McNamara J A, Seligman D A, Okeson J P
Department of Orthodontics and Pediatric Dentistry and Research Scientist, Center for Human Growth and Development, University of Michigan, Ann Arbor 48109-1078.
J Orofac Pain. 1995 Winter;9(1):73-90.
A review of the current literature regarding the interaction of morphologic and functional occlusal factors relative to TMD indicates that there is a relatively low association of occlusal factors in characterizing TMD. Skeletal anterior open bite, overjets greater than 6 to 7 mm, retruded cuspal position/intercuspal position slides greater than 4 mm, unilateral lingual crossbite, and five or more missing posterior teeth are the five occlusal features that have been associated with specific diagnostic groups of TMD conditions. The first three factors often are associated with TMJ arthropathies and may be the result of osseous or ligamentous changes within the temporomandibular articulation. With regard to the relationship of orthodontic treatment to TMD, the current literature indicates that orthodontic treatment performed during adolescence generally does not increase or decrease the odds of developing TMD later in life. There is no elevated risk of TMD associated with any particular type of orthodontic mechanics or with extraction protocols. Although a stable occlusion is a reasonable orthodontic treatment goal, not achieving a specific gnathologically ideal occlusion does not result in TMD signs and symptoms. Thus, according to the existing literature, the relationship of TMD to occlusion and orthodontic treatment is minor. Signs and symptoms of TMD occur in healthy individuals and increase with age, particularly during adolescence; thus, TM disorders that originate during various types of dental treatment may not be related to the treatment but may be a naturally occurring phenomenon.
一篇关于形态学和功能性咬合因素与颞下颌关节紊乱病（TMD）相互作用的当前文献综述表明，在表征TMD时，咬合因素之间的关联相对较低。骨骼性前牙开颌、覆盖超过6至7毫米、后退牙尖位置/牙尖交错位滑动超过4毫米、单侧舌侧反合以及五颗或更多颗后牙缺失是与特定TMD诊断组相关的五个咬合特征。前三个因素通常与颞下颌关节病相关，可能是颞下颌关节内骨或韧带变化的结果。关于正畸治疗与TMD的关系，当前文献表明，青春期进行的正畸治疗通常不会增加或降低日后患TMD的几率。与任何特定类型的正畸力学或拔牙方案均无TMD风险升高的情况。尽管稳定的咬合是合理的正畸治疗目标，但未达到特定的口腔病理理想咬合并不会导致TMD的体征和症状。因此，根据现有文献，TMD与咬合及正畸治疗的关系较小。TMD的体征和症状在健康个体中也会出现，并随年龄增长而增加，尤其是在青春期；因此，在各种牙科治疗过程中出现的颞下颌关节紊乱可能与治疗无关，而可能是一种自然发生的现象。
