的关系。在本研究中，我们旨在评估使用稳定（牙合）垫解除程序错乱之前和之后，正畸性不稳定患者的牙颌面特征和颞下颌关节紊乱病症状。
采用颞下颌关节紊乱病研究诊断标准（RDC/TMD）对60例有TMD体征和症状的患者进行评估，并接受稳定（牙合）垫治疗，以使髁突处于更稳定的肌肉骨骼位置。使用髁突位置指示器（CPI）评估髁突移位程度。在最大牙尖交错位（MI）拍摄治疗前、稳定（牙合）垫治疗后正中关系（CR）位的头颅侧位片，描绘并比较16个角度和线性硬组织标志点。
稳定（牙合）垫治疗后，超过90%的患者TMD体征和症状显著减轻或完全消除。与稳定（牙合）垫治疗前记录的值相比，治疗后垂直（<0.001）、水平（<0.05）和横向（<0.001）空间平面两侧髁突移位平均值均显著降低。治疗前后头颅侧位片比较显示，稳定（牙合）垫治疗后，下颌骨向后移动更多，且顺时针旋转更多。
对于正畸性不稳定且有TMD体征和症状的患者，强烈建议采用稳定（牙合）垫进行肌肉程序错乱治疗，以改善颞下颌关节和咀嚼结构的健康状况，并有助于更准确的正畸诊断。
