McNamara J A
Department of Orthodontics and Pediatric Dentistry, University of Michigan, Ann Arbor, USA.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Jan;83(1):107-17. doi: 10.1016/s1079-2104(97)90100-1.
The relationship between orthodontic treatment and temporomandibular disorders (TMDs) has long been of interest to the practicing orthodontist, but only during the past decade have a significant number of clinical studies been conducted that have investigated this association. This interest in orthodontics and TMD in part was prompted in the late 1980s after litigation that alleged that orthodontic treatment was the proximal cause of TMD in orthodontic patients. This litigious climate resulted in an increased understanding of the need for risk management as well as for methodologically sound clinical studies. The findings of current research investigating the relation of orthodontic treatment and TMD can be summarized as follows: (1) signs and symptoms of TMD may occur in healthy persons; (2) signs and symptoms of TMD increase with age, particularly during adolescence, until menopause, and therefore TMDs that originate during orthodontic treatment may not be related to the treatment; (3) in general, orthodontic treatment performed during adolescence does not increase or decrease the chances of development of TMD later in life; (4) the extraction of teeth as part of an orthodontic treatment plan does not increase the risk of TMD; (5) there is no increased risk of TMD associated with any particular type of orthodontic mechanics; (6) although a stable occlusion is a reasonable orthodontic treatment goal, not achieving a specific gnathologic ideal occlusion does not result in signs and symptoms of TMD; and (7) thus far, there is little evidence that orthodontic treatment prevents TMD, although the role of unilateral posterior crossbite correction in children may warrant further investigation.
正畸治疗与颞下颌关节紊乱病（TMD）之间的关系长期以来一直是正畸医生关注的焦点，但仅在过去十年中才进行了大量临床研究来调查这种关联。对正畸学和TMD的这种关注部分是在20世纪80年代后期的诉讼之后引发的，该诉讼声称正畸治疗是正畸患者TMD的近端原因。这种诉讼氛围导致人们对风险管理以及方法合理的临床研究的必要性有了更多认识。目前关于正畸治疗与TMD关系的研究结果可总结如下：（1）TMD的体征和症状可能出现在健康人群中；（2）TMD的体征和症状随年龄增加，尤其是在青春期，直至更年期，因此正畸治疗期间出现的TMD可能与治疗无关；（3）一般来说，青春期进行的正畸治疗不会增加或减少日后患TMD的几率；（4）作为正畸治疗计划一部分的拔牙不会增加TMD的风险；（5）与任何特定类型的正畸力学相关的TMD风险均未增加；（6）尽管稳定的咬合是合理的正畸治疗目标，但未达到特定的颌学理想咬合不会导致TMD的体征和症状；（7）到目前为止，几乎没有证据表明正畸治疗可预防TMD，尽管儿童单侧后牙反合矫正的作用可能值得进一步研究。
