Weinberg L A
J Prosthet Dent. 1984 May;51(5):676-85. doi: 10.1016/0022-3913(84)90417-7.
The reevaluation of the lateral transcranial radiograph is needed because of the confusion that surrounds the diagnosis and treatment of TMJ dysfunction-pain. The lack of universal acceptance of the validity of the lateral TMJ radiograph contributes to the lack of progress of TMJ dysfunction-pain treatment and improved methods for the treatment of prosthodontic patients. The lateral transcranial TMJ radiograph was reevaluated for its duplicability (+/- 0.2 mm). The image was found to be a cross section of the lateral third of the condyle rather than a composite view of the condyle made at an angle. The condylar position in the fossa can be correctly evaluated in transcranial radiographs, because the relative condylar position in the fossa is similar in all sagittal views and the image is always of the same sagittal plane (lateral third). Soft tissue within or lining the fossa does not affect the evaluation of condylar position. Chronic osteoarthritic TMJ pathology can exist without subjective pain; therefore, routine use of initial TMJ radiographs with subsequent radiographs at 5-year intervals is suggested for all patients. Because condylar repositioning may be indicated before subjective pain symptoms appear, condylar repositioning should be contemplated whenever extensive prosthodontic treatment is needed. In addition, if chronic osteoarthritic lesions are observed initially, radiographs are indicated at more frequent intervals and anti-inflammatory agents should be considered for routine use depending on the rate and extent of the pathologic development. The existence of osteoarthritic lesions was confirmed by serial radiographs over 5 to 10 years. If an osteoarthritis is present, condylar repositioning (when condylar displacement is present) or changes in occlusion should be considered. There is some clinical evidence that condylar displacement is associated with pathologic remodeling and/or osteoarthritic lesions of the condyle and that condyle repositioning arrests the pathologic process. The principle of condylar concentricity , previously established for the treatment of TMJ dysfunction-pain syndrome and for functional centric relation in prosthodontics, was formulated by associating condylar position in the fossa with TMJ dysfunction-pain in many patients. This article suggests the value of the lateral TMJ radiograph as an important practical aid in the diagnosis and treatment of TMJ dysfunction pain and in the establishment of functional centric relation in prosthodontics.
由于颞下颌关节功能紊乱 - 疼痛的诊断和治疗存在混淆，因此需要对经颅侧位片进行重新评估。对于颞下颌关节侧位片有效性缺乏普遍认可，这导致了颞下颌关节功能紊乱 - 疼痛治疗进展缓慢，以及针对修复患者的治疗方法未能得到改进。对经颅侧位颞下颌关节片的可重复性（±0.2毫米）进行了重新评估。结果发现该图像是髁突外侧三分之一的横截面，而非以一定角度拍摄的髁突的合成视图。在经颅片中可以正确评估髁突在关节窝中的位置，因为在所有矢状面视图中髁突在关节窝中的相对位置相似，且图像始终处于同一矢状面（外侧三分之一）。关节窝内或其衬里的软组织不影响髁突位置的评估。慢性骨关节炎性颞下颌关节病变可能在没有主观疼痛的情况下存在；因此，建议对所有患者常规使用初次颞下颌关节片，并随后每隔5年进行一次X线片检查。由于在主观疼痛症状出现之前可能就需要进行髁突重新定位，所以每当需要进行广泛的修复治疗时，都应考虑髁突重新定位。此外，如果最初观察到慢性骨关节炎性病变，则应更频繁地进行X线片检查，并根据病理发展的速度和程度考虑常规使用抗炎药物。通过5至10年的系列X线片证实了骨关节炎性病变的存在。如果存在骨关节炎，应考虑髁突重新定位（当存在髁突移位时）或咬合改变。有一些临床证据表明，髁突移位与髁突的病理重塑和/或骨关节炎性病变有关，并且髁突重新定位可阻止病理过程。先前为治疗颞下颌关节功能紊乱 - 疼痛综合征和修复学中的功能正中关系而确立的髁突同心性原则，是通过将许多患者关节窝中的髁突位置与颞下颌关节功能紊乱 - 疼痛联系起来而制定的。本文提出了颞下颌关节侧位片在颞下颌关节功能紊乱疼痛的诊断和治疗以及修复学中功能正中关系确立方面作为重要实用辅助手段的价值。
