Yatani H, Minakuchi H, Matsuka Y, Fujisawa T, Yamashita A
Department of Fixed Prosthodontics, Okayama University Dental School, Japan.
J Orofac Pain. 1998 Winter;12(1):75-88.
Because of a lack of substantial scientific data, the efficacy of occlusal therapy for the management of temporomandibular disorders (TMD) is still controversial. Of a total of 1405 consecutive TMD patients examined over the last 10 years, 369 (26.3%) were determined to have completed treatment at least 1 year before the present survey. A sample questionnaire was mailed to each patient in this sample population. The questionnaire failed to reach 46 patients; of the 323 patients who received the questionnaire, 260 (80.5%) responded. The mean duration of time between their last visit and this survey was 3.7 years. The questionnaire elicited information on treatment outcomes, present treatment needs, and current signs and symptoms. Participants were divided into two treatment groups: (a) those who underwent some occlusal therapies (Phase II) following successful reversible therapies (Phase I) (20 men and 114 women); and (b) those who underwent reversible therapy only (33 men and 93 women). Participants were further differentially diagnosed into five diagnostic subgroups of TMD, based on the clinical examination at the initial visit, tomography, and, for some patients, magnetic resonance imaging. The subgroups included myalgia, arthralgia, anterior disc displacement with an without reduction, and osteoarthritis/osteoarthrosis. Only 12.3% of the total population surveyed reported lack of improvement to an acceptable level and further need for treatment. The remaining patients reported satisfactory results in the reduction of TMD symptomatology and no further need for treatment, because their symptoms had either disappeared or improved to an acceptable level. Regardless of treatment groups and diagnostic subgroups, the current subjective signs and symptoms were negligible in most patients, and mean mouth openings were in the normal range. No particular diagnostic subgroups seemed to have significantly better outcome following Phase II occlusal therapy. These results suggest that the majority of TMD signs and symptoms improve to an acceptable level with only reversible therapy, and the long-term value of additional occlusal therapy following reversible therapy is minimal. Therefore, permanent occlusion-changing therapies apparently are not generally needed to maintain TMD symptom reduction over time.
由于缺乏大量科学数据，咬合治疗在颞下颌关节紊乱病（TMD）管理中的疗效仍存在争议。在过去10年连续检查的1405例TMD患者中，369例（26.3%）被确定在本次调查前至少1年已完成治疗。向该样本群体中的每位患者邮寄了一份样本问卷。问卷未送达46例患者；在收到问卷的323例患者中，260例（80.5%）做出了回应。他们上次就诊与本次调查之间的平均时间间隔为3.7年。该问卷收集了有关治疗结果、当前治疗需求以及当前体征和症状的信息。参与者被分为两个治疗组：（a）在成功的可逆治疗（第一阶段）后接受了一些咬合治疗（第二阶段）的患者（20名男性和114名女性）；（b）仅接受可逆治疗的患者（33名男性和93名女性）。根据初次就诊时的临床检查、断层扫描以及部分患者的磁共振成像，参与者被进一步鉴别诊断为TMD的五个诊断亚组。这些亚组包括肌痛、关节痛、伴或不伴复位的关节盘前移位以及骨关节炎/骨关节病。在接受调查的总人口中，只有12.3%的人报告症状改善未达到可接受水平且仍需要进一步治疗。其余患者报告TMD症状减轻的结果令人满意，且无需进一步治疗，因为他们的症状要么消失了，要么改善到了可接受水平。无论治疗组和诊断亚组如何，大多数患者当前的主观体征和症状都不明显，平均开口度在正常范围内。似乎没有特定的诊断亚组在第二阶段咬合治疗后有明显更好的结果。这些结果表明，大多数TMD体征和症状仅通过可逆治疗就能改善到可接受水平，可逆治疗后额外咬合治疗的长期价值很小。因此，显然一般不需要进行永久性的咬合改变治疗来长期维持TMD症状的减轻。
