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稳定夹板治疗后的解剖学变化:一项系统评价与荟萃分析

Anatomical Changes After Stabilisation Splint Therapy: A Systematic Review and Meta-analysis.

作者信息

Porntirit Ronlada, Rewthamrongsris Paak, Assoratgoon Itt, Osathanon Thanaphum

机构信息

Department of Occlusion, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.

Center of Excellence for Dental Stem Cell Biology and Department of Anatomy, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand; Center of Artificial Intelligence and Innovation, Faculty of Dentistry, Chulalongkorn University, Bangkok, Thailand.

出版信息

Int Dent J. 2025 Aug 14;75(5):100952. doi: 10.1016/j.identj.2025.100952.

Abstract

INTRODUCTION

Stabilisation splint therapy (SST) is one of the treatment options for patients with temporomandibular disorder (TMD) and has strong evidence supporting its benefits. However, there is still limited scientific understanding of the unintended consequences of SST that may lead to alterations of the surrounding structures. This study aims to evaluate the available evidence regarding structural and positional changes in various anatomical regions, including the skeletal system, temporomandibular joint (TMJ), upper pharyngeal airway, hyoid bone, craniocervical alignment, dentoalveolar structures, and soft tissues following SST for TMD patients.

METHODS

The PubMed, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) online databases were systematically searched from inception until 18 December 2024. Abstracts that met the selection criteria were chosen by consensus. To ensure thoroughness, a manual search of their references was also conducted. Stata version 18.0 was used to perform the pooled analysis.

RESULTS

Fifteen articles were finally included. A significant weighted mean difference was found for the superior joint space of TMJ (0.15 mm, z = 1.99, P = .05) with moderate heterogeneity (τ = 0.02, I = 48.41%). SST may cause forward and downward movements of the condyle, allowing recapturing anterior disc displacement with reduction after treatment, promoting midline correction of the mandible, and improving bone density in TMD patients. There was little evidence of appropriate investigation for upper airway assessment.

CONCLUSION

SST appears to cause a significant increase in superior TMJ joint space, while changes in other dimensions were not significant. Due to study limitations and variability, further controlled research is needed to confirm these findings.

摘要

引言

稳定型咬合板治疗(SST)是颞下颌关节紊乱病(TMD)患者的治疗选择之一,有充分证据支持其益处。然而,对于SST可能导致周围结构改变的意外后果,目前科学认识仍然有限。本研究旨在评估关于TMD患者接受SST后,包括骨骼系统、颞下颌关节(TMJ)、上咽部气道、舌骨、颅颈 alignment、牙槽结构和软组织等各个解剖区域的结构和位置变化的现有证据。

方法

从数据库建立至2024年12月18日,系统检索PubMed、Scopus和Cochrane对照试验中心注册库(CENTRAL)在线数据库。通过共识选择符合纳入标准的摘要。为确保全面性,还对其参考文献进行了手工检索。使用Stata 18.0版进行汇总分析。

结果

最终纳入15篇文章。发现TMJ上关节间隙存在显著加权平均差(0.15mm,z = 1.99,P = 0.05),异质性中等(τ = 0.02,I = 48.41%)。SST可能导致髁突向前和向下移动,使治疗后可复位前移位盘并复位,促进下颌骨中线矫正,并改善TMD患者的骨密度。几乎没有证据表明对上气道评估进行了适当研究。

结论

SST似乎导致TMJ上关节间隙显著增加,而其他维度的变化不显著。由于研究局限性和变异性,需要进一步的对照研究来证实这些发现。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3a84/12392770/c7edd6941d67/gr1.jpg

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